Abstract: Self-Management in Osteoarthritis of Hip or Knee: A Randomized Clinical Trial in a Primary Healthcare Setting

Self-Management in Osteoarthritis of Hip or Knee: A Randomized Clinical Trial in a Primary Healthcare Setting

PETER H.T.G. HEUTS, ROB de BIE, MARION DRIETELAAR, KARIN ARETZ, MARIJKE HOPMAN-ROCK, CAROLINE H.G. BASTIAENEN, JOB F.M. METSEMAKERS, CHRIS van WEEL, and ONNO C.P. van SCHAYCK

ABSTRACT.

Objective. To assess in a primary healthcare setting the efficacy of a self-management program in middle-aged patients with osteoarthritis (OA).

Methods. This was a 2-group randomized controlled trial, with 273 patients aged 40 to 60 years with OA of the hip(s) and/or knee(s). The experimental intervention was compared with care-as-usual. Treatments and followup measurements were performed in a general healthcare setting by general practitioners. Duration of followup was 21 months after start of the intervention. Instruction in self-management techniques was given by physiotherapists. The main outcome measures were pain severity in hips and knees, other significant complaints, and functional limitations.

Results. To begin, 297 patients were randomized: 149 as self-management and 148 controls; before the intervention 24 withdrew for practical reasons (17 self-management, 7 controls). At 3-month followup the intervention group was significantly improved on a visual analog scale (VAS) for knee pain (score 0.67; SD 2.10) and the WOMAC (score 2.46; SD 9.49), while the control group showed stable VAS knee pain (0.01; SD 2.00) and deterioration on WOMAC (–0.53; SD 9.47). At 21-month followup the differences between the groups increased in favor of the intervention group (VAS pain knee: p values from 0.023 at 3 mo to 0.004 at 21 mo; WOMAC: p values from 0.030 to 0.022).

Conclusion. The self-management program positively influenced knee pain and self-reported functional level in this sample of patients with OA. Differences between the study groups increased during followup in favor of the intervention group. (J Rheumatol 2005;32:543-9)

Key Indexing Terms:

OSTEOARTHRITIS
SELF-MANAGEMENT
RANDOMIZED CONTROLLED TRIAL
PRIMARY HEALTHCARE

From the Rehabilitation Foundation Limburg, Hoensbroek; Department of General Practice, Research Institute CAPHRI, Maastricht University; Department of Epidemiology, Maastricht University, Maastricht; Department of Physical Activity and Health, TNO Prevention and Health, Leiden; and the Department of Family Medicine, University Medical Centre St. Radboud, Nijmegen, The Netherlands.

Supported by grants from the Dutch Arthritis Association (Nationaal ReumaFonds) and the Rehabilitation Foundation Limburg.

P.H.T.G. Heuts, MD, Rehabilitation Foundation Limburg, Research Institute CAPHRI; R. de Bie, PhD, MSc, PT, Professor; C.H.G. Bastiaenen, MSc, PT, Department of Epidemiology, Maastricht University; M. Drietelaar, MSc; K. Aretz, MSc; J.F.M. Metsemakers, MD, PhD, Professor; O.C.P. Van Schayck, PhD, Professor, Research Institute CAPHRI; M. Hopman-Rock, PhD, TNO Prevention and Health; C. van Weel, MD, PhD, Professor, University Medical Centre St. Radboud.

Address reprint requests to Dr. P. Heuts, Rehabilitation Foundation Limburg, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands. E-mail: P.Heuts@srl.nl

Submitted April 26, 2004; revision accepted October 14, 2004.