Participation in patient self‐management programs

Objective

Participation in evidenced‐based arthritis self‐management programs (SMPs) has not been well documented. The purpose of this study was to investigate the participation rate and participant characteristics in a closed cohort of subjects in a geographic region where arthritis SMPs have been offered multiple times and continuously for 2 decades.

Methods

Data were from osteoarthritis (OA) and rheumatoid arthritis subjects participating in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) who resided in the San Francisco (SF) Bay area who had responded to questions about ever participating in an SMP. Differences between participants and nonparticipants were examined by t‐tests and chi‐square tests.

Results

Questions added to the Health Assessment Questionnaire were returned by 1,176 patients; 618 resided in the SF Bay area. Of the SF Bay area sample, 41.9% had participated in an SMP. Small group SMPs, which had been offered multiple times, in diverse settings, continuously over the past 2 decades, were attended by the highest proportion (28%) of participants. Characteristics of participants and nonparticipants in the SF Bay area were similar (～70 years old, 15 years of education, and the majority had OA [～72%]). However, a higher proportion of participants were white (88% versus 82%; P = 0.046) and female (82% versus 73%; P < 0.05).

Conclusion

When arthritis SMPs were offered multiple times in diverse settings and continuously over many years, >40% of the cohort was reached. More research is needed with larger samples and different geographic regions to identify participation rates in more diverse populations.     

Self‐management education programs for age‐related macular degeneration: A systematic review

Objective: To review the effectiveness of education programs to improve emotional status, daily living and self‐efficacy in adults older than 60 years with age‐related macular degeneration (AMD). Method: Electronic searches of three databases and manual searches of references lists located randomised controlled trials (RCTs) and quasi‐experimental studies. Health education programs aimed at increasing knowledge of AMD, skills training or behavioural change were included. Data extraction and quality assessment were undertaken by two reviewers. A narrative analysis was possible. Results: Three protocols were reported in four studies (n = 532) with three follow‐up studies – all contained elements of self‐management programs. Effect sizes for the three outcomes ranged from small to very large (0.14–1.21). Conclusions: Self‐management programs appear effective for older adults with AMD. Small sample size, use of non‐traditional statistics and methodological quality meant only a narrative analysis was possible. Future studies with more robust methodology including intent‐to‐treat analysis are still required.     

单髁置换术治疗老年人内侧单间室膝骨关节炎的临床疗效

目的分析固定平台单髁置换术治疗老年内侧单间室骨关节炎的临床疗效。方法解放军总医院骨科2005年1月至2010年3月收治膝关节骨关节炎患者38例,男14例,女24例;年龄60~72(66.0±5.6)岁。站立行走内侧关节间隙疼痛,术前膝关节正侧位X线等影像学检查提示内侧单间室膝骨关节炎。术前美国特种外科医院(HSS)评分(52.6±16.7),疼痛视觉模拟量表(VAS)评分(6.3±1.2),膝关节内翻畸形(8.9±1.6)°,关节活动度(112.6±23.5)°。结果手术时间(45.0±10.2)min,无血管、神经等副损伤,伤口均Ⅰ期愈合,无切口感染等并发症发生;所有患者均随访,无死亡、退出等情况,随访时间71~133(102.0±12.2)个月。末次随访时,膝关节HSS评分(91.8±17.9),VAS评分(1.8±0.9),膝关节内翻畸形(4.7±0.9)°,关节活动度(129.7±36.8)°;与术前相比,均具有显著的改善(P0.05)。结论固定平台单髁置换术治疗老年内侧单间室骨关节炎具有较好的临床疗效。     

Individual and contextual factors associated with follow‐up use of diabetes self‐management education programmes: a multisite prospective analysis

Aims Although a considerable body of research supports the efficacy of diabetes self‐management education (DSME), these programmes are often challenged by high attrition rates. Little is known about factors influencing follow‐up use of DSME services, thus the aim of this study was to identify these factors. Methods In this multisite prospective analysis, adults with Type 2 diabetes (n = 268) who attended one of two diabetes management centres (DMCs) were followed over a 1‐year period from their initial visit. The influence of individual and contextual factors on the number of contacts with DMC providers was examined. Data were analysed within the context of the Health Behavioral Model of Health Services Utilization. Results In a multivariable negative binomial regression model, the number of contacts over 1 year was greater for those who were female, non‐smokers, unemployed, self‐referred to the DMC, lived closer to the DMC, had a lower body mass index, or had a longer known duration of diabetes. Follow‐up use of services differed significantly between the two sites. Provider contacts were greater at the centre that offered flexible hours of services and a variety of optional educational modules. Conclusions Healthcare professionals need to encourage ongoing use of DSME, particularly for individuals prone to lower follow‐up use of these services. Providing services that are accessible, convenient, and can easily fit into patients’ schedules may increase follow‐up use. Further exploration into how operations and delivery of these services influence utilization patterns is strongly recommended.     

Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study

OBJECTIVES: Different prevalences of generalised osteoarthritis (GOA) in patients with knee and hip OA have been reported. The aim of this investigation was to evaluate radiographic and clinical patterns of disease in a hospital based population of patient subgroups with advanced hip and knee OA and to compare the prevalence of GOA in patients with hip or knee OA, taking potential confounding factors into account. METHODS: 420 patients with hip OA and 389 patients with knee OA scheduled for unilateral total joint replacement in four hospitals underwent radiographic analysis of ipsilateral and contralateral hip or knee joint and both hands in addition to a standardised interview and clinical examination. According to the severity of radiographic changes in the contralateral joints (using Kellgren-Lawrence > or = grade 2 as case definition) participants were classified as having either unilateral or bilateral OA. If radiographic changes of two joint groups of the hands (first carpometacarpal joint and proximal/distal interphalangeal joints defined as two separate joint groups) were present, patients were categorised as having GOA. RESULTS: Patients with hip OA were younger (mean age 60.4 years) and less likely to be female (52.4%) than patients with knee OA (66.3 years and 72.5% respectively). Intensity of pain and functional impairment at hospital admission was similar in both groups, while patients with knee OA had a longer symptom duration (median 10 years) compared with patients with hip OA (5 years). In 41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients. GOA was observed more often in patients with knee OA than in patients with hip OA (34.9% versus 19.3%; OR = 2.24; 95% CI: 1.56, 3.21). Adjustment for the different age and sex distribution in both patient groups, however, takes away most of the difference (OR = 1.32; 95% CI: 0.89, 1.96). CONCLUSION: The crude results confirm previous reports as well as the clinical impression of GOA being more prevalent in patients with advanced knee OA than in patients with advanced hip OA. However, these different patterns might be attributed to a large part to a different distribution of age and sex in these hospital based populations.     

Physiotherapy management of knee osteoarthritis

Knee osteoarthritis (OA) is a prevalent chronic joint disease causing pain and disability. Physiotherapy, which encompasses a number of modalities, is a non-invasive treatment option in the management of OA. This review summarizes the evidence for commonly used physiotherapy interventions. There is strong evidence to show short-term beneficial effects of exercise on pain and function, although the type of exercise does not seem to influence treatment outcome. Delivery modes, including individual, group or home exercise are all effective, although therapist contact may improve benefits. Attention to improving adherence to exercise is needed to maximize outcomes in the longer-term. Knee taping applied with the aim of realigning the patella and unloading soft tissues can reduce pain. There is also evidence to support the use of knee braces in people with knee OA. Biomechanical studies show that lateral wedge shoe insoles reduce knee load but clinical trials do not support symptomatic benefits. Recent studies suggest individual shoe characteristics also affect knee load and there is current interest in the effect of modified shoe designs. Manual therapy, while not to be used as a stand-alone treatment, may be beneficial. In summary, although the research is not equivocal, there is sufficient evidence to indicate that physiotherapy interventions can reduce pain and improve function in those with knee OA.     

Effect of peer education on self‐management and psychological status in type 2 diabetes patients with emotional disorders

Aims/Introduction

The purpose of the present study was to assess the effect of peer education in type 2 diabetes patients with emotional disorders on the metabolic index and psychological status.

Materials and Methods

Educators use psychological scales to screen type 2 diabetes patients with emotional disorders. Participants were divided into usual and peer education groups. Both groups received usual diabetes education. Peer leaders were recruited to provide support with the peer education group for 6 months. The metabolic index, diabetes knowledge, self-management, diabetes-related distress, emotional status and quality of life were compared at the end of the study.

Results

A total of 127 patients participated in the study. There were 20 peer leaders engaged in the study as volunteers for peer education. All participants completed the study and fulfilled the scales. Improvements in the peer education group were significant compared with the usual education group with respect to anxiety (49.0 ± 9.65 vs 54.0 ± 8.48), depression (51.3 ± 7.97 vs 55.8 ± 7.52), diabetes knowledge (18.8 ± 2.46 vs 16.3 ± 2.08), distress (2.67 ± 0.55 vs 3.02 ± 0.56), self-management (66.5 ± 4.26 vs 62.4 ± 5.88) and quality of life (−1.98 ± 0.82 vs −2.50 ± 0.71), whereas no significant difference existed with respect to the metabolic index.

Conclusions

Peer education, providing more attention to diabetes patients with emotional disorders, is a preferred model for delivering care.     

Redesigning care for chronic conditions: improving hospital‐based ambulatory care for people with osteoarthritis of the hip and knee

Background: Osteoarthritis of the hip and knee is a highly prevalent chronic condition in Australia that commonly affects older people who have other comorbidities. We report the pilot implementation of a new chronic disease management osteoarthritis service, which was multidisciplinary, evidence‐based, supported patient self‐management and care coordination. Methods: A musculoskeletal coordinator role was pivotal to service redesign and osteoarthritis pathway implementation. Impact evaluation included: service utilization, patient and general practitioner service experience, a ‘before and after’ audit of clinician adherence to recommendations, and 3‐ and 6‐month patient health outcomes (pain, physical function, patient and physician global health (Visual Analogue Scale), disability (Multi‐Attribute Prioritisation Tool), Partners in Health Scale and body mass index). Results: A total of 123 patients, median age of 66 years, were assessed. Documentation of osteoarthritis assessment and management improved for all parameters. At 3 months there were improvements in self‐reported pain (P < 0.001), global function (P < 0.001), physician and patient reported global health (P < 0.001), Partners in Health Score (P < 0.001) and Hip and Knee Multi‐Attribute Prioritisation Tool score (P < 0.014). Body mass index did not improve. Patients and general practitioners reported positive experiences, but there was variable uptake of recommendations by patients. The main factors influencing uptake of recommendations were access block to community services in the first 3 months and patient preferences for therapy. The cost implications for implementation were low. Conclusion: The osteoarthritis service model is feasible to implement, is well received by patients and staff, and provides a template for translation into other settings.     

Patient–provider perceptions of diabetes and its impact on self‐management: a comparison of African‐American and White patients

Aims To compare patient–provider differences in diabetes‐related perceptions between African‐American and White patients and to examine its association with self‐care behaviours. Methods One hundred and thirty patient–provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes‐related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes‐related perceptions. Patients also reported the frequency of performing self‐care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. Results There were a greater number of patient–provider differences in diabetes‐related perceptions for the African‐American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients’ semantic differential scores to be significantly associated with five self‐care behaviours for African‐American patients and two self‐care behaviours for White patients. Providers’ semantic differential scores emerged as predictors of self‐care behaviours for African‐American patients, but not for White patients. Conclusions Our findings suggest that compared with White patients, African‐Americans differ in a greater number of diabetes‐related perceptions than their providers. Patients’ and providers’ perceptions of diabetes care concepts have a significant impact on a greater number of self‐care behaviours for African‐American patients than White patients.     

Development and initial evaluation of a measure of self‐management for adults with antineutrophil cytoplasmic antibody–associated small‐vessel vasculitis

Objective

To develop a measure of illness self‐management for adults living with antineutrophil cytoplasmic antibody (ANCA)–associated small‐vessel vasculitis (ANCA‐SVV) and to gather evidence of its reliability and validity.

Methods

Development of the Vasculitis Self‐Management Scale (VSMS) was guided by previous research on self‐management in other chronically ill populations, a review of the current treatment literature for ANCA‐SVV, interviews with patients, and consultation with experts. A total of 205 patients living with ANCA‐SVV or a closely related condition then completed the VSMS, along with measures of sociodemographic and clinical variables, social desirability bias, and general adherence to medical recommendations, using a self‐administered mailed questionnaire. A principal components analysis was conducted on the VSMS items. Internal consistency reliability and construct validity of the resulting subscales were assessed. Forty‐four patients completed the VSMS a second time, for the purpose of assessing test–retest reliability.

Results

Analyses suggested an 8‐factor solution. The final VSMS consisted of 43 items representing these 8 behavioral domains. Correlations among the 8 domains were null to modest in magnitude. The internal consistency reliability of the 8 subscales ranged from minimally acceptable (α = 0.67) to excellent (α = 0.94), and correlations between subscale scores at time 1 and time 2 suggested good temporal stability. Preliminary evidence for validity was mixed.

Conclusion

These findings suggest that the VSMS is a promising method for assessing illness self‐management in adults with ANCA‐SVV. More research exploring the validity of the measure is warranted.