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Self-Management of Osteoarthritis: A Tailored, Telephone-based Intervention
Kelli Dominick Allen, PhD
Durham VA Medical Center, Durham, NC
Funding Period: April 2006 - September 2009
Osteoarthritis (OA) is the one of the most common chronic conditions among veterans, associated with significant pain and disability. Innovative, cost-effective strategies are needed to enhance care and improve outcomes among the large and growing number of veterans who suffer from OA.
The purpose of this study was to examine the effectiveness of a one-year telephone-based self-management intervention for veterans with hip and/or knee OA. The hypotheses were that the self-management intervention will result in greater reductions in pain (primary outcome), as well as improvements in physical function, affect, and arthritis-specific self-efficacy, compared to both usual care and health education (attention control) conditions.
This was a randomized control trial of 515 veterans at the Durham VAMC who had a physician diagnosis of hip and/or knee OA. Participants were equally allocated to OA self-management, attention control, and usual care groups, with stratification according to race (white vs. non-white). The self-management intervention involved written and audio educational materials plus monthly telephone calls from a health educator to assist participants with personal goals for managing OA symptoms. The attention control group received written and audio educational materials on health screening topics (not OA-related), and monthly telephone calls from the health educator to discuss these materials. The primary outcome measure for this study was self-reported pain (Arthritis Impact Measurement-2 (AIMS2) subscale), and secondary outcomes were self-reported function (AIMS2 subscale), affect (AIMS2 subscale), and arthritis self-efficacy. Pain was also assessed using a standard visual numeric scale. Outcomes were measured at baseline and 12-month follow-up. Linear mixed models were used to compare primary and secondary outcomes between the intervention group and each of the control groups, adjusting for the race stratification variable.
Of the 3,477 patients identified from VA medical records, 515 were eligible and randomized. The sample was 93% male, 53% Caucasian, 42% African American, and had a mean age of 60 years. 89% of participants completed the study. AIMS2 pain scores improved by 12% in the OA self-management group, 3% in the attention control group, and 5% in the usual care group. There was an overall significant difference among the three groups (p<0.05); the OA self-management group was significantly different from the attention control group (p=0.007) but not the usual care group (p=0.105). The OA self-management group had a significantly greater improvement in pain measured by the visual numeric scale than either of the control groups (p=0.01). There were no significant differences among the groups with respect to AIMS2 function or affect scores, but the OA self-management group had a significantly greater improvement in arthritis self-efficacy compared with the attention control group (p=0.0497).
Factors explaining racial differences in pain and function were largely psychological, including arthritis self-efficacy, affect, and use of emotion-focused coping. Self-management and psychological interventions can influence these factors, as described in the Feb 2010 article in the journal Osteoarthritis and Cartilage.
A telephone-based OA self-management intervention was feasible to deliver within the VA health care system and was associated with a clinically relevant improvement in pain. This type of program can be widely disseminated among veterans at relatively low cost. Additional efforts should examine whether this program can be modified to elicit even greater improvements in pain, as well as physical function.
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DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Treatment - Observational
Keywords: Pain, Self-care, Telemedicine
MeSH Terms: none