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RCT
ACE Report #98

Treatment of osteoarthritis: A role for education programmes?


Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

Effect of an education programme for patients with osteoarthritis in primary care--a randomized controlled trial

BMC Musculoskelet Disord. 2010 Oct 25;11(1):244.

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OE EXCLUSIVE

Education programs for Osteoarthritis with Dr. Hansson

Synopsis

114 patients of any age with symptomatic osteoarthritis (OA) in the knee, hip, or hand with pain, stiffness, and limitation of movement in the affected joint were randomized to receive an educational program or no education. 6 months after the educational programme, patients with OA had improved self-perceived health, but had a small improvement in function with no demonstrable influence on self-efficacy.

Publication Funding Details +
Funding:
Non-funded
Conflicts:
None disclosed

Risk of Bias

6/10

Reporting Criteria

17/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

3/4

Randomization

2/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

4/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Osteoarthritis (OA) affects millions of people worldwide and is a leading cause of joint replacement surgery. Patient education on self-management, exercise, or both may improve quality of life (QOL), function, and well being. Although systematic reviews have attempted to address this question in the past, the results have illustrated varying conclusions.

What was the principal research question?

Are self-management education programmes effective in improving self-efficacy, function, and self-perceived health in patients with OA in primary health care at 6 months?

Study Characteristics -
Population:
114 patients (age range 41 to 84 yr, mean age 63 yr) with clinical signs and symptoms (pain, stiffness, and limited ROM) due to OA of the knee, hip, or hand
Intervention:
Study group: Patient education programme for osteoarthritis (PEPOA) (n=61) by the general physician, orthopaedic specialist, physiotherapist, or occupational therapist; 5 group sessions, 3 hours for each session, once a week for 5 weeks, with the focus on self efficacy
Comparison:
Control Group: No education programme (n=53)
Outcomes:
Self-perceived health measured with EuroQol-5D (EQ5D); Self-efficacy measured with Arthritis Self-Efficacy Scale (ASES); Function of the upper extremities measured with Grip Ability Test (GAT), and function of the lower extremities measured with the number
Methods:
Prospective, Single Blinded RCT
Time:
6 month follow up

What were the important findings?

  • Intervention group had higher EQ5D levels in all dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) (p<0.001)
  • There was no significant difference in Arthritis Self-Efficacy Scale between the two groups
  • There was no significant difference in upper extremity function.
  • In lower extremity function, only one of the five outcomes, Standing one leg with eyes closed, was significantly different between the two groups with the intervention group performing better (p<0.02)

What should I remember most?

Educational programmes, emphasizing self-management in the primary health care setting for patients with OA, are feasible and can improve a patients self-perceived health. However, these programmes have a small effect on improving function and have not been shown to influence self-efficacy.

How will this affect the care of my patients?

Clinicians should consider providing self-management educational programmes that advocate physical activity and self-management for patients with OA.

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