Self-management Programmes for People with Osteoarthritis: A Systematic Review and Meta-analysis

Osteoarthritis is one of the most common chronic, disabling diseases, which typically causes pain, stiffness and functional impairment. Self-management programmes have been advocated in clinical guidelines aimed at reducing the effect of symptoms and illness from impacting on lifestyle and activities. This study assesses the evidence-base examining the clinical and cost-effectiveness of self-management programmes for adults with osteoarthritis. An electronic search was conducted on 6 th June 2013 of the published literature including the databases: AMED, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library. This was supplemented with a search of unpublished databases and trial registries. All randomised and quasi-randomised controlled trials comparing the clinical and/or cost-effectiveness of people with osteoarthritis randomised to self-management programmes or control group were included. Methodological quality was assessed using the PEDro appraisal tool. Meta-analyses were conducted when minimal methodological study heterogeneity was exhibited. A total of nine studies were identified, including 2237 participants. The results indicated self-management interventions provided no statistically significant benefit in respect to pain, function, perceived quality of life, depression or satisfaction during the first twelve months compared to not receiving this intervention (p>0.05). Whilst there was some evidence to suggest that self-management intervention may improve participant's knowledge of their condition, this appeared to have no significant impact on their use of analgesics or the frequency to which they consulted community physicians or physiotherapists (p>0.05). The evidence assessing the effectiveness of self-management programmes for people with osteoarthritis is equivocal. Evaluation of the different components of a self-management intervention, and investigation on how best this should be delivered for long-term adherence is required to systematically assess the clinical effectiveness of self-management programmes for different patient-groups with osteoarthritis.