By Zoler, Mitchel L.
Clinical Psychiatry News , Vol. 39, No. 3
Several U.S. public health groups recently have made self-management training for patients with arthritis a priority. But clinicians resist this, despite an evidence-based track record that goes back more than 30 years.
In essence, arthritis self-management consists of arthritis patients using exercise, injury prevention strategies, weight management through healthful eating, disease education, meditation, and other supportive therapies to ease their pain and increase their function.
Government and rheumatology organizations have been enthusiastic in their support for these measures, as shown by the following:
* The Centers for Disease Control and Prevention has formally supported arthritis self-management training (as well as similar training for patients with other chronic diseases). In addition, the CDC's arthritis program says that one of its main short-term goals is to "improve and increase self-management attitudes and behaviors among persons with arthritis." "Without doubt, self-management is a core issue in public health," said Dr. Patience White, a rheumatologist and chief public health officer of the Arthritis Foundation in Atlanta.
* The US. Administration on Aging received cash support from the 2009 American Recovery and Reinvestment Act. With that stimulus money, the AoA handed out $27 million in grants to 45 states, Puerto Rico, and the District of Columbia last year to deliver self-management training programs to patients with chronic diseases, including those with osteoarthritis (OA) or rheumatoid arthritis (RA).
* In the 2010 report "A National Public Health Agenda for Osteoarthritis," jointly issued by the Arthritis Foundation and the CDC, the first recommendation for action in the report's 10-item plan is: "Self-management education should be expanded as a community-based intervention for people with symptomatic OA."
The American College of Rheumatology has also endorsed self-management training for OA patients in the society's OA management recommendations (Arthritis Rheum. 2000;43:1905-15), and the Arthritis Foundation has promoted self-management as a key element in managing patients with RA.
* Healthy People 2020, a set of public health targets released in December 2010 by the Department of Health and Human Services, said one goal for patients with arthritis is to "increase the proportion of adults with doctor-diagnosed arthritis who have had effective, evidence-based arthritis education as an integral part of the management of their condition."
In short, self-management - with its safety and proven modest efficacy - has emerged as an attractive complement to the medical approach for dealing with arthritis.
Efficacy of Self-Management
Kate Lorig, Dr.P.H., noted that "we give patients a lot of tools to use so that they can do the things they need to do with less pain.''
"What we find is that patients who take the course have statistically significantly less pain," added Dr. Lorig, professor of medicine and director of the Patient Education Research Center at Stanford (Calif.) University in Palo Alto, in an interview. "They have a small to moderate reduction in pain that is similar to what they get from NSAIDs. ... We see people able to do things that they couldn't before, related to improvements in mobility and depression, and we see improvements in their quality of life."
Dr. Lorig has led a group at Stanford that began developing and testing an arthritis-oriented self-management program in the late 1970s (Arthritis Rheum. 1985;28:680-5). Subsequently, the same group developed a more generic chronic disease program (Arthritis Rheum. 2005;53:950-7), and arthritis programs available by mail (Arthritis Rheum. 2009;61:867-75) and over the Internet (Arthritis Rheum. 2008;59:1009-17)."The individual improvement for each patient can be rather small, but the cost saving [of promoting wide use of self-management training] is high because of the large number of patients," Dr. …