Buszewicz Marta, Rait Greta, Griffin Mark, Nazareth Irwin, Patel Anita, Atkinson Angela, Barlow Julie, Haines Andy
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London N19 5LW.
BMJ. 2006 Oct 28;333(7574):879. doi: 10.1136/bmj.38965.375718.80. Epub 2006 Oct 13.
To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis.
Randomised controlled trial.
74 general practices in the United Kingdom.
812 patients aged 50 and over with osteoarthritis of hips or knees (or both) and pain or disability (or both).
Participants were randomised to six sessions of self management of arthritis and an education booklet (intervention group) or the education booklet alone (control group).
Primary outcome was quality of life, as assessed by the short form health survey (SF-36). Several other physical and psychosocial secondary outcomes were assessed. Data were collected at baseline, four months, and 12 months.
Response rates were 80% and 76% at four and 12 months. The two groups showed significant differences at 12 months on the anxiety subscore of the hospital anxiety and depression scale (mean difference -0.62, 95% confidence interval -1.08 to -0.16), arthritis self efficacy scale for pain (0.98, 0.07 to 1.89), and self efficacy for other aspects of management (1.58, 0.25 to 2.90). Results were similar for intention to treat and per protocol analyses. No significant difference was seen in number of visits to the general practitioner at 12 months.
The self management of arthritis programme reduced anxiety and improved participants' perceived self efficacy to manage symptoms, but it had no significant effect on pain, physical functioning, or contact with primary care.
Current Controlled Trials ISRCTN79115352 [controlled-trials.com].
评估一项针对基层医疗中骨关节炎患者的关节炎自我管理项目的临床效果。
随机对照试验。
英国74家普通诊所。
812名年龄在50岁及以上、患有髋部或膝部（或两者皆有）骨关节炎且伴有疼痛或残疾（或两者皆有）的患者。
参与者被随机分为接受六节关节炎自我管理课程和一本教育手册（干预组）或仅接受教育手册（对照组）。
主要结局是通过简短健康调查问卷（SF - 36）评估的生活质量。还评估了其他几个身体和心理社会次要结局。在基线、四个月和十二个月时收集数据。
四个月和十二个月时的应答率分别为80%和76%。两组在十二个月时在医院焦虑抑郁量表的焦虑子量表（平均差异 - 0.62，95%置信区间 - 1.08至 - 0.16）、关节炎疼痛自我效能量表（0.98，0.07至1.89）以及管理其他方面的自我效能（1.58，0.25至2.90）上显示出显著差异。意向性分析和符合方案分析的结果相似。十二个月时看全科医生的次数没有显著差异。
关节炎自我管理项目减轻了焦虑并提高了参与者对管理症状的自我效能感，但对疼痛、身体功能或与基层医疗的接触没有显著影响。
当前对照试验ISRCTN79115352 [controlled - trials.com]
