Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Academic Primary Healthcare Centre, Stockholm County Council, Stockholm, Sweden.
Disabil Rehabil. 2020 Jul;42(15):2133-2140. doi: 10.1080/09638288.2018.1555616. Epub 2019 Jan 27.
Describe the change in self-efficacy after a supported osteoarthritis self-management program. An observational register-based study comprising 11 906 patients. Participants with hip or knee osteoarthritis self-reported at baseline, 3 and 12 months. Self-efficacy for pain and other symptoms were assessed with the Arthritis Self-efficacy Scale. Change was analyzed using a mixed-effect model for repeated measurements. In total, 9440 (pain subscale) and 9361 (symptom subscale) patients reported self-efficacy scores at baseline and at least one follow-up. The lowest self-efficacy at baseline was reported by patients with low education, walking difficulties, comorbidity and low physical activity level. Overall, the self-efficacy scores improved at the 3-month follow-up and returned to baseline at the 12-month follow-up. Younger age (pain and symptom subscales) and exercise (pain subscale) were associated with a greater increase in self-efficacy. Obesity (pain subscale) and hip problems (pain and symptom subscales) were associated with lower self-efficacy at baseline and a greater decrease at follow-up. Self-efficacy was related to the level of education, physical activity, mobility, and comorbidity. In addition, hip problems or obesity were associated with greater difficulties in enhancing or maintaining self-efficacy. An increased focus on patients with hip problems or obesity might help to improve outcomes after supported self-management programs for osteoarthritis.IMPLICATIONS FOR REHABILITATIONSelf-efficacy increased more in younger patients and in those who opted for exercise as part of the intervention, which indicates that offering supported self-management early in the course of the disease might be important.Lower self-efficacy at baseline and reduced beliefs about their ability to manage pain indicate that patients with hip OA or obesity may need to be given a special focus by healthcare.Self-efficacy in managing pain and other symptoms seemed to increase after a supported self-management osteoarthritis program, but was not maintained at the 12-month follow-up, indicating that more on-going support might be needed to maintain self-efficacy.
描述支持性骨关节炎自我管理计划后自我效能的变化。一项观察性基于登记的研究，纳入 11906 名患者。参与者在基线、3 个月和 12 个月时自我报告髋或膝关节骨关节炎。使用关节炎自我效能量表评估疼痛和其他症状的自我效能。使用重复测量的混合效应模型分析变化。共有 9440 名（疼痛子量表）和 9361 名（症状子量表）患者报告了基线和至少一次随访时的自我效能评分。基线时自我效能最低的是受教育程度低、行走困难、合并症和低身体活动水平的患者。总体而言，自我效能评分在 3 个月随访时提高，并在 12 个月随访时恢复到基线。年龄较小（疼痛和症状子量表）和运动（疼痛子量表）与自我效能的增加更相关。肥胖（疼痛子量表）和髋关节问题（疼痛和症状子量表）与基线时自我效能较低以及随访时自我效能下降幅度较大有关。自我效能与教育程度、身体活动、活动能力和合并症有关。此外，髋关节问题或肥胖与增强或维持自我效能的困难程度增加有关。更多关注髋关节问题或肥胖的患者可能有助于改善支持性骨关节炎自我管理计划后的结局。
年轻患者和选择运动作为干预一部分的患者自我效能增加更多，这表明在疾病早期提供支持性自我管理可能很重要。基线时自我效能较低且对管理疼痛能力的信念降低表明，髋关节 OA 或肥胖患者可能需要得到医疗保健的特别关注。在支持性骨关节炎自我管理计划后，管理疼痛和其他症状的自我效能似乎有所提高，但在 12 个月随访时并未维持，这表明可能需要更多的持续支持来维持自我效能。
