Self-management in osteoarthritis of hip or knee: A randomized clinical trial in a primary healthcare setting

Objective. To assess in a primary healthcare setting the efficacy of a self-management program in middle-aged patients with osteoarthritis (OA). Methods. This was a 2-group randomized controlled trial, with 273 patients aged 40 to 60 years with OA of the hip(s) and/or knee(s). The experimental intervention was compared with care-as-usual. Treatments and followup measurements were performed in a general healthcare setting by general practitioners. Duration of followup was 21 months after start of the intervention. Instruction in self-management techniques was given by physiotherapists. The main outcome measures were pain severity in hips and knees, other significant complaints, and functional limitations. Results. To begin, 297 patients were randomized: 149 as self-management and 148 controls; before the intervention 24 withdrew for practical reasons (17 self-management, 7 controls). At 3-month followup the intervention group was significantly improved on a visual analog scale (VAS) for knee pain (score 0.67; SD 2.10) and the WOMAC (score 2.46; SD 9.49), while the control group showed stable VAS knee pain (0.01; SD 2.00) and deterioration on WOMAC (-0.53; SD 9.47). At 21-month followup the differences between the groups increased in favor of the intervention group (VAS pain knee: p values from 0.023 at 3 mo to 0.004 at 21 mo; WOMAC: p values from 0.030 to 0.022). Conclusion. The self-management program positively influenced knee pain and self-reported functional level in this sample of patients with OA. Differences between the study groups increased during followup in favor of the intervention group.