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Rheumatology Advance Access originally published online on September 24, 2008
Rheumatology 2008 47(11):1712-1718; doi:10.1093/rheumatology/ken380
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial

A. Hammond1,2, J. Bryan3 and A. Hardy4

1Centre for Rehabilitation and Human Performance Research, University of Salford, Salford 2Department of Rheumatology, Derbyshire Royal Infirmary, Derby 3Department of Occupational Therapy, Ripley Hospital, Ripley and 4Department of Physiotherapy, Derbyshire Royal Infirmary, Derby, UK.

Correspondence to: A. Hammond, Centre for Rehabilitation & Human Performance Research, Brian Blatchford Building, University of Salford, Frederick Road, Salford M6 6PU, UK. E-mail: a-hammond{at}salford.ac.uk


  Abstract

Objectives. Rheumatology guidelines recommend people with RA receive behavioural self-management education. This study developed a modular behavioural group programme and evaluated its longer term effects on pain, physical and psychological status.

Methods. People with RA or PsA were randomized to a modular behavioural or standard information-focused education programme, both delivered by experienced rheumatology health professionals at one large district general hospital. Outcome measures were pain, self-efficacy, fatigue, functional ability, psychological status and use of health behaviours (exercise, joint protection, fatigue and cognitive symptom management). Using an intent-to-treat analysis outcomes were compared at 6 and 12 months with analysis of covariance.

Results. Out of 498 referred patients, 218 agreed to participate, met entry criteria and were randomized; 51 withdrew before education. Of the remaining patients, 86 attended the behavioural and 81 the standard programmes. Participants were aged 55.4 yrs (S.D. 12.42) with disease duration of 7.39 (S.D. 6.88) yrs (53% <5 yrs). At 6 months, the behavioural group had better pain (P = 0.01), fatigue (P = 0.01), functional ability (P = 0.05) and self-efficacy (P = 0.01) scores and greater use of health behaviours. At 12 months, they continued to have better pain (P = 0.03), self-efficacy (P = 0.001) and psychological status (P = 0.0001) scores and greater use of some health behaviours.

Conclusion. Attending a modular behavioural education programme is effective for at least 1 yr in enabling people with RA and PsA to reduce pain, improve psychological status and self-manage their condition.

KEY WORDS: Rheumatoid arthritis, Patient education, Randomized controlled trial

Submitted 7 May 2008; revised version accepted 26 August 2008.
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