Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


A Meta-Analytic Assessment of the Effects of Stanford's Small Group English Version of the Arthritis Self Management Program.

Brady,  Teresa J., O'Colmain,  Benita J., Mobley,  Brandy S., Greenberg,  Michael C., Murphy,  Louise

Center for Disease Control, Atlanta, GA
Centers for Disease Control and Prevention
ICF Macro, Calverton, MD
ICF Macro

Background:

Meta-analyses of arthritis self management education (SME) generally concludes it has modest, time limited effects. However, past analyses combined a variety of SME and examined only pain and disability. The purpose of this study was to examine the effects of Stanford's Arthritis Self Management Program (ASMP) using meta-analysis.

Methods:

7 Electronic databases (i.e. Medline, EMBASE) were searched using arthritis education-related keywords; reviews, reference lists, and expert recommendations guided hand searches to locate missed or gray literature.

All ASMP studies were included, regardless of language or delivery mode, if conducted in an English speaking country, containing data on at least 1 primary outcome, and reported in English. Primary outcomes: Fatigue (FAT), Self Rated Health (SRH), Pain, Self Efficacy (SE), Health Distress (HD), Physician Visits (MD-V). Secondary outcomes: Disability (DIS), Social/Role Limitations (LMTS), Anxiety (ANX), Depression (DEP), Aerobic Exercise (A.EX), Stretching/Strengthening Exercise (ST.EX), Cognitive Symptom Management (CSM), and Communication with MD (COMM).

Full random-effects meta-analysis was conducted for all available outcomes at 4–6 and 9–12 months. Heterogenity (HTG) was assessed using the Q Value (statistically significant at a= 0.05). Sensitivity analyses explored differences by study design (RCT vs. longitudinal [LONG]).

Results:

297 studies were identified; this report focuses on the 20 eligible studies (6 RCT, 14 LONG) of the Small Group English ASMP.

In analysis of 4–6 mo. data, there was significant HTG in 5 of 6 primary outcomes (all but SE) and 2 of 8 secondary outcomes (LMTS, CSM), indicating significant inter-study variation in effect sizes (ES) for most primary but few secondary outcomes. Only Pain and MD-V showed significant between group (RCT-LONG) HTG, indicating variation was not due to study design, and analysis of Overall effects (RCT and LONG combined) was valid.

RCT only analysis showed significant benefits in FAT (ES =-0.214), SE (0.34), ANX (-0.204), DEP (-0.201), and COMM (0.277) at 4–6 mo. At 9–12 mo. improvements in SE, ANX and DEP remained significant but slightly reduced (ES 0.21, -0.193, -0.132 respectively); no 12 mo. data were available on FAT or COMM.

In 4–6 mo. Overall analysis, all variables significant in RCT analysis were significant. HD (ES =-0.359), DIS (-0.049), A.EX (0.209), ST.EX (0.179), and CSM (0.533) were also significant with small to moderate ESs. At 9–12 mo., all variables except DIS, A-EX, and ST.EX remained significant with similar ESs. Pain and MD-V were significant in LONG 4–6 mo. analysis (ES -0.225, -0.120 respectively) but not in RCT only or Overall analyses.

Conclusions:

Based on RCT analysis, the small group English ASMP has robust psychological benefits (ANX, DEP, SE) that persist at 12 mo., along with short term benefits in FAT and COMM. In Overall analysis, benefits were also seen in health behaviors and HD; most persisted at 12 mo. Consistent with previous meta-analyses, the impact of ASMP on DIS at 4–6 mo. is significant but small, and not maintained at 12 mo. The impact of ASMP on Pain and MD-V is only found in LONG studies, and should be interpreted cautiously.

To cite this abstract, please use the following information:
Brady, Teresa J., O'Colmain, Benita J., Mobley, Brandy S., Greenberg, Michael C., Murphy, Louise; A Meta-Analytic Assessment of the Effects of Stanford's Small Group English Version of the Arthritis Self Management Program. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2062
DOI: 10.1002/art.29827

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