Study Suggests Telephone-Based Self-Management Program Improves Pain among Veterans with Osteoarthritis
BACKGROUND:
Optimal management of osteoarthritis involves both pharmacological intervention and behavioral strategies, i.e., exercise and weight management. Previous studies have shown that self-management programs can improve both healthy behaviors and outcomes among patients with osteoarthritis. This study examined the effectiveness of a one-year, telephone-based self-management support intervention for 461 Veterans with symptomatic hip and/or knee osteoarthritis who received VA primary care at the Durham VAMC. Veterans were randomly assigned to one of three interventions: osteoarthritis self-management, health education, or usual care. The self-management intervention had two main components: 1) providing educational materials related to managing osteoarthritis, and 2) helping participants develop goals and action plans related to managing this condition. It also included 12 monthly telephone calls with a health educator. Veterans in the ‘health education intervention’ were provided with non-osteoarthritis educational materials and 12 monthly telephone calls related to general health screening topics (e.g., hypertension, cholesterol, cancer). Veterans in ‘usual care’ were provided written osteoarthritis self-management materials after completing follow-up assessments, but no other intervention. At baseline and 12 months, investigators compared pain scores among Veterans in the three interventions. They also assessed physical function and costs.
FINDINGS:
- A telephone-based self-management program produced moderate improvements in pain among Veterans with osteoarthritis, particularly compared with a general health education intervention.
- The mean pain score among Veterans in the osteoarthritis self-management intervention was 0.4 points lower, indicating improvement in pain, compared to participants in the usual care arm, and 0.6 points lower compared to participants in the health education intervention.
- There were no significant differences found between Veterans participating in the three interventions in terms of function or overall mobility. However, the self-management group had greater improvement on the walking and bending subscale measure.
- When the training costs for the health educator were not included, the per-Veteran costs were $107 for the osteoarthritis self-management intervention vs. $51 for the health education intervention.
LIMITATIONS:
- This study was conducted at only one VAMC.
- The same health educator delivered both the osteoarthritis self-management and health education interventions, which could raise the risk of contamination between intervention groups; also, the average length of calls was shorter for the health education arm.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 04-016, RCS 91-408 and RCS 08-027). Drs. Weinberger and Bosworth were supported by HSR&D Career Scientist Awards. All authors are part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.
Allen K, Oddone E, Coffman C, Datta S, Juntilla K, Lindquist J, Walker T, Weinberger M, and Bosworth H. Telephone-Based Self-Management of Osteoarthritis: A Randomized, Controlled Trial. Annals of Internal Medicine November 2, 2010;153(9):570-79.
