Article

Self-management education for osteoarthritis.

Annals of internal medicine (Impact Factor: 16.1). 05/2006; 144(8):617; author reply 617-8. DOI: 10.7326/0003-4819-144-8-200604180-00014
Source: PubMed

Full-text

Available from: Kate R Lorig, Jul 06, 2014
0 Followers
 · 
89 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time and have adverse effects on quality of life, disability, and health care costs. To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. Randomized controlled trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity (Patient Health Questionnaire 9 score > or = 10). Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program over 12 weeks (step 2), and a continuation phase of therapy for 6 months (step 3). Depression (20-item Hopkins Symptom Checklist), pain severity and interference (Brief Pain Inventory), and global improvement in pain at 12 months. At 12 months, 46 of the 123 intervention patients (37.4%) had a 50% or greater reduction in depression severity from baseline compared with 21 of 127 usual care patients (16.5%) (relative risk [RR], 2.3; 95% confidence interval [CI], 1.5-3.2), corresponding to a much lower number of patients with major depression (50 [40.7%] vs 87 [68.5%], respectively; RR, 0.6 [95% CI, 0.4-0.8]). Also, a clinically significant (> or = 30%) reduction in pain was much more likely in intervention patients (51 intervention patients [41.5%] vs 22 usual care patients [17.3%]; RR, 2.4 [95% CI, 1.6-3.2]), as was global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7 [95% CI, 2.3-6.1]). More intervention patients also experienced benefits in terms of the primary outcome, which was a combined improvement in both depression and pain (32 intervention patients [26.0%] vs 10 usual care patients [7.9%]; RR, 3.3 [95% CI, 1.8-5.4]). Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability. clinicaltrials.gov Identifier: NCT00118430.
    JAMA The Journal of the American Medical Association 06/2009; 301(20):2099-110. DOI:10.1001/jama.2009.723 · 30.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: She has some experience to work and research with people with chronic illness especially diabetes. The second and the third authors, Prof Higgins and Prof Koch, are Ms Adili's supervisors. They are professors of Nursing at the University of Newcastle. Prof Higgins is experienced in older people's research and Prof Koch is experienced in the participatory action research. ABSTRACT Whilst there are many chronic conditions such as; asthma, cancer, multiple sclerosis, cardiovascular diseases, arthritis, chronic obstructive pulmonary disease, mental ill health to name a few, this study focused on researching with people living with, type 2 diabetes. Although type 2diabetes has been well researched over the years, particularly from a medical focus, there were, to date, few studies that explored what happens when a person was first diagnosed. It had been observed that when people were diagnosed with diabetes they must dramatically modify their everyday lives, but the way in which these changes take place had not been studied. More importantly, what could be learnt researching with people as they took the results of a chronic condition into their lives had not been studied. The aim of this study was to explore how older women learnt to live with diabetes during the first year post diagnosis.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To understand patients' perspectives on 'appropriateness' for hip and knee total joint arthroplasty (TJA). Focus groups were conducted, stratified by history of a previous TJA, in English-speaking men and women aged 40+ years with moderate to severe hip and knee osteoarthritis. Participants discussed: their appropriateness for TJA; the ideal candidate; patients' role in TJA decision making; and the relationship between appropriateness and willingness to consider TJA. Participants self-completed a questionnaire assessing demographics, arthritis severity (Western Ontario McMaster University Osteoarthritis index - WOMAC), perceived TJA candidacy and willingness to consider TJA. Focus groups were audio-taped and transcribed verbatim. Content analysis was performed. Eleven focus groups were conducted with 58 participants in total: mean age 72 years; 79% female; 25 (43%) with prior TJA; mean WOMAC summary score 43.1. Half reported willingness to consider TJA and 43% felt they were appropriate for TJA. Appropriateness was equated with candidacy for the procedure. Pain intensity and the ability to cope with pain were identified as the most important factors determining surgical candidacy, but felt to be inadequately evaluated by physicians. TJA appropriateness and willingness were felt to be distinct, yet related, concepts; those unwilling had stricter criteria about candidacy than those who were willing. Participants equated appropriateness for TJA with surgical candidacy. Patients' pain experience (intensity, impact on quality of life, ability to cope) was seen as most important in determining appropriateness, but felt to be inadequately evaluated currently. Enhanced patient-physician communication, possibly through use of patient decision aids, has potential to improve patient selection for TJA.
    Osteoarthritis and Cartilage 05/2012; 20(9):967-73. DOI:10.1016/j.joca.2012.05.008 · 4.66 Impact Factor