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A systematic review of outcomes of chronic disease self-management interventions

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An Erratum to this article was published on 27 November 2012

Abstract

Purpose

To carry out a systematic review of program outcomes used in the evaluation of group-based self-management interventions aimed at people with arthritis and other chronic conditions.

Methods

The systematic search was performed across databases MEDLINE, EMBASE, CINAHL, and PsycINFO. Both between-group and within-group effect sizes (ES) were calculated. Results were interpreted as small (ES ~ 0.2), medium (ES ~ 0.5), or large (ES ~ 0.8) effects.

Results

The majority of 18 included trials investigated the effectiveness of arthritis-specific interventions. Across most outcomes, small effects on course participants were shown. While effects on knowledge were large (between-group ES = 0.78), effects on clinical outcomes such as pain (ES = 0.10) were negligible to small.

Conclusions

This paper is consistent with other reviews in this area, suggesting that people with arthritis receive only marginal benefits from participating in chronic disease self-management interventions. When looking at the types of outcomes that trials are based on, however, alternative explanations for these results seem probable. As evaluations heavily rely on patient self-report, current approaches to program evaluation may not be sufficient to assess the intended impact of self-management education. An in-depth investigation of the types of outcomes assessed is provided in a separate paper.

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References

  1. Yach, D., Hawkes, C., Gould, C. L., & Hofman, K. J. (2004). The global burden of chronic diseases—overcoming impediments to prevention and control. JAMA, 291, 2616–2622.

    Article  PubMed  CAS  Google Scholar 

  2. Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M., & Strong, K. (2007). The burden and costs of chronic diseases in low-income and middle-income countries. Lancet, 370(9603), 1929–1938.

    Article  PubMed  Google Scholar 

  3. Strong, K., Mathers, C., Leeder, S., & Beaglehole, R. (2005). Chronic diseases 1—Preventing chronic diseases: How many lives can we save? Lancet, 366, 1578–1582.

    Article  PubMed  Google Scholar 

  4. Ofman, J. J., Badamgarav, E., Henning, J. M., Knight, K., Gano, A. D., Jr., Levan, R. K., et al. (2004). Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. American Journal of Medicine, 117, 182–192.

    Article  PubMed  Google Scholar 

  5. Newman, S., Steed, L., & Mulligan, K. (2004). Self-management interventions for chronic illness. Lancet, 364(9444), 1523–1537.

    Article  PubMed  Google Scholar 

  6. Astin, J. A., Beckner, W., Soeken, K., Hochberg, M. C., & Berman, B. (2002). Psychological interventions for rheumatoid arthritis: A meta-analysis of randomized controlled trials. Arthritis and Rheumatism, 47(3), 291–302.

    Article  PubMed  Google Scholar 

  7. Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., et al. (2005). Meta-analysis: Chronic disease self-management programs for older adults. Annals of Internal Medicine, 143(6), 427–438.

    Article  PubMed  Google Scholar 

  8. Devos-Comby, L., Cronan, T., & Roesch, S. C. (2006). Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. Journal of Rheumatology, 33(4), 744–756.

    PubMed  Google Scholar 

  9. Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet, 363(9421), 1589–1597.

    Article  PubMed  Google Scholar 

  10. Mullen, P. D., Laville, E. A., Biddle, A. K., & Lorig, K. (1987). Efficacy of psychoeducational interventions on pain, depression, and disability in people with arthritis: A meta-analysis. Journal of Rheumatology, 14(Suppl 15), 33–39.

    PubMed  Google Scholar 

  11. Warsi, A., Wang, P. S., LaValley, M. P., Avorn, J., & Solomon, D. H. (2004). Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Archives of Internal Medicine, 164(15), 1641–1649.

    Article  PubMed  Google Scholar 

  12. Warsi, A., LaValley, M. P., Wang, P. S., Avorn, J., & Solomon, D. H. (2003). Arthritis self-management education programs: A meta-analysis of the effect on pain and disability. Arthritis and Rheumatism, 48(8), 2207–2213.

    Article  PubMed  Google Scholar 

  13. Jordan, J. E., & Osborne, R. H. (2007). Chronic disease self-management education programs: Challenges ahead. MJA, 186(2), 84–87.

    PubMed  Google Scholar 

  14. Nolte, S., Elsworth, G. R., Sinclair, A. J., & Osborne, R. H. (2007). The extent and breadth of benefits from participating in chronic disease self-management courses: A national patient-reported outcomes survey. Patient Education and Counseling, 65(3), 351–360.

    Article  PubMed  Google Scholar 

  15. Stanford Patient Education Research Center. (2012). Organizations Licensed to Offer the Chronic Disease Self-Management Program. Retrieved 04.09.2012, from http://patienteducation.stanford.edu/organ/cdsites.html#aus.

  16. Lorig, K. R., González, V. M., & Laurent, D. D. (1999). The Chronic Disease Self-Management Program: Leaders Manual. Palo Alto: Stanford University.

  17. Lorig, K., Lubeck, D., Kraines, R. G., Seleznick, M., & Holman, H. R. (1985). Outcomes of self-help education for patients with arthritis. Arthritis and Rheumatism, 28(6), 680–685.

    Article  PubMed  CAS  Google Scholar 

  18. Ritter, P. L., Lee, J., & Lorig, K. (2011). Moderators of chronic disease self-management programs: Who benefits? Chronic Illn, 7(2), 162–172.

    Article  PubMed  Google Scholar 

  19. Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Bandura, A., Ritter, P., et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization. Medical Care, 37(1), 5–14.

    Article  PubMed  CAS  Google Scholar 

  20. Taal, E., Riemsma, R. P., Kirwan, J. R., & Rasker, J. J. (2004). What are the real effects of arthritis self-management education programs on pain and disability? Comment on the article by Warsi et al. Arthritis and Rheumatism, 50(3), 1012–1013.

    Article  PubMed  Google Scholar 

  21. Lorig, K. R. (1982). Arthritis self-management: A patient education program. Rehabilitation Nursing, 8, 16–20.

    Google Scholar 

  22. Sackett, D. L. (1994). The cochrane collaboration. ACP Journal Club, 120(Suppl 3), A-11.

    Google Scholar 

  23. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  PubMed  CAS  Google Scholar 

  24. Schwartz, C. E., Bode, R., Repucci, N., Becker, J., Sprangers, M. A., & Fayers, P. M. (2006). The clinical significance of adaptation to changing health: A meta-analysis of response shift. Quality of Life Research, 15(9), 1533–1550.

    Article  PubMed  Google Scholar 

  25. The Cochrane Collaboration. (2007). Cochrane reviews. Retrieved 03.01.2007, from http://www.cochrane.org/reviews/.

  26. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  27. Rosnow, R. L., & Rosenthal, R. (1996). Computing contrasts, effect sizes, and counternulls on other people’s published data: General procedures for research consumers. Psychological Methods, 1, 331–340.

    Article  Google Scholar 

  28. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. San Diego, CA: Academic Press.

    Google Scholar 

  29. Burckhardt, C. S., Mannerkorpi, K., Hedenberg, L., & Bjelle, A. (1994). A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. Journal of Rheumatology, 21, 714–720.

    PubMed  CAS  Google Scholar 

  30. Griffiths, C., Motlib, J., Azad, A., Ramsay, J., Eldridge, S., Feder, G., et al. (2005). Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease. British Journal of General Practice, 55, 831–837.

    PubMed  Google Scholar 

  31. Taal, E., Riemsma, R. P., Brus, H. L., Seydel, E. R., Rasker, J. J., & Wiegman, O. (1993). Group education for patients with rheumatoid arthritis. Patient Education and Counseling, 20(2–3), 177–187.

    Article  PubMed  CAS  Google Scholar 

  32. Clark, N. M., Janz, N. K., Becker, M. H., Schork, M. A., Wheeler, J., Liang, J., et al. (1992). Impact of self-management education on the functional health status of older adults with heart disease. Gerontologist, 32, 438–443.

    Article  PubMed  CAS  Google Scholar 

  33. Cohen, J. L., van Houten Sauter, S., DeVellis, R. F., & McEvoy DeVellis, B. (1986). Evaluation of arthritis self-management courses led by laypersons and by professionals. Arthritis and Rheumatism, 29(3), 388–393.

    Article  PubMed  CAS  Google Scholar 

  34. Solomon, D. H., Warsi, A., Brown-Stevenson, T., Farrell, M., Gauthier, S., Mikels, D., et al. (2002). Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. Journal of Rheumatology, 29(2), 362–368.

    PubMed  Google Scholar 

  35. Swerissen, H., Belfrage, J., Weeks, A., Jordan, L., Walker, C., Furler, J., et al. (2006). A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Education and Counseling, 64(1–3), 360–368.

    Article  PubMed  Google Scholar 

  36. Worth, H. (2002). Effects of patient education in asthma and COPD—What is provable? Medizinische Klinik, 97(2, Suppl), 20–24.

    Google Scholar 

  37. Heuts, P. H. T. G., de Bie, R., Drietelaar, M., Aretz, K., Hopman-Rock, M., Bastiaenen, C. H. G., et al. (2005). Self-management in osteoarthritis of hip or knee: A randomized clinical trial in a primary healthcare setting. Journal of Rheumatology, 32(3), 543–549.

    PubMed  Google Scholar 

  38. Hopman-Rock, M., & Westhoff, M. H. (2000). The effects of a health educational and exercise program for older adults with osteoarthritis of the hip or knee. Journal of Rheumatology, 27(8), 1947–1954.

    PubMed  CAS  Google Scholar 

  39. Keefe, F. J., Caldwell, D. S., Wiliams, D. A., Gil, K. M., Mitchell, D., Robertson, C., et al. (1990). Pain coping skills training in the management of osteoarthritic knee pain: A comparative study. Behavior Therapy, 21, 49–62.

    Article  Google Scholar 

  40. Barlow, J. H., Turner, A. P., & Wright, C. C. (2000). A randomized controlled study of the Arthritis Self-Management Programme in the UK. Health Education Research, 15(6), 665–680.

    Google Scholar 

  41. Lorig, K., Feigenbaum, P., Regan, C., Ung, E., Chastain, R. L., & Holman, H. R. (1986). A comparison of lay-taught and professional-taught arthritis self-management courses. Journal of Rheumatology, 13(4), 763–767.

    PubMed  CAS  Google Scholar 

  42. Lorig, K., González, V. M., & Ritter, P. (1999). Community-based Spanish language arthritis education program: A randomized trial. Medical Care, 37(9), 957–963.

    Article  PubMed  CAS  Google Scholar 

  43. Lorig, K., Seleznick, M., Lubeck, D., Ung, E., Chastain, R. L., & Holman, H. R. (1989). The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change. Arthritis and Rheumatism, 32(1), 91–95.

    Article  PubMed  CAS  Google Scholar 

  44. Goeppinger, J., Arthur, M. W., Baglioni, A. J., Jr., Brunk, S. E., & Brunner, C. M. (1989). A reexamination of the effectiveness of self-care education for persons with arthritis. Arthritis and Rheumatism, 32(6), 706–716.

    Article  PubMed  CAS  Google Scholar 

  45. Scholten, C., Brodowicz, T., Graninger, W., Gardavsky, I., Pils, K., Pesau, B., et al. (1999). Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program. Archives of Physical Medicine and Rehabilitation, 80, 1282–1287.

    Article  PubMed  CAS  Google Scholar 

  46. Haas, M., Groupp, E., Muench, J., Kraemer, D., Brummel-Smith, K., Sharma, R., et al. (2005). Chronic disease self-management program for low back pain in the elderly. Journal of Manipulative and Physiological Therapeutics, 28(4), 228–237.

    Google Scholar 

  47. Von Korff, M., Moore, J. E., Lorig, K., Cherkin, D. C., Saunders, K., González, V. M., et al. (1998). A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care. Spine, 23(23), 2608–2615.

    Article  Google Scholar 

  48. LeFort, S. M., Gray-Donald, K., Rowat, K. M., & Jeans, M. E. (1998). Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain. Pain, 74(2–3), 297–306.

    Article  PubMed  CAS  Google Scholar 

  49. Fu, D., Fu, H., McGowan, P., Shen, Y.-E., Zhu, L., Yang, H., et al. (2003). Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: Randomized controlled trial. Bulletin of the World Health Organization, 81(3), 174–182.

    PubMed  Google Scholar 

  50. Lorig, K. R., Ritter, P. L., & González, V. M. (2003). Hispanic chronic disease self-management—A randomized community-based outcome trial. Nursing Research, 52(6), 361–369.

    Article  PubMed  Google Scholar 

  51. Nolte, S., Elsworth, G. R., Sinclair, A. J., & Osborne, R. H. (2009). Tests of measurement invariance failed to support the application of the “then-test”. Journal of Clinical Epidemiology, 62(11), 1173–1180.

    Article  PubMed  Google Scholar 

  52. Osborne, R. H., Elsworth, G. R., & Whitfield, K. (2007). The Health Education Impact Questionnaire (HEIQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Education and Counseling, 66, 192–201.

    Google Scholar 

  53. Osborne, R. H., Spinks, J. M., & Wicks, I. P. (2004). Patient education and self-management programs in arthritis. MJA, 180, S23–S26.

    PubMed  Google Scholar 

  54. Schwartz, C. E., & Rapkin, B. D. (2004). Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health qual life outcomes retrieved April 15, 2006, from http://www.hqlo.com/content/2/1/16.

  55. Osborne, R. H., Batterham, R., & Livingston, J. (2011). The evaluation of chronic disease self-management support across settings: The international experience of the health education impact questionnaire monitoring system. Nursing Clinics of North America, 46(3), 255–270.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medical Clinic for Psychosomatics, Charité, University Medicine Berlin, Luisenstraße 13a, 10117, Berlin, Germany

    Sandra Nolte

  2. Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia

    Sandra Nolte & Richard H. Osborne

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  1. Sandra Nolte
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  2. Richard H. Osborne
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Correspondence to Sandra Nolte.

Appendix

Appendix

See Table 2.

Table 2 Included studies, types of interventions, outcome measures, and effects (Cohen’s d [95 % confidence interval, CI], effect sizes for both intervention group [IG] and control group [CG])
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Nolte, S., Osborne, R.H. A systematic review of outcomes of chronic disease self-management interventions. Qual Life Res 22, 1805–1816 (2013). https://doi.org/10.1007/s11136-012-0302-8

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