2Patient education and self-management of musculoskeletal diseases
Section snippets
Participation in arthritis self-management programs
The recognition of the substantial and increasing burden of arthritis on health-care resources led to three arthritis self-management objectives being added to the US national health objectives for 2010. One of these was arthritis education, and the other two were weight counseling and physical activity counseling.3, 4 Given the importance placed on arthritis education in the context of the US health-care agenda, it may be helpful to ask: how many with the disease are receiving education
A look at the ‘state-of-the-art’ in arthritis patient education and self-management
Education is the ‘portal’ through which a person with arthritis must go to achieve successful self-management. If they do not have a good understanding of the disease – what the course of it will look like over their life-time if untreated or under treated, what types of health behavior and support are helpful and unhelpful – then it will be difficult for them to know what they have to ‘manage’. The ideal time for a person to pass through the education portal is at the earliest formal stage of
New ideas on patient education and self-management
To build on the ‘times are changing’ theme, it is time to experiment with new ideas on development and delivery of patient education and self-management programs: ones that are customized to meet the needs of the individual, not the masses. Just like in medication therapies, programs need to be tailor-made and delivered in a timely manner and at very low cost given the growing need.
Examples of new programming might include the following.
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Audio programming (or ‘podcasts’)35 downloadable to
Conclusions
Formal patient education and self-management interventions have been a disappointment. Short-term benefits have been modest, and long-term benefits have generally not been easy to demonstrate. In part, while ‘self-management’ has been a popular term, there has been remarkably little study of it. An intervention of comparable efficacy to self-management would be the use of analgesics or non-steroidal anti-inflammatory drugs, treatments that have attracted $100s of millions of research funding.
Acknowledgements
Dr. Esdaile is supported by a Kirkland Scholar Award funded by Rheuminations, Inc., a non-profit foundation dedicated to supporting research leading to the treatment and cure of lupus.
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Cited by (25)
Patients’ perceived health information needs in inflammatory arthritis: A systematic review
2019, Seminars in Arthritis and RheumatismCitation Excerpt :Informed patients are better equipped to share in management decisions and effectively participate in co-care, which may lead to improved outcomes and better adjustment [15, 16]. Previous studies in musculoskeletal conditions showed that effective patient education needs to be patient-centred and modified to individual needs [17]. Furthermore, the information deemed important by the patient may differ to that prioritised by the clinician or health service provider, due to a focus on different disease consequences and outcomes [18, 19].
A comparison of patient education practices and perceptions of novice and experienced physiotherapists in Australian physiotherapy settings
2017, Musculoskeletal Science and PracticeCitation Excerpt :Further, patient education within physiotherapy is described as being primarily clinician-centred or didactic in nature (Trede, 2000) and often not individualised to the patient (Kerssens et al., 1999). The effective provision of patient education by a health professional is centred on skills and behaviours encompassing effective communication, patient-centredness (WHO, 1998), patient-therapist collaboration (Cooper et al., 2009), a focus on self-management (Lorig and Holman, 2003) and empowering the patient towards self-efficacy (Koehn and Esdaile, 2008). Studies of novice and experienced physiotherapists illustrate several distinguishing characteristics in cognition, reasoning and behaviours that are central to patient education practice (Jensen et al., 1990, 1992, 2000; Resnik and Jensen, 2003; Holmes, 1999; Doody and McAteer, 2002; Wainwright et al., 2011).
Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial
2013, Osteoarthritis and CartilageCitation Excerpt :In Denmark, there is no consensus around standardized minimal care for hip OA patients in primary care and standardized patient education (PE) programs are not available to the public. In other countries, PE programs have been developed for OA patients to improve self-management through understanding of the disease and change of health behavior6. Although guidelines recommend PE programs as a core intervention7, systematic reviews are contradictory in conclusions regarding their effectiveness on pain and function8,9.
Tai Chi and yoga as complementary therapies in rheumatologic conditions
2012, Best Practice and Research: Clinical RheumatologyCitation Excerpt :However, educational trials have not given the major reward one might have hoped for with small effect sizes, even in short-term evaluations [3]. To improve health, it may be wise to experiment with new ideas, other treatment modalities and self-management programmes [4]. Sometimes, it is difficult to motivate individuals to involve in demanding exercise, especially when benefits are not immediately seen, corresponding to our human inclination to avoid stressful and unnecessary activities.
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