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dc.contributorWichita State University. School of Nursingen_US
dc.contributor.authorHawley, Donna J.en_US
dc.date.accessioned2012-02-28T20:26:01Z
dc.date.available2012-02-28T20:26:01Z
dc.date.issued1995-11en_US
dc.identifier8591655en_US
dc.identifier8805770en_US
dc.identifierS0950-3579(05)80315-2en_US
dc.identifier.citationBaillière's clinical rheumatology. 1995 Nov; 9(4): 803-23.en_US
dc.identifier.issn0950-3579en_US
dc.identifier.urihttp://dx.doi.org/10.1016/S0950-3579(05)80315-2en_US
dc.identifier.urihttp://hdl.handle.net/10057/4516
dc.descriptionClick on the DOI link below to access the article (may not be free).en_US
dc.description.abstractPatient education has a long history as an integral part of clinical practice; however, controlled clinical trials of psycho-educational interventions for the rheumatic disorders emerged in significant numbers over the last 15 to 20 years. In this chapter, the efficacy of these interventions was reviewed in 34 reports (54 separate treatment arms) published in the last 10 years. Psycho-educational interventions included both traditional educational or teaching activities and psychological interventions. The most common types of intervention were self-management programmes ((21 treatment arms) and cognitive-behavioral therapy (10 treatment arms). Both approaches emphasize learning new skills helpful in managing one's disease. Self-management programmes are broadly focused on using information, problem-solving and coping skills for symptom management. Cognitive-behavioural therapy usually emphasizes control of pain by understanding the interaction of emotions and cognition with the physical and behavioral aspects of pain. Other interventions, tested either individually or as comparisons for self-management or cognitive-behavioural therapy interventions, included traditional classroom-type programmes (four treatment arms), 'materials' including pamphlets, books and computerized instruction (seven treatment arms), individualized instruction (five treatment arms), psychotherapy (one), and support groups (three treatment arms). Sixty per cent of studies used clinic samples, 52% rheumatoid arthritis and 8% with osteoarthritis. The remaining studies recruited from community samples where the exact diagnosis was not always clear, though most had either RA or OA. The majority of self-management interventions used community samples. The average effect size for treatment compared to non-intervention controls (weighted for sample size) for RA patient pain, functional ability and depression at post intervention was 0.13, -0.16 and 0.01 compared with 0.44, 0.28 and 0.56 for OA patients and 0.21, 0.08 and 0.12 for community samples. At 3 months follow-up, self-management programmes demonstrated improvement compared to controls for self-efficacy (effect sizes 0.22 to 0.29) with community patients while cognitive-behavioural therapy interventions demonstrated similar improvements in active coping skills (effect sizes 0.09 to 0.18) with RA patients. Effect sizes ranged from 0.6 to 1.1 for exercise compliance following self-management interventions. In the few studies with follow-up evaluations extending beyond 3 months post-intervention, effects generally weaken. As expected, psycho-educational interventions do not alter physical functioning with functional abilities continuing to decline over time. Lorig and colleagues have demonstrated in 4-year outcome studies important reductions in the use of health care services for participants in self-management programmes despite the progression of functional disability. Psycho-educational interventions are difficult to evaluate because of the differences in interventions, methods of assessment and varying follow-up times. Studies of these interventions differ in quality, patient population, etc., precluding a useful meta analysis. Overall, there is improvement in pain, depressive symptoms, self-efficacy, coping abilities, and self-management behaviours such as exercise compliance following psycho-educational interventions, with a trend to greater improvement for OA than RA patients. Utilization of health care services may be reduced following educational interventions. Although the overall improvement is small, it is probably of the order of that seen with therapy with NSAIDs and is independent of medical treatment. Psycho-educational interventions are a useful additional modality in the management of rheumatic diseases and may improve treatment effects and patient quality of life.en_US
dc.format.extent803-23en_US
dc.language.isoengen_US
dc.publisherBailliere Tindallen_US
dc.relation.ispartofseriesBaillière'S Clinical Rheumatologyen_US
dc.relation.ispartofseriesBaillieres Clin Rheumatolen_US
dc.sourceNLMen_US
dc.subjectReviewen_US
dc.subject.meshArthritis/psychologyen_US
dc.subject.meshClinical Trials as Topicen_US
dc.subject.meshHumansen_US
dc.subject.meshMental Healthen_US
dc.subject.meshPatient Education as Topicen_US
dc.subject.meshPsychotherapy/methodsen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshArthritis/therapyen_US
dc.titlePsycho-educational interventions in the treatment of arthritisen_US
dc.typeArticleen_US
dc.coverage.spacialEnglanden_US
dc.description.versionpeer revieweden_US
dc.rights.holderCopyright © 1995 Elsevieren_US


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