Julie H. Barlow

Self-management approaches for people with chronic conditions: a review

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Long term health impact of playing professional football in the United Kingdom

Objective—To describe the long term impact of football on the health related quality of life (HRQL) of former professional footballers in the United Kingdom. Method—A cross sectional survey gathered data from 284 former professional players. Respondents reported medical treatments, osteoarthritis (OA) diagnosis, other morbidity, disability status, and work related disability since their football career. The EuroQol (EQ-5D) and global health rating scales were selected to assess HRQL. Results—Medical treatment for football related injuries was a common feature, as was OA, with the knee being the most commonly affected joint. Respondents with OA reported poorer HRQL compared with those without OA. As with medical treatments and problems on each of the five EQ-5D dimensions (pain, mobility, usual activities, anxiety/depression, self care), frequency of disability and work related disability were higher among respondents with OA than those without. Conclusion—This exploratory study suggests that playing professional football can impact on the health of United Kingdom footballers in later life. The development of OA was associated with poorer outcomes on all aspects of HRQL.

Group education for people with arthritis

Arthritis is a common chronic disease causing pain and progressive disability to millions of people. The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis, ankylosing spondylitis (AS), in terms of change in: arthritis self-efficacy; psychological well-being; physical well-being; and home exercise activities. The Self-Management Course-Ankylosing Spondylitis (SMC-AS) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up. Analysis of change over time in the intervention group showed improvements in depression, self-efficacy and severity at 3 weeks, with trends towards continued improvement evident at 6 months. In contrast, the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months. In conclusion, the effectiveness of short, intensive patient education courses was demonstrated. However, the need for strategies to sustain improvements in exercise behaviour need to be explored.

Work disability among people with ankylosing spondylitis

OBJECTIVE To investigate work disability among people with ankylosing spondylitis (AS) in terms of correlates and coping mechanisms. METHODS The sample group (n = 133) was recruited through 2 sources: 1) consecutive patients attending outpatient clinics over a 6-month period, and 2) a random sample of members of the National Ankylosing Spondylitis Society. We used a cross-sectional survey with data collected by self-administered questionnaires and telephone interviews with a randomly selected subsample (n = 6). RESULTS The majority of participants were men. The mean age was 49 years; the mean disease duration was 28 years. Thirty-one percent were unable to work because of AS, with an additional 15% reporting changes to their working lives attributable to AS (e.g., reduction in hours worked, change of job). Compared with being in full-time work, work disability was associated with being older, longer disease duration, lower educational standard, comorbidity, greater physical impairment, pain, fatigue, stiffness, anxious and depressed mood, and lower self-esteem. Descriptive data added further insight into the experience of work disability and coping with AS in a work environment. CONCLUSION Work disability is worthy of further investigation to determine exact prevalence rates and psychosocial implications. Work disability could be addressed with simple interventions or adaptations in the workplace.

A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders

Objective:  To review current evidence for the clinical and cost‐effectiveness of self‐management interventions for panic disorder, phobias and obsessive‐compulsive disorder (OCD).

Self-management Training for People with Chronic Disease: A Shared Learning Experience:

The lay-led, Chronic Disease Self-Management Course (CDSMC) is designed to train people in self-management. The present study focused on the experiences of a group of participants attending the CDSMC. Data were collected via interviews with nine participants four months and twelve months after attending the CDSMC. Results showed that participants appreciated the opportunity to share experiences in a reassuring environment. Goal setting was critical in making changes. The CDSMC provided participants with the confidence to select the self-management technique that would meet their needs at a given point in time.

Self‐management training for people with chronic disease: An exploratory study

OBJECTIVE To determine the effectiveness of a community-based Chronic Disease Self-management Course (CDC) for UK participants with a range of chronic diseases. DESIGN The study was a multiple baseline, pre-test post test design with a sample of 185 participants who attended a CDC delivered in community settings by lay tutors, in the UK. METHOD Data were collected by self-completed questionnaires before attendance and at four-month follow-up. RESULTS The sample comprised 72% women (mean age = 53 years, mean disease duration = 16 years). The main chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. Adjusting for baseline values and gender, small to moderate increases were found on cognitive symptom management, self-efficacy (disease and symptoms) and communication with physician. A similar sized decrease was found on fatigue, and small decreases were evident on anxious and depressed moods, and health distress. There were no changes in the use of health care resources, or on self-reported exercise behaviour. CONCLUSION The results of this exploratory study suggest that self-management training for people with chronic diseases can offer benefits in terms of enhanced self-efficacy, greater use of cognitive behavioural techniques, and improvement in some aspects of physical and psychological well-being.

Comparison of knowledge and psychological well-being between patients with a short disease duration (≤1 year) and patients with more established rheumatoid arthritis (≥10 years duration)

Patients with rheumatoid arthritis (RA) of short disease duration (i.e. < or = 1 year) compared with patients of longer disease duration (i.e. > or = 10 years) in terms of RA knowledge, symptoms of anxiety, symptoms of depression and disease acceptance. In addition, the predictors of psychological distress (i.e. symptoms of anxiety and depression) were examined. Data were collected by self-administered questionnaires. As expected, patients with more established disease were significantly older and had more physical dysfunction. However, there were no statistically significant differences on anxiety, depression, acceptance of illness, pain or knowledge about RA. The need for education regarding RA and its implications was expressed by all participants regardless of disease duration. Illness acceptance beliefs were identified as significant predictors of both anxiety and depression.

The reliability and validity of the arthritis self-efficacy scale in a UK context

Abstract The aim of this research was to examine the comprehensibility, reliability and validity of the Arthritis Self-Efficacy Scale (ASE), amongst British people with arthritis in the context of community-based Arthritis Self-Management Programmes (ASMP). The ASE scale is designed to measure perceived ability to control various aspects of arthritis. Data were drawn from four studies: Study 1 tested the comprehensibility of the ASE; and Studies 2, 3 and 4 examined the reliability and validity of the scale. Data were collected through self-administered questionnaires mailed to participants. Reliability and structure of the ASE were examined using standard item analysis, internal consistency (Cronbachs alpha), and factor analyses. Construct, concurrent and predictive validity were examined in relation to demographic variables, physical health status, psychosocial well-being and generalized self-efficacy beliefs. The ASE had a two-dimensional structure: ASE: Pain and ASE: Other symptoms. As expected, highe...

A randomised controlled trial of lay-led self-management for people with multiple sclerosis.

OBJECTIVE To determine the impact of the Chronic Disease Self-Management Course (CDSMC) on people with multiple sclerosis (MS). METHODS 2-group, randomised, controlled trial with Intervention Group (IG) and Waiting-List Control Group (WLCG). Additional data were collected from a Comparison Group (CG) who chose not to attend the CDSMC. Participants completed baseline questionnaires; IG participants attended the CDSMC immediately; all participants were assessed at 4-months and 12-months. RESULTS 216 baseline questionnaires were returned; 73% were female, mean age 51.1 years, mean disease duration 12.0 years. Results showed that the CDSMC had an impact on self-management self-efficacy (ES 0.30, p=0.009 for the IG) and MSIS physical status (ES 0.12 for the IG, p=0.005). There were no other statistically significant changes. However, trends towards improvement on depression (ES 0.21 for the IG, p=0.05) and MS self-efficacy (ES 0.16 for the IG, p=0.04) were noted. All improvements were maintained at 12-months. At baseline, CG participants were older, had longer disease duration (p<0.01) and less anxiety (p=0.009) compared to RCT participants. CONCLUSION The CDSMC provides some small positive effects for people with MS. Motivation to attend may be linked to psychological distress and disease duration. PRACTICE IMPLICATIONS The CDSMC may be of value for those with mild anxiety/depression who need extra support. Attendance early in the disease course is recommended.