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Health Promotion Journal of Australia Health Promotion Journal of Australia Society
Journal of the Australian Health Promotion Association
RESEARCH ARTICLE

Take Charge of Pain: evaluating a community-targeted self-management education program for people with musculoskeletal pain

Elizabeth Hoon A E , Karen Smith B , Julie Black B , Simon Burnet C , Catherine Hill C D and Tiffany K. Gill D
+ Author Affiliations
- Author Affiliations

A School of Public Health, The University of Adelaide, Mail Drop DX 650 205, SA 5005, Australia.

B Arthritis SA, 118 Richmond Road, Marleston, SA 5033, Australia.

C The Queen Elizabeth Hospital, Rheumatology Unit, 28 Woodville Road, Woodville, SA 5011, Australia.

D School of Medicine, The University of Adelaide, Level 3, Medical School South, SA 5005, Australia.

E Corresponding author. Email: Elizabeth.Hoon@adelaide.edu.au

Health Promotion Journal of Australia 28(1) 77-80 https://doi.org/10.1071/HE15123
Submitted: 22 October 2015  Accepted: 11 April 2016   Published: 6 June 2016

Abstract

Issue addressed: Musculoskeletal conditions are highly prevalent, affecting 28% of the Australian population. Given the persistent nature of many musculoskeletal conditions self-management is recognised as an important aspect of effective disease management. However, participant recruitment and retention for formal self-management programs is a challenge.

Methods: Arthritis SA (Arthritis Foundation of South Australia, a non-profit community health organisation) redesigned a shorter, community-orientated self-management education program delivered by health professionals. The program utilises aspects of the Stanford model of chronic disease self-management and motivational interviewing as well as principles of adult learning to create an effective learning environment. The program aims to guide participants to learn and practise a range of pain management strategies that are known to be effective in improving quality of life. This study used a pre- and post-test (at 6 weeks) design to determine whether this program achieved benefits in self-reported health outcomes. Outcomes that were measured included pain, fatigue, health distress, self-efficacy and communication.

Results: A response rate of 47% (n = 102) was achieved and small but statistically significant improvements in mean [s.d.] pain scores (6.1 [2.3] to 5.4 [2.4], P = 0.001), health distress (2.3 [1.3] to 2.0 [1.3], P = 0.002) and self-efficacy (6.2 [2.1] to 6.8 [2.2], P = 0.002) were found.

Conclusion: Community-based participants of this shorter, focused program recorded small but significant improvements in self-reported pain, health distress and self-efficacy. For those who completed the current program, Arthritis SA is currently exploring the potential of developing a booster session to promote sustainable positive health outcomes.

So what?: Supporting self-management through education is recognised as important but also as a key challenge for effective management of musculoskeletal conditions. Using a pre-post evaluation design, this study demonstrated effectiveness (short-term improvements for self-reported pain, health distress and self-efficacy) for a redesigned and shortened community-targeted program focusing on musculoskeletal pain.


References

[1]  Australian Institute of Health and Welfare. Arthritis and other musculoskeletal conditions across the life stages. Arthritis Series no.18 PHE 173 Canberra: AIHW; 2014.

[2]  Arthritis Australia. Time to Move: Arthritis. A national strategy to reduce a costly burden. 2014. Available from: http://www.arthritisaustralia.com.au/images/stories/documents/reports/TTM/Final%20Arthritis%20Aus%20Time%20to%20Move_140618.pdf [Verified 19 April 2016].

[3]  Kendall E, Ehrlich C, Sunderland N, Muenchberger H, Rushton C (2011) Self-managing versus self-management: reinvigorating the socio-political dimensions of self-management. Chronic Illn 7, 87–98.
Self-managing versus self-management: reinvigorating the socio-political dimensions of self-management.Crossref | GoogleScholarGoogle Scholar | 20921037PubMed |

[4]  Lorig KR, Holman H (2003) Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 26, 1–7.
Self-management education: history, definition, outcomes, and mechanisms.Crossref | GoogleScholarGoogle Scholar | 12867348PubMed |

[5]  Ackerman IN, Buchbinder R, Osborne R (2013) Factors limiting participation in arthritis self-management programmes: an exploration of barriers and patient preferences within a randomized controlled trial. Rheumatology 52, 472–9.
Factors limiting participation in arthritis self-management programmes: an exploration of barriers and patient preferences within a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 23148089PubMed |

[6]  Hootman JM, Helmick C, Brady T (2012) A public health approach to addressing arthritis in older adults: the most common cause of disability. Am J Public Health 102, 426–33.
A public health approach to addressing arthritis in older adults: the most common cause of disability.Crossref | GoogleScholarGoogle Scholar | 22390506PubMed |

[7]  Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks, CA: Sage Publications; 1996.

[8]  Carnes D, Homer KE, Miles CL, Pincus T, Underwood M, Rahman A, et al (2012) Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain 28, 344–54.
Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review.Crossref | GoogleScholarGoogle Scholar | 22001667PubMed |

[9]  Carnes D, Homer K, Underwood M, Pincus T, Rahman A, Taylor SJC (2013) Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course. BMJ Open 3, e003534
Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course.Crossref | GoogleScholarGoogle Scholar | 24231458PubMed |

[10]  Gill T, Wu J, Taylor A. Evaluation of self-management course. Report by Population Research and Outcome Studies, University of Adelaide, for Arthritis SA. 2011. Available from: http://health.adelaide.edu.au/pros/docs/reports/Arthritis_Self_management_report_final.pdf [Verified 19 April 2016].

[11]  Jamieson-Lega K, Berry R, Brown CA (2013) Pacing: a concept analysis of the chronic pain intervention. Pain Res Manag 18, 207–13.
Pacing: a concept analysis of the chronic pain intervention.Crossref | GoogleScholarGoogle Scholar | 23717825PubMed |

[12]  Ritter PL, González V, Laurent D, Lorig K (2006) Measurement of pain using the visual numeric scale. J Rheumatol 33, 574–80.

[13]  Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17, 1022–4.

[14]  Lorig K, Chastain RL, Ung E, Shoor S, Holman HR (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 32, 37–44.
Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M7gsFWjuw%3D%3D&md5=e6b2b8b143b5a17b57444da65550752dCAS | 2912463PubMed |

[15]  Morris NS, MacLean CD, Chew LD, Littenberg B (2006) The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 7, 21
The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability.Crossref | GoogleScholarGoogle Scholar | 16563164PubMed |

[16]  Cohen J (1992) A power primer. Psychol Bull 112, 155–9.
A power primer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MvlsV2mug%3D%3D&md5=59f11c126192be0d188347a2d565b22aCAS | 19565683PubMed |

[17]  Posten H. Robustness of the two-sample t-test. In Rasch D, Tiku L, editors. Robustness of statistical methods and nonparametric statistics (pp. 92–99). Kluwer Academic Publishers Group: Dordrecht, the Netherlands; 1984.

[18]  Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al (2008) Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 9, 105–21.
Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.Crossref | GoogleScholarGoogle Scholar | 18055266PubMed |

[19]  Lorig KR, Sobel D, Ritter P, Laurent D, Hobbs M (2001) Effect of a self-management program for patients with chronic disease. Eff Clin Pract 4, 256–62.