Nineteen trials (more than 7,000 participants) were included in the review. Studies ranged in size from 51 to 1,090 patients. Follow-up ranged from two months to three years. Compliance ranged from 56% to 97%. Attrition rates ranged from 4% to 43%. Five studies were classified as having a low risk of bias and 14 as having a moderate risk.
Among patients with arthritis, self-management programmes were associated with a moderate reduction in pain intensity compared with control group at four months (SMD -0.23, 95% CI -0.36 to -0.10; seven trials) and six months (SMD -0.29, 95% CI -0.41to -0.17; three trials). The effect was smaller at 12 months (SMD -0.14, 95% CI -0.23 to -0.04; three trials). There was a moderate degree of heterogeneity at four months (Ι²=60%) but none at later follow-up points (Ι²=0% for both). A further five studies which were not included in the meta-analysis showed inconsistent findings.
Self-management programmes were associated with no change in disability in patients with arthritis as measured by HAQ at four months (five RCTs) and a small reduction in disability at 12 months (SMD -0.17, 95% CI -0.27 to -0.07; three trials; no statistical heterogeneity, Ι²=0%). Eight studies were reported narratively; three showed significant and five showed non-significant findings.
No meta-analysis was performed for chronic back pain due to differences in outcome measurement. None of the three RCTs showed beneficial effect of self-management programmes in reducing back pain. There was no consistent pattern in the effect of these programmes on improving disability.
Few adverse events were reported but in two trials a small number of participants reported that pain became worse with exercise in patients in the self-management groups.