Arthritis self-management. A five-year history of a patient education program.

There are several lessons to be learned from the ASM experience. First, and most outstanding, is the willingness of large numbers of people across the United States to participate in both the ASM course and the research. Second, we have found that lay leaders can be trained to offer a rather complex arthritis course. They have proved to be reliable and, most important, are acceptable to the public and most health professionals. When their acceptance has been questioned, it is usually by persons with little or no experience with either the course or the lay leaders. Third, a national organization, in this case the Arthritis Foundation, has been able to disseminate the course widely and, to some extent, to conduct evaluations. From the national evaluation experience, we have learned that local areas are much more interested in service than evaluation and almost too readily accept an unproven yet hopeful arthritis education program. However, this acceptance of a new innovation before thorough testing is no different than that seen with other new medical technologies from medication to coronary bypass. Finally and most intriguing, we have found that such standard arthritis treatments as exercise and relaxation seem to directly contribute only slightly to the reductions in pain experienced by ASM participants. This unexpected lack of correlation has led us to begin studying other mediating factors such as self-efficacy, depression or both.(ABSTRACT TRUNCATED AT 250 WORDS)