| Lorig et al. (2005) | Compare disease specific self-management (ASMP) versus generic self-management (CDSMP) | Self-efficacy theory | Community centers U.S. | ・ RCT ・ Randomized to either disease specific (ASMP) or Generic (CDSMP) ・ Data Collected at baseline, 4 months, and 12 months | ・ ASMP = 239 ・ CDSMP = 116 ・ Mean age = 65 ・ Years of Education = 16 ・ Female: ASMP 81% ・ CDSMP: 78% ・ Diagnosed with Arthritis ・ ・ | ・ Demographics ・ Health Distress ・ -Self-reported Global Health ・ Activity Limitation ・ -Disability ・ Fatigue ・ Pain ・ -Aerobic Exercise ・ Stretching and Strengthening ・ Self-efficacy ・ Physician Visits ・ Hospitalizations ・ -Validity and Reliability Addressed | ・ Improvement in individual groups compared to baseline ・ 4-month: ASMP demonstrated greater improvement in health distress, activity limitation, and fatigue ・ 1 year: ASMP had significant improvements in health distress, activity limitation, disability, fatigue, pain, practice mental stress management, stretching and strengthening, and self-efficacy | Interpretations: ASMP has advantages compared to CDSMP, lessening slightly at 1 year Limitations: CDSMP enrollment half of ASMP, Self-report Recommendations: As chronic diseases are different need to study other disease specific groups to see if positive effects are achieved versus the CDSMP Generalizability: Not addressed, adequate power for sample size. volunteers could limit generalizability | 1b |
| Farrell et al. (2004) | To evaluate the effectiveness and acceptability of the CDSMP in the underserved, poor, rural, predominantly African American population (pilot) | Self-Efficacy Theory CDSMP | Rural, underserved, socioeconomically declined Clinic U.S. | ・ Quasi-experimental, pre-post design ・ 6-week intervention ・ Lay leaders from community | ・ N = 48 ・ 79% Caucasian ・ 81% women ・ Mean Age: 60 ・ Education Mean: 12 years ・ Heterogeneous chronic diseases | ・ Demographics ・ Self-efficacy: Self-Efficacy Cantril Ladder (face and content validity) ・ CDSMP validated and reliable testing done previously for instruments used for ・ Health behaviors ・ Symptom management ・ Communication Provider | ・ Improvement in all measurements noted, but only self-efficacy (P = 0.01) cognitive symptom management (P = 0.10 were significant immediately after intervention | Interpretation: All findings consistent with previous studies of similar populations except for exercise being slightly increased which is not normally seen. Possibly due to location or timing of study. Limitations: heterogeneous patient mix, lack of comparison group with usual care, short-term follow-up, pre-post design, and convenience sampling. Generalizability: Small sample size unable to generalize to population, volunteers could limit generalizability | 2b |
| Lori, K.R. et al. (2001) | To assess the 1 year and 2-year effect of the CDSMP on health status, self?efficacy and healthcare utilization | Self-Efficacy Theory | Community U.S. | ・ Longitudinal follow-up to RCT-2 year ・ Lay leaders, observational education | ・ Randomized sample with wait list rotation into program. ・ N = 683 ・ Mean age: 65.3 ・ 64% female ・ 90% Caucasian ・ Education: 15 years ・ Heterogeneous Disease Sample | ・ Demographics ・ Health Status ・ Healthcare Utilization ・ Perceived Self-Efficacy ・ Discussion of validation of newly validated tools provided. | ・ At 1 and 2 year, decreased healthcare utilization (0.006), health distress (0.0001) and increased self-efficacy (0.0001) ・ All other measures were not significant | Interpretation: Findings support the use of the 7 week program to decrease hospital visits and health distress. Participants with 2 chronic diseases did not show deterioration during the study period. Limitations: to interpreting findings: Dropout rate, lack of control group due to wait list method design so true comparison not a possibility Generalizability: Based on these results and previous studies recommend tertiary implementation of CDSMP/volunteers could limit generalizability | 1b |
| Lorig et al. (1999) | Explore the effectiveness of a chronic disease self-management program with a heterogeneous group of chronic disease patients | Self-Efficacy Theory | Community based sites U.S. | ・ 6 month RCT, wait-list control subjects, ・ Intervention including role-modeling, feedback, and goal setting, 7 weekly sessions, lay leaders, small classes | ・ Randomized sample ・ N = 952 ・ Mean Age Control: 65 ・ Mean Age Intervention: 65.6 ・ 64% and 65% female respectively ・ 91% Caucasian ・ Average 2.2 chronic disease ・ Heterogeneous Disease Sample | ・ Demographics ・ Health Status: Self-rated-Health Scale and modified-Health Assessment Questionnaire Disability Scale; Medical Outcomes Survey (MOS) Pain Scale, MOS distress scale, MOS fatigue and energy scale, ・ Health Behaviors: scales developed for this study ・ Healthcare utilization: scales developed for this study ・ Validity and Reliability discussed | ・ At 6 months, intervention group had significant (p < 0.05) increased exercise (P = 0.01), improvement in cognitive symptoms management (P = 0.01), communication with providers (P = 0.01), self-rated health, fatigue, disability, and social limitations. (P = 0.02) ・ Decrease in provider visits and days in hospital. ・ Other indicators were not significant | Interpretation: Based on the findings, suggests that the individual can be successfully used with a heterogeneous groups of diseases and not disease specific. Limitations: Not all patients had same symptoms and need same changes in behavior. Difficult to evaluate homogeneously due to comorbidities Need replication to determine effectiveness of proposed program. Generalizability: generalizability limited due to participants volunteering for study affecting motivation | 1b |