SEEK: Salford Environment for Expertise and Knowledge

April 2013

The Lifestyle Management for Arthritis Programme in Practice: results of an observational study

Hammond, A & Rayner, J 2013, 'The Lifestyle Management for Arthritis Programme in Practice: results of an observational study', Rheumatology, 52(Suppl 1), p.i109.


Background: The LMAP is a practical, group self-management programme led by occupational therapists (OT) and physiotherapists (PT), including two modules (weekly meetings: 4 x 2.5h) and a review session. It includes: module A: arthritis information, joint protection and, fatigue management; module B: exercise (flexibility, strength, walking programme, Tai Chi for Arthritis), foot care, pain and stress management. Each module is led by one LMAP trained therapist. At 12m follow-up of an earlier randomized parallel group trial, significant improvements in pain, self-efficacy and self-management behaviours resulted. We next investigated its effectiveness in clinical practice.

Methods: A team of 5 OTs and 2 PTs completed 4 days LMAP training, with protocolized leader manuals and patient workbooks for each module. This included theory, the evidence for LMAP components, skills practice and role play. The OTs led both modules A and B; the PTs led module B. 
An observational pre-post study was conducted with postal questionnaires at 0, 6 and 12m. Patients with rheumatoid arthritis (RA), early inflammatory arthritis (EIA) or psoriatic arthritis (PA) attending Rheumatology out-patients at one district general hospital were invited to the LMAP and provided with study information. 

Results: Over 2.5 years, 393 people were referred: 224 wished to attend (57%); but 144 did so (37%). 100 women and 34 men consented: average age was 55.66y (SD 12.62); disease duration 3.81 y (SD 5.57); and 65 (49%) were employed. Significant improvements occurred in hand pain and self-efficacy (see Table 1). Significant improvements also occurred at 6 and 12m in self-reported use of joint protection, fatigue management, exercise and cognitive symptom management (p = 0.002 to 0.005). No significant differences in pain or fatigue resulted. 

Conclusions : The LMAP in clinical practice resulted in similar outcomes to those in a previous trial. The team of therapists successfully delivered it following 4 days training, suggesting it can be readily implemented elsewhere.
Table 1
12m p
Hand pain VAS
48.34 (24.38)
41.87 (25.78)
41.44 (28.72)
Perceived health VAS
58.73 (23.40)
64.50 (18.97)
66.13 (22.59)
RA Self-efficacy
106.34 (11.77)
108.99 (11.19)
108.14 (14.73)
Self-efficacy: pain
5.64 (1.95)
6.25 (1.60)
6.30 (1.94)
Self-efficacy: other
5.82 (1.91)
6.54 (1.76)
6.58 (1.91)
Perceived control
20.79 (3.93)
21.77 (4.26)
21.93 (4.86)


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External Authors

J Rayner

Publication Details

Rheumatology, 52(Suppl 1), p.i109.