Reports on self-management often focus on use of the skills with three diseases: arthritis, asthma, and diabetes. This is not only because of the prevalence of the conditions, but because they are likely the disorders where patients can make the biggest impact on the control of their illness. By only looking at these three chronic illnesses, however, we often overlook other uses of self-management. An article by Morris in the U.K. examined how patients can use self-management skills to help control their back pain. He combined interviews, observations, and other methods to determine the views of patients on self-management following a program designed to change behavior, increase activity levels, and the encouragement of these skills. There was a small sample of patients, only six participants, but all said they were using self-management by continuing to exercise and using the advice they received in the program. Two patients felt they should continue attending the therapy department to exercise in order to gain benefit; these views suggested a reliance on continued health care support and, in turn, less reliance upon their own self-management skills. Participants listed barriers to continuing to exercise as pain, time, and family constraints.

Comments: The study showed the importance of patient beliefs and outlooks prior to and after a self-management program for back pain. As only a small number participated in the study, there is need to expand self-management to more patients with back problems. Of additional interest would be a greater focus on what parts of the program were particularly valuable in both teaching self-management skills and in maintaining performance once participation in the program ended. It would also be important to be sure that patients were actually gaining self-management skills and not relying on support from the staff of the program. Still, however, the approach showed a promising beginning.

Do you have any comments or suggestions?

A.L. Morris. Patients' perspectives on self-management following a back rehabilitation program. Musculoskeletal Care, 2004;2:165-179.