Manage Your Illness

Self-management among older and younger workers

Thu, 02 Jul 2009 18:44:47 +0000

Munir and colleagues examined the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness. Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: (a) using prescribed medication, (b) monitoring and responding to symptoms, (c) managing an appropriate diet, and (d) exercising. The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain, or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism, or diabetes.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that the findings indicate that there are differences in diet and exercise activities among younger and older workers. To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes, and arthritis and rheumatism.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: We’ve repeatedly noted the importance of tailoring self-management programs for individual patients. Fortunately, more and more educators and health care professionals are providing such programs. If you have a chronic condition, you are more apt to follow a program if it fits your individual needs. Ask your health care provider to tailor a self-management program especially for you.

F Munir et al. Self-management of health-behaviors among older and younger workers with chronic illness. Patient Education & Counseling, April 6, 2009.

Impact of a self-management program among patients with congestive heart failure

Wed, 01 Jul 2009 16:38:35 +0000

The 'Chronic Disease Self-Management Program (CDSMP) emphasizes patients' responsibility for the day-to-day management of their condition(s), and has shown favorable effects on health behavior and healthcare utilization among various groups of patients with chronic conditions. However, the effects of the CDSMP among congestive heart failure (CHF) patients are unknown. Smeulders and coworkers aimed to assess the effects of the CDSMP on health behavior and healthcare utilization in patients with CHF. The randomized, controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity. Control patients (n = 131) received usual care, consisting of regular checkups at an outpatient clinic. Intervention group patients (n = 186) received usual care and participated in a 6-week self-management group program. Favorable effects on walking for exercise and other physical activities such as aerobic, stretching, and strength exercises, sports, and gardening were reported in the intervention group immediately after completion of the program. The effect of the program on other physical activities extended to 6 months of follow-up. No favorable effects were found for the other outcomes.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The CDSMP significantly improved physical activity among CHF patients for up to 6 months after the end of the program; however, it did not affect other health behavior outcomes or healthcare utilization.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The performance of self-management skills can help you make a significant contribution to the management of any chronic condition, including heart failure. A longer follow-up would have been appropriate for this study, but it is suspected that the patients who were doing a number of physical activities at the end of 6 months would still be performing the actions.

ES Smeulders et al. The impact of a self-management group programme on health behaviour and healthcare utilization among congestive heart failure patients. European Journal of Heart Failure, April 9, 2009.

Internal locus of control and asthma management

Tue, 30 Jun 2009 17:33:50 +0000

Patients' perception of their ability to influence their asthma symptoms has not been sufficiently addressed. Laforest and colleagues studied the relationship between patients' perceived ability to self-care, as approached by internal locus of control (LOC) orientation, and concomitant level of asthma control. A cross-sectional study was conducted from May 19, 2004, through July 7, 2005. Asthma patients receiving inhaled corticosteroids and supervised in primary care were identified. Asthma control was measured with the Asthma Control Test. Patients reported their LOC orientation on a 100-mm visual analog scale (0%, "I have absolutely no influence on asthma change," to 100%, "this change only depends on me"). Asthma therapy was obtained from a prescription database. The risk of an internal LOC of less than 50% was studied. Among the 163 patients with documented LOC (mean age, 52 years; 58% female), 72 (44.2%) had an internal LOC of less than 50%. Asthma control was inadequate for 65 of the 157 patients with available data on the global score of the Asthma Control Test (41.4%). Patients with inadequately controlled asthma had a higher risk of a LOC of less than 50% (odds ratio, 2.68; 95% confidence interval, 1.23-5.81). A three-fold increased risk also appeared for patients older than 65 years compared with those younger than 45 years. Conversely, no association was identified with sex, asthma severity markers, or therapy.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that asthma control was related to internal LOC orientation (i.e., perceived ability to self-care). Improved self-care efficiency should be a target for adequate disease management.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Once again, the study showed that you must have some confidence that you take whatever steps are required to control your asthma. In this study, the investigators looked at the construct of internal locus of control, but they could have just as well focused on self-efficacy.

L Laforest et al. Asthma patients' perception of their ability to influence disease control and management. Annals of Allergy, Asthma, & Immunology, 2009;102:378-384.

The Tour de France Migraine Tour

Mon, 29 Jun 2009 16:37:27 +0000

Migraine is a common and frequently disabling condition. Nevertheless, many migraine sufferers do not consult for migraine, are not medically followed up and self-treat the attacks. In their study, Donnet and colleagues described the "Tour de France of migraine." This consisted of free-access conferences held in six large towns in France following a wide public information campaign. The sensitization campaign was aimed at providing participants with educational information on migraine disease and current therapies. Headache sufferers were then invited to respond to two consecutive questionnaires delivered at the end of the conferences and three months later to assess the influence of the information delivered on their migraine management. Tour de France of migraine recruited mainly severe migraine sufferers, most of who had already consulted and were medically followed up. However, migraine management was often suboptimal in these subjects since most of them found their acute treatment of attacks ineffective and only few of them received a prophylactic treatment. Three months after the conferences, more than half of respondents had consulted for headaches. There was a significant improvement in migraine-related disability, as reflected by a significant decrease in mean Headache Impact Test 6-item score, which might have been related to the higher proportion of subjects receiving a prophylactic treatment of migraine. The Tour de France of migraine campaign revealed the difficulty in sensitizing migraine sufferers towards the necessity of being medically followed up.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that mainly patients with severe migraine attended the conferences and derived clinical benefit from the educational program. Other strategies should be developed to reach a wider population of migraine sufferers.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: This appeared to be a well-thought out approach to reach patients with migraine headache. Although the program seemingly benefited only those with more severe migraine headaches, it had the potential to reach a broader range of patients with the condition. It is hoped that the “Tour de France of Migraine” is used on an annual basis.

A Donnet et al. Impact of a public sensitization campaign on migraine management in France. Journal of Headache Pain, May 30, 2009.

A pilot study of a fatigue self-management program

Thu, 25 Jun 2009 16:56:58 +0000

Although an effective face-to-face fatigue program is available, people with transportation, time, or geographic restrictions cannot access this intervention. The aim a study by Ghahari and colleagues was to develop and evaluate effectiveness of an online fatigue self-management program (online FSMP). Key features of the face-to-face program were captured and transferred to an online FSMP prototype. Subsequently, three pilot tests were conducted for formative evaluation of the program and necessary changes were made to improve the program. During the third pilot test, the effectiveness of the online FSMP was also tested using a pre-test post-test design on a sample of individuals with multiple sclerosis, Parkinson's disease, or post-polio syndrome. The study resulted in a standardized 7-week online FSMP mimicking its face-to-face version. Participants were offered fatigue self-management skills through structured activities, sharing information and experiences, expressing their ideas or feelings, and offering advice and support to one another. The participants in the third pilot study significantly improved on the Fatigue Impact Scale (p <0.05); a trend toward significance was shown on the Personal Wellbeing index (p = 0.08).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER. The authors concluded that the online FSMP could be a viable treatment for people with neurological conditions and warrants further study.

WHAT THE STUDY MAY MEAN TO YOU AS APATIENT: This was but a pilot study so we really don’t have too much to go on with respect to your condition. The program warrants a large-scale testing before we know what actions could be predicted. Nevertheless, it is significant that the online program may be teaching you to be less fatigued.

S Ghahari et al. Development, standardisation and pilot testing of an online fatigue self-management program. Disability Rehabilation, May 19, 2009.