Summary: In a randomised trial in patients with obesity and osteoarthritis awaiting joint replacement, adding a structured self-management programme to usual care improved osteoarthritis-specific social quality-of-life domains, but did not change general health-related quality of life.
PICO Summary
| Element | Detail |
|---|---|
| Population | 95 patients with obesity and osteoarthritis awaiting hip or knee arthroplasty; Australia. |
| Intervention | Flinders Program of self-management support plus usual care (n=48). |
| Comparison | Usual care alone (n=47); intention-to-treat at 10 months. |
| Outcome | No effect on SF-36. On the osteoarthritis-specific measure, the intervention improved social support (d=0.43; 95% CI 0.01–0.83; p=0.03) and social activity (d=0.47; 95% CI 0.05–0.89; p=0.005) versus usual care. No adverse effects. |
Self-management before arthroplasty
RCT · obesity + osteoarthritis · 10 months
Adding self-management support improved osteoarthritis-specific social quality of life, but not generic SF-36 scores. Effects are small-to-moderate and preliminary.
Expert Commentary
The premise is sound: the wait for joint replacement is a period of decline that is largely wasted, and structured self-management is a reasonable way to use it, so a trial testing this is welcome. The result, though, is modest and specific, and the authors are appropriately restrained in calling it preliminary. The generic quality-of-life measure, SF-36, showed nothing; the benefits appeared only on the osteoarthritis-specific scale and only in the social domains, support and activity, not in pain or physical function. Those are real, small-to-moderate effects worth having, but they are narrower than a patient hoping for less pain while they wait might want. With 95 patients, a single centre, an unblinded design, and no postoperative or long-term outcomes, this is a signal to test further, not an established intervention. Can I use this with my patients? Cautiously and with honest expectations. For someone with obesity awaiting arthroplasty, offering self-management support is reasonable and low-risk, and may help social engagement and coping during the wait, but I would not promise improvements in pain or overall health, and a larger trial is needed to confirm even these social benefits.
References
Sahafi L, Smith D, Jaarsma R, Battersby M. Preliminary efficacy of a self-management programme to improve quality-of-life in patients with obesity and osteoarthritis awaiting arthroplasty: a randomised trial. Int J Nurs Pract. 2025;31(4):e70044. doi:10.1111/ijn.70044