University of Salford Manchester

Self-management for people with arthritis

With one in five of the adult population in the UK living with arthritis, self-management education is a key approach used by occupational therapists (OTs) to support people. Research undertaken by Professor Alison Hammond in the School of Health Sciences has improved the tools available to OTs to deliver more effective self-management education, improving patients’ quality of life through supporting them in:

  • Managing their pain and fatigue;
  • Improving their psychological resilience; 
  • Remaining in work and engaged in leisure activities;
  • Supporting occupational therapists to deliver effective self-management services;
  • Developing evidence informed policy and strategy focused on improving the availability of self management services for people with arthritis.

Supporting people with arthritis in managing their pain and fatigue

Rheumatoid arthritis (RA) affects 0.5-1.0% of the population and causes significant pain, debilitating fatigue, joint deformity, and psychological distress. It affects people’s abilities to perform everyday activities and causes work disability, which can reduce financial status. “Approximately one third of people stop work because of the disease within 2 years of onset, and this prevalence increases thereafter. The total costs of RA in the UK, including indirect costs and work-related disability, have been estimated at between £3.8 and £4.75 billion per year.” NICE Clinical Guidance 79

  • Supporting people with arthritis in managing their pain and fatigue, and supporting Occupational Therapists (OTs) to develop effective self-management and joint protection methods for people with arthritis when taught using educational-behavioural approaches, significantly reduces pain, improves functional ability, and in the long–term, limits hand deformity development.
  • Self-management education is a key approach used in Rheumatology by OTs and other team members to help people with arthritis practically manage symptoms, improve psychological outlook and maintain ability to perform everyday home, work and leisure activities. The OT and self-management education research led by Hammond, has addressed three key areas helping: 
  • People with arthritis manage their symptoms and everyday activities more effectively;
  • Developing patient reported outcome  measures, from the patients’ perspective, to enable patients and therapists identify problems and find solutions together, and; 
  • OTs to deliver more effective OT and self-management education to people with RA.

Alison was a member of the NICE Guideline Development Group: The management of rheumatoid arthritis in adults, offering best practice evidence on the care of adults with RA, which included the recommendation that people with RA should have access to specialist Rheumatology OT for assessment, provision of comprehensive OT and periodic review if they have problems with either everyday activities and/or hand function; including joint protection and hand exercises taught using educational-behavioural approaches, not just simple advice. Rheumatology OT departments now set standards of service delivery based on these guidelines.

  • Alison has trained over 200 OTs in delivery of LMAP modules in practice. The programmes are provided in Rheumatology OT departments across England, Scotland, the Republic of Ireland, the Netheralnds and Turkey. OTs are provided with a detailed leader manual and audio-visual resources to facilitate delivery; and patient workbooks support learning. Course evaluations have consistently shown that the training programme increased confidence in teaching using cognitive-behavioural approaches. OTs also incorporate the training approaches when teaching self-management to individual patients.
  • Alison was the lead author for the Arthritis Research UK advice booklet “Looking after your joints when you have arthritis” (2011) for people with inflammatory and osteoarthritis, provided free to arthritis patients in the majority of Rheumatology and Rheumatology OT departments in the UK. It is used as a key element of teaching joint protection by OTs and one of the core information booklets provided to people newly diagnosed with inflammatory arthritis in Rheumatology departments and freely available as a download from the Arthritis Research UK website.

Key reports

a) National Institute of Clinical Excellence (2009) Guidelines for the management of adults with RA

b) Link to the Looking after your joints when you have arthritis advice booklet