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Rheumatology (Oxford). 2013 Mar;52(3):472-9. doi: 10.1093/rheumatology/kes295. Epub 2012 Nov 12.

Factors limiting participation in arthritis self-management programmes: an exploration of barriers and patient preferences within a randomized controlled trial.

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Melbourne EpiCentre, Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia.



To improve understanding of barriers to participation in community-based arthritis self-management programmes and patient preferences for self-management education.


Individuals with hip or knee OA referred to orthopaedic surgeons or rheumatologists at six public and private hospitals in Victoria, Australia, were recruited for a randomized controlled trial (RCT) of the Stanford Arthritis Self-Management Programme (ASMP). As part of the study design, potential participants were asked during the screening and recruitment process about reasons for being unable to attend the course, reasons for not participating in the study and individual preferences for course scheduling.


Of 1125 individuals assessed, 216 (19%) were unable to attend six ASMP sessions. This was commonly due to physical limitations, including illness, restricted mobility and pain (22%), difficulty getting to or from courses (22%), work commitments (22%), the time commitment required (17%) and family roles (12%). Among those who did not want to participate in the study (n = 258), the overwhelming reason was disinterest (74%). Specific preferences for course scheduling were frequent, confirming the practical challenges faced in organizing courses for the RCT.


Incorporating patients from public and private settings, this study has elicited new insights into barriers to ASMP participation. Many people with hip or knee OA have limited capacity and motivation to attend community-based group programmes. Future self-management programmes and research should include more accessible options for those who cannot attend group-based programmes. Trial registration. Australian New Zealand Clinical Trials Registry,, ACTRN12606000174583.

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