OBJECTIVE: The objective of this study was to test the effectiveness of a mail-delivered, tailored self-management intervention (SMART) and to compare it with the classic Arthritis Self-Management Program (ASMP). METHODS: We performed 2 randomized controlled trials: (1) a study of 1,090 participants randomized to SMART or USUAL CARE, and (2) a study of 341 participants randomized to SMART or ASMP. Dependent variables included disability, pain, depression, role function, global severity, doctor visits, and self-efficacy. SMART interventions were provided in months 0 to 18 and not reinforced. Results were assessed at 1, 2, and 3 years using analyses of covariance (ANCOVA). RESULTS: Compared with USUAL CARE, SMART participants at 1 year had decreased disability, improved role function, and increased self-efficacy (all p < 0.01). At 2 years, decreases in global severity, doctor visits, and increases in self-efficacy (all p < 0.01) were noted. At 3 years without reinforcement, no statistically significant effects remained. Compared with ASMP, SMART at 1 year had greater decreases in disability (p = 0.02) and increases in self-efficacy (p = 0.01). There were no differences at 2 years. At 3 years, role function (p = 0.04) and doctor visit (p = 0.03) were improved in ASMP as compared with SMART. Improvements from baseline were seen for nearly all variables in both groups. CONCLUSIONS: A mail-delivered arthritis self-management program, SMART, was similarly effective to the classic ASMP, with slightly better results in the first year and a slightly more rapid attenuation over the next 2 years. Results suggest that both programs are effective, and that the addition of a mail-delivered program could improve accessibility to arthritis self-management treatment.

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