The effects of self-management intervention among middle-age adults with knee osteoarthritis

Self-care behaviors in older adults suffering from knee osteoarthritis: Application of theory of planned behavior

Background

Osteoarthritis is one of the main reasons causing disablement. Educational intervention for self-care behaviors of patients suffering from knee osteoarthritis is important because its effect on quality of patient life decreases the economic burden of disorder on society and family. This study aimed to investigate the effect of educational intervention based on the theory of planned behavior (TPB) on promoting self-care behaviors in elderly patients suffering from knee osteoarthritis.

Methods

This quasi-experimental study was performed on 200 elderlies suffering from knee osteoarthritis in the rheumatology clinics of Shiraz, Iran, in 2019. The subjects were divided into two groups (100 experimental and 100 control). Before and after 4 months, both experimental and control groups filled a questionnaire. After administering a pre-test to both groups, only the experimental group was trained based on the TPB constructs on self-care behaviors in elderly people suffering from knee osteoarthritis in eight sessions by presenting educational films and images, power points, and group discussions for solving problems.

Results

The mean age of the experimental group was 67.25 ± 3.64, and the mean age of the control group was 66.12 ± 3.50. The average scores of attitudes, subjective norms, perceived behavioral control, intention, and behavior before the educational intervention did not have significant differences in experimental and control groups, however, 4 months after the educational intervention, the paired t-test indicated significant enhancement in every construct in the experimental group, but no significant changes in the control group.

Conclusion

According to the results, the educational intervention increased the self-care behaviors of patients suffering from knee osteoarthritis based on the theory of planned behavior. Therefore, the results of this study can be used in theory-based intervention strategies for self-care behaviors of patients suffering from knee osteoarthritis.

Clinical Effectiveness of a Self-Regulation Theory-Based Self-Management Intervention for Adults With Knee Osteoarthritis: A Long-Term Follow-Up

PURPOSE

To determine if there are long-term effects of a self-management intervention guided by self-regulation theory for adults with knee osteoarthritis at 6 and 12 months after completing the intervention.

DESIGN

This long-term follow-up study used a longitudinal quasi-experimental design with repeated measures.

METHODS

A convenience sample of 127 patients with knee osteoarthritis who were 45 to 64 years of age were recruited from outpatient clinics in Taiwan. The Self-Management Needs of Knee Osteoarthritis Scale was used to assess self-management needs at enrollment (baseline). To evaluate the long-term effects, participants were reassessed at 6 and 12 months after the intervention using the following questionnaires: The Knee Injury and Osteoarthritis Outcome Score, Healthcare Outcomes, and the Short-Form Health Survey. Generalized estimating equations compared assessments at baseline with scores at 6 and 12 months following completion of the intervention. Multiple regression was used to examine significant factors associated with the assessments.

FINDINGS

Participants had moderate levels of self-management needs. When assessments at 6 months were compared with baseline, scores for knee symptoms and physical function and quality of life showed significant improvements; significant reductions were seen in body mass index, unplanned medical consultations, and pain medication doses. Assessments at 12 months compared with baseline measures indicated these improvements were maintained. These improvements were significant from baseline measures at both 6 months and 12 months after adjustments were made for time and other significant variables.

CONCLUSIONS

Twelve months after completion of the intervention, the significant improvements seen at 6 months were maintained. Our findings demonstrate that the self-management intervention had significant long-term effects on knee symptoms and physical function, body mass index and pain medication doses, and overall quality of life for patients with moderate self-management needs of knee osteoarthritis.

CLINICAL RELEVANCE

Clinical care of knee osteoarthritis that includes a self-regulation theory-based self-management intervention could provide long-term benefits to patients.

A self-management support intervention on knee functional status and health-related quality of life among middle-age women: A randomized controlled trial

AIM

To determine the effectiveness of a self-management support intervention on knee functional status and health-related quality of life among middle-age women with knee osteoarthritis.

DESIGN

Randomized controlled trial.

METHODS

The participants were 40 middle-aged women who had been clinically diagnosed with knee osteoarthritis for more than 3 months and randomly assigned into intervention and control groups equally. After IRB approval code 02-05-2562 was obtained, data collection was carried out from July - November 2019 at the Outpatient Department of Orthorpedics, Thasala Hospital, Thailand. The modified Thai version of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Short Form Survey (SF-36) were used to measure knee functional status and health-related quality of life at baseline (T1), immediately after completing the intervention (T2) and 4 weeks after the intervention (T3). The participants in the intervention group received a self-management support program developed by the researcher based on the Individual and Family Self-Management Theory and a review of related literature plus routine care. The implementation consisted of eight sessions over 4 weeks. The control group received only routine care from the hospital. Two-way repeated measure ANOVAs were used to analyze the data.

RESULTS

The findings revealed that the participants in the intervention group had better knee functional status and HRQOL than those in the control group at follow-up. Additionally, in the intervention group, both knee functional status and HRQOL significantly improved from pre- to post-intervention and follow-up.

CONCLUSIONS

The findings indicate that this self-management support intervention is effective.

IMPACT

For women, the prevalence rate of knee OA rises dramatically post-menopause due to lower oestrogen levels. Policy makers and healthcare providers could obtain and promote this intervention as part of standard practice. This should lead to improved knee functional status and HRQOL among middle-aged women. Thai Trial Registration number: TCTR20191223003. on February 5th, 2019.

Effect of self-management program on outcome of adult knee osteoarthritis

BACKGROUND & AIM

Chronic disease is a major concern with an aging population, and arthritis is one of the most prevalent chronic diseases affecting 10% of the population. Self-management can be appropriate to relieve the outcome of osteoarthritis as one of the most suitable approaches in people with chronic diseases. This study aimed to determine the effect of self-management education programs on the outcome of knee osteoarthritis in adult patients.

METHODS

Eighty participants were randomized into either control (40) or intervention (40) groups. Initially, demographic data and outcome of knee osteoarthriti datas were collected. The intervention group was then offered a self-management program. After completing the education, the KOOS questionnaire was completed by both groups. The intervention group practiced the self-management program for 8 weeks at their homes. The outcome of knee osteoarthritis in the two groups was then reassessed and compared.

RESULTS

There was no significant difference in the total score of the outcome of knee osteoarthritis before the training of the self-management education program (P > 0.05) between the two groups. After implementation of the self-management education program, the two groups demonstrated significant differences in scores for pain, symptoms, activities of daily living, sport and recreation function, and quality of life (P < 0.001).

CONCLUSION

Self-management education can improve all outcomes of knee osteoarthritis. Adherence to the proper diet and the use of pain reduction methods along with exercise improve the effects of knee osteoarthritis.

Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis

Background

Osteoarthritis (OA) is a progressive disease of the joints, leading to decreased function and disability.

Objectives

The study aimed to investigate the effect of self-management (SM) program on disability index and pain in aging men with knee OA.

Methods

The study included an SM group and a control group. Given the sample size of the previous studies, 83 patients were recruited. The study tools included a demographic profile questionnaire, visual analogue scale (VAS), and HAQ 8-item DI. The intervention included 10 SM sessions for patients in the SM group (8 sessions of in-person intervention and 2 sessions of telephone intervention). Patients were placed in groups of 7, and the sessions were held weekly each for a period of 45 to 60 minutes. Data were analyzed using descriptive and analytical tests by SPSS V. 16 software.

Results

The two groups(SM and control group) were homogeneous in terms of demographic characteristics (P > 0.05). The mean (SD) disability score was 19.12 (1.92) in the SM group before the intervention, which reduced to 14.70 (1.63) after the intervention (P = 0.000, T = 10.02). The mean (SD) pain score, was 9.19 (0.71) in the SM group before the intervention, which reduced to 6.48 (0.84) after the intervention (P = 0.000, T = 18.15).

Conclusions

Training can help patients perform SM measures and improve their health status by enhancing the information needed for the disease.

Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial

Background

Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA.

Purpose

This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population.

Materials and methods

A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs).

Results

Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found.

Conclusion

Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.

Effect of physical activity and dietary restriction interventions on weight loss and the musculoskeletal function of overweight and obese older adults with knee osteoarthritis: a systematic review and mixed method data synthesis

BACKGROUND

Despite the clinical recommendation of exercise and diet for people with knee osteoarthritis (OA), there are no systematic reviews synthesising the effectiveness of combining physical activity and dietary restriction interventions on the musculoskeletal function of overweight and obese older adults with knee OA.

OBJECTIVE

To evaluate the effectiveness of combined physical activity and dietary restriction programmes on body weight, body mass index (BMI) and the musculoskeletal function of overweight and obese older adults with knee OA.

INFORMATION SOURCES

A detailed search strategy was applied to key electronic databases (Ovid, Embase, Web of Science andCumulative Index to Nursing and Allied Health Literature (CINAHL)) for randomised controlled trials (RCTs) published in English prior to 15 January 2017.

PARTICIPANTS

Participants with BMI ≥25 kg/m², aged ≥55 years of age and with radiographic evidence of knee OA.

INTERVENTIONS

Physical activity plus dietary restriction programmes with usual care or exercise as the comparators.

OUTCOME MEASURES

Primary outcome measures were body weight, BMI or musculoskeletal function. Secondary outcome measures were pain and quality of life.

RESULTS

One pilot and two definitive trials with n=794 participants were included. Two articles reporting additional data and outcome measures for one of the RCTs were identified. All included RCTs had an unclear risk of bias. Meta-analysis was only possible to evaluate mobility (6 min walk test) at 6 months and the pooled random effect 15.05 (95% CI -11.77 to 41.87) across two trials with n=155 participants did not support the combined intervention programme. Narrative synthesis showed clear differences in favour of a reduced body weight and an increased 6 min walk in the intervention group compared with control groups.

CONCLUSION

The quality of evidence of benefit of combining exercise and dietary interventions in older overweight/obese adults with knee OA is unclear.

TRAIL REGISTRATION NUMBER

CRD42015019088 and ISRCTN, ISRCTN12906938.