The Health Seeking Behaviors and Perceptions of Iranian Patient with Osteoarthritis about Pain Management: A Qualitative Study

Features and management of osteoarthritis from the perspective of individuals with osteoarthritis: A systematic review of qualitative studies

Objective

To enable person-centered care, considering beliefs, needs, and priorities of individuals with osteoarthritis (OA) is crucial. Nevertheless, concepts that they consider important are not fully recapitulated in assessment and care. The aim of this study was to clarify how individuals with OA conceive, experience, and manage their OA and pain.

Design

A systematic literature review was conducted including qualitative studies (interviews, focus groups, open questionnaires) regardless of OA joint location. Verbatim quotations relating to OA and OA-related pain were collected and merged in codes. Themes and categories relating to these codes were defined.

Results

The seven databases yielded a total of 9585 studies of which 79 qualitative studies were selected. Analysis of 667 verbatim quotations of 2009 participants led to 117 codes and 24 themes. Themes were grouped into 2 categories, 'features' and 'management'. 'Features' encompassed experiences ranging from common challenges (e.g., adjust to reduced function) to high impact outcomes needing therapeutic attention (e.g., devastating pain). The 'management' category captured positive and negative conceptions associated with pharmacological and cognitive-behavioral self-management, psychoeducation, and interventions. Themes from both categories were classified into four domains: symptoms, functioning, psychological, and social. A fifth domain 'disease' was also used to categorize the themes under 'features'.

Conclusions

Several themes reported by OA individuals are hardly represented in current assessment and recommendations, e.g., fatigue, sleep disturbance, psychosocial impact, and effects on family and caregivers. The reviewed beliefs, needs, and priorities may support individualized screening, complement existing assessment instruments, and can help refine interventions and psychoeducational materials.

Cross-cultural adaptation and validation of the Indonesian version of the Critical-care Pain Observation Tool

Objective

The Critical-care Pain Observation Tool (CPOT) is one of the most accurate methods for assessing pain in ICU patients with critical illness and/or a decreased level of consciousness (LOC). This study aimed to determine the validity and reliability of the Indonesian version of the CPOT.

Methods

The English version of CPOT was translated into the Indonesian version following five steps: initial translation, synthesis of instrument translation results, back translation, validation of the instrument by an expert committee, and testing of the Indonesian instrument. Between September and December 2022, a total of 52 ICU patients from four hospitals in Indonesia were evaluated for pain at rest, during body-turning procedure, and 15 minutes after the procedure using the CPOT. The researcher used the verbal Faces Pain Thermometer (FPT) instrument as a gold standard to assess the CPOT's criteria validity. Validity assessments included content and criterion validity. Reliability was evaluated using Cronbach's α coefficient and interrater reliability.

Results

Higher CPOT scores were found during the body-turning procedure than at rest and after the procedure. The instrument's item-content validity index (I-CVI) ranged from 0.75 to 1.00, and the overall instrument's average scale-level content validity index (S-CVI/Ave) was 0.93. The statistical analysis revealed a positive correlation (r) between the CPOT and the patient's FPT scores (0.877-0.983, P < 0.01). The significant agreement amongst raters (κ) revealed the inter-rater reliability of the CPOT (0.739-0.834, P < 0.01).

Conclusion

The Indonesian version of the CPOT has been proven valid and reliable in assessing pain in patients with critical illness and/or decreased LOC.

Approaches to osteoarthritis - A qualitative study among patients in a rural setting in Central Western India

BACKGROUND

Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world.

OBJECTIVE

The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India.

DESIGN AND METHOD

Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India.

RESULTS

Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients' approaches to OA. The categories were further elaborated on in seven subcategories.

CONCLUSION

Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists' implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients.

The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study

Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults’ understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults’ knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants’ knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.