- : Ms Word, Ms Word Format
- : 100 Pages
- : ₦5000
- : 1-5 Chapters
- Click to DOWNLOAD Materials
THE EFFECT OF STRUCTURED PSYCHO-EDUCATION ON THE QUALITY OF LIFE OF PATIENTS WITH KNEE OSTEOARTHRITIS IN GENERAL AND ORTHOPAEDIC OUTPATIENT DEPARTMENT, JOS UNIVERSITY TEACHING HOSPITAL, JOS
SUMMARY
Objective: To determine the effect of structured psycho-education on the quality of life of patients with knee osteoarthritis.
Study Design/Setting: A randomised controlled trial involving 120 patients with knee osteoarthritis aged 18 years and above presenting in General Outpatient Department and orthopaedic clinics of the Jos University Teaching Hospital.
Methods: Participants were randomly allocated to the control and the intervention groups. The intervention offered was psycho-education that was delivered in structured format to the subjects and their care givers. Data collected from the participants include socio-demographic data, medical history and family history. Knowledge about osteoarthritis (OA) was assessed using a structured questionnaire and Quality of Life (QoL) was assessed using the WHOQOL-BREF questionnaire. Focused physical examination was done with assessment of pain using the visual analog scale (VAS). Participants were followed up monthly over 12 weeks during which measurements were repeated.
Results: Majority (71.6%) of the study participants reported their overall QoL as poor or fair and all the domains of the QoL were low. QoL scores were relatively low for domain due to psychological health and environment with that of psychological health more severely affected. Mean score in the osteoarthritis knowledge assessment increased from 30.1±12.27% at baseline to 55.2±15.5% at the end of the study (t=8.33, p < 0.000). The QoL scores improved in the intervention group compared to the control group (p=0.0005). In the intervention group, the mean pain scores reduced from 6.8±1.3 to 2.2±0.9 (p= 0.000). This study however found only epilepsy among many factors as predictive of poor QoL.
Conclusion: Psycho-education administered along with routine medical care led to increased subject/caregiver’s knowledge about OA and a significant improvement in the QoL of patients with knee osteoarthritis.
TABLE OF CONTENTS
Title page
Declaration – – – – – – – i
Dedication – – – – – – – – – ii
Acknowledgement – – – – – – – – iii
Certification – – – – – – – – – iv
Table of contents – – – – – – – – v
List of figures – – – – – – – – – ix
List of tables – – – – – – – – – x
List of abbreviations – – – – – – – – xi
Summary – – – – – – – – – 1
CHAPTER ONE
1.1 Introduction – – – – – – – – 2
1.2 Statement of the problem – – – – – – 5
1.3 Aim and objectives of study – – – – – – 7
1.4 Justification/Relevance of study to family medicine – – – 7
CHAPTER TWO: Literature review
2.1 Overview of osteoarthritis – – – – – – 9
2.2 Risk factors – – – – – – – – 11
2.3 Pathogenesis – – – – – – – – 14
2.4 Clinical features – – – – – – – 18
2.5. Diagnosis of osteoarthritis – – – – – – 20
2.6 Complication of osteoarthritis – – – – – 22
2.7 Management of osteoarthritis 23
2.7.1 Pharmacological management 23
2.7.2 Non pharmacological management 29
2.7.3 Surgery – – – – – – – – 33
2.7.4 Complementary and alternative medicine – – – – 35
2.7.5 Assistive devices – – – – – – – 36
2.8 Prevention – – – – – – – – 37
2.9. Quality of life – – – – – – – – 38
2.9.1 Measurement of health related quality of life – – – 40
2.9.2 Abbreviated WHO quality of life questionnaire (WHOQOLBREF) – 42
2.9.2 Quality of life in adult with knee osteoarthritis – – – 42
2.9.3 Factors affecting quality of life of knee osteoarthritis – – 45
2.10 Psycho-education – – – – – – – 46
2.10.1 Psychosocial impact of osteoarthritis – – – – 53
2.10.2 Psycho-education in chronic disease – – – – 54
2.10.3 Psycho-education in osteoarthritis – – – – – 55
CHAPTER THREE: Methodology
3.1 Study area – – – – – – – – 58
3.2 Study population – – – – – – – 59
3.3 Study period – – – – – – – – 59
3.4 Eligibility – – – – – – – – 59
3.5 Sample size determination – – – – – – 60
3.6 Ethical consideration – – – – – – – 61
3.7 Instruments of data collection – – – – – 61
3.8 Study design – – – 61
3.9 Study protocol – – 61
3.10 Method of data analysis – 64
CHAPTER FOUR: Results
4.1 Participants flow through the study – – – – – 65
4.2 Baseline characteristics of the study groups – – – – 67
4.3 Medical characteristics of the study groups – – – – 69
4.4 Family characteristics – – – – – – 71
4.5 Knee assessment report of the study participants – – – 73
4.6 Physical examination of both groups – – – – – 74
4.7 Patient’s knowledge of osteoarthritis – – – – – 76
4.8 Report of mean pain scores – – – – – – 78
4.9 Comparison of quality of life scores of the participants – – 80
4.10 Factors affecting quality of life – – – – – 84
4.11 Hypothesis testing – – – – – – – 89
CHAPTER FIVE: Discussion
5.1 Socio-demographic characteristics – – – – – 90
5.2 Medical characteristics – – – – – – 92
5.3 Family characteristics – – – – – – 92
5.4 Body mass index – – – – – – – 93
5.5 Osteoarthritis knowledge scores – – – – – 94
5.6 Changes in knee pain scores – – – – – – 95 5.7 Quality of life scores – – – – – – – 95
5.8 Strengths of the study – – 99
5.9 Limitations of the study – 99
5.10 Implications of the study – 100
5.11 Suggestion for future studies – – – – – – 101
5.12 Conclusions – – – – – – – – – 101
5.13 Recommendations – – – – – – – 102
REFERENCES – – – – – – – – 104
CHAPTER ONE 1.1 INTRODUCTION
Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease is a group of mechanical abnormalities involving degradation of joints including articular cartilage and subchondral bone.1 Osteoarthritis is the most prevalent rheumatological disorder affecting the musculoskeletal system. It has a major impact on functioning and independence of the elderly. Osteoarthritis is a common presentation in general practice.1 Over 80% of people over the age of 65years have radiological evidence of the disease and approximately 10% of men and 18% of women have symptomatic OA.1 The prevalence of OA is in the region of 10-20% in the adult population.2 In all populations studied so far the prevalence of knee OA is higher than that of hip OA. The most common form of OA in the developing world is knee OA.3
Hospital based studies have shown that OA is common in Nigeria.4,5 A female preponderance has been reported and the knee has been found to be the most commonly affected joint among Nigerians accounting for 65-78% of cases.5 Community based studies in Nigeria reported a prevalence of knee osteoarthritis to be 19.6% in the southwest and 16.3% in the northeast.6, 7 About 8 million people in the United Kingdom8 and nearly 26.9 million U.S adults were suffering from OA in 2005.8 It accounts for 25% of visits to primary care physicians, and half of all NSAID prescriptions.9
Osteoarthritis affects the knee more than other joints.10 Several factors play a role in osteoarthritis risk; these include age, gender, genetics, behavioural influences and ethnicity.11 Trauma is a recognized predisposing factor to development of osteoarthritis of the knee associated with raised intra osseous pressure and death of the chondrocytes. Osteoarthritis of the knees reduces the ability to avoid obstacles and supporting epidemiologic studies have found osteoarthritis to be a risk factor for falls.11
As the population ages or the disease worsens, knee osteoarthritis is associated with incapacity and a deteriorating quality of life owing to increased pain, loss of mobility and the consequent loss of functional independence.12 Majority of patients with osteoarthritis are managed in primary care, and the prevalence of knee osteoarthritis is rising, such that simple interventions which are effective in a community setting are necessary.13
Osteoarthritis is characterised by joint pain and stiffness and reduces mobility with considerable impact on quality of life. It is associated with pain, functional disability and being homebound.14 Half of all disability among older persons has been attributed to OA.14 It is a crippling disease that imposes significant economic burden on the society due to its effect on function and activities of daily living.15 In 2005 an estimated 27 million US adults more than 10% of the US adult population had clinical OA affecting quality of life through pain and functional limitations, lost earnings, concomitant chronic conditions, and chronic disease risk factors. Such issues can have a substantial impact, including the almost 1 million years of life lost to disability in 1996 and the rising number of hospitalizations.14
The approach to the care of osteoarthritis patients has been the routine use of analgesic. This is being challenged by family physicians, who advocate for a holistic approach to care using the biopsychosocial model of care and caring for patients within the context of the family system.16-18
Management of chronic diseases like OA constitutes a huge cost burden to the health care system. This has paved way for new management approaches and methods that would focus on enhancement of health and quality of life (QoL).19 These approaches include the patient-centred care that emphasizes the importance of psychosocial factors in health with the aim of improving quality of life.20 Chronic diseases may not kill but they may consume a lot of health care resources and threatened the quality of life of the sufferers.
The WHO defines QoL as an individual’s perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns.21 It could also mean the “degree to which a person enjoys the important possibilities of her/his life”.22 Further still, QoL has been defined as a “descriptive term that refers to people’s emotional, social and physical well being and their ability to function in the ordinary tasks of living”.23
The term quality of life refers to the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. QoL should not be confused with the concept of standard of living, which is based primarily on income. Instead, standard indicators of the quality of life include not only wealth and employment, but also the built environment, physical and mental health, education, recreation and leisure time, and social belonging.24
For most chronic illnesses, therapeutic success is traditionally measured by disease-free period, overall survival, and control of major physical symptoms. While these factors play a primary role in such evaluations, efforts have been made to assess the extent to which chronic diseases and their treatments affect patient’s functional capacity, psychological and social health, and sense of well-being or QoL.25,26
Psycho-education is a specialized education that consists of educational and psychosocial endeavours with an aim to create terminal behaviour change in patients and their families. Planned psycho-educational programs assist patients and their families to cope with and adapt to the difficulties associated with the disease, enable them to develop their problem solving skills and improve their quality of life.27
Psycho-education is the most commonly used psychosocial intervention in the clinical care of patients with chronic diseases. Psycho-education involves education about the cause, course and care of the chronic illness as well as emotional and psychological effects of the disease on the patient and family. It aims to provide better disease comprehension that leads to improved personal and relational coping skills to the disease.16
1.2 STATEMENT OF THE PROBLEM
Osteoarthritis (OA) is a significant chronic disease and a common presentation in general practice. Joint pain and reduced mobility cause considerable impact on quality of life. With no current cure for this condition, general practitioners are left with a range of management options aimed at optimising quality of life.1
In the United States, hospitalizations for osteoarthritis increased from 322,000 in 1993 to 735,000 in 2006.28 In 2003 the costs attributable to arthritis and other rheumatic condition represented nearly 1% of that year’s U.S. gross domestic product.28 The number of U.S. adults with arthritis is projected to rise to 67 million by 2030.29 Globally osteoarthritis causes moderate to severe disability in 43.4 million people as of 2004.30 Even though local literature on economic burden of osteoarthritis is scarce, the impact of osteoarthritis of the knee causing substantial pain and disability, results in a significant burden on health care provision.13
The present care of these patients is the biomedical approach. This biomedical approach to health care reduces diseases into signs, symptoms and the pathophysiology of the disease. Approach to diseases in this manner has led to much accomplishment in understanding of diseases in medicine. However, the effect of the disease on the patient is ignored. Thus, care of patients in this way ignores the illness experience and the entirety of the patient.31
This is in contrast to the bio-psychosocial approach, which is based on holistic assumption. The holistic approach takes into consideration biologic and psychosocial factors in health. Biologic factors in health include genetics, environmental and behaviours (exercise, diet, and smoking) that affect biologic functioning. The psychological factors assessed in health include affective, cognitive, and behavioural components such as feelings, beliefs, expectations, personality and coping style. These psychological factors are contributors to a patient’s experience of health and illness. Social factors include access to health care, quality of available health care, social systems
(family, school, work, church, and government), social values, customs and social support.31
Physicians who narrowed their treatment to simply medical considerations are of limited use to their patients. Despite this, revolution of thinking from a purely biomedical model to the biopsychosocial model, bio-psychosocial model is still a major challenge to modern medicine.31
Psychosocial issues including quality of life are often neglected by physicians attending to these patients. Quality of life is narrowed to aspects of an individual’s life that is affected by health, disease and/or its treatment. It encompasses emotional, physical, social and subjective feelings of well being that reflect an individual’s subjective evaluation and reaction to his/her illness.31 There have been several studies on health related quality of life in OA worldwide and some on psychosocial interventions.32-34 There is paucity of data on psychosocial interventional studies related to osteoarthritis in Nigeria despite the impact of this chronic disease on quality of life in this part of the world.
Due to considerable impact of osteoarthritis on quality of life, there is need for further intervention to optimise the quality of life, hence the need for this study.1
1.3 AIM AND OBJECTIVES OF THE STUDY
1.3.1 Aim of the study
To determine the effect of structured psycho-education on the quality of life of patients with knee OA in order to provide an intervention which when combined with routine care will lead to an improvement in the quality of life and better adaptation of the patients to the disease. .
1.3.2 Specific objectives
- To determine the effect of structured psycho-education on the mean quality of life score of patients with knee OA attending general and orthopaedic outpatient department of Jos University Teaching Hospital.
- To determine and compare the quality of life scores of patients with knee OA receiving psycho-education with routine medical care and routine medical care alone.
- To determine factors affecting the quality of life of patients with knee OA attending orthopaedic and general outpatient department of Jos University Teaching Hospital.
1.4 JUSTIFICATION/RELEVANCE TO FAMILY MEDICINE
Family medicine is the medical specialty that provides continuing and comprehensive health care for the individual and the family. A Family physician possesses unique attitude, skill, and knowledge that qualify him/her to provide continuing and comprehensive medical care, health maintenance, and preventive services to each member of a family regardless of sex, age, or type of problem (i.e. biologic, behavioural, or social).35
Osteoarthritis is a common and significant chronic disease, reducing mobility and causing considerable impact on quality of life. It is a common presentation in general practice. Measurement of efficacy of treatment in chronic diseases has shifted from that based purely on survival, to one that takes into account the quality of the resulting life. Hence, the need for research on interventions that focuses on improvement of the quality of life of these patients.1 Most patients with OA are assessed and treated within primary care settings but there seems to be a discrepancy between how doctors and patient define the importance of an illness. Furthermore, OA of the knee is often ignored by doctors until the disease is very advanced because it is often considered as part of the ‘normal’ ageing process. As OA and other rheumatic conditions seldom cause death but have a substantial impact on health, QoL measures are better indicators of their impact than related mortality rates.36
The study goes beyond just treating the disease of the patient by considering the psychosocial factors in health of osteoarthritic patients. It will also test an intervention that is expected to improve their quality of life, consequently rendering a holistic care to these patients-this is the hallmark of family medicine. Psycho-education, if integrated into clinical practice, is simple and more cost-effective in the long term than just routine medical treatment.27
THE EFFECT OF STRUCTURED PSYCHO-EDUCATION ON THE QUALITY OF LIFE OF PATIENTS WITH KNEE OSTEOARTHRITIS IN GENERAL AND ORTHOPAEDIC OUTPATIENT DEPARTMENT, JOS UNIVERSITY TEACHING HOSPITAL, JOS
