Andrea Sport Nurs 7940 EBP Oral Presentation

 Musculoskeletal pain in the elderly population is common and disabling, yet often underreported, underestimated, and undertreated. Some form of symptomatic arthritis affects at least 50%of the elderly population, and over 80% of the population will experience back pain at some point in life.  In the elderly, osteoarthritis is by far the most prevalent arthritic complaint and is the cause of an increasing public health problem. Because OA greatly impacts all aspects of life and there is no cure for the disease, symptom management is paramount for affected individuals.  Pain affects many day-to-day functions such as sleep, appetite, energy, mobility, independence, and overall state of health.  Better pain management leads to better quality of life.

 Elders (age 60 +) diagnosed with Osteoarthritis

In elders diagnosed with osteoarthritis (P), is the addition of complementary and alternative medicine to standard treatment (I) more effective than standard treatment alone (C) in order to reduce pain levels, enhance quality of life, and decrease occurrences of medication interactions (O )

 Databases used for literature search included CINAHL, Health Source: Nursing/Academic Edition, Medline, ERIC, PsycARTICLES, and the Cochrane Library. The literature search returned numerous randomized controlled trials, descriptive cross-sectional studies, and literature reviews.

 Glucosamine sulfate, when used long term such as six months, can be used to improve joint function, reduce pain, and decrease analgesic consumption in those diagnosed with osteoarthritis. - Grade: A - Wu, Huang, Gu, & Fan (2013) - Giordano et al. (2009)  A comfrey root extract (Symphytum officinale L.) cream applied to affected joints three times daily can significantly reduce pain, stiffness, and swelling, improve joint function, and potentially decrease the usage of oral pain-relieving medications. - Grade: B - Smith & Jacobson (2011) - Laslett et al. (2012)

 Both aquatic and land-based exercises are beneficial to reduce pain and improve joint function in those with osteoarthritis. - Grade: B - Wang et al. (2011) - Hiyama et al. (2011)  Self-management education, including disease-specific processes, exercise regimens, healthy lifestyle choices, and other relevant information, is beneficial in reducing pain and improving quality of life in those diagnosed with osteoarthritis. - Grade: B - Coleman et al. (2012) - Coleman et al. (2008)  THESE TWO RECOMMENDATIONS WERE CHOSEN AS THE FOCUS FOR THE SMALL TEST OF CHANGE!

 Setting: East Alabama Orthopaedics and Sports Medicine  Participants: Patients of Dr. Bob McAlindon aged 60+ that have been diagnosed with Osteoarthritis

 Intervention: Consenting patients fitting into the population of interest were provided with the Measure of OA Pain Self-Assessment Questionnaire- Pre. Patients were then educated about OA, disease management, and the importance of exercise. Patients were then given an exercise regimen to follow at home. Patients were asked to exercise for an average of 30 minutes per day for 5 days out of the week.  Follow-up: After 3-4 weeks of exercising, patients were contacted via telephone or and answered questions from the Measure of OA Pain Self-Assessment Questionnaire-Post.

 Tools: Measure of Osteoarthritis Pain Self- Assessment Questionnaire-Pre and Post  Outcome measures: Results measured OA pain, medication consumption/frequency, and quality of life.

 The implementation of an educational session and exercise regimen significantly reduce (p=<0.05) the impact OA pain symptoms have on quality of life measures as determined by the Measure of OA Pain Self-Assessment Questionnaire  Education and exercise were shown to decrease pain scale ratings from 4.3 (mean-pre) to 3.5 (mean-post). However, this decrease is not statistically significant (p=0.14).  Education and exercise led to decreases in the frequency of acetaminophen and opioid pain medication consumption, but these decreases were not statistically significant (p=0.29, p=0.20).  90% of participants strongly agreed or agreed that education and exercise were beneficial for managing OA pain symptoms.

60%

 Education and exercise are beneficial components of osteoarthritis symptom management.  The benefits of education and exercise include reduced pain, decreased oral pain medication consumption, and an improved quality of life.  Further implementation of the education and exercise program is warranted in this setting with evaluations every three months to determine long-term effectiveness of this program.

Wu, D., Huang,Y., Gu, Y., & Fan, W. (2013). Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: A meta-analysis of randomized, double-blind, placebo- controlled trials. International Journal of Clinical Practice, 67(6), doi: /ijcp Giordano, N., Fioravanti, A., Papakostas, P., Montella, A., Giorgi, G., & Nuti, R. (2009). The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial. Current Therapeutic Research, 70(3), doi: /j.curtheres Smith, D. & Jacobson, B. (2011). Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: Randomized, placebo-controlled, double-blind, multiclinical trials. Journal of Chiropractic Medicine, 10, doi: /j.jcm Laslett, L.L., Quinn, S.J., Darian-Smith, E., Kwok, M., Fedorova, T., Korner, H.,…Jones, G. (2012). Treatment with 4Jointz reduces knee pain over 12 weeks of treatment in patients with clinical knee osteoarthritis: A randomized controlled trial. Osteoarthritis and Cartilage, 20, doi: /j.joca

Wang, T., Lee, S., Liang, S., Tung, H., Wu, S., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20, doi: /j x Hiyama, Y., Yamada, M., Kitagawa, A., Tei, N., & Okada, S. (2011). A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: A randomized controlled trial. Clinical Rehabilitation, 26(5), doi: / Coleman, S., Briffa, N.K., Carroll, G., Inderjeeth, C., Cook, N., & McQuade, J. (2012). A randomized controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Research & Therapy, 14(1), R21. doi: /ar3703