Dissertation to receive a master's degree
Abstract
Aim: This research was conducted with the aim of determining the effect of a self-management program on knee pain, self-care self-efficacy and performance of elderly people with knee osteoarthritis.
Study method: This research is a semi-experimental pre-test and post-test study with a control group of an applied type, which was conducted in 2013 in the orthopedic clinic of Khorram Abad city on 80 elderly patients with osteoarthritis of the knee. The samples were randomly divided into two intervention and control groups. Data collection tools include: Demographic Profile Questionnaire, Visual Analogue Pain Scale, Performance Questionnaire and Self-Efficacy Questionnaire. The intervention includes self-management training for 4 weeks, 1 session of 70 minutes per week. After the intervention, patients are followed up by phone calls at home. The intervention includes: providing information about the disease, diagnosis, treatment, diet plan, pain reduction methods and exercise. Questionnaires were completed after the intervention and analyzed using SPSS software using chi-square, independent t and analysis of variance statistical methods. Findings: In the data analysis, there is no significant difference between the average knee pain, performance and self-efficacy between the intervention and control groups before the intervention (p>0.05). . Meanwhile, after the intervention, there was a statistically significant difference in the average knee pain, performance and self-efficacy in the two intervention and control groups (P<0.05).
Conclusion: The results showed that the implementation of a self-management program is effective in improving the condition of knee pain, performance and self-efficacy in patients with osteoarthritis of the knee, so using this method Non-pharmacological and support can be useful and can be used as an effective method to manage the disease and problems caused by osteoarthritis of the knee and empower them.
Keywords: osteoarthritis of the knee, pain, performance, self-efficacy, self-management, elderly
Introduction:
Increasing life expectancy and decreasing fertility has caused an increase in the number of elderly people around the world, such that population aging has become one of the most important public health challenges in recent years (1). According to psychologists, old age is a period of life that usually starts from the age of 60 to 65 years old. Old age is not considered a disease in any way, but it is an inevitable necessity in the passage of life and the natural path of growth (2). To define old age in terms of age, there is no cut-off point that is agreed upon by everyone. In developed countries, the age of 65, when a person is eligible to receive pension, is considered as the age of old age. The United Nations has accepted the age of 60 as the cut-off point (3). The increase in the elderly population is not unique to developed countries, but is a phenomenon that both developed and developing countries are facing. In Iran, surveys and statistical indicators indicate the rapid growth of the elderly population, so that it is predicted that the elderly population of Iran will reach 10.5% by 2025 and 21.7% by 2050. With the increase in the population of the elderly, their health problems also increase and the need to pay attention to their problems increases (4).
1-1. Statement of the problem
Elderly people are increasingly exposed to various diseases because the physiological changes that occur during the aging process, such as specific changes in different body systems (cardiovascular, musculoskeletal, digestive, respiratory, etc.) weaken the body's natural function (5) and reduce the ability of salamanders to take care of themselves, which increases the probability of contracting diseases and dying in old age. It comes with (6). After middle age, every year on average 1.5% of people's physical and mental performance decreases. In this way, when a person reaches the age of 70, he loses 26% of his abilities. And most people face many disabilities and diseases when they reach old age. One of these common diseases is osteoarthritis, which affects performance.One of these common diseases is osteoarthritis, which affects the performance of the elderly(7).
Chronic diseases are among the common health problems around the world(8) and the health habits and behaviors of people have a significant impact on the incidence and severity(9). Chronic diseases are one of the main and important concerns in the elderly population, and the prevalence of chronic diseases in the elderly population is increasing (10). The increase in the elderly population and the prevalence of chronic diseases is considered a major challenge in the health and care system. Arthritis [1] is one of the common chronic diseases (11) and osteoarthritis [2] is the most common joint disease in the world (12). Osteoarthritis is known as degenerative arthritis which is characterized by the progressive reduction of articular cartilage along with the renewal of subchondral bone and joint margins and a series of biological changes in the synovium (13) which causes pain, disability, joint stiffness and joint deformation (14). Osteoarthritis may be primary, idiopathic, or secondary to trauma, infection, surgery, and other diseases. Common treatments in osteoarthritis include: drug treatments such as: the use of painkillers and anti-inflammatory drugs, acetaminophen, non-steroidal anti-inflammatories [3] and narcotics, and non-drug treatments and surgery (15). Although surgeries such as joint replacement are effective in reducing pain and improving function in advanced osteoarthritis, due to the risks of surgery, only a small group of patients prefer using these methods. The non-pharmacological treatment of patients with osteoarthritis in the Rheumatoid Arthritis Association includes: patient education, weight control, exercise, physical therapy (16). The prevalence and incidence of osteoarthritis increases with age. In Iran, 25% of people over 65 years of age suffer from osteoarthritis, and knee joints are the most common joints involved in this disease.(17). Osteoarthritis is one of the most important causes of disability that affects approximately 43 million people in the United States. So that it accounts for 24% of all hospital discharges and 4 thousand days of hospital care. These patients visit doctors' offices 38.9 million times, clinics 2.9 million times, and emergency rooms 2.2 million times (18). Osteoarthritis is more common in women than men. It is estimated that in America 10-15% of people over 35 years old and 30-45% of people 65 years old have knee osteoarthritis (19). Age is the strongest risk factor for this disease. Other risk factors for this disease include obesity, type of job, metabolic diseases and trauma. This disease causes impairment in walking, climbing stairs. and weight bearing, which in turn causes mobility restrictions in the elderly (20). In America, about one hundred thousand people are unable to go to and from bed and the bathroom without help. However, osteoarthritis, which is the most common condition limiting activity among the elderly, has not been found to prevent or reverse the disease in humans. are considered more like cancer or stroke, it can be considered responsible for more cases of total disability in the elderly (21). Past studies have shown that physical pain is the main obstacle to physical activity in the elderly. In the old age, there is this misconception that osteoarthritis is a natural consequence of the aging process, but studies show that although aging is a strong risk factor for osteoarthritis, it does not cause osteoarthritis and not all elderly people suffer from it (22-21).
One ??of the recent approaches in the treatment and care of osteoarthritis is self-management[4]. Several definitions of Self-management is presented in chronic diseases, but the following definition includes almost all the concepts of self-management. In the self-management approach, people are encouraged to perform activities that promote health and control and treat the signs and symptoms of the disease, and they are encouraged to adopt methods that affect performance, feelings, and interpersonal communication and compliance with the treatment regimen (23). Also, self-management is a strategy that allows a person to maintain the sequence of his behavior or increase a positive behavior or skill or reduce an inappropriate behavior.