Self-Management Education Program For Osteoarthritis Discussion Paper

Major Causes Of OA

The chronic degenerative disease of the joints that causes the ‘wear and tear’ of the cartilage that covers the end of every bone is referred to osteoarthritis (OA). OA is the most common disease of arthritis and one of the leading causes of pain and disability in many adults (Johnson & Hunter, 2014). OA affects any joint, however, in most cases it affects the knees, joints, lower back, and the neck as well as the joints at the base of the thumb, big toe and small bones at the fingers.  OA is the third leading cause of disability in Australia whereby 10% of its population suffers from this condition (Coleman et al., 2012). About 50% of the people above 65 years suffer from this condition with a predicted rise as the population changes demographically. Most of these adults (40%) are affected by the knee OA (Hunter, Schofield & Callander, 2014).

The disease results from previous joint injury, the abnormal development of the joints and limbs as well as from inherited factors (Sandell, 2012). Bruises on the bones such as fractures speedup the breakdown of cartilage as a result of damaging the joints, ligaments, and tendons. Some disorders affect the proper development of the joints and bones, for example, rheumatoid arthritis which leads to the development of OA. Inherent factors, the genes, predisposes an individual to the development of OA. One of these genetic defects is the inability to synthesize collagen which is a protein responsible for making cartilage (Mayer et al., 2013). It is worth noting that being overweight exacts much pressure on the hips and knees accelerating the wearing out of the cartilage cushioning the bones at the joints. Moreover, a study shows that the excess fat tissues are responsible for the release of cytokines, a chemical with the potential of damaging the joints (Johnson & Hunter, 2014).  Self-Management Education Program For Osteoarthritis Discussion Paper

The symptoms of OA vary depending on the severity of the damage and the joints affected. However, pain and stiffness are exhibited by patients of this disease particularly after a rest, for example, the first thing in the morning after the night rest. The symptoms often build up over time, and the affected joints may swell. For instance the stiff and sore joints begins with stiffness on a limited range of motion which goes away after movement. There can also be cracking or clicking sound when a joint is bent accompanied with pain that worsens after activities as the joints show mild swelling. The swelling at the joints especially at the fingers and toes leads to bony growths called spurs (Hochman et al., 2013).

Symptoms And Signs

OA is the primary cause of disability among older adults affecting more than one eight of the adults (Murphy & Helmick, 2012). The effect of the disease has health, social and economic implications on both the patient and the society. Patients with OA are burdened with pain, limited activity and consequently reduced quality of life. The disease is accompanied with chronic pain which is of two forms; intermittent, which is often intense and the other one is persistent aching (Neogi, 2013). Pain consequentially hinders activity participation among the individuals with OA (Karttunen et al., 2012). Besides the negative implications of pain, OA affects the mood of the individual, bringing about fatigue and lack of sleep. About 70% of older adults with OA experience poor sleep resulting from this kind of fatigue (Hunter, Schofield & Callander, 2014).

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Knee OA is responsible for 83% of the burden of OA diseases with the patients having limited movement of differing degrees. Approximately 25% of these individuals are unable to carry out their daily living activities as 11% of them requiring assistance with their personal care while the other 14% needing help with their everyday needs. With the lack of treatment, the disease incapacitates the individual for extended periods causing further individual and societal burden (Hunter, Schofield & Callander, 2014).

Studies have reported increased mortality among patients with OA in comparison with the general public substantiated by the disease’s impact on the patient’s quality of life (Hawker et al., 2014). Most elderly individuals with knee OA lose quality-adjusted life years for the rest of their lives. OA is also prevalent on the hands particularly at the base of the thumb, on the proximal and distal interphalangeal joints which leads to hand functional impairment (Neogi & Zhang, 2013).

In Australia, OA uses between 1-2.5% of the country’s gross national product (Chen et al., 2012). As the active life of these individuals deteriorates, the country’s productivity reduces. People with OA will have to depend on their families and friends for assistance, and they spend more funds on health care as compared with their age-matched or sex-matched people of the general population. Medical costs and hospitalization especially for joint replacement surgery accounts for about 43% of the Australian healthcare budget (Chen et al., 2012).

Moreover more funds (13%) are spent for visitations to general practitioners as well as rheumatologists. Then another 15% of the healthcare budget funds is spent on medications and other associated healthcare services (Menon & Mishra, 2018). One of the most cost-effective interventions for OA is the joint replacement for example the replacement of the hip and knee joints. However, the pressing demands for this procedure significantly stretch the healthcare budget. Other health-promoting programs get affected as the healthcare budget is burdened by the high expenditure on OA. Patients of OA bring about financial burdens as well as associated needs that the country’s economy has to take care of since these persons rely on others to a more considerable extent for their welfare.

Effects Of OA

A self-management support is a description of actions put in place by a healthcare professional to aid a patient in managing his or her chronic condition such as OA (Kawi, 2012). These actions are for promoting the wellbeing of the patient through facilitating the appropriate usage of medications, initiate and facilitate change of behavior to slow disease progression, assist the patient to adjust to socioeconomic and psychological consequences. Also, the program is an empowerment strategy for helping the patient’s efforts to have an input in the treatment decisions and ensure normal activities (Nolte & Osborne, 2012).

Since there is yet a cure for OA, the treatment focus on alleviating the symptoms. Pain incapacitates the patient. Therefore, it’s advisable to use pain relievers such as analgesics, for example, acetaminophen on the directions of the physician. Then the patient ought to remain active through engaging in physical activities for studies has proved that physical exercises are appropriate for promoting quality life (Messier et al., 2013). Practices are good for boosting energy as they aid the strengthening of the muscles, bones and keeping the joints flexible. Simple activities such as taking a walk to the neighborhood for knee OA will go a long way in reducing pain and maintaining a healthy weight. The range of motion exercises is essential in ensuring the joints are flexible to reduce stiffness. As the pain subsides, other practices such as aerobics can be carried out to build up the stamina and energy levels and facilitate the burning of calories hence reducing excess weight. These exercises are carried out for about twenty five minutes per day. In case the patient is unable to move, he or she can use assistive devices with the help of a physical or occupational therapist.

The patient requires a balanced diet with a variety of nutrients to ease the symptoms. For example foods rich in vitamin C such as fruits will be of great value. Also, Omega-3 fatty acids often found in the fish oil are useful in relieving pain. It’s essential to use a balanced diet all through with plenty of fruits and vegetables, whole grains, low-fat milk, fish and lean meat. On the fats, the patients should go for healthy fats such as avocados and healthy oils, for example, canola oil.

Sleeping well is an appropriate remedy for pain and stress. The patient must ensure he or she sleeps enough and goes to bed at the same time every night. Distractions such as televisions should be out of the sleeping area. In case of discomfort during sleep, use of pillows will relieve the weight pressure of the painful joints.

Economic Implications

Furthermore, it is important to use hot and cold parks. The hot packs are useful for increasing blood flow consequently reducing pain as well as stiffness. On the other hand, the cold compresses function in reducing the swelling that occurs at the joints as a result of inflammatory processes. Both the cold and hot compresses can be used. However, one can be used versus the other to ascertain the one that suits the patient.

The patient should keep on using the over the counter medications such as acetaminophen which keep pain under check and does not bring about stomach upsets. However, care is to be taken not to overdose which may lead to liver issues. Other pain relievers include aspirin and ibuprofen which have possible side effects such as stomach upset and bleeding.

Use of complementary medications and supplements has proved to help in the recovery of OA. Most of the supplements for example Glucosamine usage along with chondroitin alleviate pain. Self-Management Education Program For Osteoarthritis Discussion Paper For about a month usage of these supplements and complementary medicine, the assessment of the response of the body can be substantiated.  Other treatments such as massage and acupuncture can be incorporated into the program. Massage facilitates blood circulation especially to the paining joints hence easing it. Acupuncture is helpful in relieving the pain of the knees and improving their functionality.

To avoid injuries and lessen pain during movement, aids such as braces and splints are worth using. In the day to day activities, some devices such as an electric can opener and chairs are essential for making life more comfortable.

At this stage, supportive groups can share essential ideas and information for enhancing healthful living. These forums can be searched online to be sure which ones are near and how they operate. Living with chronic illness is not easy; therefore, support is paramount where there is sharing of ideas and positive messages that foster positivity. With such information, the patient is empowered and capable of making and participating in making decisions about his or her health as well as life in general.  The people that associate with the patient are to help him or her through the process of setting health goals and making decisions. Further, help the patient to achieve the set goals, therefore, boosting his or her confidence and self-worthiness. Also, the patient needs to engage in doing whatever intrigues him or her for example hobbies. The patient is to always focus on the abilities and not the disabilities to help the body recover since the good feeling of contentment makes the body to function correctly. The patient should avoid isolating himself or herself from other people in the society but instead spend time with friends to break boredom and loneliness that may be as a result of the sedentary life.

Self-Management Plan For OA

A large proportion of the indigenous Australian thrives in the rural communities where they experience a more significant burden of illness in comparison with the non-indigenous in the same neighborhoods (Durey & Thompson, 2012). These indigenous rural dwellers are more likely to be faced with rural risk factors such as inadequate proper local healthcare services, economic burden regarding access to distant services as well as reduced transportation services. Moreover, the manual activities that these people are engaged in for their livelihood predispose them injury and trauma. These factors are risk factors for the development of OA.

Furthermore, there are impending cultural factors of language and attitudes against the aboriginals (Young et al., 2013). The less access to quality healthcare service together with the associated cultural and occupational disadvantages among the Australia indigenous people thwarts social safety measures. Inadequate information and education among the indigenous Australians derail strategies for achieving cultural safety. Therefore, the self-management plan can be explained to the patients and their families by the local healthcare practitioners to help the patient in implementing it. Such efforts empower the whole society including the aboriginals for it is executed at an individual level with little reliance on other people hence advocating for cultural safety.

Conclusion

OA is an incapacitating chronic disease with adverse impacts on the individual as well as the society. The self-management plan is one of the most appropriate, effective and cheap remedies for OA. Such a program not only empowers the patients by promoting their health but also reduces health disparities among the indigenous and the non-indigenous people of Australia through cultural safety.

References

Coleman, S., Briffa, N. K., Carroll, G., Inderjeeth, C., Cook, N., & McQuade, J. (2012). A randomised 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:10.1186/ar3703

Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Services Research, 12(1). doi:10.1186/1472-6963-12-151

Hawker, G. A., Croxford, R., Bierman, A. S., Harvey, P. J., Ravi, B., Stanaitis, I., & Lipscombe, L. L. (2014). All-Cause Mortality and Serious Cardiovascular Events in People with Hip and Knee Osteoarthritis: A Population Based Cohort Study. PLoS ONE, 9(3), e91286. doi:10.1371/journal.pone.0091286

Hochman, J., Davis, A., Elkayam, J., Gagliese, L., & Hawker, G. (2013). Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis.  Self-Management Education Program For Osteoarthritis Discussion Paper