Background Osteoarthritis (OA) is more commonly found in women. Joint pain, stiffness, decreased levels of physical activity, obesity and chronic diseases are common problems experienced1. A non-pharmacological patient-centered management approach using exercise, education and self-management strategies, may help to ameliorate the impact of joint pain and chronic diseases of life style (CDL) on function, pain and health-related quality of life 2.
Objectives To establish if an intervention programme incorporating physical activity and health education and using self-management principles would result in improved physical functioning, a decrease in pain and improved health related quality of life (HRQoL) in women.
Methods Women with osteoarthritis and hypertension were randomized in two groups (experimental group and control group that received standard care in a form of a support group). The primary outcome was improved physical function using World Disability Schedule (WHODAS) and the Aggregated Locomotor Functioning Score (ALF). Secondary outcomes were decreased joint pain (BPI), improved HRQoL using EQ-5D, decreased Body Mass Index (BMI), decreased blood glucose levels and blood pressure. Measures were taken by a blinded observer at baseline, at six and twelve weeks. The intervention was offered on a weekly basis for six weeks and was led by a physiotherapist.
Results Thirty-five participants were allocated to the experimental and 38 to the control group. There was no difference between the baseline outcome measurements, apart from blood glucose which was ranked higher in the control group (p=0.037). Post-intervention, the WHODAS score was significantly lower (better) (p=.032), the ALF was significantly lower (better, p=.013), joint pain was significantly less (p<.001); and the HRQoL significantly higher (Visual Analogue Scale p=.002) in the experimental group. Blood glucose remained lower in the experimental group (p=0.034) and within-group analysis indicated that whereas the control group had not lowered their glucose (p=.656), the experimental group had (p=.002). However, there was no difference in BMI (p=.340) or blood pressure category (p=.558).
Conclusions The six week intervention significantly improved physical functioning, pain, HRQoL and blood glucose levels. However, it did not lower Blood pressure or BMI. It is recommended that this intervention be rolled out in primary health care clinics as it is relatively low cost and requires minimal exercise equipment. The results of this study support the inclusion of physiotherapists as members of the primary health care team in the management of osteoarthritis and chronic diseases of lifestyle.
Covinsky KE, Lindquist K, Dunlop DD, Gill TM, Yelin E. Effect of arthritis in middle age on older-age functioning. J Am Geriatr Soc. 2008 Jan;56(1):23–8. PubMed PMID: 18184204. Pubmed Central PMCID: PMC2875135. Epub 2008/01/11. eng.
NICE. Osteoarthritis National clinical guideline for care and management in adults. London: National Institute for Health and Clinical Excellence, 2008.
Acknowledgement This study was funded by the National Research Foundation (NRF) Thuthuka grant and the University of Cape Town.
Sincere thanks to Prof Jelsma and A/Prof Parker for their assistance and contribution to this project
Disclosure of Interest None declared
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