A review and synthesis of correlates of fatigue in osteoarthritis.

Fatigue affects nearly half of all adults with osteoarthritis. Affected individuals report difficulty with daily functioning, requiring more time and rest during activities, feeling easily exhausted, and having to give up on social and volunteer activities known to improve quality of life. Because its etiology is poorly understood, clinical practice guidelines are unable to address management of fatigue in osteoarthritis. Elucidating a mechanism of osteoarthritis fatigue is a high priority, but few studies have identified key factors associated with fatigue in osteoarthritis. Thus, the purpose of this narrative literature review is to present the current evidence of known and potential correlates of fatigue in osteoarthritis, and synthesize our findings into a conceptual framework. The overarching goal of this work is to provide insight into areas of needed research and guide future work toward mechanistic insight of osteoarthritis fatigue. This knowledge could lead to novel nursing interventions for prevention, management, and treatment of fatigue among adults with osteoarthritis.

Enquanto a cirurgia não chega: a experiência dos pacientes na fila de espera de Artroplastia total de quadril / While the surgery does not come: the experience of the patients waiting for Total Hip Arthroplasty

Este estudo tem como objetivo geral conhecer o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril. E como objetivos específicos: analisar o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril e propor um plano de cuidado de enfermagem para assistir o paciente que se encontra na fila baseado na teoria de enfermagem de Joyce Travelbee. Estudo do tipo descritivo com abordagem qualitativa, aprovado pelos Comitês de Ética em Pesquisada UERJ e da Instituição campo de coleta de dados, com os seguintes pareceres: CAAE 79594817.8.0000.5282 e 79594817.8.3001.5273, respectivamente. Foi desenvolvido em um Instituto especializado em traumatologia e ortopedia na cidade do Rio de Janeiro com 17 participantes, sendo sete mulheres e dez homens, na faixa etária de 31 a 80 anos. A coleta de dados ocorreu nos meses de março e abril de 2018, onde foram realizadas as entrevistas no referido Instituto. Para tratamento dos dados, utilizou-se a análise de conteúdo delineada por Bardin, emergindo quatro categorias e seis subcategorias: I- Minha vida antes do comprometimento articular; II- Mudanças na vida frente à limitação articular (Limitações físicas que causam restrição na vida; Modificações na rotina após a doença e Limitações socioafetivas geradas pela doença); III- Sentimentos vivenciados enquanto a cirurgia não vem (Sentimentos vivenciados ao receber o diagnóstico cirúrgico; Sentimentos vivenciados enquanto espera pela cirurgia e Sentimentos vivenciados pelo paciente quando ele é chamado para realizar a cirurgia); IV- Recursos utilizados para gerenciamento dos efeitos da doença enquanto a cirurgia não vem (Família como rede de apoio; Crença religiosa como suporte frente à espera e Busca de tratamentos para amenizar os efeitos da doença). Análise dos resultados se deu à luz da teoria de enfermagem de Joyce Travelbee. Os principais resultados evidenciam que os pacientes precisaram aguardar de 3 a 10 anos pela cirurgia e esse tempo os afetou tanto física quanto psicologicamente, com a piora da dor, aumento das limitações físicas, afastamento do convívio social e prejuízo emocional, trazendo implicações para o cuidado de enfermagem sob a ótica da teoria de Joyce Travelbee. Conclui-se que o tempo de espera prolongado pode afetar integralmente a saúde do paciente, sendo necessário criar estratégias como um acompanhamento por telemonitoramento com vistas a acolher as demandas desses pacientes durante o tempo de espera, favorecendo assim, a redução de danos à saúde.

This study has as general purpose to know the meaning that has for the person the experience of waiting for Total hip arthroplasty. And as specific goals: to analyze the meaning that has for the person the experience of waiting for Total hip arthroplasty and to propose a nursing care plan to assist the patient who is waiting for surgery based on the nursing theory of Joyce Travelbee. It s a descriptive study with a qualitative approach, approved by the Research Ethics Committees UERJ and the Institution data collection field, with the following opinions: CAAE 79594817.8.0000.5282 and 79594817.8.3001.5273, respectively. It was developed in an Institute specialized in traumatology and orthopedics in the city of Rio de Janeiro with 17 participants, being seven women and ten men, in the age group of 31 to 80 years. The data collection took place in March and April of 2018, where the interviews were held at the mentioned Institute. For the data treatment, the content analysis outlined by Bardin was used and four categories and six subcategories emerged: I- My life before the joint involvement; II- Changes in life in the face of joint limitation (Physical limitations that cause restriction in life; Modifications in routine after illness and Socio-affective limitations generated by the disease); III- Feelings experienced while surgery does not come (Experienced feelings when receiving the surgical diagnosis; Feelings experienced while waiting for surgery and Feelings experienced by the patient when he is called to perform the surgery); IV- Resources used to manage the effects of the disease while the surgery does not come (Family as a support network; Religious belief as support in front of waiting and Search for treatments to mitigate the effects of the disease). Analysis of the results was given in light of the nursing theory of Joyce Travelbee. The main results show that patients had to wait from 3 to 10 years for surgery and this time affected them both physically and psychologically, with worsening of pain, increased physical limitations, withdrawal from social life and emotional impairment, with implications for care from the perspective of Joyce Travelbee theory. It is concluded that prolonged waiting time can affect the patient's health, and it is necessary to create strategies such as telemonitoring to meet the demands of these patients during the waiting time, thus favoring the reduction of health damage.

Interpreting measures of risk: Translating evidence into practice.

Advanced practice registered nurses must have a working knowledge of statistical principles in order to provide high-quality, evidence-based care. This article presents basic concepts of risk indexes and case study examples illustrating how these measures can inform practice.

Arthritis: joints inflamed.

ARTHRITIS IS a generic term for inflammatory joint disease. There are various forms of arthritis, including osteoarthritis, rheumatoid arthritis and spondyloarthritis. Arthritis can be a chronic debilitating condition or a transient effect of bacterial or viral infections. As a chronic condition, arthritis can cause loss of quality of life, disability and, with rheumatoid disease, early death. The economic burden of arthritis, in terms of management and loss of productivity due to disability, is high and set to increase with the ageing population. Recent advances in our understanding of the causes and progression of a number of forms of arthritis have raised hopes of better management and possible remission. Pharmacotherapy has moved from symptom management to addressing underlying disease processes. However, therapies that prevent or cure arthritis remain elusive. Current care for people with arthritis relies on a multidisciplinary approach and substantial pharmacological intervention. Nurses have a key role to play in guiding patients through treatment, ensuring they receive optimal therapy to reduce the impact of arthritis and its management on their lives.

Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program.

New strategies are needed to improve access to cognitive and behavioral therapies for patients with persistent pain. The purpose of this randomized, controlled trial was to determine the effectiveness of the Chronic Pain Management Program, an 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants. Program efficacy and engagement was evaluated for 92 individuals with a diagnosis of chronic noncancer pain who had a current opioid prescription. Participants were recruited from primary care practices and Internet sites, then randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Engagement was evaluated by examining completion of program learning modules. The results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy. In conclusion, patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program. Future efforts toward heightening engagement could further maximize impacts.

Osteoarthritis: A review.

Disabling for nearly 27 million people, osteoarthritis is expected to double by the year 2030. Although age is a strong predictor of osteoarthritis, it is not an inevitable consequence of aging. Nurse practitioners, frequently the first healthcare providers to see patients with osteoarthritis, must be up-to-date on current treatment recommendations.

Ginger Therapy for Osteoarthritis: A Typical Case.

PURPOSE: To describe a treatment for osteoarthritis known as ginger therapy applied by anthroposophic nurses for a specific personality type. BACKGROUND: Ginger has been used medicinally in Asia since ancient times to bring inner warmth. Ginger therapy is part of the tradition of anthroposophic nursing, when managing chronic inflammatory conditions such as osteoarthritis. Osteoarthritis is a progressive disease of the synovial joint tissue that primarily affects those older than 65 years, causing pain on movement. DESIGN: A patient with specific characteristics suffering osteoarthritis received 7 consecutive days of ginger therapy by anthroposophic nurses at an integrative medical center. Two weeks after the therapy, education was given to enable self-treatment in the home for a further 24 weeks. Data were obtained using body physiological recordings, a case diary and pain scale, and self-report arthritis Health Assessment Questionnaire. FINDINGS: Ginger therapy activated a marked relief of osteoarthritis symptoms that progressively improved over the 24 weeks, with no negative effects reported. Ginger therapy needs to be considered by nurses caring for specific personality types with osteoarthritis.

Older black adult osteoarthritis pain communication.

A quantitative descriptive secondary data analysis design was used to describe older black adult communication of osteoarthritis pain and the communication strategies used to convey the pain information. Pain content from 74 older black adults with persistent osteoarthritis pain was analyzed using criteria from the American Pain Society arthritis pain management guidelines that included type of pain (nociceptive/neuropathic), quality of pain, source, location, intensity, duration/time course, pain affect, effect on personal lifestyle, functional status, current pain treatments, use of recommended glucosamine sulfate, effectiveness of prescribed treatments, prescription analgesic side effects, weight management to ideal body weight, exercise regimen or physical therapy and/or occupational therapy, and indications for surgery. Communication strategies were analyzed with criteria derived from Communication Accommodation Theory that included being clear, using medical syntax, using ethnic specific syntax, being explicit, and staying on topic when discussing pain. The majority of communicated pain content included pain location, intensity, and timing. Regarding communication strategies, most of the older black adults used specific descriptions of pain and remained on topic. Fewer used explicit descriptions of pain that produced a vivid mental image, and few used medical terminology. Use of medical syntax and more explicit descriptions might improve communication about pain between health care practitioners and patients. Practitioners might assist older black adults with persistent osteoarthritis pain to communicate important clinical pain information by helping them to use relevant medical terminology and more explicit pain descriptions when discussing pain management.

Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms.

AIM: This article is a report of a study evaluating changes in health status before and after topical ginger treatment for adults with moderate to severe osteoarthritis. METHOD: In 2011, 20 adults with chronic osteoarthritis were randomly assigned to one of two groups for 7 consecutive days of topical ginger treatment by trained nurses: Group 1 received a manually prepared ginger compress and Group 2 a standardized ginger patch. Participants had the option to continue self-treatment using the ginger patch for a further 24 weeks. A brief arthritis health questionnaire was completed weekly for 3 weeks and 4 weekly for 24 weeks. RESULTS: The mean scores for Group 1 and Group 2 show a notable decline following 1-week topical ginger treatment; scores in pain, fatigue, global effect, and functional status reduced by 48%, 49%, 40%, and 31%, respectively, whereas health satisfaction improved from 80% dissatisfied to 70% satisfied. Scores for all participants in all five domains progressively reduced over the following 24 weeks of self-treatment. CONCLUSION: Topical ginger treatment has the potential to relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis.

Effect of a virtual pain coach on pain management discussions: a pilot study.

There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners' pain management changes, and on older adults' reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication-only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults' communicated pain information and practitioners' pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication-only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.

A closer look at osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis affecting 26.9 million Americans. OA is a degenerative disorder of the synovial joint that leads to pain, stiffness, and decreased function of the affected joint. An understanding of both the nonpharmacologic and pharmacologic management of OA is essential for nurse practitioners.

[Nursing care of osteoarthritic patients who require a prosthesis]. / La prise en charge infirmière de patients arthrosiques nécessitant une prothèse.

Nursing patients undergoing an operation for a prosthetic due to osteoarthritis requires the nurse to be attentive during postoperative surveillance. The nurse must provide preventative and educational care to facilitate the patient's return home.

Osteoarthritis, osteoporosis, and exercise.

With the aging of the work force, occupational health nurses must prepare for encounters with clients who are challenged by osteoarthritis or osteoporosis. Clients should be encouraged to exercise safely to promote functioning at home and work. This article reviews recent literature on the benefits of exercise for workers with osteoarthritis, osteoporosis, or both.

Musculoskeletal US: examining the joints.

Musculoskeletal ultrasound (US) is an excellent tool to diagnose muscle, tendon and ligament injuries, cystic structures and peripheral nerve compression, as well as soft tissue masses, without the risk of ionizing radiation. Musculoskeletal US is now routinely used by a growing number of rheumatology and sports medicine centres throughout UK. In standard clinical practice, US has an extremely useful application in differentiating fluid from soft tissue and identifying the severity of joint inflammation. The work described in this article was carried out to assess patients' feedback regarding the use of US guidance for intra-articular injections and/or the removal of fluid from their inflamed knee joints in a nurse-led clinic. Nineteen patients who had US-guided knee joint injection/aspiration in the clinic were asked to complete a questionnaire regarding their satisfaction with the procedure, and to rate their joint pain and patient global assessment (using numerical visual analogue scale) before the US-guided procedure, and 1 month after. Results revealed a significant improvement (p<0.001) of the joint injection outcome measures and the patients' satisfaction of the US-guided procedure. Therefore, musculoskeletal US can improve two fundamental clinical skills: the clinical diagnosis of joint inflammation, and the accuracy of joint injection/aspiration. This study supports the concept that incorporating musculoskeletal US into clinical practice leads to significant improvements in patient care. It also reveals that US-guided procedures are appreciated by patients.

Osteoarthritis 1: Physiology, risk factors and causes of pain.

Osteoarthritis (OA) is a synovial joint disorder characterised by pain, stiffness, and restricted function. It is often classed as a degenerative disease because the affected joints deteriorate over time. This article, the first in a three-part series, describes the complex pathophysiology and causes of pain in OA, risk factors, and how it is diagnosed.