Dissertations / Theses on the topic 'Osteoarthritis – Nursing'

Book Summary: Serves the needs of advanced practice nurses because it’s written by nurse practitioners for nurse practitioners, in collaboration with a physician. Organizes content around the Circle of Caring framework for nursing-based knowledge and holistic care. Explores complementary and alternative treatments for each disorder. Covers the broadest range of human disease and disorders using a systems-based approach, presenting both common complaints and common problems to help students narrow down the possible differentials to the most likely diagnosis. Considers interactions of pharmaceuticals with alternative medications and nutraceuticals. Features coverage of pathophysiology and diagnostic reasoning as well as up-to-date guidance on laboratory and diagnostic tests. Emphasizes evidence-based practice with information on evidence levels and more references to primary studies. Integrates discussions of health policy and primary care throughout the text.

Over 26 million U.S. citizens have a form of arthritis; osteoarthritis (OA) is the most common form. Self-efficacy (SE) is defined as a psychological construct which identifies an individual's confidence when performing a behavior. SE is deemed a vital judge of self-management (SM) in those with OA. The purpose of this evidence-based practice, quality improvement project was to improve SE in OA patients. The identified gap in nursing practice was the lack of SE in OA patients. The project question asked whether a toolkit with information regarding SE in OA can improve SE of management of disease-associated symptoms in adults with OA as evidenced by improved Arthritis Self-Efficacy Scale (ASES) scores pre- to post-program. Concepts and theory used to inform the doctoral project were SE, pain, SM and OA, and Bandura's theory of SE. The sources of evidence were obtained from a variety of peer-reviewed journals related to OA management, and the outcome was measured using the ASES. Thirty-five participants (16 males and 19 females) with a mean age of 62 from a physical medicine and rehabilitation clinic in San Antonio, Texas participated in the project. The National Institute of Arthritis and Musculoskeletal and Skin Disorders 2015 Handout on Health: OA was used as the SE OA toolkit. Mean scores from pre- and post-program were tabulated and compared to determine the outcome. Results showed improved ASES levels by 11.84%. Implications for nursing practice and positive social change include the enhancement of SE levels, which can improve compliance in SM by use of a toolkit and further as policy implementation for OA patients to improve SE and SM abilities.

Introduction: Chronic joint (CJ) pain is the foremost osteoarthritis (OA) symptom that affects older African Americans’ (AAs) functional ability. Every effort should be made to reduce the development of high-impact chronic pain. One way to effectively do this is for older AAs to consistently engage in self-management utilizing the recommended OA treatments. Recommended behaviors include land-based exercise, water-based exercise, strength (muscle and endurance) training and stretching, self-management education, analgesic medications, thermal (warm/cool) modalities, and use of assistive and/or orthotic devices. However, evidence suggests these core behaviors of chronic pain self-management are not optimally utilized in older AAs. Methods: A convergent, parallel mixed-methods study explored patterns, preferences, and predictors of stage of engagement (pre-contemplation, preparation, or action) in recommended OA and CJ self-management behaviors. One hundred ten AAs aged 50 and older from communities in north Louisiana completed quantitative surveys, and a subset of 18 participated in audio-recorded qualitative interviews. Using SPSS, multinomial and binomial regression were used to build predictive models to determine which contextual and cognitive factors predict stage of engagement in each recommended and complementary OA self-management behaviors. A qualitative descriptive approach underscored a conventional content analysis of qualitative data. Results: Older AAs were “dealin’ with it [pain]” in a variety of ways, and their experience of having OA and CJ pain was based on their ability and willingness to bear the pain, understand the nature of OA pain, and experience life with daily pain. These dimensions of dealin’ with pain acted as a catalyst for engagement in complementary and recommended behaviors. In addition, participants’ and providers’ cultural receptivity may limit or enable engagement in certain recommended evidence-based OA behaviors. Specifically, each recommended OA self-management behavior was associated with different predictors of engagement. Confidence to manage pain was a predictor for land-based exercise, while there were no factors associated with water-based exercise. The most reasonable explanation for this finding of lack of participation in water-based exercise is likely due to inability to swim and lack of access to a personal or community pool. Engagement in strength training was significantly associated with confidence, knowledge of strength training recommendation, motivation, pain interference, and spirituality. For self-management education, only knowledge of self-management education recommendation was a predictor. Most AA older adults were unaware that this was recommended or didn’t have access to a self-management program; subsequently the majority had never participated in such but were in the preparation stage. Predictors for medication use included confidence, knowledge, and pain interference. Almost all AAs were using either over-the-counter or prescribed medications. Use of thermal modalities was predicted by pain interference. Lastly, using assistive and/or orthotic devices was significantly associated with employment status, OA pain severity, pain interference, and perceived social support. Assistive and/or orthotic device use was evenly split between users and non-users. Pain interference emerged as the most salient factor predicting stage of engagement in any of the recommended behaviors. Depending on the specific behaviors, pain interference prevented or motivated engagement. Conclusion: OA and CJ pain is a significant symptom in older AAs. This study’s mixed method approach uncovered what older AAs do to manage pain. More specifically, these results illuminate the daily patterns and preferences for self-management. We identified specific barriers and motivators that influence engagement in OA self-management behaviors, and determined the most relevant predictors for each stage of engagement. In addition, we were able to develop a model of OA and CJ pain self-management based on the predictors.

Knee osteoarthritis (OA) is a common chronic disease that leads to knee pain, stiffness and limited physical function. A multi-faceted treatment composed of medication management, exercise, health education, and weight control is identified as effective for the reduction of knee pain and increased physical function. This quasi-experimental study undertaken in rural Thailand had an interrupted time-series design and examined whether a multi-faceted intervention delivered by nurse practitioners resulted in improved health status regarding knee OA symptom, quality of life and satisfaction with nursing care and reduced medication usage compared to standard treatment. There were 108 participants (58 experimental, 58 control) who completed the study. The multi-faceted intervention included education, group exercise, weight loss, and medication management delivered over aI2-week period. Four time points were used across the study (weeks 1 and 4 pre-intervention and 16 and 20 post-intervention) to collect data including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Self-Form 36 (SF-36), Leeds Satisfaction Questionnaires (LSQ) and medication usage diary. Analysis of variance and non-parametric analyses were used to examine differences across time and t-tests and mean change differences were used to examine the group differences pre- and post- intervention. The experimental group reported significant mean change increase in LSQ score and a mean change decrease in medication usage than the control group post-intervention. This supported the hypotheses that the multi-faceted intervention delivered by nurse practitioners would result in greater satisfaction with nursing care and a reduction in medication usage than standard treatment among patients with knee OA. There were no significant mean change differences in the WOMAC and SF-36 scores between the groups. However, both groups reported improvement in WOMAC and SF-36 scores so it is probable that both treatments helped to maintain health status and quality of life.

SUMMARY Joint damages make a big part of orthopedic pathology and rheumatic diseases. One of the most often rheumatic diseases is osteoarthritis. Osteoarthritis is a difficult and widespread joint disease requiring special public health care attention and healing expenses and it has caused especially great interest of scientists in the world. Exercise therapy is an important part of complex treatment of osteoarthritis. However, information about exercise therapy frequency, duration, intensity and different exercises influence upon functional possibilities is still limited. Research purpose. To determine exercise therapy influence upon functional activity of patients with leg joints osteoarthritis. Goals. 1) To evaluate strength exercise therapy effect on clinical and functional data of patients with leg joint osteoarthritis. 2) To evaluate balance exercise therapy impact upon clinical and functional data of patients with leg joints osteoarthritis. 3) To compare strength and balance exercise therapy influence upon clinical and functional data of patients with leg joints osteoarthritis. 4) To determine pain intensity and functional data interrelation of patients with leg joints osteoarthritis. Research methods and organisation. Patients with leg joint osteoarthritis volunteered to participate in research. The participants were divided into two groups, each consisting of 15 persons. The two groups were homogenous by main data: sex, age, height, weight, diseases duration... [to full text]

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

Darbo aktualumas: Osteoartritas (OA) senstančioje visuomenėje darosi vis svarbesnė problema. Daugumai žmonių OA – tai sindromas, kurį sudaro sąnarių skausmo, sustingimo ir dėl to prastėjančių funkcijų simptomai ir kuris daro didelę įtaką gyvenimo kokybei (Conaghan & Sharma, 2009). Sergantiems osteoartritu ligoniams pažeidžiamos daugelis gyvenimo sričių: apsitarnavimas, namų ruoša, darbas, laisvalaikis, judėjimas, miegas (Thorstenson, 2007; Sunden et al. ,2007). Siekiant sumažinti skausmą bei pagerinti funkciją pacientams, sergantiems kelių sąnarių osteoartritu, analizavome, kaip skirtingos kineziterapijos programos veikia pacientų skausmą, pusiausvyrą ir šlaunies raumenų jėgą. Tyrimo objektas: skausmo, pusiausvyros ir raumenų jėgos pokyčiai, taikant skirtingas kineziterapijos programas – kineziterapiją vandenyje bei kelių sąnarių mobilizaciją ir kineziterapiją salėje bei TENS. Tyrimo tikslas: Nustatyti skirtingų kineziterapijos programų efektyvumą ligoniams, sergantiems kelio sąnario osteoartritu. Tyrimo uždaviniai: 1. Nustatyti klinikinio rodiklio – kelių sąnarių skausmo stiprumo – kaitą, taikant skirtingas kineziterapijos programas; 2. Nustatyti funkcinių rodiklių: statinės ir dinaminės pusiausvyros bei blauzdą tiesiančių raumenų jėgos kaitą, taikant skirtingas kineziterapijos programas; 3. Nustatyti, kuri kineziterapijos programa veiksmingesnė, mažinant skausmą ir didinant funkciją – pusiausvyrą bei blauzdą tiesiančių raumenų jėgą. Tyrimo hipotezė: Manome, kad taikydami... [toliau žr. visą tekstą]<br>Problem of study: Osteoarthritis (OA), in an aging society is becoming increasingly important problem. OA, for the majority of people - is a syndrome consisting of joint pain, stiffness and function because of deteriorating symptoms and who have a significant impact on the quality of life (Conaghan & Sharma, 2009). Patients ill with osteoarthritis are vulnerable to many disabilities in different areas of life: self-service, household chores, work, leisure, movement, sleep (Thorstenson, 2007; Sunden e al. 2007). In order to reduce pain and improve function in patients with knee osteoarthritis, we examined how different physical therapy programes are affecting the pain, balance and strength of the thigh muscles of the patients.. Object of study: changes in pain, balance and muscle strength while applying different physical therapy programs - physical therapy in water, knee joint mobilization, physical therapy room and TENS. Aim of study: to determine the effectiveness of various physical therapy programs for patients with knee osteoarthritis. Goals of study: 1. Establish a clinical indicator – change in the intensity of knee pain with different physical therapy programs; 2. Identify the functional characteristics: static and dynamic balance and change in force of the extensor muscles of the thigh, with different physical therapy programs; 3. To establish which physical therapy program is more effective in reducing pain and improving function - balance and power of the extensor... [to full text]

Tyrimo problema: sergant kelio sąnario osteoartritu atsiranda skausmas, apsunkinama kasdieninė veikla, trinka pusiausvyra, padidėja griuvimo rizika. Siekiant pagerinti pusiausvyrą ir sumažinti griuvimų riziką, analizavome kaip įvairios kineziterapijos programos veikia pagyvenusių žmonių, sergančių kelio sąnario osteoartritu, šlaunies raumenų jėgą, statinę ir dinaminę pusiausvyrą bei skausmą. Tyrimo objektas: pusiausvyros, raumenų jėgos ir skausmo pokyčiai taikant skirtingas kineziterapijos programas. Tyrimo tikslas: nustatyti skirtingų kineziterapijos programų poveikį ligoniams sergantiems kelio sąnario osteoartritu. Tyrimo uždaviniai: 1. Nustatyti pusiausvyros kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 2. Nustatyti šlaunies raumenų jėgos kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 3. Nustatyti pusiausvyros kaitą taikant tik TENS ir fizinius pratimus. 4. Nustatyti šlaunies raumenų jėgos kaitą taikant tik TENS ir fizinius pratimus. 5. Įvertinti skirtingų kineziterapijos programų efektyvumą. Tyrimo hipotezė: manome, kad didžiausią teigiamą poveikį pusiausvyros, šlaunies raumenų jėgos ir skausmo kaitai turi ankstyvas sąnarių mobilizacijos, TENS bei fizinių pratimų taikymas. Taikant minėtus metodus atskirai, poveikis pusiausvyrai, šlaunies raumenų jėgai ir skausmui turėtų būti mažesnis arba visai nepasireikšti. Tyrimo metodai ir organizavimas: tyrimas atliktas VšĮ Kauno slaugos ligoninėje 2005-2007 metais. Tyrime dalyvavo asmenys, sergantys... [toliau žr. visą tekstą]<br>Problem of study: osteoarthritis of knee joint causes pain, aggravates everyday activities, disconcerts balance, and increases the risk of fall. Aiming to improve balance and to decrease the risk of falls, we analyzed how various programs of physiotherapy influence the strength of thigh muscles, static and dynamic balance, and pain of elderly with knee osteoarthritis. Object of study: changes of balance, muscle strength and pain after application of various programs of physiotherapy. Aim of study: to determine the impact of various physiotherapy programs to the patients with knee osteoarthritis. Goals of study: 1. To determine the change in balance, when the joint mobilization, TENS and physical exercises are applied. 2. To determine the change in the thigh muscles strength, when the joint mobilization, TENS and physical exercises are applied. 3. To determine the change in balance, when TENS and physical exercises alone are applied. 4. To determine the range of thigh muscles strength, when TENS and physical exercises alone are applied. 5. To evaluate effectiveness of various physiotherapy programs Hypothesis of study: we believe that the biggest positive impact on the change of balance, strength of thigh muscles and pain has the combination of early joint mobilization, TENS and physical exercises. While applying all those methods separately, the impact on the change of balance, strength of thigh muscles and pain is lesser or even doesn’t emerge. Methods and organization of... [to full text]

Tyrimo objektas: tiriamųjų funkcinė būklė. Tyrimo tikslas: įvertinti skirtingų kineziterapijos programų poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei. Hipotezė: kineziterapija salėje bei kineziterapija vandenyje turės didesnį poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei, nei tik kineziterapija salėje. Uždaviniai: 1. Įvertinti pacientų, kuriems taikyta kineziterapija salėje, funkcinės būklės kaitą. 2. Įvertinti pacientų, kuriems taikyta kineziterapija salėje ir kineziterapija vandenyje, funkcinės būklės kaitą. 3. Palyginti skirtingų kineziterapijos metodų efektyvumą. Tyrimo metodika: Tyrimas atliktas VŠĮ ,,Tulpė“ ir AB Birštono sanatorija ,,Versmė“. Trisdešimt tiriamųjų – asmenų, kuriems buvo atliktas klubo sąnario endoprotezavimas, – suskirstyti atsitiktine tvarka į dvi grupes po 15 ligonių. Vienai grupei buvo taikoma kineziterapija salėje, o kitai grupei – kineziterapija salėje ir vandenyje. Taikant šias priemones buvo pildomas tyrimo protokolas reabilitacijos eigoje: 1. Skausmui vertinti naudota VAS skalė (analoginė skausmo skalė); 2. Klubo sąnario judesių amplitudei vertinti naudotas goniometras; 3. Šlaunies apimčiai išmatuoti naudota centimetrinė juostelė; 4 . Funkciniam mobilumui ir griuvimo rizikai nustatyti naudotas ,,Stoti ir eiti“ testas; 5. Klubo sąnario funkcijai nustatyti naudota Harris Hip skalė. Visi matavimai atlikti I-ą dieną atvykus ir po 18 reabilitacijos dienų. Įvertinus abiejų grupių tiriamųjų... [toliau žr. visą tekstą]<br>The object of the Thesis: functional state for persons with endoprosthetic hip joint. The aim of the Thesis: to assess the effect of different physiotherapy methods on the functional state for persons with endoprosthetic hip joint. Hypothesis: Physiotherapy combined with aquatic therapy had a greater impact on persons functional status than only physiotherapy in the gym. The tasks of the Thesis: 1. To assess the effect of physiotherapy on the functional state for persons with endoprosthetic hip joint. 2. To asses the effect of physiotherapy combined with aquatic therapy on the functional state for persons with endoprosthetic hip joint. 3. To compare the effectiveness of different physiotherapy methods. The methods of the Thesis: The study was performed in ,,Tulpė“ sanatorium and sanatorium ,,Versmė“ in Birštonas. Thirty research subjects - persons with endoprosthetic hip joint – were randomly divided into two groups with 15 patients in each. One group received physiotherapy, the other – physiotherapy compared with aquatic therapy. While applying these modalities, a research protocol was completed during the rehabilitation: 1. VAS scale to assess pain; 2. Goniometer was used to assess the range of hip joint motions; 3. Measuring tape was used to assess thigh volume; 4. ,,Stand up and go“ test was used to assess functional mobility and risks of falls; 5. Harris Hip scale was used to assess joint function. All measurements were performed 1 day after arrival and 18 day after... [to full text]

Bakgrund Artros, som är en degenerativ ledsjukdom, är en av de vanligaste sjukdomarna i Sverige. Sjukdomen är vanligare hos äldre än hos yngre och det är fler kvinnor än män som utvecklar artros. Normalt sker en nybildning av brosk kontinuerligt i alla kroppens leder, men vid artros bryts brosket ner utan att någon nybildning sker. Artros kan förekomma i alla kroppens leder, men det är framför allt knä, höft och fingerleder som drabbas. Smärta är oftast det första symtomet på sjukdomen. Smärtan behandlas i första hand med paracetamol eller non steroid inflammatory drugs (NSAID). En annan typ av behandling som personer med artros använder sig av är Komplementär och Alternativ Medicin (KAM). KAM är per definition av National Center for Complementary and Alternative Medicine (NCCAM) en grupp av produkter, metoder och inrättningar som utövar dessa metoder som normalt inte inräknas i den traditionella vården. Dessa metoder och produkter indelas av NCCAM i större grupper. De fyra huvudgrupperna är naturliga produkter, mind-body, manipulation av vävnader och övriga KAM. Det har visats att personer med artros väljer att använda sig av KAM för att lindra sin smärta då de inte fått tillräcklig smärtlindring genom den traditionella vården. Vid artros är de vanligaste använda KAM metoderna kiropraktik, naturliga produkter (kosttillskott), massage och magnetterapi. Syfte Var att beskriva KAM metoder som används vid artros och i vilken utsträckning de ger smärtlindrande effekt. Metod Denna litteraturstudie syftade till att beskriva den forskning som gjorts på om olika KAM metoder hade smärtlindrande effekt vid artros. Sökord som användes vid databassökningen var osteoarthritis, pain, complementary therapies och alternative therapy. Förutom dessa användes mer specifika sökord för de olika KAM metoder som personer med artros använder sig av, till exempel massage. I studien har 17 artiklar inkluderats. Resultat I gruppen naturliga produkter var det Phytalgic®, purple passionfruit-peel, gurkmeja och ingefära som uppvisade smärtlindring. Mind-body metoder som studerades var tai chi och akupunktur. Smärtreducering erhölls av tai chi och effekten kvarstod i minst12 veckor. Två av tre akupunkturstudier visade att smärtlindring erhölls, men effekten kvarstod olika länge. Massage och kiropraktik studerades i gruppen manipulation av vävnader och även dessa metoder gav smärtlindring under varierande tid. Övriga KAM som studerades var magnetarmband, olika former av elektrisk stimulation och balneoterapi. Alla metoderna visade någon form av smärtreduktion, men magnetarmband visade enbart reduktion på sensorisk smärta. Slutsats Alla undersökta KAM metoder i samband med artros visade smärtreducering i varierande grad och effekten kvarstod under olika lång tid. Föreliggande studies resultat kan inte direkt användas för att rekommendera olika KAM-behandlingar för personer med artros. Mer forskning kring metoderna behövs för att utifrån vetenskap och beprövad grund få tillräckligt evidens för att integrera KAM med den traditionella vården. Då skulle personer med artros kunna ges ytterligare möjligheter till smärtkontroll. Nyckelord: Artros, smärta, komplementär och alternativ medicin och KAM

Bakgrund: Artros är en av de 10 mest vanliga sjukdomarna i världen och 25% av alla med artrosrelaterad rörelseinskränkning kan inte utföra dagliga aktiviteter i sitt liv. Sjukdomen leder till långvarig smärta och rörelseinskränkning som kan resultera i sjukskrivning och sjukpensionering.  Syfte: Syftet var att undersöka hur personer med artros upplever att långvarig smärta påverkar livskvaliteten. Metod: En allmän litteraturöversikt där 9 kvalitativa artiklar samt en multimetodsstudie med separat kvalitativt resultat inkluderats, analyserats och sammanställts. Artiklarna togs fram från sökningar i databaserna Pubmed och CINAHL.  Resultat: Under innehållsanalysen utformades två kategorier med vardera två underkategorier. Fysisk hälsa; symtomlindring och aktiviteter i det dagliga livet samt psykisk hälsa; välmående och sociala aspekter. Slutsats: Fysiska och psykiska aspekter ingår i definitionen av livskvalitet, således upplever personer med artrosrelaterad långvarig smärta att begränsningar i det dagliga livet, den sociala samvaron samt försämrat generellt välmående ger en försämrad livskvalitet.<br>Background: Osteoarthritis is one of the ten most common diseases in the world and 25% of people with osteoarthritis-related disability can not perform activities in daily life. The disease leads to long-term pain and disability which can result in medical leave or retirement related to disability. Aim: The aim of the study was to explore how persons with osteoarthritis-related long-term pain perceive their quality of life.  Method: A general literature review where 9 qualitative articles and one multimethodstudy that presented the qualitative result separately were included, analyzed and compiled. Results: During the content analysis two categories with two subcategories each emerged. Physical health; sympthomatic relief and activities in daily life and also psycological health; general wellbeing and social aspects.  Conclusion: Physical and psychological aspects are included in the definition of quality of life, therefore persons with osteoarthritis-related long-term pain experience that limitations of activities in daily life, social life and also impaired general wellbeing decreases quality of life.

Bakgrund: Åldersrelaterade sjukdomar och skador som höftledsartros och höftfrakturer ökar i takt med att befolkningen blir allt äldre. Vårdkostnader för smärta relaterat till höftkirurgi förväntas därmed öka. För att äldre ska få fullgod smärtlindring som kan öka chansen för en effektiv rehabilitering krävs kunskap om upplevelser hos patienter äldre än 50 år. Syfte: Att beskriva upplevelser av smärta och smärtlindring hos patienter som genomgått höftkirurgi. Metod: Litteraturstudien omfattade 11 vetenskapliga artiklar. Samtliga artiklar var publicerade mellan år 2003 och 2019 och använde sig av kvalitativa metoder. Patientgruppen omfattade personer mellan 50 år och äldre. Huvudresultat: Smärtan efter höftkirurgi var som mest påtaglig de första dagarna och särskilt vid mobilisering. Långvarig smärta påverkade förmågan att klara av vardagsaktiviteter och bidrog till en mer isolerad tillvaro. Den långvariga smärtan skapade även känslor av frustration och hopplöshet. Samtidigt förekom ett accepterande förhållningssätt där smärtan sågs som naturlig och som en del av läkningsprocessen. Smärtlindringen var central för rehabiliteringen och återanpassningen till det vardagliga livet. Det fanns dock en rädsla för läkemedelsbiverkningar hos många äldre. Slutsats: Det fanns stora variationer i hur smärtan upplevdes, hanterades och kommunicerades. Äldre patienter riskerar dessutom att inte få fullgod smärtlindring. Smärta behöver kommuniceras på fler sätt än genom enbart skattning av intensitet. Sjuksköterskan har därför en central roll i att hjälpa patienten att hitta mening med lidande och smärta, vilket är en viktigt del i personcentrerad vård. Smärtan kan annars leda till försämrad rehabilitering samt ökade vårdkostnader som följd.<br>Introduction: Age-related illnesses and injuries such as hip arthrosis and hip fractures are increasing as the population grows older. Costs for pain related to hip surgery are thus expected to increase. Knowledge of experiences in patients older than 50 years is required for the elderly to receive adequate pain relief that can increase the chance of effective rehabilitation. Aim: To describe experiences of pain and pain relief in patients who have undergone hip surgery. Methods: The literature study included 11 scientific articles. All articles used qualitative methods and were published between 2003 and 2019. The patient group included persons between 50 years and older. Results: The pain was experienced by the whole individual and in a unique way for each person. The pain after hip surgery was most evident during the first few days, and especially during mobilization. Prolonged pain affected the ability to cope with everyday activities and contributed to isolation. The lingering pain also created feelings of frustration and hopelessness. At the same time, there was an accepting approach where the pain was seen as natural and as part of the healing process. The pain relief of the elderly was central to the rehabilitation and re-adjustment to everyday life. However, there was a fear of drug side effects among many elderly people. Conclusion: There were large variations in how the pain was experienced, managed and communicated. There was also a risk that elderly patients did not receive adequate pain relief. Pain needs to be communicated in more ways than by estimating intensity alone. The nurse therefore has a central role in helping the patient find meaning with suffering and pain, which is an important part of person-centered care. The pain can otherwise lead to impaired rehabilitation as well as increased health care costs as a result.

Syftet med denna studie var att undersöka hur fetma/övervikt påverkar lederna och utvecklingav artros och hur sjuksköterskan kan informera, undervisa i förebyggande syfte. Metoden ären litteraturstudie. Tolv vetenskapliga artiklar granskades enl. Polit et al (2001) kriterier förvetenskaplighet. Därefter inleddes analysen där fyra huvudteman framträdde: BMI ochpåverkan på lederna, Smärtpåverkan vid artros, Genusskillnader vid artros och övervikt samtSjuksköterskans undervisande roll. Carnevalis omvårdnadsmodell användes som teoretiskreferensram.<br>The aim of this study was to describe how overweight/obesity influence on the joints and thedevelopment of osteoarthritis. And how the nurse can inform and teach to preventdevelopment of osteoarthritis. The result is based on 12 articles based on Polit et al (2001)criterion for science. The analysis resulted in four the mes: BMI and the influence on the joint,Pain with osteoarthritis, Gender difference at osteoarthritis and overweight and Nursesteaching role. Carnevali´s theory of caremodel was used as a theoretical framework.

碩士<br>長榮大學<br>護理學系碩士班<br>99<br>The purpose of this study was to assess the effectiveness of an early rehabilitation nursing intervention program among women with osteoarthritis knee and after Total Knee Replacement(TKR)surgery. The research applied a quasi-experimental method. A total of 86 participants were recruided using purposed sampling procedure. Forty-three of them were assinged to the control group and received regular nursing care after surgery. Another 43 participants who were assinged to the experimental group were received the rehabilitation nursing program on the next day after surgery. Research data were collected through a structured questionnaire that included all participants’ ages, educational levels, BMIs, the knee angles, and the lower extremity functions on the day before surgery. Then, the 6th day after surgery, all participants were assessed the knee angles and the lower extremity functions again. Results of the study showed that the improvements of the knee angles and the lower extremity functions among the experimental group were higher than the control group significantly. In conclusion, the early rehabilitation nursing intervention program. The result of this study offers a reference for clinical nurses who were working with osteoarthritis knee patients.

Tsang Kam Wing, Edwin.<br>Thesis (M.Phil.)--Chinese University of Hong Kong, 2003.<br>Includes bibliographical references (leaves 145-151).<br>Abstracts in English and Chinese ; questionnaire also in Chinese.<br>Chapter CHAPTER 1 --- INTRODUCTION --- p.1<br>Chapter CHAPTER2 --- LITERATURE REVIEW --- p.6<br>Anatomy and Physiology of Knee --- p.6<br>Anatomy and Physiology of Knee Osteoarthritis --- p.8<br>Clinical KOA in Older Persons --- p.10<br>Consequence of Clinical KOA --- p.13<br>Management of Clinical KOA --- p.15<br>Role of Knee Exercise in Clinical KOA --- p.18<br>Goal of Treatment of Clinical KOA --- p.18<br>Function of Knee Exercise --- p.18<br>Physiological and Psychological Effect of Knee Exercise --- p.21<br>Knee Exercise for Clinical KOA --- p.23<br>Knee Exercise for Older Persons --- p.25<br>Role of Health Education for Treatment of Clinical KOA --- p.27<br>Community Nurse-Led Care for Clinical KOA --- p.29<br>Nurse-Led Care in Community --- p.31<br>Summary --- p.37<br>Chapter CHAPTER 3 --- method --- p.39<br>Aim and Hypotheses of the Study --- p.39<br>Aim of the Study --- p.39<br>Objectives of the Study --- p.40<br>Null Hypotheses --- p.40<br>Research Design --- p.42<br>Diagnostic Criteria of Clinical KOA --- p.43<br>Sample --- p.44<br>Inclusion Criteria --- p.45<br>Exclusion Criteria --- p.45<br>Sample Size --- p.45<br>Sample Recruitment --- p.47<br>Intervention: community nurse-led protocol for clinical KOA --- p.48<br>Treatment group --- p.49<br>Control Group --- p.50<br>Data Collection Procedure --- p.54<br>Pre-test Assessment --- p.54<br>Post-test Assessment --- p.55<br>Outcome Measures --- p.56<br>Disease-Specific Health Status Assessment: Western Ontario and McMaster Universities Osteoarthritis Index: Hong Kong VA 3.0- Cantonese ( WO MAC) --- p.56<br>Score management and Interpretation --- p.58<br>General health status assessment: the Chinese ( HK) Version of the Medical Outcome Survey ( MOS SF-36 ) --- p.60<br>Score management and Interpretation --- p.62<br>Specific physical function Assessment --- p.68<br>Chair Rising --- p.68<br>Timed performance test of mobility --- p.68<br>Data Analysis --- p.69<br>Ethical Consideration --- p.70<br>Chapter CHAPTER 4 --- RESULTS --- p.71<br>Subjects Characteristics --- p.71<br>Demographic Profile --- p.72<br>Baseline Assessment --- p.77<br>Normality of Study Outcome --- p.84<br>"Treatment Effect on WOMAC, MOS SF-36 and Specific Physical Function" --- p.86<br>Disease-specific health status ( WOMAC) --- p.86<br>General health status (MOS SF-36) --- p.88<br>MOS SF-36 Reported-Health Transition --- p.93<br>Specific Physical Function Performance --- p.95<br>Chair-rise --- p.97<br>Comfort-walk --- p.98<br>Fast-walk --- p.99<br>Documentation of the Treatment Process --- p.99<br>Summary --- p.103<br>Chapter CHAPTER 5 --- DISCUSSION AND CONCLUSION --- p.104<br>Disease-specific Health Status --- p.106<br>General Health Status --- p.108<br>Pain and Physical Function Performances --- p.111<br>MOS SF-36 Versus WOMAC --- p.114<br>Service Collaboration --- p.118<br>Effectiveness of the Protocol --- p.121<br>Limitation --- p.125<br>Recommendations and Implications for Future Studies --- p.133<br>Implication to Practice --- p.139<br>Conclusion --- p.142<br>REFERENCES --- p.145<br>APPENDIX I --- p.152<br>Community Nurse-Led Protocol for Clinical Knee Osteoarthritis in Older Persons --- p.152<br>HEALTH EDUCATION --- p.154<br>Home Exercise --- p.154<br>Daily Activities Involving the Knee Joints --- p.154<br>Sitting and Stretching Exercise --- p.155<br>Strengthening Exercise --- p.156<br>APPENDIX II --- p.159<br>Community Nurse-Led Protocol for Clinical Knee Osteoarthritis in Older Persons ( Chinese ) --- p.159<br>骨關節炎家居運動治療的健康教育 --- p.160<br>家居運動治療須知 --- p.160<br>影響膝蓋關節的日常活動包括 --- p.161<br>坐式伸展運動練習 --- p.161<br>張力運動練習 --- p.164<br>APPENDIX III --- p.167<br>Western Ontario and Mcmaster Universities Osteoarthritis Index： Hong Kong 226}0ؤ ( Questions in English ) --- p.167<br>APPENDIX IV --- p.171<br>Western Ontario and Mcmaster Universities Osteoarthritis Index： Hong Kong - Cantonese --- p.171<br>APPENDIX V --- p.178<br>Medical Outcome Survey SF-36 (MOS SF 226}0ؤ 36) ( English Version ) --- p.178<br>APPENDIX VI --- p.184<br>簡明健康狀況調查表（MOS SF-36) --- p.184<br>APPENDIX VII --- p.190<br>Community-Based-Care of the --- p.190<br>Usual Home-Help Teams --- p.190<br>APPENDIX VIII --- p.192<br>"""Information on Right & Obligatiońح and" --- p.192<br>"""Consent Form""" --- p.192<br>APPENDIX IX --- p.203<br>Research Schedule --- p.203<br>APPENDIX X --- p.205<br>Letter for Institutional Approval for the Study --- p.205

A mixed-methods design consisting of two phases was adopted. In Phase I, a purposive sample of 31 older Clnnese people with KOA was invited for a semi-structured interview to explore their perceptions and experiences of exercise. Five major categories emerged: typical living pattern with KOA, self-management of KOA, the practice of exercise, views about exercise, and preferences for learning exercise. The findings were used in the development of an exercise programme for this client group.<br>Knee osteoarthritis (KOA) is prevalent in the growing older Chinese population in Hong Kong. Therapeutic exercise for KOA has strong empirical evidence of its effectiveness on reducing knee pain and physical disability in people with KOA provided that they persists in practising the recommended exercise regimen. However, few previous studies have incorporated the client's perspectives into the design of an exercise programme for promoting continual practice of exercise. This study aimed to develop a new therapeutic exercise programme and pilot its acceptability to promote continual practice for older Chinese people with KOA.<br>The Phase II study used both quantitative and qualitative approaches to examine participants' satisfaction with the new exercise programme, adherence to the prescribed exercises, mastering of the exercise movements and health outcomes (knee pain, stiffness and range-of-motion, physical function, muscle strength and endurance of the lower extremities, and quality of life). A convenience sample of 33 older Chinese people with KOA participated in the programme. Seven measurement tools in Chinese versions (if applicable) were used to collect quantitative data from the participants: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 12-item Short Form of the Medical Outcome Study Questionnaire (SF-12), a goniometer, the Timed-Stands Test (TST), a satisfaction questionnaire, an exercise diary, and a return-demonstration performance record sheet. Six of the participants were invited for a semi-structured interview to explore their experience of the programme.<br>The quantitative results showed that the participants were highly satisfied with the exercise programme with a mean score of 90.15 out of 100 (SD = 8.05). Their average exercise adherence was high with a mean percentage of 91.04% (SD = 14.54) and their overall performance in mastering of the exercise movements was good with a mean score of 76.71 out of 100 (SD = 21.75). Most participants' health outcomes significantly improved at three months after the exercise programme, except for the SF-12 physical health summary score. The qualitative findings revealed four major categories: satisfaction with the exercise programme, mastering of the exercise movements, experience of the exercise's effects, and integration of the exercises into the daily routine. These findings were mainly consistent with the quantitative results of the study.<br>The results of this study showed that the exercise programme was acceptable to the participants in terms of satisfaction with the programme, adherence to the prescribed exercises and mastering of the exercise movements. Therefore, adopting a client-centred approach is likely to be a way forward in the development of exercise programmes for promoting continual practice of therapeutic exercise regimens by older Chinese people with KOA.<br>Lee, Fung Kam.<br>Advisers: Tak Ying Ann Shiu; Tze Fan Diana Lee; Kwok Wei Winnie So.<br>Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: .<br>Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.<br>Includes bibliographical references (leaves 332-369).<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Abstract also in Chinese; some appendixes in Chinese.