Title
of Health Intervention: Living with Osteoarthritis
Health
Topic & Intended Audience:
This lesson plan is intended to provide
education for clients who currently have been diagnosed with osteoarthritis
(OA). OA is the most common form of
arthritis. OA affects 21 million people
in the United States. 13.5 million patient’s with OA report their daily
activities are affected and have issues that affect their ability to work. In Texas, 22% of adults (3,859,000) have been
diagnosed with arthritis. Of these
adults, 18 to 64 years old, 36% have work limitations (Centers for Disease
Control and Prevention, 2010). It
affects both young and old. Without knowledgeable self-management
osteoarthritis can have a devastating effect on the person’s quality of life (Hochberg,
1995).
Self-management of OA includes being
informed about the latest medication and pain control, maintaining and
increasing function and being an active partner in their own health care (Hampton,
Glasgow and Zeiss, 1994). The goal of
self-management is to control and lessen the impact of OA on everyday life. Consistent self-management has been shown to
reduce hospital visits and improve health conditions. Self-management depends
on accurate knowledge about the disease (Barlow, 2000).
The population of the public hospital is
often the uninsured and underinsured from the lower socioeconomic status. It has been found that this population is not
predisposed to follow up with regular medical care for chronic conditions
(Baker, 2006). In addition, those
patients from a lower socioeconomic status have been found to have lower health
literacy (Kutner, et al, 2006). This
combination of a chronic illness as well as low health literacy make these
clients from a public hospital outpatient clinic an appropriate choice for this
lesson plan.
Intended
Audience: The audience includes a maximum of 25 English-speaking
clients from an outpatient rehabilitation clinic of a public hospital. These clients have been diagnosed with osteoarthritis
and have attended at least one rehabilitation therapy session. The age range is
from 35-65 years old.
Setting:
The setting is a large meeting room adjacent to the rehabilitation department
in the community hospital. The room is 12’x24’
square feet. The room will be arranged with 5 round tables with 5 chairs
each. This room is equipped with an
overhead projector for Power Point presentations and includes a drop-down screen
as well as a large television screen on opposite ends of the room for
viewing. The class will be held on
Monday from 11am to 12noon. This will
allow attendees who drive to avoid early morning or late afternoon traffic and
attendees that use Metro Lift to avoid late departure home. If patients have nutritional requirements the
cafeteria is open for lunch before and after the presentation scheduled time.
Estimated
Time: Total time
approximately 1 hour
Introduction of
speaker/staff and review physical space
(bathrooms, water
fountain) – 3 minutes
Icebreaker, attendee
introduction – 10 minutes
Pre-intervention
Questionnaire – 10 minutes
Lecture 1. What is OA? What are the risk
factors? How is OA diagnosed?
Power Point with notes
(5 slides) – 5 minutes
Activity 1. Joint
Protection Techniques – 10 minutes
Lecture 2. How is OA
treated? What can I do about it?
Power Point with notes (5
slides) – 5 minutes
Activity 2. Exercises
for OA of the hand and knee - 5 minutes
Post- Intervention Questionnaire – 10 minutes
Materials
Needed:
Power Point handouts –
30 copies
Program outline – 30
copies
Laser Pointer
Folders x 30
Sticky notes x 30 sets
Built up foam rollers x
5
Adapted key holder x 5
Elastic shoe strings tied
into a tennis or dress shoe x 5
Dycem pieces (4” x 6 “)
x 5
Small jars with lids x
5
Large zip lock bags to
hold the adaptive equipment for joint protection exercise
Exercise sheets
Hand exercises, 3 sets of 5 each
Knee exercises, 2 sets of 5 each
List of energy
conservation techniques - 30 copies
Pre- intervention
questionnaires labeled #1 – 30 each
Post –intervention
questionnaires labeled #2 – 30 each
30 pencils
30 business cards
Guiding
Health Education Theory or Model:
Theories serve to
explain why a behavior exists and how it can be changed or modified. Theoretical frameworks provide a connection
between behavior and intervention (Doughty, 2011).
The Health Belief Model has been used
extensively to explain health behaviors.
It is a theory based on patient motivation that specifically attributes
behavior change due to the patient’s belief or attitude concerning the severity
of a health threat, and the expectation that they might avoid this threat if
they follow recommended behavioral changes (Rosenstock, 1974).
As in many behavior models, self-efficacy
is the key construct. Self-efficacy is defined as the patient’s belief in their
control over a behavior. According to
Bandura (1977), this construct is the basis of belief that one can be
successful in changing a behavior. In
this lesson plan, the construct of self-efficacy determines how motivated the
client will be to follow guidelines for self-management of their OA diagnosis.
Goal:
The overall goal of the lesson plan is to
educate patients regarding OA including definition, diagnosis and
treatment. It is also designed to
encourage self-management of OA.
Objectives
and Learning Domains:
1.
Program Outcome Objective
Participants
will improve their scores on the post-intervention questionnaire by 10% as
compared to the scores on the pre-intervention questionnaire.
(Cognitive)
2.
Program Outcome Objective
90%
of participants will show a willingness to improve function by sharing with the
group one joint-protection technique they will use, as discussed during the
lesson plan.
(Affective)
3.
Program Process Objective
To
register 20-25 English-speaking clients from the outpatient clinic to
participate in the lesson plan.
Procedure:
1.
Set up, Prepare 30 folders with a copy
of Power Point handout, pre and post-intervention questionnaire, energy
conservation techniques, 1 pack of sticky notes, program outline, presenter’s
business card and a pencil. Place five folders on each table.
2.
Introduction:
I want to welcome each of you here
today. I am (your name) and I am here
today to lead this discussion about Osteoarthritis. I am (your position) and I (what your expertise
is in the area of arthritis) for example: “ I
am an occupational therapist and I help people with arthritis improve their
ability to do everyday activities.”
This time together is to learn more about osteoarthritis, and ways that
we can better manage arthritis in our everyday lives. My assistant today is (assistant’s name). She is here to lend a hand whenever you need
some assistance.
Before
we begin, I just want to point out the bathrooms are out the door and across
the hall. There is a water fountain
outside the bathrooms. If you need to
leave the room, please feel free to do so. We will not be taking any official
breaks.
At
your tables each of you have a folder and in that folder you will find a copy
of the information we will discuss today, a copy of today’s program outline, a
copy of “Energy Saving Ideas”, a copy of a blue questionnaire marked #1 and a
pink questionnaire marked #2. You should also have a pencil and my business
card if you need to contact me after we leave here today.
3.
Icebreaker
Now that you know who we are, let’s just
go around the room and take a few moments to introduce yourselves. You can tell us your name and what you hope
to gain from your time here today. (Starting with table to your right, have
each participant introduce themselves to the group).
4.
Complete Pre –Intervention Questionnaire.
Appendix A
Great! So now we know a little bit about
each other. To begin today’s program, I
am going to ask each of you to take out the paper from your folder marked #1
and with your pencil, answer the questions as best you can. Don’t worry, nobody is going to be graded
here today. I just want to get an idea
of what you may already know and feel about osteoarthritis. Please let me or
(the assistant’s name) know if you need any help filling out these
questionnaires. Once you have completed the #1 questionnaire, my assistant and
I will pick them up from you.
5.
Power Point lecture 1 - What is OA? What
are the risk factors? How is it diagnosed?
Now we
are going to look at a few slides and discuss the definition, diagnosis and
risk factors of osteoarthritis. You
should be able to see a screen from where you are sitting. Move your chair if you need to get a better
view.
6.
Activity 1- Joint Protection/ Energy
Conservation Techniques
Being placed on your tables are four
different objects that can be used for different activities that you may have
difficulty doing because of your osteoarthritis. We are going to examine each object and learn
more today about how these objects can help protect our
joints
during certain activities. These are
called joint protection techniques. Protecting joints is one way to manage your
osteoarthritis.
Some of you ladies will recognize the
first object. That’s right, it is a foam
roller, but can be used to pad a pencil or small tool so that you do not have
to grip as hard. Gripping a pencil or
small tool too hard will cause pain to your finger joints and tire them out
very easily. A built-up handle, which is
what this is called, will protect your fingers and thumb from too much
pressure.
The second object is an extended key
holder. This extension for your key will
allow you to put the key into a lock and turn it with more force because the
handle has been made longer. Many people
with osteoarthritis cannot turn a key in their front door or in their car
without causing themselves much pain. In some cases, they cannot turn the key
because of lack of strength in their hands. A key holder can be purchased or
made for you by an occupational therapist.
The third object is the red shiny
material. It is called Dycem. Dycem helps turn caps, jar lids and open
bottles by improving your grip. You may have seen similar material at the
store. You will find a small jar there on the table, and you can give it a
try. See if it makes it easier to
open. Can you think of other things you
might use Dycem for ? (opening prescription bottles, stabilizing plates or
bowls when eating)
The fourth item is a pair of elastic shoe
strings. They have been laced into a
shoe so you can see how they work. These
can be used to keep your shoes tied without having to tie and untie every time
you put your shoes on or take them off.
This will save some wear on your hands and knees. Once the shoes are tied, you just slip your
foot into the shoe. The elastic keeps
the shoe tight on your foot
In your folder, you will find a
sheet of paper marked “Energy Saving Ideas”.
These are suggestions to allow you to use less energy while doing
chores. When you have
osteoarthritis, you may find that you
get tired easily. Saving your energy and
resting
between chores may make it easier to
complete your daily activities.
Please take a minute to consider these joint
protection ideas. If you find one
that
you would be willing to try at
home, please write it down on the sticky note provided and
share it with the others at your
table. If you need other information
about finding one of
these joint protection items,
please let me know after the meeting.
7.
Power Point lecture 2 - How is OA
treated? What can I do about it?
If I can have your attention back to the
screens. We will now take a look at how
osteoarthritis is treated by your medical team and what you can do to better
manage your own life with osteoarthritis.
8.
Activity 2- Exercises for OA of the hand
and knee
Each table has a copy of an exercise. Some
of you have exercises for hands and some are for the knee. Please review the exercises with the others
at your table. In a couple of minutes, each table will lead the group in their
assigned exercise. Start at the first table to the left. Have the group stand and demonstrate the
exercise, then have the remainder of the group practice the exercise. Continue
until every table has had an opportunity to demonstrate their exercise.
9.
Post – Intervention Questionnaire,
Appendix A
To end our program today please take
the paper from your folder marked #2 and
with your pencil, answer the questions as best you can. I hope you have learned
some things about managing osteoarthritis that you didn’t already know. You
will notice these are the same questions as before but since our discussions, you
may want to choose a different answer. Once you have completed the questionnaire
please turn it in to the assistant as you leave.
Thank
you for your attendance here today! I
hope you have learned something and found this time to be helpful to you.
Evaluation:
Evaluation
measure for Outcome Objective 1: Pre and Post - Intervention Questionnaire
(knowledge
of living with OA), will be completed by each attendee.
Evaluation
measure for Outcome Objective 2: Each participant will provide verbal/written
feedback on one joint-protection technique they are willing to try.
Anticipated
Problem (s) and Solutions:
1.
Problem: Overhead may not work
Solution:
Have paper copies of the power point available
2.
Problem: Participant cannot read
Solution:
Have at least one assistant to help with questionnaire and activities
3.
Problem: The room is too cold.
Solution:
Have engineering’s extension available to call and report this if necessary.
References
Baker, D.W., Shapiro,
M.F & Shur, C.L. (2000). Health
insurance and access to care for
symptomatic conditions. Archives of Internal Medicine, 160, 1269-1274.
Bandura, A. (1977).
Self-efficacy: toward a unifying theory of behavioral change. Psychological
Review,
84, 191.
Barlow, J. (2001). How
to use education as an intervention in osteoarthritis. Best Practice and
Research
Clinical Rheumatology, 15 (4) , 545-558. doi: 10.1053/berh.2001.0172
Centers for Disease
Control and Prevention (2010). Arthritis.
Retrieved from
http://www.cdc.gov/arthritis/data_statistics/state_data_list.htm.
Doughty,
P. (2011). Contextual considerations for behavior change: Intervention/Method
selection. In G.Gilbert, R. Sawyer, &
E. McNeill (Eds.), Health Education:
Creating
Strategies for School and Community Health. (pp. 46 - 96). Sudbury, MA: Jones
and
Bartlett Publishers.
Hampton, S.E., Galsgow, R.E. & Zeiss,
A.M.(1994). Personal models of osteoarthritis and their
relation
of self-management activities and quality of life. Journal of Behavioural Medicine,
17,
143-158.
Hochberg, M.C., Altman, R.D., Brandt, K.D., Clark,
B., Dieppe, P.E., Griffin, M.R… (1995).
Guidelines for the medical management of osteoarthritis. Part I.
Ostoarthritis of the hip.
American
College of Rheumatology. Arthritis and
Rheumatology, 38, 1541-1546.
Kutner, M., Greenberg, E., Jin,Y., &
Paulsen, C. ( 2006 ). The health literacy of America's
adults:
Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483).
Washington, DC: U.S. Department of
Education, National Center for Education Statistics
Rosenstock, I.M. (1974). The health belief model: Origins
and correlates. Health Education
Monographs, 2 (4), 336.
Appendix
A:
Pre and Post -Intervention Questionnaire,
page 1
1. Only
really old people have Osteoarthritis.
True False
2. The
most common kind of arthritis is:
a. rheumatoid
arthritis
b. osteoarthritis
c. spinal
arthritis
d. psoriatic
arthritis
3. Osteoarthritis
is the same as Osteoporosis.
True
False
4. When
you have osteoarthritis, unless you are very overweight, it doesn’t matter what
kind of food you eat.
True False
5. You
are having difficulty going up stairs because of the pain in your knees, but you should try not to use a cane or
walker until you absolutely have to.
True False
6. If
your doctor told you that you have osteoarthritis, you should exercise as
little as possible.
True False
7. If
you have osteoarthritis, you should not spend a lot of time in the sun.
True False
8. All
people with osteoarthritis have the same symptoms or complaints.
True False
9. What
is not a risk factor for osteoarthritis?
a. Being
overweight
b. Whether
you are male or female
c. Family
history
d. If
you live in a part of the country that is cold rather than warm
Appendix
A:
Pre and Post -Intervention
Questionnaire, page 2
10. Osteoarthritis
can affect your
a. Hips
b. Knees
c. Hands
d. Shoulders
e. All
of the above
11.
Osteoarthritis alternative treatment can include Yoga and Tai Chi.
True
False
12.Water aerobics is an excellent form of exercise
for osteoarthritis
patients.
True False
13.Splints can help improve your function by
a.
providing a better position for your
hand and wrist
b.
keeping your hands warm
c.
protecting your joints
14. There have not been any new medications found
for osteoarthritis in the
last 10
years.
True False
15. Your doctor is the only person who should manage
your treatment.
True False
16. If you have pain while working - don’t
stop! Just push through the pain.
True False
Appendix A: Pre and Post -Intervention Questionnaire, page 3
17. When lifting something heavy, use your larger,
stronger joints.
True False
18. Osteoarthritis
treatment plans always involve surgery.
True False
19. You can get osteoarthritis in any joint.
True False
20. Successful management of
osteoarthritis includes:
a.
early diagnosis
b. early treatment
c. limiting daily exercise
