Lesson Plan

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