Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Development and Evaluation of a Joint Health Self-management Program for the Elderly with Knee Osteoarthritis in Communities: Applying the IMB Model

Article information

Res Community Public Health Nurs. 2017;28(1):55-68
Publication date (electronic) : 2017 March 12
doi : https://doi.org/10.12799/jkachn.2017.28.1.55
Young-il Kim1, Jeong Sook Park,2
1Daegu Health College, Deagu, Korea
2College of Nursing, Keimyung University, Deagu, Korea
Corresponding author: Park, Jeong Sook College of Nursing, Keimyung University, 1095 Dalgubeoldae-ro, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3907, Fax: +82-53-580-3916, E-mail: jsp544@gw.kmu.ac.kr
Received 2016 December 15; Revised 2017 March 10; Accepted 2017 March 13.

Abstract

Purpose

The purpose of this study is to develop and evaluate a joint health self-management program for knee osteoarthritis elders in communities.

Methods

This program was developed based on the IMB (information-motivationbehav-ioral skills) model. The program methods include education, setting and achieving goals, sharing experiences, telephone counseling, and self-monitoring. The topics of the program include joint assessment, exercise, massage, joint protection, medication, depression management, diet, and healthcare approach. The research was conducted following the principles of the nonequivalent control group pretest-posttest design. Participants were 26 subjects in the experimental group, and 27 subjects in the control group. The experimental group participated in the self-management program, and the control group received general education.

Results

Both post-test scores of personal motivation, social motivation, behavior skill, self-management behavior, joint pain, joint stiffness, physical function disability, right knee extension, left knee extension, and depression were significantly different between the experimental group and the control group.

Conclusion

The results of the study can be used to develop and standardize a systematic joint health self-management program. Further research is highly recommended to develop a strategy to continuously facilitate self-management of osteoarthritis patients’ procedures.

Keywords: Osteoarthritis; Self-management; Knowledge; Motivation; Behavior
Figure 1.

Conceptual framework of research.

Joint Health Self-management Program for Osteoarthritis Elderly in Community

Homogeneity Test of General Characteristics and Dependent Variables (N=53)

Effect of Self-management Program in Information, Motivation, Behavioral Skill, Self-management Behavior, K-WOMAC, Knee Range Of Motion (ROM), and Depression (N=53)

References

1. Ministry of Health and Welfare. Korea health statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANESV-3) Seoul: Ministry of Health and Welfare; 2013. December. Report No.: 11-13851159-000027-10.
2. Kim SY, Jeon EY. Influencing factors on osteoarthritis in Korean. The Korean Journal of Rehabilitation Nursing 2011;14(2):111–117.
3. Jeon EY. Health behaviors of the elderly with osteoarthritis across gender groups. Journal of The Korean Data & Information Science Society 2015;26(6):1453–1463. http://dx.doi.org/10.7465/jkdi.2015.26.6.1453.
4. Alves JC, Bassitt DP. Quality of life and functional capacity of elderly women with knee osteoarthritis. Einstein (Sao Paulo) 2013;11(2):209–215. http://dx.doi.org/10.1590/s1679-45082013000200013.
5. Yoon CH. Current clinical practice: Osteoarthritis update. The Korean Journal of Medicine 2012;82(2):170–174. http://dx.doi.org/10.3904/kjm.2012.82.2.170.
6. Lorig K, Holman HR. Self-management education: History, definition, outcomes, and mechanism. Annals of Behavioral Medicine 2003;26(1):1–7. http://dx.doi.org/10.1207/s15324796abm2601_01.
7. Lee EO, Kim SY, Seo MJ, Han JS, Kim MJ, Kang HS, et al. Arthritis, self-management of patients Seoul: Shinguang; 1999. p. 451.
8. Brown GA. AAOS clinical practice guideline: Treatment of osteoarthritis of the knee: Evidence-based guideline. Journal of American Academy of Orthopaedic Surgeons 2013;21(9):577–579. http://dx.doi.org/10.5435/jaaos-21-09-577.
9. Sim KH, Hwang MS. Effect of self-monitoring of blood glucose based diabetes self-management education on glycemic control in type 2 diabetes. Journal of Korean Academic Society of Nursing Education 2013;19(2):127–136. http://dx.doi.org/10.5977/jkasne.2013.19.2.127.
10. Lee EN, Lee KS, Lee I, Bak WS, Choi HK, Cho KS, et al. Effects of the new version of the arthritis self-management program in patients with osteoarthritis. Journal of Muscle and Joint Health 2015;22(2):105–113. http://dx.doi.org/10.5953/jmjh.2015.22.2.105.
11. Atkins DV, Eichler DA. The effects of self-massage on osteoarthritis of the knee: A randomized, controlled trial. International Journal of Therapeutic Massage and Bodywork 2013;6(1):4–14. http://dx.doi.org/10.3822/ijtmb.v6i1.119.
12. Lee MS, Lim HJ, Kim JS. The effect of health promotion program in vulnerable women with osteoarthritis. Journal of Korean Academy of Community Health Nursing 2011;22(3):241–251. http://dx.doi.org/10.12799/jkachn.2011.22.3.241.
13. Kim J, Hyun H. Effect of program promoting intention to exercise performance based theory of planned behavior in the elderly. Journal of Korean Biological Nursing Science 2015;17(1):1–10. http://dx.doi.org/10.7586/jkbns.2015.17.1.1.
14. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretro-viral therapy. Health Psychology 2006;25(4):462–473. http://dx.doi.org/10.1037/0278-6133.25.4.462.
15. Cho SJ. The effect of a self-efficacy reinforcement stretching exercise program for elderly patients with osteoarthritis [master’s thesis] [Seoul]: Korea University; 2012. p. 165.
16. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior 1st edth ed. Upper Saddle River, NJ: Prentice-Hall; 1980. p. 278.
17. Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers Newcastle upon Tyne: University of Newcastle; 2004. p. 42.
18. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatology 1989;32(1):37–44. http://dx.doi.org/10.1002/anr.1780320107.
19. Kim JI. The nurse's role of exercise intervention in patients having arthritis. The Korean Nursing 1994;33(3):28–32.
20. Jo KH, Oh WO, Choe JY. Development of a health behavior assessments scale of patients with rheumatoid arthritis. Journal of Korean Academy of Nursing 2000;30(5):1333–1346.
21. Bellamy N, Campbell J, Stevens J, Pilch L, Stewart C, Mah-mood Z. Validation study of a computerized version of the Western Ontario and McMaster universities VA3.0 osteoarth- ritis index. The Journal of Rheumatology 1997;24(12):2413–2415.
22. Bae SC, Lee HS, Yun HR, Kim TH, Yoo DH, Kim SY. Cross-cultural adaptation and validation of Korean Western Ontario and McMaster Universities (WOMAC) and Lequesne osteoarthritis indices for clinical research. Osteoarthritis and Cartilage 2001;9(8):746–750. http://dx.doi.org/10.1053/joca.2001.0471.
23. Sheikh JI, Yesavage JA. Geriatric depression scale (GDS): Recent evidence and development of a shorter version. In : Brink, TL, ed. Clinical gerontology: A guide to assessment and intervention Binghamton, NY: The Haworth Press, Inc; 1986. p. 165–173.
24. Kee BS. A preliminary study for the standardization of geri- atric depression scale short form-Korea version. Journal of Korean Neuropsychiatric Association 1996;35(2):298–307.
25. Seels B, Richey R. Instructional technology: The definition and domains of the field Washington, DC: Association for Educational Communications and Technology; 1994. p. 208.
26. Park SY, Son JT, Park DH, Lee KH, Kim JS. Effect of self help program or pain, ADL, exercise self-efficacy, and knowledge about arthritis in patients with osteoarthritis. Journal of Rheumatology Health 2004;11(1):31–41.
27. Lee HD, Han SW. The effects of swimming and aquarobics exercise programs for female elderly suffering from degenerative arthritis on leg muscular function and knee joint ROM. The Korea Journal of Sports Science 2010;19(4):1129–1139.

Article information Continued

Copyright © 2017 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1.

Figure 1.

Conceptual framework of research.

Table 1.

Joint Health Self-management Program for Osteoarthritis Elderly in Community

Week Theme Contents Conception Classification
1 Orientation & joint heath assessment ․ Program introduction
․ Written consent form, Pretest
․ Education: Joint health assessment Information Social motivation Personal motivation Education Sharing experience Goal attainment
․ Sharing experiences of osteoarthritis
․ Goals setting
  - Goal of health
  - Behavioral objectives of self-management: joint health assessment
2 Joint exercise & massage ․ Check in goal achieving: Joint health assessment Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: Joint exercise & joint massage Information Education
․ Goal setting of self-management: joint exercise & massage Personal motivation Goal attainment
3 Joint protection ․ Check in goal achieving: joint exercise & massage Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: Joint protection Information Education
․ Goal setting of self-management: joint protection Personal motivation Goal attainment
․ Leg muscle strengthening exercise & massage Social motivation Sharing experience
4 Medication for osteoarthritis ․ Check in goal achieving: joint protection Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: Medication for osteoarthritis Information Education
․ Goal setting of self-management: Medication Personal motivation Goal attainment
․ Leg muscle strengthening exercise & massage Social motivation Sharing experience
5 Depression management ․ Check in goal achieving: medication Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: Laughing therapy Information Education
․ Goal setting of self-management: depression management Personal motivation Goal attainment
․ Leg muscle strengthening exercise & massage Social motivation Sharing experience
6 Diet ․ Check in goal achieving: depression management Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: Diet for osteoarthritis Information Education
․ Goal setting of self-management: Diet Personal motivation Goal attainment
․ Leg muscle strengthening exercise & massage Social motivation Sharing experience
7 Healthcare approach ․ Check in goal achieving: diet Personal motivation Goal attainment
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: healthcare approach Information Education
․ Goal setting of self-management: healthcare approach Personal motivation Goal attainment
․ Leg muscle strengthening exercise & massage Social motivation Sharing experience
8 Wrap up ․ Check in goal achieving: Personal motivation Goal attainment
- Goal of health
- Total behavioral objectives of self-management
․ Review of self management checklist Behavioral skill Self monitoring
․ Sharing experiences of self-management Social motivation Sharing experience
․ Education: wrap up Information Education
․ Lower muscle strengthening exercise & massage Social motivation Sharing experience
․ Posttest
․ Closing ceremony
Every week Telephone counseling ․ Encourage fill in self-management checklist Behavioral skill Self monitoring
․ Encourage self-management practice Social motivation

Table 2.

Homogeneity Test of General Characteristics and Dependent Variables (N=53)

Characteristics Categories Exp. (n=26)
 Cont. (n=27)
 x2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 2 (7.7) 0 (0.0) 2.16 .236
Female 24 (92.3) 27 (100.0)
Age (year) 74.6±5.85 76.8±5.75 24.92 .108
Marital status Married 15 (57.7) 5 (18.5) 8.89 .007
Bereavement 11 (62.3) 22 (81.5)
Religion Christianity 10 (38.5) 13 (48.1) 3.54 .289
Buddhism 14 (53.8) 9 (33.3)
No 2 (7.7) 5 (18.5)
Education Uneducated 1 (3.8) 3 (11.1) 3.08 .608
Elementary school 14 (53.8) 13 (48.1)
Middle school 9 (34.6) 8 (29.6)
≥High school 2 (7.6) 3 (11.1)
Job Yes 1 (3.8) 1 (3.7) 0.00 1.000
No 25 (96.2) 26 (96.3)
Drinking Yes 3 (11.5) 2 (7.4) 0.27 .669
No 23 (88.5) 25 (92.6)
Smoking Yes 0 (0.0) 0 (0.0) 1.000
No 26 (100.0) 27 (100.0)
Duration of arthritis (month) 77.62±81.18 79.59±78.01 19.88 .312
Medication of analgesic Yes 4 (15.4) 11 (40.7) 4.20 .067
No 22 (84.6) 16 (59.3)
Experience educated on arthritis Yes 3 (11.5) 3 (11.1) 0.00 1.00
No 23 (88.5) 24 (88.9)
Information 14.15±2.85 14.41±2.31 -0.36 .724
Motivation Personal motivation 5.60±0.97 5.86±0.94 3.27† .393
Social motivation 5.48±1.27 5.40±1.23 3.62† .799
Behavior skill 1,075.77±108.08 1,007.74±203.35 1.51 .134
Self-management behavior 3.32±0.47 3.25±0.53 0.53 .601
K-WOMAC Joint pain 9.27±3.17 8.81±3.92 0.47 .137
Joint stuff 3.65±1.16 4.07±1.92 3.21† .331
Physical function disability 29.46±7.22 33.41±15.45 -1.18 .242
ROM Rt. knee flexion 116.35±11.10 113.30±13.60 0.89 .376
Rt. knee extension 168.65±4.81 163.52±12.47 2.07† .163
Lt. knee flexion 116.85±8.38 114.81±11.22 0.75 .458
Lt. knee extension 168.65±9.44 165.26±9.05 1.34 .188
Depression 5.35±2.93 6.30±3.73 -1.03 .308

Exp.=experimental group; Cont.=control group; Rt.=right; Lt.=left; ROM=range of motion;

†

Mann-Whitney U test.

Table 3.

Effect of Self-management Program in Information, Motivation, Behavioral Skill, Self-management Behavior, K-WOMAC, Knee Range Of Motion (ROM), and Depression (N=53)

Variables Categories Groups Pretest
 Posttest
 F p
M±SD M±SD
Information Exp. 14.15±2.85 18.58±1.58 31.10 <.001
Cont. 14.41±2.31 15.19±2.35
Motivation Personal motivation Exp. 5.60±0.97 6.69±0.51 13.72 .001
Cont. 5.86±0.94 5.84±0.93
Social motivation Exp. 5.48±1.27 6.28±0.68 6.57 .013
Cont. 5.40±1.23 5.52±1.12
Behavioral skill Exp. 1,075.77±108.08 1,184.23±151.61 12.36 .001
Cont. 1,007.74±203.35 1,014.81±176.08
Self-management Exp. 3.32±0.47 4.07±0.94 12.39 .001
behavior Cont. 3.25±0.52 3.33±0.50
K-WOMAC Joint pain Exp. 9.27±3.17 5.42±4.60 8.30 .006
Cont. 8.81±3.92 9.00±3.87
Joint stuff Exp. 3.65±1.16 2.58±1.75 5.32 .025
Cont. 4.07±1.92 3.85±1.75
Physical function Exp. 29.46±7.22 16.31±13.92 12.40 .001
Disability Cont. 33.41±15.45 31.07±14.03
ROM Rt. knee flexion Exp. 116.35±11.10 119.04±12.72 1.19 .281
Cont. 113.30±13.60 114.59±18.46
Rt. knee extension Exp. 68.65±4.81 171.15±5.16 8.43 .005
Cont. 163.52±12.47 165.56±8.24
Lt. knee flexion Exp. 116.85±8.38 122.12±10.31 1.71 .196
Cont. 114.81±11.22 118.04±12.43
Lt. knee extension Exp. 168.65±9.44 170.00±5.29 5.81 .020
Cont. 165.26±9.05 165.00±10.38
Depression Exp. 5.35±2.93 3.08±2.24 14.04 < .001
Cont. 6.30±3.73 6.07±3.41

Exp.=experimental group (n=26); Cont.=control group (n=27); Rt.=right; Lt.=left; ROM=range of motion.