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A nurse-led service to provide information on osteoarthritis

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VOL: 101, ISSUE: 03, PAGE NO: 38

Ann-Marie Hall, RGN, is senior staff nurse, rheumatology department, The James Cook University Hospital, Middlesbrough

Osteoarthritis literally means inflammation of the bones and joints. The condition destroys the hyaline cartilage at the articulating surfaces of bone, and is the most common joint disorder.

Osteoarthritis literally means inflammation of the bones and joints. The condition destroys the hyaline cartilage at the articulating surfaces of bone, and is the most common joint disorder.

According to the charity Arthritis Care (2004) about 8.5 million people in the UK are affected, and one million ask for treatment. Osteoarthritis is the leading cause of physical disability for people over 65 and demographic trends suggest that there will be a 66 per cent increase in the number of people with disability related to osteoarthritis by 2020 (Nuki, 2002).

Osteoarthritis is a chronic disease with no known cure. In the report OA Nation (2004), 81 per cent of respondents to a survey said they experienced constant pain or were limited in their ability to perform everyday tasks. The report also suggests that patient awareness of the help available is low, with 34 per cent of people with osteoarthritis never having visited a doctor. This is worrying as professional help, information and education can help patients manage pain control, function better and modify the disease process.

Hill (1998) states that patient education can be regarded as a treatment enhancer as it has been shown to lead to changes in behaviour, enhanced physical function and increased psychosocial health.

With this in mind, a survey was undertaken to review the quality of information given to osteoarthritis patients in the author's department and discover any issues that they might have. The aim was to highlight any improvements that could be made to enhance current practice. It was decided to evaluate certain aspects of care (Box 1).

The audit department of the trust was involved in developing a questionnaire, analysing the data and preparing the report. Survey forms were given to 30 patients with osteoarthritis. The forms were distributed by doctors and a physiotherapist in outpatient clinics.

Of the respondents, 16 per cent were under 50 years of age, 36 per cent were between 50-60, 32 per cent were 61-70, and 16 per cent were over 70. About 80 per cent were female.

The length of time respondents had been diagnosed with osteoarthritis was also analysed:

- 4 per cent had been diagnosed for less than 6 months;

- 14 per cent for 6-12 months;

- 29 per cent for up to two years;

- 18 per cent for up to three years;

- 14 per cent for up to five years; and

- 21 per cent for more than five years.

About 60 per cent had been diagnosed by their GP and 40 per cent by a hospital doctor. Overall, nearly 90 per cent had been given information and advice. Of these, about 96 per cent said they had understood it and a similar number felt it had answered their questions.

Respondents received information on a number of subjects including diagnosis, pain relief, weight, exercise and using heat/ice packs to relieve pain (Fig 1). Asked which members of the multidisciplinary team they had been referred to, 57 per cent said they had seen a physiotherapist, 33 per cent had seen an occupational therapist and 20 per cent had seen the appliance officer.

Patients also rated the importance of education on certain subjects, including osteoarthritis itself, medication and the future (Fig 2). They rated the usefulness of four education methods: classes, one-to-one contact, leaflets and a telephone call to monitor progress.

Education classes were rated as very useful by 27 per cent, useful by 54 per cent, eight per cent were indifferent and 11 per cent found them to be not useful or not useful at all.

One-to-one contact with a nurse was rated as very useful by 67 per cent, useful by 22 per cent and 11 per cent were indifferent.

Leaflets were thought by 64 per cent to be very useful, by 32 per cent to be useful and by four per cent not to be useful at all. A phone call to monitor progress was considered very useful by 40 per cent, useful by 44 per cent and not useful at all by four per cent. The remainder were indifferent. When asked their preferred interval between phone assessments, 22 per cent said monthly, 74 per cent six-monthly and four per cent yearly.

The sources of information utilised by respondents in decreasing order of use were:

- GP - 70 per cent;

- Hospital doctor - 63 per cent;

- Physiotherapist - 43 per cent;

- Leaflets - 43 per cent;

- Magazines - 40 per cent;

- Occupational therapist - 30 per cent;

- Newspapers - 30 per cent;

- Nurse - 23 per cent;

- Friends/relatives - 23 per cent;

- Other patients - 16 per cent;

- TV - 13 per cent;

- Internet - seven per cent.

All of the respondents were affected in more than one joint, but by far the most common site was the knees, affecting 87 per cent of the respondents.

Ninety per cent of patients had received information and advice, and of these about 96 per cent understood it and felt it answered their questions. However, 10 per cent had received no advice or information, and of those who did, a small number either did not understand or felt it did not answer their questions.

As the patients rated information about diagnosis, treatments, medication, self-help and future/prognosis equally, it would appear that nurses should also give equal value to information and education on weight/diet, exercise/rest and other self-help measures.

One of the main ways in which people can help themselves is by maintaining a healthy weight, and it is therefore surprising that none of the patients had seen a dietitian. In fact, the multidisciplinary team seems to be under-utilised, with only 33 per cent of patients seeing an occupational therapist and 20 per cent seeing an appliance officer. Both are able to provide help such as special footwear or solutions to lifestyle problems.

When asked to choose the method of education they found most useful, 67 per cent picked one-to-one education with a nurse. This contrasts with the sources of information actually utilised - only 23 per cent used a nurse.

By far the greatest sources of information for this group were doctors, with GPs cited by 70 per cent and hospital doctors by 63 per cent. However, this still suggests that at least 30 per cent did not consider their doctor a good source of information.

These results were discussed at a department education and audit meeting where it was decided to pilot a nurse-led education group for patients. While one-to-one education with a nurse was the preferred method, time and budget constraints made this unworkable.

It was decided to review the information leaflets that are given out in the department, as patients felt they were helpful but staff thought they were too generic.

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