Quality of Life Among Tawau Hospital Staff With Osteoarthritis (knees) Been Treated in Physiotherapy Unit Quality of life among Tawau hospital staff with osteoarthritis (knees) being treated in physiotherapy unit

Pilot study

Demographics

Knowledge about OA before physiotherapy

Severity of disease before and after rehabilitation

Degree of difficulty as a result of knee OA

Effect on work performance

Effect on emotional status and social activities

Opinion on self-management

Impact of physiotherapy on their knowledge and understanding of the disease

Impact of physiotherapy on their ability to cope and QoL

Publication of the study

Time schedule

Budget

Consent form

Appendix 4: Interview schedule

Quality of life among Tawau hospital staff with osteoarthritis (knees) being treated in physiotherapy unit

Introduction

Osteoarthritis (OA) in general is also referred to as degenerative joint disease and is a progressive joints disorder whereby there is gradual cartilage loss that results in formation of spurs (areas of abnormal hardening) and subchondral cysts (fluid-filled pockets in the marrow) of the bones at the margins of the joints. OA of the knee comes about as a result of "wear and tear" or gradual degradation of the hyaline cartilage that covers the articulating surfaces of the knee joint bones Solomon et al., 2010: 6.

It is characterized by atrophic thinning and wear of the cartilage, sclerosis of the underlying bone and osteophytic hypertrophy and roughening of the tibia and femur. Obesity predisposes individuals to greater risk of developing knee OA Coggon et al., 2001: 624(, Felson, 1996: 430S)

. Other risk factors of OA are muscle weakness and high bone density Bosomworth, 2009: 872()

As OA of the knee progresses, it causes deformation of bones and accumulation of fluids in the joints. Rest often relieves the pain. However, it may be made worse by placing weight on the joint. In the early stages of the disease, the pain is usually minor and may manifest as mild stiffness in the morning. As the disease progresses, inflammation develops and the patient may experience pain even when they are not using the joint. The person may also suffer from permanent loss of the normal range of motion in that particular joint.

Until the late 1980s, OA was regarded as an inevitable part of aging, caused by simple "wear and tear" of the joints. This view has been replaced by recent research into cartilage formation. OA is now considered to be the end result of several different factors contributing to cartilage damage, and is classified as either primary or secondary. In the UK alone, OA is the primary cause of disability, joint deformity and loss of joint mobility that have substantial impact on the health of an individual The National Collaborating Centre for Chronic Conditions, 2008: 8.

The increasing number of cases of OA, especially with knee pain, being referred from primary care or orthopedic clinics show that there are many people experiencing problems with OA. This problem now also affects middle age people who are considered to be active and career-oriented. However, due to little knowledge and awareness of the condition, it impacts and limits their physical activities, psychosocial life and working life quality.

Quality of life (QoL) generally refers to the well-being of an individual. This includes their physical, mental and emotional well-being Fallowfield, 2009.

General occurrence of knee pain caused by OA could lead to a decline of quality of life.

The research study is aimed at identifying the impact of OA on patients and the limitations they face as a result of their condition. This will help to evaluate the impact of OA on their quality of life. The study will also find out the coping behaviors that patients have developed to mitigate these limitations and how rehabilitation affects their coping behaviors. The findings or results of study will help to inform practitioners on the impact of OA on patient's QoL in order to develop more client-centered interventions.

Literature review

Joint pain especially in the knees is a most common complaint which impact quality of life. Osteoarthritis (OA) or a degenerative joint disease (DJD) is the most common form of joint disease, cause by wear and tear process of the articular cartilage and the underlying bone become deteriorated Brandt et al., 2009: 3.

There may also be hypertrophy of bone at the joint margins, with the formation of osteophytes

ADDIN EN.CITE

(Arehart-Treichel, 1982: 156, Hutton, 1989: 959)

. The changes may affect predominantly the femoro-tibial joint or the patello-femoral joint, but usually the whole joint is affected. Effusion of fluid into the joint is unusual, except after much...

It is a major weight-bearing joint which is held together or supported by a muscles, ligaments and soft tissues Felson, 2005: 626.
The articular cartilage provides shock absorption especially when we walk, run, climb stairs or play. Clinically, patients with knee OA suffer pain in and around the knee joint which worsens with weight-bearing activities but improves with rest. They also experience morning stiffness and gel phenomenon Felson, 2004: 9

( ADDIN EN.CITE )

. On physical examination, they often have tenderness, bony enlargement, crepitus on motion, and/or limitation of joint motion Hochberg et al., 1995: 11()

"Patient quality of life is an increasingly important outcome measure in medicine and healthcare. It is now widely used in clinical trials and in patient management for assessing morbidity and the impact of treatment," Rees et al., 2005: 563

( ADDIN EN.CITE )

. The clinical outcome of people suffering from knee OA includes limitations of daily living activities, pain and overall decline in the quality of life. More importantly, knee OA leads to the state of unbalance where those suffering from knee OA face the risk of frequent falls as a result of bone deterioration. Age also plays an important role in knee OA progression and cartilage degradation Moskowitz, 2009: S224()

Overall, people suffering from knee OA not only experience a significant deterioration in overall performance-based status but also low quality of life. Chacon et al. (2004: 377-381)

focus on the impact of knee OA on the quality of life of patients. The authors point out that knee OA generally affects people aged 40 years and above and is the most rheumatic disease among general population (p. 379). However, the disease generally affects the joints, and it increases the level of pain, risk of physical disability and mobility restriction. Knee OA may also lead to decreased joint function, early retirement and physical disability. More importantly, knee OA contributes to increased mortality and impairment of the quality of life among people suffering from the condition. Pain is the major clinical component in knee OA leading to the negative sense of well-being among people. OA also leads to increment in anxiety and mortality rate. Though there is evidence that there is a direct correlation between knee OA and patient's well-being, the overall conclusion of the authors is that knee OA leads to a decline in the quality of life of patients because the chronic pain associated with knee of patients (p. 380).

Breedveld, 2004: i6()

provides a similar argument of knee OA by ranking the health impact of OA equally with congestive heart failure, heart disease, and chronic obstructive pulmonary disorder (COPD). People suffering from knee OA generally require human assistance in carrying out functional activities such as walking long distances, climbing stairs, carrying heavy loads and housekeeping chores. However, the risk of knee osteoarthritis worsens with increase in age. Typically, more than 13% of people between 55 and 64 in the United States suffer from knee osteoarthritis. It is a general agreement that influence of age may result from insufficient cartilage repair, hormonal changes as well as cumulative exposure to damaging environmental effects. The author further argues that presence of knee OA may trigger the occurrence of other diseases (p. i5). A large proportion of people suffering from OA also suffer from comorbidities such as cardiovascular disease, congestive heart failure, renal function impairment, peripheral vascular disease, respiratory and diabetes disease.

Murphy and Helmick (2012: S13 - S15)

in their own case reveal the cost burden of OA on patients. "In 2003, the costs attributable to knee osteoarthritis and other rheumatic conditions were $128 billion ($81 billion in medical expenditures and $47 billion in earnings losses), which represented nearly 1% of that year's U.S. Gross domestic product" (p. S13). Furthermore, the total cost burden for knee and hip replacements in the United States was approximately $43.9 billion in 2009. Nevertheless, people with knee OA are likely to bear the burden of medical costs. The authors also found that those with rheumatic conditions caused by OA are likely to spend $3,613 per person (p. S14). These findings show that the costs associated with OA in general are extremely high. Knee OA is also seen to contribute a huge chunk of medical expenditure on patients which may cause them financial stress that deteriorates their quality of life through stress and depression.

In a study that was conducted under the PraxArt project, it was found that OA has a negative effect on the quality of life of patients. The study also reveals that when a patient-centered intervention that allows for…