Many people with OA suffer from chronic pain, joint degeneration and disability. Lack of independence and decreased social relationships severely affect these individuals and reduce their quality of life. Osteoarthritis is clearly a significant health problem for patients as well as for health care professionals.145 Psycho-educational interventions are a useful additional modality in
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the management of rheumatic diseases and may improve treatment effects and patient quality of life. Overall, there is improvement in pain, depressive symptoms, self-efficacy, coping abilities, and self-management behaviours such as exercise compliance following psycho-educational interventions, with a trend to greater improvement for OA than other forms of arthritis like rheumatoid arthritis.145
Owing to severe pain, most patients with OA initially seek conventional pharmacologic therapies, including analgesics, nonsteroidal antiinflammatory drugs (NSAIDs), intra-articular corticosteroids, peripatellar corticosteroids, intra-articular hyaluronic acid, and topical capsaicin.
Many of these pain medications have adverse side effects that have the potential to compromise the health status of patients with OA.145
The guidelines of American College of Rheumatology underscore NPTs as an indispensible OA management strategy. According to those guidelines, among various NPTs, including patient education, self-management programs, social support, physical/occupational therapy, exercise, and use of assistive devices, Patients education is recommended as the most important approach for managing OA before any other therapies.91 Psychosocially focused NPTs, in the form of psycho-education may increase patients' self-efficacy and adherence to certain OA therapies and ultimately increase their effectiveness.145 Because OA is a chronic condition, a balanced multidisciplinary approach using both pharmacologic and non-pharmacologic strategies is needed to manage this problem across time. Psychosocial interventions, especially psycho-education in combination with routine medical treatment, when effective help to reduce pain, improve physical mobility, and maintain function.145
Psycho-education is important in OA because of the poor knowledge of OA in the general population.7,146 Kurubaran et al. in a cross-sectional study to assess the level and determinants of knee OA among railway workers in Malaysia found out that, 53.6% of the respondents had low or poor knowledge score.146 Akinpelu and colleagues in a study in rural community settings in north
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eastern Nigeria to determine the rural dwellers belief about the cause of OA, found majority of the respondents with poor knowledge of OA. 7
Many randomised controlled trials (RCTs) reported positive effects of psychosocially focused NPTs on pain reduction and function improvement. The intervention group participants showed statistically significant improvements in self-efficacy, adherence to therapies, and quality of life compared with the control group. Most of the studies reported that, the effects of psycho-education on improved self-efficacy, adherence to therapies, and quality of life persisted for at least 12 months. However, few of the studies did not show a significant difference on pain and mobility.145
Family-focused intervention in the form of couple-oriented education among patients with OA which consisted of 5 sessions attended by patients and their spouses showed better disease adaptation and coping.147 Nunez et al. in Spain found an improvement in physical function and HRQOL after 9months of educational program in patients with knee OA awaiting TKA.148 Similar findings were observed by Peter et al. who found a positive significant difference in VAS and WOMAC scores of patients with OA after three months of psycho-educational intervention (self management).149
2.10.4 Benefits and limitations of psycho-education
Psycho-education applied to the management of chronic diseases like OA, SCD and bronchial asthma were found to improve patient attitude towards medical services, QoL and adherence to therapy as well as reducing global family conflicts. Family psycho-educational programs for patients and their caregivers are effective in improving the physical and emotional health. Psycho-education is cost effective though complexity of care may be increased.16, 101
Psychosocial approaches enhance medical regimes of care. There is evidence that psychosocial interventions improve coping and self efficacy, reduce psychological distress and reduce pain
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among patients with OA. While there is a body of literature examining psychosocial approaches, the volume addressing one specific approach or research question is not large enough to draw confident conclusions. More studies into their effectiveness are required.141
Although most of the studies demonstrated the positive effects of psychosocially focused NPTs for OA patients, the evidence is modest. High-quality randomised controlled trials which examined the effects of psychosocially focused NPTs only are relatively few in number. Only patients with lower-extremity OA (knee and hip OA) were examined, and most studies failed to demonstrate long-term effects for pain control and joint mobility. Only few study provided follow-up data at 24 months. In addition, there was no research which considered how the experience of OA pain and immobility may differ and how interventions may need to be modified for various ethnic groups.145
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CHAPTER THREE
3.0 METHODOLOGY 3.1 STUDY AREA
Jos is the capital of Plateau State and is located in North-Central Nigeria with an estimated population of 510,000. It is located at latitude 9° 55' N and longitude 8° 53' E and at an altitude of about 1300 m (about 4,100 ft) above the sea level. Its landscape is mostly treeless in the North and comprises features like hills and captivating rock formations, ranging from bare rocks, artificial hillocks and deep ponds which emanated from years of tin mining. It has a dry season between November and March and a rainy season between April and October It covers an area of about 7,800 sq km. Temperatures on the Plateau are generally about 4oC cooler than those on the coast and the annual rainfall of about 1,300 mm is considerably higher than that in the surrounding lowlands. Jos is a cosmopolitan city where various tribes of the country are represented. The population of Plateau state was 3,178,712 according to the 2006 national census.150
The Jos University Teaching Hospital is a 525 bed facility that provides primary, secondary and tertiary health care to the people of Plateau State and the adjoining States of Gombe, Nassarawa, Benue, Bauchi, Kaduna, Taraba and Adamawa.
The study was carried out at the general outpatient department and the orthopaedic clinic of the Jos University Teaching Hospital (JUTH).
The general outpatient department (GOPD) of JUTH is a primary care setting managed mainly by Family Medicine Residents and consultants. Most patients attending the clinic understand and speak either English or Hausa Language or both. The orthopaedic clinic managed orthopaedic patients including patients with osteoarthritis who are seen weekly on Wednesdays.
On the average, about 60 patients are seen per clinic.
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