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

Young-il Kim; Jeong Sook Park

doi:10.12799/jkachn.2017.28.1.55

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

Original Article

J Korean Acad Community Health Nurs 2017;28(1):55-68.

Published online: 12 March 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.1.55

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

Young-il Kim¹, Jeong Sook Park²

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 15 December 2016 Revised 10 March 2017 Accepted 13 March 2017

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.

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

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 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. Brink, TL, editor. 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.

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
Every week	Telephone counseling	․ 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
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	2 (7.7)	0 (0.0)	2.16	.236
Gender	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
Marital status	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
Job	No	25 (96.2)	26 (96.3)
Drinking	Yes	3 (11.5)	2 (7.4)	0.27	.669
Drinking	No	23 (88.5)	25 (92.6)
Smoking	Yes	0 (0.0)	0 (0.0)		1.000
Smoking	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
Medication of analgesic	No	22 (84.6)	16 (59.3)
Experience educated on arthritis	Yes	3 (11.5)	3 (11.1)	0.00	1.00
Experience educated on arthritis	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
Motivation	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
Variables	Categories	Groups	M±SD	M±SD	F	p
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.

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