Arthritic patients' views and perceptions on exercise as an adjunct treatment regime for managing their condition
Date
2016
Authors
Pillay, Lervasen
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Abstract
Introduction: Arthritic disease, presenting with a variety of joint pathologies has a
myriad of treatment modalities. Treatment is dependant on various types of
medication stemming from the specific diagnosis. Treatment is often
supplemented with dietary changes, lifestyle related changes and exercise.
Objective: This study aimed to assess the view of arthritic patients towards
exercise as an adjunct treatment to medication in managing symptoms of their
condition, participant’s knowledge of appropriate exercise regimes in managing
their symptoms, whether or not healthcare providers prescribed exercise as a part
of treatment, the different healthcare providers exercise prescription habits, the
exercise modes and the outcome of the effects of exercise (subjective feeling of
pain relief).
Methods: A cross-sectional survey study design was used. Patients presenting at
two private general practitioners and a biokineticist practices based in the
southern suburbs of Johannesburg were invited to participate in this
questionnaire-based study. Patients that met the inclusion criteria (those
participants diagnosed with any arthritic disease with or without a co-morbid
disease not contra-indicating exercise) were included in the study. Questions
were developed to determine various aspects of the effect of exercise and
participants’ attitudes toward exercise as an additional management tool in
arthritic patients. These were all self-reported by the participant using the
questionnaire. In addition, information on the type of healthcare providers
prescribing exercise, exercise modes and outcomes of exercise were also
gathered. Outcomes (improvements in the participants’ arthritic condition,
symptoms and activities of daily living with exercise) were used as criteria for
improvement. This study did not differentiate between single joint and multi joint
arthritis.
Results: A total of 67 participants were surveyed of which 25% were male and
73% female. The remaining two percent were unspecified. Age distribution was as
follows: 60% >50 years old, 36 % were 30-50 years old and the remaining four
percent <30 years of age. Most participants suffered from osteoarthritis (N=29),
followed by rheumatoid arthritis (N=27), gout (N=five) and post traumatic arthritis
(N=three) while the remaining participants were not specific. Exercise was
advised mostly by doctors, followed by physiotherapists then biokineticists.
Osteoarthritis and rheumatoid arthritis accounted for the multi-joint involvement
arthritic disease. Exercise that was advised by doctors was found to be general
(walking-no specifics regarding intensity and time). It was not specific enough and
mostly included walking (48%). Exercise alone diminished pain (not statistically
significant; p=0.18) and improved activities of daily living by 11%, while
medication alone did relieve pain (p=0.034) and improved activities of daily living
by 21%. Pain was measured using a numeric pain scale and activities of daily
living were self-reported by the participants using the questionnaire. Observations
and analysis from the study concludes that medical treatment aided by exercise
will improve results in the treatment of participants with arthritic disease. The
largest improvement and statistically significant finding in perceived pain relief
was noted in the combination of both exercise and medication (p=0.01) with a
32% improvement in activities of daily living.
Participants surveyed are of the view that exercise assists them in managing the
symptoms of arthritis.
Conclusions: Exercise is an important adjunctive treatment modality. Doctors
were in fact advising exercise more than other healthcare providers but this
advice was very non-specific. Participants were physically active (N=52) and
believe that exercise can benefit them. This studies findings suggest that
healthcare providers need to prescribe exercise more specific to the patient’s
condition and physical capabilities. There is no “one size fits all” exercise
prescription.
This study adds to the knowledge base of the field in the management of arthritic
disease in the southern suburbs of Johannesburg in South Africa. It is consistent
with other research done in this field. Future research should be directed toward
exploring further these findings and the reasons why healthcare practitioners fail
to be specific in their exercise advice.
Description
A research report submitted to the Faculty of Health Sciences, University of
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the
degree of Master of Science of Medicine in Sports Medicine.
Johannesburg, 2016.