Benefits of Therapeutic Education (TE)

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Benefits of Therapeutic Education (TE)

The WHO states that “‘‘the aim of therapeutic education (TE) is to teach the patient the adequate know-how. The patient’s TE is a permanent process, which is part of medical care. It includes sensitization, information, learning and psychosocial support, which are all related to the pathology and its treatments. The education should allow the patient and his family to have a better collaboration with the health care professionals’’

Therefore, TE aids patients with chronic conditions to have a better understanding of their disease and learn how to manage it. The main goal of TE is to improve the prognosis of the diseases and that can be achieved by reducing both morbidity and complications. Another objective of TE regards public health costs. TE offers patients with OA better self-management, as a result, it reduces medical care attention and because of lesser help from the medical care, it reduces the direct and indirect costs. Further studies are needed regarding the impact of TE on medical cost.

The Haute Autorite´ de Sante (HAS) in France has outlined the overall and specific goals of TE. Improving the patients’ health and patients’ families’ way of living is the general goal of TE. Patients’ achievement and maintenance of self-care competency or the ability to cope with competency depending on background and experience are the specific goals of TE. TE programs should consider data from evidence-based medicine, as well as recommendations from evidence-based practice.

The HAS focuses on the important role of the patients in the implementation of the education activity, the demand for a multidisciplinary team to lead the program, and the need to assess the quality and efficacy of these programs. Educational programs for OA include the ­­­­­­­­­diseases chronic nature, treatment involving pharmacological and non-pharmacological therapy, and lifestyle modification. The educational process must start at the first medical visit, from the diagnosis, and continue after surgical therapy, with rehabilitation being the best time to begin a self-care program.

PKQ-OA a questionnaire specifically for OA patient knowledge has been used to assess patients’ knowledge regarding their condition. When the authors assess the questionnaire, they found out that there is a wide range of knowledge levels among patients diagnosed with OA, the scores are ranging from 8 to 26 out of 30. Knowledge was not correlated with disease duration or patient’s age or sex; however, the number of years spent in formal education was correlated with high test scores.

Most patients know the symptoms of their condition but many methods of joint protection and energy conservation have been reported. Wrong beliefs were identified and common ones are ‘‘OA is caused by cold damp weather’’ and ‘‘blood tests are useful in OA diagnosis’’.  Poor knowledge about analgesics was identified: < 1/3 of patients knew that analgesics should be taken when experiencing pain.

Muscle tightening and strengthening exercises are helpful exercises for OA but 13% of patients assumed that housework is included in these exercises. Only 71% of patients knew that maintaining a recommended weight according to their height or taking note of their BMI (Body Mass Index) and age is a helpful way of slowing down the progressions of OA.

Avoidance of activity has been related to musculoskeletal disorders. Fear and anxiety may both contribute to the fear-avoidance model in musculoskeletal disorders. A patient’s interpretation of pain may lead to either of the two:

  • An adaptive response, whereby the patient deals with the pain and is more likely to manage it and maintain daily activities that will help achieve functional recovery;
  • A non-adaptive response that leads to maladaptive behaviours, including pain-related fear, avoidance, and hypervigilance.

Because of pain patients with musculoskeletal disorders tends to avoid activities for the fear of experiencing it. Now that the patient is avoiding or abstaining from physical activities, this will lead to further disability through unfavourable effects of physical inactivity and weakening of the musculoskeletal system.

TE should be included in the management of OA according to European League Against Rheumatism (EULAR), Osteoarthritis Research Society International (OARSI), and The French College of Physical Medicine and Rehabilitation (SOFMER). EULAR concerns patients’ education, physical exercise, technical aids and diet, but do not supply sufficient information regarding non-pharmacological therapies.

OARSI insist on the importance of educating patients with hip or knee OA and stating the areas where TE must be stressed to patients. Explaining the goals of treatment and the importance of changing lifestyles, such as the importance of exercise, activity adaptations, weight loss and other measures to help the joint(s) are the areas involved in the education.

SOFMER highlights the need for educational programs that are designed to encourage the daily practice of exercise activities. With these recommendations, sufficient details must be supplied for these measures to be implemented, especially patient’s education. The recommendations created by the US National Institute of Health regarding weight loss in OA are commonly used for obesity treatment in TE because no specific recommendation exists for TE regarding weight loss in OA.

According to the literature and international recommendation, TE should be included in OA management. The main goal of the education is to change the patient’s lifestyle, especially regarding physical activity and weight loss. Education must be started from the early stage of OA, as well as the pre-and postoperative periods. Further studies are required to create a better effective educational program for OA, it is either unaided or with the help of other therapies and measure its cost-effectiveness.

Self-management aid interventions that can help patients with OA improve their quality of life. One way to offer self-management to patients with OA is through a telephone-based OA management program. In a study conducted by Sperber et. al., the program offers 4 components: phone calls, educational material, setting goals and action plans.

Among all the participants more than 80% agreed that each component was helpful and the average rating of overall helpfulness on a scale from 1 to 10 was 7.6. Participants of these programs said that this intervention and each components is helpful in managing osteoarthritis.

Benefits of Therapeutic Education (TE)

Participants most frequently mentioned the health educator’s calls (44 of 140, 31%) as the most helpful component of the intervention. The health educators’ phone calls aided patients to stay on task with the educational materials and goal setting. With the phone call, patients have ease discussing their condition with someone who has the knowledge and understands their condition. Also, the calls provided them with educational benefits by teaching and clarifying information.

Educational materials (written and audio) (20 of 140, 14%) provided patients with information regarding OA and ways how to manage OA better. Audio cassettes and easy-to-read references are helpful and with these materials combined with the phone call, it will be more helpful for patients with OA. Goalsetting (11 of 140, 8%), setting goals were helpful and with the consistent phone calls, participants takes an active role in managing their condition.

Participants also commonly said that exercise (42 out of 140, 30%) and healthy eating and weight management (20 of 140, 14%) are helpful for managing their osteoarthritis symptoms because implementing these behaviours helps them manage their pain levels. But one patient stated that the exercise increases his strength and improves his ability to stand up but does not diminish pain.

This study has limitations but these results provide information on planning OA self-management support interventions. These programs may target and benefit some patients with OA.

Reference

  • Coudeyre, E., Sanchez, K., Rannou, F., Poiraudeau, S., Lefevre-Colau, M.-M. (2010) Impact of self-care programs for lower limb osteoarthritis and influence of patients’ beliefs. Annals of Physical and Rehabilitation Medicine 53, 434–450
  • Sperber, N.R., Bosworth, H.B., Coffman, C.J., Juntilla, K.A., Lindquist, J.H., Oddone, E.Z., Walker, T.A., Weinberger, M., Allen, K.D. (2012). Participant evaluation of a telephone-based osteoarthritis self-management program, 2006-2009. Prev Chronic Dis;9:110119. DOI: http://dx.doi.org/10.5888/pcd9.110119

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