Healthy People 2020's Goal: "prevent illness and disability related to arthritis and other rheumatic conditions, osteoporosis and chronic back conditions"

Objectives for stated goal:

• "Reduce the mean level of joint pain among adults with doctor-diagnosed arthritis"
• "Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation in activity due to arthritis or joint symptoms"
• "Increase the proportion of adults with doctor-diagnosed arthritis who have had effective, evidence-based arthritis education as an integral part of the management of their condition"

1. Understand what osteoarthritis is
2. Determine main concerns with osteoarthritis
3. Understand what guided imagery and relaxation is
4. Understand what exercises are used for people with osteoarthritis
5. Understand what spa therapy is
6. Feel confident to perform application of new knowledge independently

Take the Pre-Quiz to assess your current level of knowledge

What is Osteoarthritis?

Osteoarthritis is a chronic disease that affects more than 43 million people across the world, so remember you are not alone! It is recognized as a national priority health problem. The inability to have complete control over your hand from the disease is mostly from the pain and joint degeneration, so if we can decrease these main two problems, we can increase the quality of life for you! It is possible to decrease pain and increase mobility related to osteoarthritis without medications (non-pharmacological measures). However, it is important to keep in mind that there is not absolute cure for osteoarthritis.

Guided Imagery and Relaxation

Guided imagery is a self-management intervention to improve quality of life for those who have osteoarthritis. It can be more effective than using just medications. Since it can lead to decreased pain and ability of move affected parts with less pain and more ease. Verbal suggestions create a flow of thoughts that focus your attention on imagined visual, auditory, touch, and smell sensations. Relaxation along with the guided imagery will allow more concentration on visualization. An audiotape can be used to aid in guidance of the imagery. For example, you may imagine a hillside with your favorite flowers scattered throughout, then you would think about how the flowers smell and how they feel on your hands. You would deep breath while imagining this hillside and focus on how your breathing sounds and feels; imagine the air coming in your lungs and coming out of your lungs. You can also imagine using your hands to plant the flowers, and the planting doesn't cause you any pain the entire time. Guided imagery is easy to use independently which will lead to decreased anxiety around the disease and improved quality of life.

Exercises

Based on evidence, the following are recommendations for an exercise program to reduce pain and swelling, and increase range of motion and use of the hand:

1. The exercises should be performed 2-3 days in a week
2. A warm-up should be included in the beginning of the exercises
3. The exercises should involve range of motion, increasing strength and endurance along the way
4. Each recommended exercise should be performed 4 times
5. The exercises should last 20 minutes
6. Allow your body to rest 48 hours (2 days) between the exercises
7. Maintain the exercise program for 12-15 weeks

A journal should be kept of exercises performed and rest periods. This will increase adherence to the exercise program and maintain alignment with recommendations.

The following images are examples of exercises to perform that are shown to reduce pain and increase mobility in the affected body parts:

Spa Therapy

Spa therapy consists of alternative remedies to decrease pain and other problems related to osteoarthritic. These therapies include paraffin-ozokerite treatment, mud treatment, pearl bath, and underwater massage.

• Paraffin-ozokerite treatment - slab of paraffin-ozokerite which is gently wrapped locally around the affected limbs to provide a deep-heating effect upon bones and muscles
• Mud treatment - mud is applied to the whole body
• Pearl bath - air bubbles are gently passed through a warm bath of water to encourage muscle and joint relaxation with the water providing gentle massage
• Underwater massage - focused joint and muscle massage via a submerged water jet

This therapy will reduce pain, improve your sense of wellbeing and increase your quality of life. It potentially can lead to a decrease in use of pain medication.

Summary

It is shown with evidence that there are alternative ways to manage osteoarthritis symptoms than use normal pharmacological means. Guided imagery with relaxation, exercises, and spa therapy could be used together or separately to change the quality of life, ability to move freely, and many other aspects of your life that may be effected by osteoarthritis. Always consult with your physician before starting new therapies to promote the safest, most effective path to healing. Your local physician, occupational and physical therapists, and other health care workers in the community can be reached at any time with questions.

Take the Post-Quiz to assess how much you learned

References

Baird, C., & Sands, L. (2006). Effect of guided imagery with relaxation on health-related quality of life in older women with osteoarthritis. Research In Nursing & Health, 29(5), 442-451.

Kjeken, I., Grotle, M., Hagen, K. B., & Østerås, N. (2015). Development of an evidence-based exercise programme for people with hand osteoarthritis. Scandinavian Journal Of Occupational Therapy, 22(2), 103-116. doi:10.3109/11038128.2014.941394

Office of Disease Prevention and Health Promotion. (2017, Feb. 23). Arthritis, Osteoporosis, and Chronic Back Conditions. In Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions/objectives

Vaht, M., Birkenfeldt, R., & Ubner, M. (2008). An evaluation of the effect of differing lengths of spa therapy upon patients with osteoarthritis (OA). Complementary Therapies In Clinical Practice, 14(1), 60-64.