Journal of Korean Academy of Nursing

Original Articles

A Structural Equation Model of Health-Related Quality of Life among Older Women Following Bilateral Total Knee Replacement: Lee, Hyun Ok , Yoo, Jae Soon; J Korean Acad Nurs 2020;50(4):554-570. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19216

Purpose
This study aimed to develop and test a structural equation model of health-related quality of life among older women following bilateral total knee replacement based on a literature review and Wilson and Cleary’s model of health-related quality of life.
Methods
One hundred ninety three women who were diagnosed with osteoarthritis, were older than 65 years, and were between 13 weeks and 12 months of having a bilateral total knee replacement were recruited from an outpatient clinic. Data were collected from July 2017 to April 2018 using a structured questionnaire and medical records. Data were analyzed using SPSS/WIN 22.0, AMOS 22.0, and Smart PLS 3.2.4.
Results
The fitness of the hypothetical model was good, with coefficients of determination (R² ) ranging between .28 and .75 and predictive relevance (Q² ) between .26 and .73. The standardized root mean square residual of the model fit indices for the hypothetical model was .04; which explained 64.2% of physical and 62.5% of mental health-related quality of life. Self-efficacy, symptom status, functional status, and general health perceptions had a significant direct effect on physical health-related quality of life, while social support, symptom status, and general health perceptions had a significant direct effect on participants’ mental-health-related quality of life.
Conclusion
To improve the physical and mental quality of life of older women who receive bilateral knee replacement, nursing-based intervention strategies that reduce symptoms, improve functional status, and increase health perceptions, self-efficacy, and social support are needed. The most important factor is the symptom status.

Citations

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Health-related quality of life for older patients with chronic low back pain: A structural equation modeling study
Suin Lee, Eun-Ju Lee
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Effect of a Physical Activity Promoting Program Based on the IMB Model on Obese-Metabolic Health Outcomes among Obese Older Adults with Knee Osteoarthritis: Kim, Jung-Suk , Kim, Chun-Ja; J Korean Acad Nurs 2020;50(2):271-285. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.271

Abstract PDF

Purpose
This study examined the effects of a physical activity promoting program based on the Information-Motivation-Behavioral Skills (IMB) model on physical activity and health outcomes among obese older adults with knee osteoarthritis.
Methods
This study utilized a randomized controlled trial with a convenience sample of 75 obese older adults with knee osteoarthritis in a university hospital. The older adults in the intervention group participated in a 12-week program involving weekly group sessions and monitoring calls with education booklets and video clips for exercise dances, while those in the control group received an usual care. Outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. The intervention effects were analyzed using Mann-Whitney U test and ANCOVA.
Results
The mean age of participants was 74.9 years with 84.0% women. The intervention group at 12 weeks showed significantly greater improvements in self-efficacy for physical activity (F=81.92, p <.001), physical activity amounts (Z=-2.21, p =.044), knee joint function (F=15.88, p <.001), and health-related quality of life (F=14.89, p <.001) compared to the control group. Among obese-metabolic outcomes, the intervention group at 12 weeks showed a significant decrease in visceral fat mass (F=7.57, p =.008) and improvement in high-density level cholesterol (F=9.51, p =.003) compared to the control group.
Conclusion
Study findings support the need for an IMB based physical activity program for promoting physical activity, knee function and health outcomes in obese older adults with knee osteoarthritis. Longitudinal studies are warranted to confirm the persistence of obese-metabolic effects in clinical settings.

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Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta‐Analysis
Belinda J. Lawford, Rana S. Hinman, Libby Spiers, Alexander J. Kimp, Andrea Dell'Isola, Alison R. Harmer, Martin Van der Esch, Michelle Hall, Kim L. Bennell
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An Effect of Muscle Strengthening Exercise Program on Muscle Strength, Pain, Depression, Self-efficacy, and Quality of Life of Patients with Knee Osteoarthritis: Mi Ra Lee; Journal of Nurses Academic Society 1996;26(3):556-575. Published online March 30, 2017; DOI: https://doi.org/10.4040/jnas.1996.26.3.556

Abstract PDF

In an attempt to investigate the effect of a muscle strengthening exercise program on muscle strength, pain, depression, self-efficacy and quality of life of patients with knee osteoarthritis, a pre-experiment, one group pre-test and post-test design, was planned. Muscle strengthening exercise was carried out from May 22 through August 14, 1995 at isokinetic exercise room in rehabilitation department of University Hospital in Taejon. The subjects were seven female clients conveniently sampled from University Hospital located in Taejon, between 39 and 61 years of age, who had a osteoarthritis in knee. Muscle strengthening exercise program was composed of three sessions per week, one isokinetic exercise at angular velocity of 60degrees and 180degrees with Cybex isokinetic dynamometer and two resistance home exercise sessions with elastic band. Data were analyzed with frequency, percentage of change, Friedman test, Duncan test using SAS program. Results were obtained as follows: 1) Flexion and extension muscle strength at angular velocity of 60degrees and 180degrees were increased after 12weeks' exercise than those of before experiment. But exept flexion muscle strength at angular velocity of 180degrees (F=3.34, P=0.0261), there was no statistically significant difference among muscle strengths, which is measured every 3 weeks. 2) Pain was decreased after 6weeks' exercise than that of before experiment, and after 12weeks' exercise than that of 6weeks' exercise. There was statistically significant difference(F=4.28, P= 0.0396). 3) Depression was increased after 6weeks' exercise than that of before experiment, and after 12weeks' execise than that of 6weeks' exercise. There was no statistically significant difference between before experiment and after 6weeks' exercise. But, there was statistically significant difference between after 6weeks' exercise and 12weeks' exercise (F=9.38, P=0.0035). 4) Self-efficacy was decreased after 6weeks' exercise than that of before exercise. But, it was increased after 12weeks' exercise than that of before exercise and after 6weeks' exercise. But there was no statistically significant difference (F=1.46, P=0.2706). 5) Quality of life was increased after Gweeks' exercise than that of before exercise, and after 6weeks' exercise than that of 12weeks' exercise. But there was no statistically significant differ-ence(F=1.06, P=0.3816). Thus, the significant of muscle strengthening exercise for the improvement of muscle strength, pain, depression, is verified. But, this study was a preexperiment with small size subjects. So, controlled experimental study is necessary to determine the effect of this muscle strengthening exercise program on muscle strength, pain, depression, self-efficacy, and quality of life of patients with knee osteoarthritis.

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The effects of elastic band exercises and nutritional education on frailty, strength, and nutritional intake in elderly women
Yena Bong, Wook Song
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Public Health Nursing.2009; 26(6): 523. CrossRef

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Effects of a Sun-style Tai Chi Exercise on Arthritic Symptoms, Motivation and the Performance of Health Behaviors in Women with Osteoarthritis: Rhayun Song, Eun Ok Lee, Paul Lam, Sang Cheol Bae; Journal of Korean Academy of Nursing 2007;37(2):249-256. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2007.37.2.249

Abstract PDF

Purpose

Tai Chi exercise, an ancient Chinese martial art, has drawn more and more attention for its health benefits. The purpose of the study was to identify the effects of a Sun-style Tai Chi exercise on arthritic symptoms (joint pain and stiffness), motivation for performing health behaviors, and the performance of health behaviors among older women with osteoarthritis.

Methods

Total of 72 women with the mean age of 63 years old were recruited from outpatients clinic or public health centers according to the inclusion criteria and assigned randomly to either the Tai Chi exercise group or the control. A Sun-style Tai Chi exercise has been provided three times a week for the first two weeks, and then once a week for another 10 weeks. In 12 weeks of study period, 22 subjects in the Tai Chi exercise group and 21 subjects in the control group completed the posttest measure with the dropout rate of 41%. Outcome variables included arthritic symptoms measured by K-WOMAC, motivation for health behavior, and health behaviors.

Results

At the completion of the 12 week Tai Chi exercise, the Tai Chi group perceived significantly less joint pain (t=-2.19, p=0.03) and stiffness (t=-2.24, p=0.03), perceived more health benefits (t=2.67, p=0.01), and performed better health behaviors (t=2.35, p=0.02), specifically for diet behavior (t=2.06, p=0.04) and stress management (t=2.97, p=0.005).

Conclusion

A Sun-style Tai Chi exercise was found as beneficial for women with osteoarthritis to reduce their perceived arthritic symptoms, improve their perception of health benefits to perform better health behaviors.

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Structural Equation Modeling on Quality of Life in Older Adults with Osteoarthritis: Jihyun Oh, Myungsun Yi; J Korean Acad Nurs 2014;44(1):75-85. Published online February 28, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.1.75

Abstract PDF

Purpose

The aim of this study was to explore how individual factors, physiologic factors, symptoms, environmental factors, functional status and health perception predict the quality of life (QOL) for older adults with osteoarthritis and to provide guidelines for interventions and strategies to improve QOL in these patients. The conceptual model was based on the Wilson and Cleary's Model.

Methods

Data were analyzed using SPSS WIN 20.0 and AMOS 19.0 program.

Results

The proposed model was a good fit for the data based on the model fit indices. Based on the constructed model, individual factors, social support, functional status and health perception were founded to have direct effects on QOL. Symptom had a indirect effect on QOL. Social support had a significant effect on QOL, and this model explained 63.6% of the variance in QOL.

Conclusion

The results of this study suggest that nursing strategies to increase QOL in this population should contain social support to promote QOL and manage functional limitations and health perception.

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Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis: Chung Yul Lee, Yoon Hee Cho; J Korean Acad Nurs 2012;42(7):965-973. Published online December 12, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.7.965

Abstract PDF

Abstract Purpose

The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea.

Methods

The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables.

Results

The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group.

Conclusion

Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.

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Effects of Tai Chi Exercise in Elderly with Knee Osteoarthritis: Hea-Young Lee, Keum Jae Lee; Journal of Korean Academy of Nursing 2008;38(1):11-18. Published online February 29, 2008; DOI: https://doi.org/10.4040/jkan.2008.38.1.11

Abstract PDF

Purpose

This study was to determine whether the Sun-style 24 forms of Tai Chi exercise improve pain, stiffness, disability, knee joint motion, mobility, balance or falling.

Methods

Forty-six community-dwelling elderly subjects (mean age, 75.46±6.28) voluntarily participated in an intervention group of either 24 forms of Sun-style Tai Chi for 60 min, 2 times per week for 12 weeks or a control group. A on-equivalent pretest-posttest design was used. Independent t-test and ANCOVA were used to examine group differences by using SPSS12.0.

Results

The experimental group had significantly less pain (F=7.60, p=.008) and stiffness (t=-3.19, p=.003) than the control group. Also there were significant improvements in knee joint motion on the right knee (t=2.44, p=.019), left knee (t=2.30, p=.026), rising time (F=8.03, p=.07), balance on the left single leg test (t=2.20, p=.033), and fear of falling (t=-2.33, p=.024) in the Tai Chi exercise group. No significant group differences were found in disability and falls efficacy.

Conclusion

The Sun-style 24 forms Tai Chi exercise is effective in decreasing pain, stiffness, fear of falling and it improves balance, rising time, and knee joint motion. We suggest a continuing long term intervention to decrease disability and increase efficacy concerning falls.

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Comparison of Effects among Tai-Chi Exercise, Aquatic Exercise, and a Self-help Program for Patients with Knee Osteoarthritis: Hea Young Lee; Journal of Korean Academy of Nursing 2006;36(3):571-580. Published online June 30, 2006; DOI: https://doi.org/10.4040/jkan.2006.36.3.571

Abstract PDF

Purpose

This study was to compare the effects among Tai-Chi exercise, aquatic Exercise, and a self-help program for knee osteoarthritis patients on symptoms of arthritis, muscle strength, balance, and difficulty of performing activities.

Method

There were 50 final subjects50. A non-equivalent pretest-posttest design was used. The collected data was analyzed using SPSS for Window. One-way ANOVA and Scheffe's multiple comparison test were used 8weeks after each program.

Result

There were significant differences in joint pain(p=.000), stiffness (p=.001), knee extensor peak torque(p=.006), knee flexor(p=.002), and difficult of performing activity (p=.000), but there was no significant difference in balance(p=.648). The Tai-Chi group was significantly different from the self-help group for knee extensor peak torque, knee flexor and stiffness on Scheffe's multiple comparison tests. In addition, the Tai Chi group or aquatic group were significantly different from the self-help group for difficulty of performing activities(p<0.05).

Conclusion

There are significant differences in the effects of the nursing intervention among the three groups. The Tai Chi group and aquatic group were significantly different from the self-help group. However, it seems that Tai-chi exercise may be more suitable than aquatic exercise in osteoarthritis exercise programs. Further studies with a longitudinal study are necessary to confirm the longer exercise period.

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