Introduction: India is likely to notice an endemic of osteoarthritis with about 80% of the 55 years and above population in the country suffering with wear and tear of joints. 40% of these people are likely to suffer from severe osteoarthritis, which will disable them from daily activities, say the experts quoting the World Health Organization (WHO). Objectives: The study aimed to investigate the effect of isometric exercise in elderly with osteoarthritis in a selected old age home in Delhi. Methods: A randomized control trial was conducted on 50 elderly (25 elderly in experimental group and 25 elderly in control group) aged 60 to 90 years. Nonprobability purposive sampling technique was used for selection of the sample. A structured interview schedule and Numerical Pain Rating Scale, were used for data collection and the data was analyzed using descriptive and inferential statistics. Results: Results revealed that the elderly with osteoarthritis in the experimental group had reduction in pain followed by isometric exercise compared to the elderly with osteoarthritis in the control group. Conclusion: Results confirmed that isometric exercise is an effective method of pain relief for elderly with osteoarthritis

Bhardwaj, Urmila

Rani, Seema

Varghese, Tincy

English

Advanced Research Publications: Medical Journals

Research Article     © ADR Journals 2016. All Rights Reserved. Tincy Varghese1, Seema Rani2, Urmila Bhardwaj3 1M.Sc. Nursing Student, 2Assistant Professor, 3Associate Professor, Rufaida College of Nursing, Jamia Hamdard, New Delhi-110062. Correspondence to:          Ms. Seema Rani, Rufaida College of Nursing, Jamia Hamdard, India. E-mail Id: seema9rani@ yahoo.co.in               How to cite this article:  Varghese T, Rani S, Bhardwaj U. The Effectiveness of Isometric Exercises on Pain Perception of Elderly with Osteoarthritis in Selected Old Age Homes. Int J Nurs Midwif Res 2016; 3(4): 60-64.  ISSN: 2455-9318  The Effectiveness of Isometric Exercises on Pain Perception of Elderly with Osteoarthritis in Selected Old Age Homes Abstract Introduction: India is likely to notice an endemic of osteoarthritis with about 80% of the 55 years and above population in the country suffering with wear and tear of joints. 40% of these people are likely to suffer from severe osteoarthritis, which will disable them from daily activities, say the experts quoting the World Health Organization (WHO). Objectives: The study aimed to investigate the effect of isometric exercise in elderly with osteoarthritis in a selected old age home in Delhi. Methods: A randomized control trial was conducted on 50 elderly (25 elderly in experimental group and 25 elderly in control group) aged 60 to 90 years. Non-probability purposive sampling technique was used for selection of the sample. A structured interview schedule and Numerical Pain Rating Scale, were used for data collection and the data was analyzed using descriptive and inferential statistics.  Results: Results revealed that the elderly with osteoarthritis in the experimental group had reduction in pain followed by isometric exercise compared to the elderly with osteoarthritis in the control group.  Conclusion: Results confirmed that isometric exercise is an effective method of pain relief for elderly with osteoarthritis. Keywords: Elderly, Osteoarthritis, Isometric exercises. Introduction Osteoarthritis is the most common musculoskeletal condition affecting the quality of life of older adults.1,2 A recent survey in India reported that the prevalence of osteoarthritis in adults more than 65 years of age was 32.6% in the rural population and 60.3% in the urban population.2 Knee osteoarthritis is likely to become the eighth most important cause of disability in men and the fourth most important cause of disability in women according to the World Health Organization report on global burden of disease.3 Three major physical impairments, such as knee pain, stiffness, and decreased quadriceps strength, are highly associated with knee osteoarthritis and are believed to contribute to physical disability and progression of the disease.4 Strength of the quadriceps and hamstring musculature is one of the intrinsic factors that have been shown to affect the knee joint functions. It is evident that lower extremity strength has a major role in knee joint shock attenuation during weight-bearing activities. However, research is still going on to investigate the role of strengthening in the treatment of osteoarthritis of the knee.5 There is increased risk of development or progression of disease due to greater or uncontrolled loading on the joint; therefore, quadriceps and hamstring strength needs to be considered in the study of knee. A reduced quadriceps and hamstring strength has been shown to be associated with the presence of osteoarthritis in the knee.6  Int. J. Nurs. Midwif. Res. 2016; 3(4)               Varghese T et al. 61  ISSN: 2455-9318 Reduction of pain and disability is the main aim of any treatment approach in the management of knee osteoarthritis. Combinations of treatment approaches including both pharmacological and non-pharmacological methods are often preferred.7 The Osteoarthritis Research Society International (OARSI) recommended non-pharmacological methods including patient education programs, weight reduction, coping strategies, and exercise programs for treatment of knee osteoarthritis.8 There are three types of basic therapeutic exercises: ‘isotonic, isokinetic, and isometric.’ Of these three, isometric exercise might be the most appropriate and easy to understand by the patient and can be easily and safely performed at home because it requires no or minimal apparatus. Further, isometric exercise causes the least intra-articular inflammation, pressure, and bone destruction.9 Norden et al. reported that “isometric exercises” are simple and inexpensive to perform and that they rapidly improve strength.10 Methodology The research approach of this study was quantitative with a randomized controlled pretest-posttest design to determine the effectiveness of isometric exercise on pain of elderly with osteoarthritis. After obtaining ethical permission, the subjects were selected according to the inclusion and exclusion criteria as set in the screening sheet. Elderly suffering from osteoarthritis were selected through purposive sampling technique from old age home for experimental and control group. Experimental and control groups were assigned randomly. In experimental and control group each there were 25 elderly and thus the sample size was 50. Informed consent was obtained from each participant of the experimental and control group. The demographic data was collected using a subject data sheet. The pain score level was assessed using numerical pain rating scale before the administration of isometric exercise in experimental and no intervention was given in control group. The isometric exercise was administered to the experimental group by the researcher. Isometric exercise was performed for experimental group for 20 minutes once a day for one week, 20 minutes for isometric exercise in experimental group and in control group elderly were getting only routine care. The pain score levels were assessed one week after the interventions in the experimental group and, in control group after one week of routine activities were done, using numerical pain rating scale. Pretest and posttest pain scores were entered in the record sheet. The data taken was subjected to be analyzed using descriptive and inferential statistics.  Results Section 1: Finding related to background data of experimental and control group Data in Table 1 shows the characteristics, i.e., age, duration of diagnosis, affected knee joint, strategy of pain relief, strategy of pain relief used in both the experimental and control groups and p value. In experimental group, 13(52%) of elderly belonged to 71–80 years age group, as shown in Table 1 and the minimum percentage of elderly with osteoarthritis, i.e., 4(16%) of subjects belonged to 60–70 years age group and 8(32%) of elderly were in 81–90 years group. In control group, 13(52%)of elderly belonged to 71–80 years age group and 6(24%) each were in 60–70 and 81–90 years age groups. The groups were compared using Fisher exact test (p=0.703) for age which was not significant. In the experimental group, 19(76%) were diagnosed with osteoarthritis for 0 to 5 years and 6(24%) for 6–10 years. In control group, 20(80%) were diagnosed with osteoarthritis for 0–5 years and 5 (20%) for 6–10 years. The groups were compared using Chi-square test (p=0.647) which was not significant. In the experimental group, the elderly affected with osteoarthritis in both knee joints were 16(64%) which is higher than right knee joint 3(12%) and left knee joint by 6(24%) whereas in the control group 16(64%) were affected with osteoarthritis in both knee joints 16(64%) which is higher than right knee joint 5(20%) and left knee joint 4(16%). Both groups were compared using fisher exact test (p=0.658) which was not significant. In the experimental group, 19(76%) used pain relief strategies and rest 6(24%) were not using any pain relief strategies. In control group, 16(64%) were not using any pain relief strategies and 9(36%) were using pain relief strategies. Both the group were compared using Chi square test (p=0.355) which was not significant. In the experimental group, 3(12%) were using traditional massage as a pain relief strategy whereas 2(8%) were using yoga as a pain relief strategy. In control group, 6(24%) were using yoga as a pain relief strategy and majority of the elderly 16(64%) were not using any pain relief strategy. The groups were compared using Fishers exact test (p=0.387) for the strategy used for pain relief and it was not significant. Varghese T et al.                                                             Int. J. Nurs. Midwif. Res. 2016; 3(4) ISSN: 2455-9318  62 Table 1 Comparison of Selected Variables of Subjects by Their Age, Duration of Diagnosis, Affected Knee Joint, Strategy for Pain Relief, Strategy Used for Pain Relief in Experimental and Control Group                         n=50 S. No. Characteristics Experimental Group (n1=25) Control Group (n2=25) Test Used p Value  1  Age (in years) • 60–70 • 71–80 • 81–90 f % f %   Fischer exact test    0.703*  4 13 8  16 52 32  6 13 6  24 52 24 2 Duration of diagnosed • 0–5 years • 6–10 years  19 6  76 24  20 5  80 20  Chi-square  0.647* 3 Affected knee joint • Right • Left • Both  3 6 16  12 24 64  5 4 16  20 16 64  Fisher exact test  0.658* 4 Strategy of pain relief: • Yes • No  6 19  24 76  9 16  36 64 Chi-square   0.355* 5 Strategy used for pain relief • Yoga • Traditional Massage • Nothing  2 3 20  8 12 80  6 3 16  24 12 64  Fisher exact test  0.387* *NS–Not Significant at 0.05 level, p>0.05level. Section 2: Findings related to the point prevalence of osteoarthritis among elderly  The result revealed that the total elderly population in the old age home was 120, out of which 74(61.66%) of the elderly were diagnosed with osteoarthritis at the time of study. The point prevalence of elderly having osteoarthritis is 61.66%. Section 3: Finding related to pre- and post-intervention pain score in the experimental group Table 2 .Mean, Standard Deviation and t-Value of Pre-intervention and Post-intervention                                                              Pain Score of Elderly in Experimental Group                                                                                                                                                                                              n=25 Experimental Group Mean Mean Difference MD Standard Deviation SD df t-Value Pre-intervention pain score 5.28 1.72 0.737 24 5.85* Post-intervention pain score 3.56 1.279   ‘t’(24)=2.06, p<0.05*significant at 0.05 level.  The result in Table 2 revealed that the mean pre-intervention pain score 5.28 of experimental group was higher than their mean post-intervention pain score 3.56. There is a significant reduction in the mean pain score of experimental group after one week of intervention. The standard deviation of experimental group before intervention was 0.737 and the post-intervention standard deviation was 1.279.     Int. J. Nurs. Midwif. Res. 2016; 3(4)               Varghese T et al. 63  ISSN: 2455-9318 Finding related to pain score in the control group pre-intervention and after 1 week Table 3 Mean, Mean Difference, Standard Deviation and t-Value of Pain Score of Elderly with Osteoarthritis in the Control Group at First Day and after 1 Week                                                                                                                                                                                              n=25 Control Group Mean Mean Difference MD Standard Deviation SD df t-Value Pre- intervention pain score 5.0 0.96 0.816 24 3.68* Pain score after 1 week 5.96 1.0149   *‘t’(24)=2.06, p<0.05 significant at 0.05 level. n2*=25 The result in Table 3 reveals that the mean pain score after 1 week was 5.9 of control group which was higher than the mean pain score at first day i.e. 5.0. There was significant increase in the mean pain score after one week among the control group. The standard deviation of pain score on first day was 0.816, lower than the mean pain score after 1 week i.e. 1.014. The t-value of 3.68 is greater than the table t-value of 2.06 at 0.05 level of significance. Findings related to comparison of pain score in the experimental and control group. Table 4 Mean, Mean Difference, Standard Deviation and t-Value of Post-Test Pain Score of Elderly with Osteoarthritis in the Experimental and Control Groups Group Mean Mean Difference MD Standard Deviation SD df t-Value Experimental Post-intervention pain score 3.56 2.4 1.279 48 2.87* Control pain score after 1 week 5.96 1.0149  n1* – Experimental group, n2* – Control group. ‘t’(49)=2.02, p<0.05*significant at 0.05 level. n1*+n2*=50 The result in Table 4, while comparing the post-pain score of experimental and control groups there was a difference in the experimental post-pain score and control post-pain score by 2.4. The experimental group receiving the treatment had decrease in mean post pain score by 3.56 as compared to control group by 5.96. The standard deviation of pain score after 1 week in control group is 1.0149 that is lower than the mean post intervention pain score 1.279 in experimental group. The t-value of 2.87 is greater than the table t-value of 2.02 at 0.05 level of significance. Discussion of Findings A similar study was done by Topp et al.11 who conducted and compared changes in pain after dynamic and isometric strength-training interventions and no-intervention to control group in a sample of 102 older adults. Participants assigned to the exercise interventions completed 2 weeks of strength training. Participants in the dynamic intervention performed traditional exercises, and participants in the isometric intervention to prevent any movement or change in joint angle during the exercise. Pain was assessed with the numerical pain rating scale. Attrition and adherence during the strength-training interventions was not reported. Analysis revealed that improvements in pain were significantly greater after dynamic and isometric exercise (14%). The result showed that isometric exercise and dynamic are effective for reducing pain. The finding of this study is in line with the present study, which also shows reduction in pain score after isometric exercise. A similar study done by Petrella and Bartha12 compared the effects of combination of isometric exercise and non-steroidal anti-inflammatory drugs (NSAID), to NSAID-alone treatment another group of 179 older adults with unilateral knee osteoarthritis. Isometric exercise involved lower extremity resistance exercises in which participants progressed from completing two repetitions per session three times per week to completing two-week repetitions per session three times per week. Compliance to isometric exercise sessions and weekly physical Varghese T et al.                                                             Int. J. Nurs. Midwif. Res. 2016; 3(4) ISSN: 2455-9318  64 activity participation were monitored using exercise logs and the Physical Activity Scale for the Elderly (Washburn et al. 1993). Assessments of pain were obtained using the WOMAC, as well as a VAS assessing self-rated pain at rest and during walking and stair-climbing tasks. Intention-to-treat analyses revealed that the combination treatment produced significantly greater improvements in the WOMAC pain subscale at 2 weeks. Participants in both the combination and NSAID-alone interventions also reported increased volume of weekly physical activity. In the present study, medication was not used to reduce the pain; not even the study subjects were asked to withhold the medication due to ethical reasons. Still, the result of the study exercise was shown as reduction in pain score. The improvement with exercises in this study was supported by Fransen et al.,13 who conducted a systematic review to determine whether isometric exercise is beneficial for people with hip or knee osteoarthritis. Fourteen studies provided data on 1633 participants with knee osteoarthritis but only nine of these studies were considered to be of high methodological quality. The result showed that strengthening of the quadriceps musculature with isometric exercise was associated with significant improvement in quadriceps strength, reduction of knee pain, and improved function. The findings of the study are in line with the present study, which also showed reduction in pain score after isometric exercise. Conclusion Isometric exercise is an effective method of pain relief for elderly with osteoarthritis. Conflict of Interest: None  Reference 1. Guccione AA, Felson DT, Anderson JJ et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham study. American Journal of Public Health1994; 1(10): 351-58.  2. Burckhardt CS. Chronic pain. Nursing Clinical North America 1990; 25(4): 863-70. 3. Sharma MK, Swami HM, Bhatia V et al. An epidemiological study of correlates osteoarthritis in geriatric population of UT. Indian J Community Med 2014; 32(1): 77-78. 4. Murray CJ, Lopez AD. The global burden of disease. Geneva: World Health Organization 2015. 5. Slemenda C, Brandt KD, Heilman DK et al. Quadriceps weakness and osteoarthritis of the knee. Annals of Internal Medicine 1997; 127: 97-104.  6. Hurley MV, Scott DL, Rees J et al. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Annals of Rheumatic Diseases 1997: 641-48. 7. McAlindon TE, Cooper C, Kirwan JR et al. Determinants of disability in osteoarthritis of the Knee. Annals of Rheumatic Diseases 1993; 52(3): 258-62.  8. Zhang W, Moskowitz RW, Nuki G et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part I: Critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007; 15(7): 981-1000. 9. Jayson MI, Dixon AS. Intra-articular pressure in rheumatoid arthritis of the knee: Pressure changes during joint use. Annals of Rheumatic Diseases 1970; 29(4): 401-08.  10. Norden DK, Leventhal A, Schumacher RH. Prescribing exercise for osteoarthritis of the knee. Journal of Musculoskeletal Medicine 1994; 11: 14-21. 11. Topp R, Woolley S, Hornyak J et al. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Archives Physical Medicine and Rehabilitation. 2002; 83(9): 1187-95. 12. Petrella RJ, Bartha C. Isometric exercise therapy for older patients with knee osteoarthritis: A randomized clinical trial. Journal of Rheumatology 2000; 27: 2215-21. 13. Fransen M, McConnell S, Bell M. Therapeutic exercise for people with osteoarthritis of the hip or knee: A systematic review. The Journal of Rheumatology 2002: 1737-45. Date of Submission: 25st Jul. 2016 Date of Acceptance: 24st Nov. 2016 

The Effectiveness of Isometric Exercises on Pain Perception of Elderly with Osteoarthritis in Selected Old Age Homes

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The Effectiveness of Isometric Exercises on Pain Perception of Elderly with Osteoarthritis in Selected Old Age Homes

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