Abstract
This retrospective
study explored the relationship between joint osteophyte severity and activity
limitation and evaluated activity-enhancing nursing interventions in 30
patients with joint osteophytes. Patients were divided into intervention group
(n=15) and control group (n=15). The control group received routine nursing
care, while the intervention group received additional activity-enhancing
nursing interventions including graded activity training, assistive device
guidance and environmental modification advice. Primary outcomes included the
correlation between osteophyte severity (Larsen grade) and activity limitation
(WOMAC physical function score) and the change in WOMAC physical function score
at 8 weeks. Secondary outcomes included 6-Minute Walk Test (6MWT) distance,
Timed Up and Go (TUG) test time and patient-reported activity confidence (PAC).
Results showed a significant positive correlation between Larsen grade and
initial WOMAC physical function score (r=0.73, p<0.01). At 8 weeks, the
intervention group had a significantly greater reduction in WOMAC physical
function score compared to the control group (28.6±7.2 vs 14.3±6.5, p<0.01).
The intervention group also showed better performance in 6MWT, TUG test and
higher PAC score (p<0.05 for all). Activity-enhancing nursing interventions
effectively improve activity ability in patients with joint osteophytes and
reduce activity limitation.
Keywords: Osteophyte severity; Larsen grade; Timed up and go
Introduction
Activity limitation is
a major consequence of joint osteophytes, with 50-60% of patients reporting
difficulty in daily activities such as walking, climbing stairs and dressing1. The degree of activity limitation is closely related
to osteophyte severity, joint pain and muscle weakness, requiring comprehensive
nursing interventions to improve functional independence2. This study aims to explore the relationship between
joint osteophytes and activity limitation and evaluate the effect of
activity-enhancing nursing interventions, providing evidence for clinical
nursing practice3.
Methods
Study design and
participants
Retrospective analysis of 30 patients with
radiographically confirmed joint osteophytes (knee: 23 cases, hip: 7 cases).
Inclusion criteria: age 50-80 years; Larsen grade I-IV osteophytes; presence of
activity limitation (WOMAC physical function score ≥20). Exclusion criteria:
severe cardiovascular diseases, musculoskeletal disorders other than
osteophytes and cognitive impairment.
Grouping & interventions
Control group: Routine nursing care,
including health education, pain management and basic mobility advice.
Intervention group: On
the basis of routine nursing, activity-enhancing nursing interventions were
added:
• Graded activity training: Formulating individualized activity plans with progressive intensity and duration, starting from low-intensity activities (sitting to standing) and gradually transitioning to more complex activities (walking, stair climbing).
• Assistive device guidance: Assessing and recommending appropriate assistive devices (canes, walkers) to reduce joint load during activities and training patients on correct usage.
• Environmental modification advice: Suggesting home modifications (installing handrails, raising toilet seats) to facilitate daily activities and reduce activity barriers.
• Activity confidence building: Using positive reinforcement and goal setting to enhance patients' confidence in performing activities.
Outcome measures
• Primary: Correlation between Larsen grade and initial WOMAC physical function score; change in WOMAC physical function score (0-68, higher score indicates more severe activity limitation) at 8 weeks.
• Secondary: 6MWT distance (m), TUG test time (sec), PAC score (0-10, higher score indicates higher activity confidence).
Statistical analysis
SPSS 26.0 software was
used for statistical analysis. Pearson correlation analysis was used to explore
the correlation between Larsen grade and WOMAC physical function score.
Measurement data were expressed as mean ± standard deviation (x̄±s) and
independent sample t-test was used for comparison between groups. P<0.05 was
considered statistically significant.
Results
Relationship Between Osteophyte Severity and Activity
Limitation
There was a significant
positive correlation between Larsen grade and initial WOMAC physical function
score (r=0.73, p<0.01) (Figure 1).
Baseline characteristics
There were no
significant differences in age, gender, affected joint, Larsen grade and
baseline outcome measures between the two groups (p>0.05), which was
comparable (Table 1).
Table 1: Comparison of baseline
characteristics between the two groups
|
Characteristics |
Intervention
Group (n=15) |
Control Group
(n=15) |
p-value |
|
Age (years, x̄±s) |
65.3±8.5 |
66.1±7.9 |
0.786 |
|
Gender
(male/female, n) |
9/6 |
8/7 |
0.763 |
|
Affected joint
(knee/hip, n) |
12/3 |
11/4 |
0.731 |
|
Larsen grade (I/II/III/IV, n) |
2/8/4/1 |
3/7/4/1 |
0.925 |
|
WOMAC physical
function score (x̄±s) |
42.5±8.3 |
43.2±7.8 |
0.791 |
|
6MWT distance (m, x̄±s) |
285.6±52.4 |
278.3±49.6 |
0.715 |
|
TUG test time (sec,
x̄±s) |
18.2±4.1 |
18.8±3.9 |
0.732 |
|
PAC score (x̄±s) |
4.2±1.3 |
4.0±1.2 |
0.683 |
Primary outcome
At 8 weeks, the WOMAC
physical function score in the intervention group was significantly lower than
that in the control group and the reduction amplitude was significantly larger
(p<0.01) (Table 2).
Table 2: Comparison of WOMAC
physical function score between the two groups at different time points (x̄±s,
points)
|
Group |
n |
Baseline |
4 weeks |
8 weeks |
Reduction at 8 weeks |
|
Intervention Group |
15 |
42.5±8.3 |
30.2±7.5 |
13.9±6.1 |
28.6±7.2 |
|
Control Group |
15 |
43.2±7.8 |
35.6±7.1 |
28.9±6.3 |
14.3±6.5 |
|
p-value |
- |
0.791 |
0.023 |
<0.001 |
<0.001 |
Secondary outcomes
At 8 weeks, the
intervention group showed significantly better performance in 6MWT, TUG test
and higher PAC score compared to the control group (p<0.05) (Table 3).
Table 3: Comparison of secondary outcomes between the two
groups at 8 weeks (x̄±s)
|
Outcome Indicators |
Intervention Group (n=15) |
Control Group (n=15) |
p-value |
|
6MWT distance (m) |
425.3±68.5 |
332.6±62.8 |
<0.001 |
|
TUG test time (sec) |
10.5±2.3 |
15.8±3.1 |
<0.001 |
|
PAC score |
8.2±1.1 |
5.3±1.4 |
<0.001 |
Discussion
This study found a
significant positive correlation between joint osteophyte severity and activity
limitation, which is consistent with previous studies4. The more severe
the osteophytes, the greater the joint space narrowing and cartilage damage,
leading to increased pain and decreased joint mobility, thereby resulting in
more severe activity limitation5.
The
activity-enhancing nursing interventions in this study achieved good results.
Graded activity training can gradually improve muscle strength and endurance
around the joint, enhance joint stability and reduce activity limitation, which
is supported by relevant research6. Assistive device
guidance can effectively reduce joint load, improve balance during activities
and increase patients' ability to perform daily activities7.
Environmental
modification advice can remove activity barriers in the home environment,
making it easier for patients to perform daily activities independently, which
is beneficial to improving their quality of life8. Activity
confidence building can enhance patients' self-efficacy, reduce their fear of
activities and promote their active participation in activity training, thereby
improving activity ability9.
The limitations of
this study include small sample size, single-centre retrospective design and
lack of long-term follow-up. Future studies with larger samples and longer
follow-up periods are needed to further verify the effectiveness of
activity-enhancing nursing interventions.
Conclusion
There is a significant positive
correlation between joint osteophytes and activity limitation.
Activity-enhancing nursing interventions can effectively improve activity
ability, reduce activity limitation and enhance activity confidence in patients
with joint osteophytes. It is worthy of clinical promotion and application.
References
1. Felson DT, Lawrence RC,
Dieppe PA, et al. Osteoarthritis: new insights. Part 2: treatment approaches.
Ann Intern Med 2000;133(8):647-655.
2. 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 2008;16(2):96-110.
3. American College of
Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the
medical management of osteoarthritis of the hip and knee. Arthritis Rheum
2000;43(9):1905-1915.
4. Pisters M, Vliet Vlieland TP, de Jong Z, et al. Determinants of
physical function in patients with osteoarthritis of the lower extremities. Ann
Rheum Dis 2006;65(6):756-761.
5. Goldring MB. Osteoarthritis:
pathogenesis. Ann
Rheum Dis 2000;59(1):i3-i6.
6. Messier SP, Loeser RF,
Miller GD, et al. Exercise and dietary weight loss in overweight and obese
older adults with knee osteoarthritis: the Arthritis, Diet and Activity
Promotion Trial. Arthritis Rheum 2004;50(5):1501-1510.
7. Menz HB, Lord SR, Fitzpatrick R. Effects of assistive devices on
balance and mobility in older people with osteoarthritis of the knee. Age
Ageing 2005;34(3):258-263.
8. Cleland J, Speechley M, Tiedemann A, et al. Home environmental
modifications to improve functional ability and safety of older people with
osteoarthritis: a systematic review. J Aging Health 2012;24(8):1335-1359.
9. Bandura A.
Self-efficacy: toward a unifying theory of behavioural change. Psychol Rev
1977;84(2):191-215.