Pastoral care and religious support as a part of treatment of religious patient with the severe form of osteoarthritis
Authors: Djurovic Aleksandar , Sovilj Sasa , Djokic Ivana , Brdareski Zorica , Vukomanovic Aleksandra , Ilic Natasa , Milavic-Vujkovic Merica 
Published: April 2016

Introduction. Religious needs of patients are consistently being neglected in
the clinical medicine. Pastoral care is a religious support which a religious
patient receives from priests, chaplains, imams, rabbis or other religious
authorities. Religious support, in terms of clinical medicine, is a spiritual
support which religious patients obtain from religious and trained medical
workers. The aim of this report was to present the effects of pastoral care
and religious support in hospital treatment of a 73-year-old patient with the
severe form of osteoarthritis. Case report. The 73- year-old, highly
religious patient with severe form of osteoarthritis was admitted at the
Clinic for Physical Medicine and Rehabilitation, Military Medical Academy in
Belgrade, due to heterogeneous problems in the activities of daily living.
The patient walked with difficulty using a stick, suffered pain, and was
anxious and depressive. In order to objectively demonstrate effects of both
pastoral care and religious support in this patient we performed multiple
treatment with reversal design, in which the basic treatment consisting of
hospital care, pharmacotherapy and physical therapy (the treatment A) was
alternatively changed with the treatment that included combination of the
basic treatment and religious support provided by religious physiatrist and
physiotherapist (the treatment B) or combination of the basic treatment and
pastoral care provided by military priest (the treatment C). The treatment A
was applied three times and lasted two weeks, every time. Treatments B and C
were applied once and lasted three weeks, each. The order of the treatments
was: A?B?A?C?A. During the whole treatment period the patient?s condition was
assessed by several measuring scale: the level of depression by The Hamilton
Rang Scale for Depression and The Zung Self Rating Depression Scale; the
level of anxiety by The Zung Self Rating Anxiety Scale; the functional
capability of patient by The Barthel Index and The Functional Independent
Measure. Measuring was carried out on a daily basis. In statistical analysis
two nonparametric statistic were used: the percentage of non-overlapping data
(PND) and the percentage of data points exceeding the median (PEM). PND and
PEM values below 0.7 reflect questionable effectiveness of the treatment. The
values between 0.7 and 0.9 reflect moderate effects. The values above 0.9 are
considered as a highly effective treatment. The anxiety of the patient was
moderately to significantly reduced after introducing religious support
(treatment B: mean and mean deviation = 50.1 ? 10.89; variability = 4.598653;
mean shift = 0.219626; PND = 0.6; PEM = 0.9) and pastoral care (treatment C:
mean and mean deviation = 53.5 ? 5.90; variability = 9.062591; mean shift =
0.207407; PND = 0.9; PEM = 0.9). The patient?s depression was reduced after
introducing pastoral care (treatment C: mean and mean deviation = 51.3 ?
4.66; variability = 10.99005; mean shift = 0.08881; PND = 0; PEM = 0.9). On
the contrary, the patient?s functional capability was not significantly
improved. Conclusion. In the highly religious patient with severe
osteoarthritis pastoral care and religious support, applied along with the
standard medical treatment of this condition, produced some beneficial
effects on anxiety and depressive mood, but with no significant effect on
patient?s functional capability.