Effect of nursing instructional guidelines on fatigue and pain associated with knee osteoarthritis
Authors: El-Sayed Zeinab M. , Hassanein Safaa M. 
Published: February 2022

Background
Knee osteoarthritis (KOA) is the most widespread type of arthritis and considered as the main health problem all over the world. It is a progressive degenerative joint disease that produces joint pain, declines the physical function, and leads to progression of disability. Therefore, nursing instructions are crucial to improve and enhance patient’s quality of life. The aim of the current study was to evaluate the effect of nursing instructional guidelines on fatigue and pain associated with KOA at a university hospital.

Hypotheses
H1–patients with KOA who receive nursing instructional guidelines will have significantly lower mean scores of fatigue compared with those who receive routine hospital care. H2–patients with KOA who receive nursing instructional guidelines will have significantly lower mean scores of related pain compared with those who receive routine hospital care.

Design
Pretest/posttest nonequivalent control group design was utilized to achieve the aim of the current study.

Tools
(a) Demographic and medical data form related to age, sex, level of education, family history of OA, type of KOA, BMI, etc.; (b) numerical pain rating scale; and (c) (SF-36) multidimensional assessment of fatigue scale were used for assessment.

Setting
The study was conducted at the medical and orthopedic departments in addition to the outpatient clinic at a university hospital in Egypt.

Sample
A purposive sample of 60 adult male and female patients was recruited over six consecutive months, who are diagnosed as having mild (stage 2) or moderate (stage 3) KOA and divided randomly into study and control groups; 30 patients in each group were recruited in the current study.

Results
It was found that 30% of the patients had an age from 50 to less than 60 years, with mean±SD of 50.83±9.97 years. Females were 90% in the study group and 83.3% in the control group. Moreover, 80% of the study group compared with 70% of the control group had grade II OA, with χ
2=3.21, P=0.91. There was no statistically significant difference regarding three pain readings in the study and control groups. However, there was marked difference in the mean±SD total related pain score between the study and control groups at the third pain reading (mean±SD=5.50±2.46 and 6.06±1.91, respectively). Moreover, there was a statistically significant difference over the three pain readings in the study group, as analysis of variance=32.56 and P=0.000, compared with an absence of a statistically significant difference over the three pain readings in the control group. There was a statistically significant difference in the third reading between study and control groups, as t test=3.9, as well as over the three fatigue readings in the study group, as analysis of variance=95.68 and P=0.000, compared with an absence of a statistically significant difference over the three fatigue readings in the control group.

Conclusion
Nursing instructional guidelines were effective in improving fatigue associated with KOA and reducing pain level.

Recommendation
Patients with KOA should be encouraged to follow nursing instructions through continuous health teaching to improve patient quality of care over the long term. Nursing implications: the instructional nursing guidelines could be applied in curriculum, nursing practice, and patients’ health.