Study explores group therapy for osteoarthritis relief

Study explores group therapy for osteoarthritis relief

An interdisciplinary team composed of an East Carolina University physical therapist, an ECU Health doctor, and their physical therapy and nursing students recently wrapped up a pilot research study exploring whether having patients work as a team can reduce the painful effects of osteoarthritis better than working alone.

The Centers for Disease Control and Prevention define osteoarthritis as "a disease that breaks down one or more joints in the body" that usually occurs in people over 45. Their recommendations for treatment are common sense: maintaining physical activity and a healthy weight, and consulting medical professionals.

The recommendations don't, however, say how best to pursue those treatments. Working through health challenges alone can sap motivation, even for the most dedicated patients.

Designing a Pilot Study

"Research has shown us that with knee osteoarthritis, the best forms of treatment can be medications and weight loss, physical activity," said Dr. Sarah Johnson, a clinical assistant professor of physical therapy. But that research was mainly conducted in individual therapy sessions, Johnson said.

Dr. Greg House, director of ECU Health's sports medicine center, said he and his clinic do "quite a bit of osteoarthritis management." When he stepped back to see the bigger picture, House said he noticed a trend - they were repeating the same lifestyle management practices time and again for each patient individually. Clinical teams treating other chronic conditions like high blood pressure and diabetes had seen success with group treatment programs.

Why not give it a try with joint pain patients, as well?

"So, I reached out to Sarah, and she was on board with it and we came up with this pilot program," House said.

House and Johnson recruited 10 participants who were already patients in sports medicine but were not receiving physical therapy for osteoarthritis in the knee. They wanted to see if a different approach might improve results: bringing members of complimentary medical disciplines together to fill in treatment gaps and get patients together to work as a team.

Of the 10 patients recruited, six stuck it out for in-person sessions every other week with physical therapy and nursing students, along with their faculty and clinical practice mentors. The goal, Johnson said, was to give patients a more well-rounded understanding of how to improve mobility and reduce pain in their knees, with the added benefit of including students in the research process.

Each time the groups met, they started with an education session before moving on to traditional physical therapy activities in the PT gym at the ECU Health Family Medicine center.

Two meetings were with a registered dietician, to empower patients with on food choices that could make their condition better - or worse. In one class the research team helped patients load exercise and food tracking apps on their phones. Another class was all about anti-inflammatory foods, how to improve the taste of food while reaping the natural benefits of spices that reduce inflammation.

House used individual counseling sessions with the half-dozen patients to discuss the benefits and dangers of medications to help with pain management.

House said the hardest part of treating chronic disease is getting patients to change behaviors that run counter to their improving physically.

"You can't just mention that people need to lose weight so their knees feel better when you're talking about their whole disease process," House said. "It was a lot of repeating those kinds of phrases, but also realizing when I'm saying them out loud, they're not all that meaningful. Everyone knows they should be more active and lose weight."

House said the patients in the study bought in to the program and were excited about working as a group and it was heartening to see them build friendships and learn how to employ non-medical methods to improve their pain and range of motion.

Johnson said they aren't treating osteoarthritis differently; instead, they are bringing together therapies and resources in one setting instead of requiring patients to attend multiple therapy or counseling sessions.

Also, key to the pilot study is determining how important patients feel being part of a group was to their therapy. Survey results will help determine how the team will proceed with more robust studies.

Training Students

The study, Johnson knew, would be an ideal way to offer students hands-on clinical experience and also give them an opportunity to learn the ins and outs of organizing and carrying out a research study.

The students, Johnson said, devised the exercise protocols from clinical practice guidelines they had learned in their coursework and in clinical settings, putting their schoolwork into practice.

Sara Windsor, a senior undergraduate nursing student in the Honors College, had a key role in patient education, a foundational responsibility of the nursing profession. In addition to information about community resources like aquatic fitness classes and Tai Chi, and other low-impact forms of exercise, the Morehead City native also took each patient's vital signs to establish a baseline and monitor progress throughout the course of the study.

Windsor said she and her follow students benefitted as much from the cooperative learning as the patients they worked with. They heard from guest speakers about the role of the brain in pain and the importance of nutrition in treating osteoarthritis.

"I like the group environment, and it's been good to see a different side of health care and work with different people from different roles," Windsor said.

Madison Gilder, from Huntersville, is in her third year of the Doctor of Physical Therapy program. She's on track to graduate in May but has one semester of clinical rotations left. Her planning and student leadership role in Johnson's and House's research project fulfilled the capstone requirement for graduation, one she shared with fellow DPT student Tyler White.

"Tyler and I were in charge of determining the outcomes we wanted to measure, the goals for the patients," Gilder said. "We designed the evaluation process and then the intervention process. I haven't done anything like this in my clinical experience, so it's been interesting to do group treatment and learn about planning, how studies work and how you have to adjust along the way."

For Gilder, working with the patients in a group setting was a new experience. She said learning with, and from, the doctors, nursing students and dietitians was important to see how her part in the rehabilitative process fit into the bigger picture of patient health.

Johnson said in the spring semester she will have another student parse the results of a survey of the students participating to see how student learning might improve in future clinics.

"I'm already getting feedback, how they would like to meet more frequently than every other week, to see if that would help with adherence to sticking with the program," Johnson said.

Making Moving Easier

Learning and research are important, the clinicians, faulty members and student agree, but they are all working toward the same goal: figuring out how to make lives better for patients with osteoarthritis.

Felicia Weston is originally from Oklahoma but calls Belhaven home now. She said the physical therapy she has received during the study is comparable with past therapy experiences, but going through it with others has been meaningful.

"It's been wonderful, meeting new people and getting helpful information from the doctors and the rest of the staff," Weston said.

Renita Stanley said the effects of age forced her to seek treatment for the pain in her knees. She had received physical therapy in the past, as well, but she enjoyed the combination of one-on-one meetings with doctors and dieticians, and the encouragement she received from the other patients.

The therapy activities turned into a competition, Stanley said, reducing the frustration that comes from pushing through the pain that often accompanies physical exertion.

"We're all in it together. Competing makes it kind of fun; it pushes you to do more. Do better," Stanley said.

House said the initial feedback from patients and the faculty-student team are promising, but he wants to see what the data they collected says about the efficacy of a group treatment for joint pain, and how involving students will empower the next generation of health care professionals to innovate physical therapy and patient care.

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