الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Osteoarthritis (OA) is the most common form of the degenerative joint disease and the third-leading cause of life-years lost due to disability. The disease most commonly affects the middle-aged and elderly and is more common in women than in men. The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. Patients affected by OA suffer from pain, functional disability, depression, social isolation, and diminished quality of life. OA causes a considerable burden in lost time at work, early retirement and considerable economic loss Aim of the study: The study was conducted to study self-management behavior and socio-ecological determinants among osteoarthritis patients attending outpatient clinics in EL Hadara University hospital in Alexandria and to investigate the association between the studied socio-ecological determinants and osteoarthritis self management behavior. Target population and study sampling: To achieve this aim, a cross sectional descriptive study was performed on a sample of 170 osteoarthritis patients attending outpatient clinics in EL Hadara University Hospital in Alexandria. A systematic random sampling technique was used based on a hypothetical assumption that prevalence of self management behaviour =87.4 % (Alfa=0.05, precision=5%). The orthopedic physicians sample was purposive sample of twelve physicians working in outpatient clinics in EL Hadara University Hospital who agreed to participate in the study. Tools of the study: A- A structured interview questionnaire was used to collect data and included: • Sociodemographic data • Medical data • Patient education related data • Knowledge about OA and its management • Osteoarthritis self management behavior • Health beliefs, self efficacy and social support
B-Physician’s semi-structured self-administered questionnaire: This included: • Physician’s personal and professional data • Physician participation and performance in OA-SME. • Assessment of physician’s self efficacy to provide OA-SME services.
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• Physician’s perception of barriers and facilitators of provision OA-SME services.
Results The results of the present study can be summarized as follows: A. Patients’ knowledge about OA: - It was found that 58.8% of the sample had poor knowledge level and 5.9% had
good level. The least knowledgeable domains; pain management, exercise and
physical activity and OA risk factors. - Knowledge about signs and symptoms of joint deterioration achieved the highest subtotal score by only 39.4% of the sample. B. Patients’ self management behavior - For the total score, it was found that 32.4% of OA patients had bad OA-SMB level, 66.5% of them had fair level and only 1.2% had good practice level. - The worst practiced SM domains were; exercise adherence (66.5% had bad practice level), joint protection (45.9% had bad practice level), communication with medical team (47.6% had bad practice level) and OA medication use (24.4% had bad practice level). While the best practiced domains were pain management and weight
management (61.2% and 67.1% had fair practice level respectively).
C. Health beliefs: The results showed that: -Perceived susceptibility to OA complications: it was found that 47.6% of OA patients had high level, 47.1% of them had moderate level and 5.3 % of them had low level. -Perceived severity of OA: the greater percentage of OA patients (85.3%) has high
levels of perceived severity of OA. -Perceived SM benefits: only 28.8% of the studied sample had high level of perceived benefits of OA-SM. -Perceived barriers to SM practices: higher percentage of the studied sample
represented by (50.6%) had high level of total score of perceived barriers to SM
practices. Barriers to exercise adherence was the most prominent where 80% had
high level of perceived barriers , followed by barriers to use medication (67.7%),
barriers to adherence to healthy diet (50%) then barriers to communicate with
medical team (40%).
D. Self efficacy the great majority of the studied sample had low level of self efficacy to perform OA-SM practices (83.5%) while 13.5% of them have moderate levels, only 2.9% has high self efficacy level.
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E. Social support 42% of the studied sample had low level of social support satisfaction score, while more than one third of them (35.3%) had high level.
F. Association between self management behavior and some socioecological determinants. - Patients’ OA-SMB has significant positive correlation with knowledge, perceived susceptibility to OA complications, , perceived severity of OA complications, perceived SM benefits, total perceived barriers, and self efficacy (r= 0.284 to 0.628, p<0.05). - A very weak non significant correlation was found between OA-SM behavior and social support(r=0.08, p=0.29). - When applying stepwise multiple regression analysis, the following findings were
found: Four variables proved to significantly affect SM total score; perceived benefits and barriers, OA patients’ knowledge and perceived susceptibility to OA
complications as they had a significant positive effect on SM total score where
increase of their score increases SM total score by 0.366, 0.201, 0.156 and 0.133 (p value 0.000 and 0.006, 0.029, 0.046) respectively. G. Orthopedic physicians sample - The great majority (83.3%) of the studied orthopedic physicians had poor level of performance in OA-SME while, none attained good level of performance. Half of them had moderate level of self efficacy about OA-SME; meanwhile, one third of the sample (33.3%) had low self efficacy level. - More than half of orthopedic physician’s sample (58.3%) had low level, and none had high level of perceived barriers of provision of OA-SME while 16.7% had high level of perceived barriers of provision of OA-SME. - The majority of the orthopedic physicians (83.3%) had low level of perception of needs and facilitators of provision OA-SME while none of them had high level of perception of facilitators. Based on the findings of the present study, many recommendations are suggested and summarized as follows: A culturally sensitive, well planned and coordinated osteoarthritis self management education program was proposed for hospitals and family health units. The Egyptian health care system should establish policies and regulations for: -CME programs for training physicians and health care providers in aspects of OA- SME. -Training and skill enhancement in aspects of OA-SME dictated that OA-SME is a duty of physicians.
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-Supporting tools and resources for OA-SM and directing all resources to treatment (drugs/surgery). Community involvement with the private sector and charity organizations for provision of rehabilitation centers offering cheap services for OA patients and OASME programs. Mass media, social network technology and community workers should play a role in providing information and improving patient’s awareness about the disease Future research can focus on further exploration and assessment of other factors that impair or improve self management behavior of OA patients as well as exploring the best intervention methods and strategies that can improve it.