Thesis (Ph.D.) - Indiana University, School of Public Health, 2017
Globally, osteoarthritis (OA) is projected to be widespread among older adults; the most profoundly affected joints are the spine, hip, and knee (A. Fisken, Keogh, Hing, & Waters, 2015). Studies in epidemiology have indicated that OA is responsible for more disability, sick days off, difficulty climbing stairways, and walking than all other conditions related to musculoskeletal ailments (E. M. Bartels, Juhl, C.B., Christensen, R., Hagen, K. B., Danneskiold-Samsoe, B., Dagfinrud, H., Lund, H. , 2016). The symptoms most salient are: pain, muscle weakness, diminished function, and reduced well-being (Lu et al., 2015). In consideration of the enormity of the physical and psychological impact that OA has on persons who are affected by OA of the knee or hip, and the financial burden that it exerts on health care systems around the world, as well as the individual, cost effective nonpharmacological interventions such as shallow-water functional movement, may help to alleviate this growing and serious public health issue. The purpose of this study was to determine if there is a difference in participant perceived pain and well-being of older adult women with knee and or hip OA engaged in an aquatic functional movement intervention without the use of a stationary pole compared with engagement in the same aquatic intervention with the use of a stationary pole. The conceptual framework for the study was grounded in self-efficacy theory, and the selection, optimization, and compensation model of aging well. The study used a replicated and randomized single-case two-condition crossover design to collect data. Data were collected through repeated pain measures, pre and post treatment measures, and retrospective pretest and posttest measures. Pain data were entered into the Microsoft Excel® ExPRT 2.0 single-case AB design program to generate graphs and pre-crossover and post-crossover phase means. Visual analysis of graphs and descriptive mean pain data, showed no convincing difference between the two conditions. This finding was confirmed with follow up sensitivity analysis with a mixed model for repeated measures linear regression using SAS® 9.4 software, and a paired t-test using Microsoft Excel 2013. For well-being, physical function, general self-efficacy, and pain self-efficacy, graphs were generated with Excel 2013 on pretest and posttest primary data. Comparison of individual score means and visual analysis of graphed scores, indicated a positive effect of the intervention, except some findings were contradictory, in particular for self-efficacy. For the recreational or aquatic therapist, and the individual, results from the pain data indicate use of a stationary pole may not be any more effective on perception of pain than the movement program itself; this may translate to cost savings. In addition, the study preliminarily found a positive correlation between the intervention and pain, well-being, and physical function that further investigation using a larger sample for a longer duration, is recommended.