Hunter David J, McLachlan Andrew J, Carroll Peter R, Wakefield Tom A N, Stosic Rodney
University of Sydney, Camperdown, New South Wales, Australia, and Royal North Shore Hospital, St. Leonards, New South Wales, Australia.
School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia.
Arthritis Care Res (Hoboken). 2023 Apr;75(4):848-859. doi: 10.1002/acr.24851. Epub 2022 Dec 2.
Management guidelines encourage self-care in patients with symptomatic osteoarthritis (OA). We undertook this study to investigate the relationship between health literacy (HL) and appropriateness of selection of self-care strategies in people with self-reported symptoms of OA.
We conducted an online national observational, demographically representative, cross-sectional survey of adults (ages 45-74 years). The eligibility criterion of "self-reported OA symptoms" was screened for using guideline-endorsed clinical criteria. Participants completed a custom-built questionnaire that included validated scales for HL, pain intensity, sleep quality, and OA function/disability. Management strategies were grouped into self-care activities, analgesics, and complementary medicines, and analyses of appropriateness were based on predefined, evidence-based quality indicators.
Of 6,800 participants, 628 met the inclusion criteria and completed the survey. HL was categorized as follows: low (100 of 628, 15.9%), moderate (317 of 628, 50.5%), and excellent (211 of 628, 33.6%). In the past 7 days, mean pain intensity (0-10 scale) was 3.11 (95% confidence interval [95% CI] 3.06-3.16), and 71.7% of participants (450 of 628) had not achieved adequate pain relief. In the past month, 54.1% (340 of 628) reported disrupted sleep. Participants managed their pain with multiple self-care activities (mean 1.44; 95% CI 1.32-1.57), analgesics (mean 1.74; 95% CI 1.60-1.88), and complementary medicines (mean 1.01; 95% CI 0.90-1.12). There was a statistically significant (P < 0.001) interaction between HL and appropriateness of current management strategies (HL low, guideline-recommended management strategies less likely). Higher HL did not always translate into making appropriate pain management choices.
Appropriate selection and use of evidence-based management options is critical for patients with OA to obtain the full benefits from their treatment. Knowledge about suitable choices for OA self-care is suboptimal, and future education should be tailored to different levels of HL.
管理指南鼓励有症状的骨关节炎（OA）患者进行自我护理。我们开展这项研究以调查健康素养（HL）与自我报告有OA症状的人群选择自我护理策略的恰当性之间的关系。
我们对成年人（45 - 74岁）进行了一项全国性的在线观察性横断面调查，该调查在人口统计学上具有代表性。使用指南认可的临床标准筛查“自我报告的OA症状”这一纳入标准。参与者完成了一份定制问卷，其中包括经过验证的HL、疼痛强度、睡眠质量以及OA功能/残疾量表。管理策略分为自我护理活动、镇痛药和补充药物，恰当性分析基于预先定义的、循证的质量指标。
在6800名参与者中，628名符合纳入标准并完成了调查。HL分类如下：低（628名中的100名，15.9%）、中（628名中的317名，50.5%）和高（628名中的211名，33.6%）。在过去7天里，平均疼痛强度（0 - 10分制）为3.11（95%置信区间[95%CI]3.06 - 3.16），71.7%的参与者（628名中的450名）未获得充分的疼痛缓解。在过去一个月里，54.1%（628名中的340名）报告睡眠受到干扰。参与者通过多种自我护理活动（平均1.44；95%CI 1.32 - 1.57）、镇痛药（平均1.74；95%CI 1.60 - 1.88）和补充药物（平均1.01；95%CI 0.90 - 1.12）来管理疼痛。HL与当前管理策略的恰当性之间存在统计学显著的交互作用（P < 0.001）（HL低时，指南推荐的管理策略可能性较小）。较高的HL并不总是能转化为做出恰当的疼痛管理选择。
恰当选择和使用循证管理方案对于OA患者从治疗中获得充分益处至关重要。关于OA自我护理合适选择的知识并不理想，未来的教育应针对不同水平的HL进行量身定制。
