Date of Award
Doctor of Nursing (ND)
Karim Singh, DNP, APRN, FNP-C
Primary knee osteoarthritis is a common diagnosis found in people over 65 years of age. As a progressive disease, the burden on daily life is significant. Typically, patients complain of knee pain, stiffness, and swelling which worsens after prolonged sitting resulting in reduced participation in activities of daily living.
Locally, many patients with symptomatic knee OA are seen at a geriatric primary care clinic in West El Paso, Texas. Current practice in the clinic was to use methylprednisolone acetate 40 mg and referral to physical therapy for patients 65 years or older when the treatment plan included an intra-articular injection. This project was undertaken to identify the optimal corticosteroid and exercise regimen for patients 65 years or older with symptomatic primary knee osteoarthritis, and then implement and evaluate the regimen.
The methods for this quality improvement project use the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) which is an effective and common tool to adequately translate evidence into practice. The PDSA (Plan, Do, Study, Act) Cycle was also used to test the change that was implemented into practice. The validated pain score tool, WOMAC (Western Ontario and McMaster’s Universities Arthritis) Index was utilized to monitor patients’ pain pre- and post-intervention.
The use of triamcinolone acetonide for the intra-articular injection accompanied by provider-taught land-based exercises with repeat back demonstration were two high-evidence modalities in treating knee osteoarthritis that were put into practice for this quality improvement project.
A total of 13 patients met the criteria for this quality improvement intervention during a seven-week project timeline. The main findings demonstrated approximately 87.5% pain improvement with the use of a lower soluble corticosteroid. Lastly, 61% of the patients were still performing the land-based exercises at the end of the seven weeks. The dual practice change to a lower soluble corticosteroid and provider-taught exercises proved to be highly effective.
Cabrera, Yadira I., "Primary Knee OA: Rethinking Intra-articular Pain Management" (2023). Cohort XI. 11.