Conservative Management of Osteoarthritis: Resources for Patients and Advanced Practice Providers in the Federal Bureau of Prisons

Conservative Management of Osteoarthritis: Resources for Patients and Advanced Practice Providers in the Federal Bureau of Prisons

By Joe Douglass, SPT, CSCS

Background

This past year I was accepted to the U.S. Public Health Service as an officer in training, with plans to be assigned to a Federal Prison facility as my first job after graduation from physical therapy school. This project has given me the opportunity to make a positive impact in the clinical setting I will work in after school. After publication, an effort will be made to reach out to health administrative staff at the Bureau of Prisons (BOP) to make them aware of this project. The goal of this communication is to start the process to approve the products of this project for dissemination throughout the BOP so it can benefit providers and patients agency-wide.

 

Statement of Need

Osteoarthritis (OA) is one of the most common medical diagnoses in the world. As it is often a result of normal wear-and-tear on our joints, almost everyone will develop it if they live long enough. The prevalence of arthritis in the U.S. is estimated to be about 23%, and that figure is expected to grow to 26% by 2040 as the population continues to age.¹ In 2013, arthritis-attributable medical costs were estimated to be approximately $140 million.¹

Individuals who are incarcerated in this country are not immune to medical ailments, in fact they tend to have worse mental and physical health when compared to their non-incarcerated counterparts.² Studies have shown that people of both genders who are incarcerated are more likely to have a number of medical conditions, including arthritis.² Similar to the general population, the population of incarcerated people is aging as well.² Due to these facts, medical professionals who work in jails and prisons need to be well-equipped to manage a myriad of diagnoses in order to narrow the gap on this health disparity.

My final clinical rotation will be at Federal Correctional Center (FCC) Butner, a BOP facility in rural North Carolina. My clinical instructor there, CDR Gwen Hall, expressed that there is a need throughout the BOP for physical therapy-centric care at facilities where there is no physical therapist on staff. At these facilities, physician assistants (PA) and nurse practitioners (NP) do most of the primary care. When an inmate at one of these facilities is diagnosed with OA, or has a traumatic orthopedic injury that predisposes them to developing OA, these advanced practice providers are the ones managing the care on their own.

Through anecdotal reports, these advanced practice providers have expressed a lack of knowledge on how to conservatively manage OA aside from injections and medications. This leads to inmates continuing to move and function in ways which rapidly progresses the cartilage degeneration in their joint(s). By the time these inmates are transferred to a facility with a physical therapist on staff, such as a Federal Medical Center, their OA is often so severe that they are significantly debilitated and already on a waiting list for total joint arthroplasty.

Finally, I created a survey for advanced practice providers (i.e., PA, NP) to gain more insight into what type of information they wanted to learn about. I received responses and used this information to tailor the provider presentation to their learning desires.

 

Purpose

This project is meant to provide advanced practice providers with information regarding conservative management of patients with OA from a physical therapy perspective. The goal is to improve these providers’ knowledge and skills regarding OA and how to provide patients with self-management strategies other than injections and medications. This project is also designed to equip patients with information regarding how to self-manage their OA and what to expect long term. Ideally, the knowledge from this project will help mitigate the progression of symptoms for patients with OA in the BOP and prolong or prevent the need for total joint replacement.

 

Overview of Products

There is a separate set of materials for providers and patients in this project. For the providers, there is one presentation with a corresponding handout. The handout is a summary of the presentation that providers can quickly reference while in clinic. For patients, there is one presentation with two accompanying handouts (one for hip and knee OA, one for spine OA). There are two additional handouts targeted toward patients, and these will be delivered to providers to give to their patients if appropriate. These handouts contain basic exercise recommendations for individuals with hip and knee OA and spine OA  .

       Provider Products

       Provider Presentation Video (YouTube link)

      Provider Presentation Slides; Provider Handout

       Patient Products

       Patient Presentation Video (YouTube link)

       Patient Presentation Slides; Patient Hip/Knee OA Handout; Patient Spine OA Handout

       Hip and Knee OA Exercises; Spine OA Exercises

       Patient Handout Sources

 

Evaluation

Throughout the creation process, I have received consistent feedback from my committee members regarding content and how to present the information. Everyone was outstanding at communicating and coming to a consensus when issues presented themselves.

I created three evaluation forms for individuals to complete after viewing the materials of this project. The evaluation form for committee members is focused more on appropriateness of content, and if the content is presented in such a way that would effectively educate the target audience. The patient and provider evaluation forms are focused on enjoyment and engagement of the presentation as well as if the audience feels they learned something beneficial.

My plan is to present both lectures to their respective target audiences while on rotation at FCC Butner this summer. I will gather feedback from these audiences and use the information to improve the project going forward with hopes of submitting it to the BOP for agency-wide dissemination.

       Evaluation Forms  

Committee Evaluation Form; Patient Evaluation Form; Provider Evaluation Form

 

Health Literacy Evaluation

The patient handouts emphasize the use of plain language.³ I focused on use of shorter words and sentences that are easier to understand, and limited medical/physical therapy jargon.³ I consulted the “Plain Language Checklist” for guidance on how to make the handout more readable for all audiences.⁴ According to measures of reading level, the patient handouts are currently at approximately a 6^th-7^th grade reading level.³ People who are incarcerated have appreciably lower literacy levels than their non-incarcerated counterparts.⁵ Based on this analysis, I will need to simplify the language by using fewer words per sentence and fewer words of three syllables or more to reduce the reading level to be consistent with approximately 5^th grade.³ This will be a future goal for the project.

 

Self-Assessment/Reflection

I am very proud of the finished products. I feel the materials created have the opportunity to make a legitimate impact with providers and patients throughout the BOP. I have gained insight into what it takes to generate educational materials at this scale, which will prove meaningful going forward in my professional career. This project has helped me familiarize myself with the current evidence-based practice for management of OA, giving me confidence in my ability to treat patients in this population as a new practitioner coming out of school. More importantly, I feel confident in my ability to teach other providers about it. This project has given me a perspective of what the educational background is like for PAs and NPs, better preparing me for effective professional communication in the future.

 

Acknowledgements

A very big thank you to my committee advisor, Michael Gross, PT, PhD, FAPTA, and committee members, CDR Gwen Hall, PT, DPT, OCS, TPS, Cert. MDT, and Paul Chelminski, MD, MPH, FACP. This project is the result of your expertise, time, and dedication. I cannot thank you enough for your support through this entire process. I would also like to thank those advanced practice providers within the BOP who took the time to generate responses to the survey I created. Your responses helped me fine-tune my focus and include topics that are relevant to your desired learning objectives. Finally, to my classmates and colleagues, I thank you for the thought-provoking discussions that have contributed to the materials created, and for an amazing three years of learning and growing together.

 

References

1. Arthritis-Related Statistics | Data and Statistics | Arthritis | CDC. Available at: https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm. Accessed April 14, 2020.
2. Incarceration | Healthy People 2020. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/incarceration. Accessed April 14, 2020.
3. Jensen G, Mostrom E. Ch 12: Patient Education and Health Literacy. In: Handbook of Teaching and Learning for Physical Therapists, Third Edition.; 2013:200-216.
4. Cornett S. Plain Language Checklist. 2006.
5. Michon C. Uncovering Mass Incarceration’s Literacy Disparity. Prison Policy Initiative 2016. Available at: https://www.prisonpolicy.org/blog/2016/04/01/literacy/. Accessed April 13, 2020.

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