Benchmark – Evidence-Based Practice Project PICOT Paper

Benchmark – Evidence-Based Practice Project PICOT Paper

Benchmark – Evidence-Based Practice Project PICOT Paper

            Osteoarthritis can be described as a painful chronic disorder of the joints which most affects the knees, hands, hips, and spine. It usually affects the entire joint from the cartilage, menisci and ligaments, synovium or joint lining, and muscles around the joint. Recent studies show that approximately 30 million adults in the United States have some kind of clinical knee, hand, or hip osteoarthritis (Xu & Wu, 2021). The total annual medical expenditure for the management of osteoarthritis in the United States is estimated at over $100 billion every year and is speculated to increase as the population ages in addition to the increase in the number of performed joint replacement procedures (Vina et al., 2021). With the increasing burden of the disease, several management options have been provided through the evidence to improve the quality of life of the patient. The purpose of this paper is to illustrate the development of a PICOT question to help in identifying and implementing evidence-based interventions in improving pain and sleep problems among African American female adults above the age of 55 years diagnosed with osteoarthritis.

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Population Demographics and Health Concerns

            The target population for this project is African American female adults above the age of 55 years diagnosed with osteoarthritis. Despite racial minorities accounting for only 3 million of the cases of osteoarthritis reported in the United States, severe forms of joint pain, activity and functional limitations, and decreased mobility have been reported among aging African Americans diagnosed with the disorder (Xu & Wu, 2021). Studies also report worse incidences and progression of the disorder for both knee and hip osteoarthritis among African Americans as compared to whites (Callahan et al., 2021). Consequently,   the incidences of osteoarthritis among adult females above the age of 55 years have been reported to be twice that of men. Most women start displaying symptoms after menopause (Cheung et al., 2022). 

Proposed Evidence-Based Intervention

            Culturally tailored behavioral interventions have been reported as the most effective management strategies for improving pain-related outcomes among African American adults. Such interventions include yoga, meditation, exercise, and relaxation techniques (McLeod et al., 2020). The Pain Coping Skills Training for African Americans with Osteoarthritis (STAART) has conducted several studies supporting the effectiveness of the above interventions in reducing pain and improving sleep among this vulnerable population (Cheung et al., 2022). The National Public Health 2020 Agenda for Osteoarthritis also provides policies that assure equity in the delivery and access of the interventions that prevent the development of symptoms and improve the management of osteoarthritis among all Americans (Cheung et al., 2022).

Comparison of Intervention to Current Research

            Previous evidence demonstrates that yoga, comprising of breathing techniques, poses and meditation has been beneficial in improving physical symptoms of osteoarthritis such as stiffness and pain in addition to psychological issues like anxiety and stress (Vina et al., 2021). Adult patients with different forms of osteoarthritis who practice yoga have reported reduced joint pain. Improved flexibility of joints and reduced stress and tension promote better sleep (Cheung et al., 2022). The Integrated approach of yoga therapy (IAYT) intervention has also been reported to help improve muscle flexibility, strength, and functional mobility among adults with osteoarthritis (Park et al., 2020).

Expected Outcome for Intervention

            With the successful implementation of Yoga as the main non-pharmacological intervention among adults with osteoarthritis, patients are expected to report reduced joint pain, in addition to improved muscle flexibility, strength, and functional mobility (Lauche et al., 2019). Some of the measurable outcomes that are expected to improve include the falls efficacy scale (FES), goniometer test, handgrip strength (HGS), Sit-to-Stand (STS), and Timed Up and Go Test (TUG) (Cheung et al., 2022). Patients are also expected to report reduced stress levels improving their quality of sleep.

Time Estimated for Implementing Intervention and Evaluating Outcome

            Given that osteoarthritis is considered a chronic joint pain, patients are expected to exhibit optimal management of symptoms within 6 months with the use of Yoga and the main pain management non-pharmacological intervention (Vina et al., 2021). The treatment outcome will be based on the consistency and the amount of time spent by the patient every day to engage in breathing exercises poses, and meditation as the main components of yoga (Park et al., 2020). Evaluation of the outcome will be done based on the outlined outcome measures at the end of the 6 months.

Support/Conclusion

            Previous epidemiologic and genomic studies have provided data supporting the high incidences and burden of osteoarthritis among African American adult patients (Park et al., 2020). Consequently, with consideration of social determinants of health, yoga among other non-pharmacological interventions has been proven as the most effective intervention in managing osteoarthritis for this minority group (Lauche et al., 2019). Generally, clinical data provide scientific evidence supporting the use of yoga in the management of pain and improving sleep among patients with osteoarthritis.

References

Callahan, L. F., Cleveland, R. J., Allen, K. D., & Golightly, Y. (2021). Racial/Ethnic, Socioeconomic, and Geographic Disparities in the Epidemiology of Knee and Hip Osteoarthritis. Rheumatic Disease Clinics of North America, 47(1), 1–20. https://doi.org/10.1016/j.rdc.2020.09.001

Cheung, C., Wyman, J. F., & Peden-McAlpine, C. (2022). Long-Term Yoga and Aerobic/Strength Exercise Adherence in Older Women with Knee Osteoarthritis: A Mixed Methods Approach. International Journal of Yoga Therapy, 32(2022), Article-4. https://doi.org/10.17761/2022-D-20-00033

‌Lauche, R., Hunter, D. J., Adams, J., & Cramer, H. (2019). Yoga for Osteoarthritis: a Systematic Review and Meta-analysis. Current Rheumatology Reports, 21(9). https://doi.org/10.1007/s11926-019-0846-5

McLeod, A., Schiffer, L., Castellanos, K., DeMott, A., Olender, S., Fitzgibbon, M., Hughes, S., Fantuzzi, G., & Tussing-Humphreys, L. (2020). Impact of Physical Activity and Weight Loss on Fat Mass, Glucose Metabolism, and Inflammation in Older African Americans with Osteoarthritis. Nutrients, 12(11), 3299. https://doi.org/10.3390/nu12113299

Park, J., Sherman, D. G., Agogo, G., Hoogendijk, E. O., & Liu, Z. (2020). Frailty modifies the intervention effect of chair yoga on pain among older adults with lower extremity osteoarthritis: Secondary analysis of a nonpharmacological intervention trial. Experimental Gerontology, 134, 110886. https://doi.org/10.1016/j.exger.2020.110886

Vina, E. R., Youk, A. O., Quinones, C., Kwoh, C. K., Ibrahim, S. A., & Hausmann, L. R. (2021). Use of complementary and alternative therapy for knee osteoarthritis: race and gender variations. ACR Open Rheumatology, 3(9), 660-667. https://doi.org/10.1002/acr2.11307

Xu, Y., & Wu, Q. (2021). Trends and disparities in osteoarthritis prevalence among US adults, 2005–2018. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-01339-7

Appendix A

Table 1: PICOT Question

Population (P)	Female African American aged 55 years and above with osteoarthritis
Intervention (I)	Structured yoga including breathing exercises, meditation, and postures
Comparison (C)	Usual care
Outcome (O)	Improved pain and sleep problems
Timeframe (T)	Six months

“In African American females aged 55 years and above with osteoarthritis, does the use of structured yoga interventions for six months improve pain and sleep problems as compared to the usual care?”

Appendix B

APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☒ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☒  The title page is present. APA format is applied correctly. There are no errors.

☒ The introduction is present. APA format is applied correctly. There are no errors.

☒ Topic is well defined.

☒ Strong thesis statement is included in the introduction of the paper.

☒ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☒ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☒ All sources are cited. APA style and format are correctly applied and are free from error.

☒ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☒ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.

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Requires Lopeswrite
Assessment Description
Refer to the PICOT you developed for your evidence-based practice project proposal. If your PICOT required revision, include those revisions in this assignment. You will use your PICOT paper for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Write a 750-1,000-word paper that describes your PICOT.

Describe the population’s demographics and health concerns.
Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.
Compare your intervention to previous practice or research.
Explain what the expected outcome is for the intervention.
Describe the time for implementing the intervention and evaluating the outcome.
Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.
Create an Appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite at least four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

MS Nursing: Public Health

MS Nursing: Education

MS Nursing: Acute Care Nurse Practitioner

MS Nursing: Family Nurse Practitioner

MS Nursing: Health Care Quality and Patient Safety

4.1: Synthesize nursing science, determinants of health, and epidemiologic, genomic, and genetic data in the management of population health.

Rubric Criteria

Population Demographics and Health Concerns
7.5 points

Proposed Evidence-Based Intervention
19.5 points

Comparison of Intervention to Current Research
18 points

Expected Outcome for Intervention
15 points

Time Estimated for Implementing Intervention and Evaluating Outcome
15 points

Support (B)
15 points

Appendix
7.5 points

Required Sources
7.5 points

Thesis Development and Purpose
10.5 points

Argument Logic and Construction
12 points

Mechanics of Writing
7.5 points

Paper Format
7.5 points

Documentation of Sources
7.5 points

Total
150 points

PICOT Question
P Population Female African American aged 55 years and above with osteoarthritis
I Intervention Structured yoga including breathing exercises, meditation, and postures
C Comparison Usual care
O Outcome Improved pain and sleep problems
T Timeframe Six months
PICOT
Create a complete PICOT statement. In African American females aged 55 years and above with osteoarthritis, does the use of structured yoga interventions for six months improve pain and sleep problem as compared to the usual care?
Problem Statement
Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.
Osteoarthritis is a common problem that affects elderly women in the population. Women have a high prevalence rate of osteoarthritis than men due to hormonal changes during the menopause and post-menopausal period. Osteoarthritis affects significantly the health and well-being of the women populations. Accordingly, it lowers their quality of life and well-being due to the reduced physiological state. It also causes frailty characterized by slowed physical activity, muscle strength, global weakness, loss of weight, and overall slowness (Seguin-Fowler et al., 2020). Patients also experience persistent, chronic pain, that affects their ability to engage in activities of daily living.
Osteoporosis treatment aims at improving symptoms and patient functioning. Generally, the management of osteoporosis relies on the use of pharmacological interventions. Drugs classified as DMARDS have proven effective for short and long-term symptom management (Gautam et al., 2019). The use of non-pharmacological interventions has also gained popularity over the past years. Their popularity is attributed to the general safety, tolerance, and effectiveness in improving symptom management in osteoporosis. One such intervention entails the use of yoga. Yoga is a non-pharmacological intervention with its origins in India. It aims at integrating physical postures with meditation and breathing techniques (Seguin-Fowler et al., 2020). Studies have demonstrated that yoga improves psychological well-being, physical functioning, muscle strength, balance, and health-related quality of life in the elderly populations.
Yoga has also demonstrated effectiveness in improving symptoms of osteoarthritis. For example, a systematic review and meta-analysis performed by de Orleans Casagrande et al., (2022) showed that yoga improves sleep quality, mood, anxiety, and depressive symptoms in patients with rheumatic diseases, including osteoarthritis, rheumatoid arthritis, and fibromyalgia. The results showed that yoga favored a significant reduction in depressive symptoms, anxiety, and sleep quality among patients suffering from these conditions. A meta-analysis and systematic review by Lauche et al., (2019) also demonstrated similar results. Outcomes from their analysis showed that yoga is effective in improving pain, stiffness, and function in patients with knee osteoarthritis as compared to exercise.
Despite the evidence on the effectiveness of yoga on osteoarthritis, its use in the practice site has not been explored. Accordingly, mainstream management has mainly focused on the use of pharmacological interventions to manage osteoarthritis. Perharps adopting yoga for osteoarthritis may be associated with enhanced outcomes such as pain and sleep improvements as compared to the usual care involving medication use. In addition, yoga has other benefits such as improving anxiety and depression symptoms among patients with osteoarthritis (de Orleans Casagrande et al., 2022). Therefore, the proposed project seeks to bridge the gap in evidence and knowledge by investigating the effect of yoga on African American women aged 55 years with osteoarthritis, with a focus on pain and sleep quality.

 
References
de Orleans Casagrande, P., Coimbra, D. R., de Souza, L. C., & Andrade, A. (2022). Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis. PM&R, n/a(n/a). https://doi.org/10.1002/pmrj.12867
Gautam, S., Tolahunase, M., Kumar, U., & Dada, R. (2019). Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial. Restorative Neurology and Neuroscience, 37(1), 41–59. https://doi.org/10.3233/RNN-180875
Lauche, R., Hunter, D. J., Adams, J., & Cramer, H. (2019). Yoga for Osteoarthritis: A Systematic Review and Meta-analysis. Current Rheumatology Reports, 21(9), 47. https://doi.org/10.1007/s11926-019-0846-5
Seguin-Fowler, R., Graham, M., Ward, J., Eldridge, G., Sriram, U., & Fine, D. (2020). Feasibility of a yoga intervention to decrease pain in older women: A randomized controlled pilot study. BMC Geriatrics, 20(1), 400. https://doi.org/10.1186/s12877-020-01818-y