|Year : 2019 | Volume
| Issue : 4 | Page : 460-468
Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis
N Mirmaroofi1, A Ghahramanian2, M Behshid3, F Jabbarzadeh3, TC Onyeka4, M Asghari-Jafarabadi5, J Ganjpour-Sales6
1 Department of Orthopaedics, Shohada Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Medical Surgical, Nursing and Midwifery Faculty, Haematology and Oncology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Anaesthesia/Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
5 Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
6 Department of Orthopaedics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
|Date of Acceptance||06-Nov-2018|
|Date of Web Publication||11-Apr-2019|
Dr. A Ghahramanian
Medical Surgical Department, Nursing and Midwifery Faculty, Haematology and Oncology Research Centre, Tabriz University of Medical Sciences, South Shariati St, Tabriz, East Azerbaijani
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: This study aimed to determine the relationship between pain of osteoarthritis (OA) and body mass index (BMI), age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in a cohort of Iranian women. Subjects and Methods: In total, 150 women with advanced knee OA, candidates for arthroplasty in Tabriz, in the Northwest of Iran were enrolled into the study. A convenience sampling method was used, and data was collected using demographic form, short-form McGill pain questionnaire, pain self-efficacy questionnaire, self-efficacy for exercise, and functional activities scales. Results: The present pain intensity of 74.7% of women was described as excruciating with mean (±SD) score 9.58 (±0.77) in the visual analogue scale. The majority of the women had a low self-efficacy for pain, exercise, and functional activities with means of 31.8, 17.28, and 57.63 respectively. There was a significant inverse relationship between sensory and affective components of pain and self-efficacy for pain control and functional activities (P < 0.001). The sensory and affective components of pain was related to age (P < 0.05), pain control self-efficacy (P < 0.01), and BMI (P < 0.05). A great majority of the women (79.33%) used complementary medicine (CM) for pain management. Those who used CM reported lower pain and higher self-efficacy (P < 0.01). Conclusion: The findings of this study suggest that life style modification and pain management education of women with OA and nurses on non-pharmacological interventions as well as integration of these into nursing care is essential.
Keywords: Complementary medicine, osteoarthritis, pain control, self-efficacy, women
|How to cite this article:|
Mirmaroofi N, Ghahramanian A, Behshid M, Jabbarzadeh F, Onyeka T C, Asghari-Jafarabadi M, Ganjpour-Sales J. Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis. Niger J Clin Pract 2019;22:460-8
|How to cite this URL:|
Mirmaroofi N, Ghahramanian A, Behshid M, Jabbarzadeh F, Onyeka T C, Asghari-Jafarabadi M, Ganjpour-Sales J. Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis. Niger J Clin Pract [serial online] 2019 [cited 2021 May 17];22:460-8. Available from: https://www.njcponline.com/text.asp?2019/22/4/460/255928
| Introduction|| |
Osteoarthritis (OA) is a degenerative joint disease. Pathological changes resulting from OA not only damages the joint cartilage but also destroys all joint structures. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. The number of people affected with symptomatic OA is likely to increase owing to the aging of the population and the obesity epidemic. This disease is the most common form of the adult joint disease worldwide with limitation of range of motion in 11% of cases reported. The prevalence of OA increases with age, female gender, overweight, and obesity, and it is estimated that by 2020, a 60% increase in the incidence of OA and motor function limitation will occur. It has been shown that women are more severely impacted by knee OA. Differences in knee anatomy, kinematics, previous knee injury, and hormonal influences may play a role.
The knee joint is the most common weight-bearing joint to be involved in OA. The common symptoms of knee OA are pain, stiffness, limited range of motion, joint deformities, and muscle wasting and weakness. The prevalence of knee OA as the causative agent of musculoskeletal pain among people age 65 or older is between 60 and 90%. OA is one of the main reasons for dysfunction, impacting significantly on people's lives in the areas of mobility, independence, and activities of daily living (ADL), and can lead to limitations in recreational, sports, and occupational activities. Knee OA is the most common cause of chronic disability in house-bounded adults. Patients with knee OA suffer from a progressive disability in walking, going up, and down stairs due to pain and stiffness. The aim of treatment and care is to relieve pain, maintain joint mobility, and minimize disability. There may be a perception that women's symptoms are an exaggeration. Some physicians may attribute part of their patients' complaints to being “emotional” or overly dramatic. In addition, women may be more willing to forgo surgery and accept disability and less willing to accept the risks of surgery and any disruption in their care giving responsibilities,, and for these reasons, women may suffer more in the disease.
Changes in clinical practice for physicians and nurses can play an important role in early detection and appropriate management of patients' pain. In addition, considering that pain relief is required for fast recovery and achieving the optimal range of motion, it seems that healthcare providers' efforts can improve pain control and patient movement ability simultaneously. Evidence suggests that the improvement of self-efficacy leads to self-care activities, improvement of health, and reduction of the severity of pain and pain-related dysfunctions., The concept of self-efficacy refers to the belief that one can confidently execute a task,,, the person's belief in his/her ability to organize, and implement the measures required to achieve the treatment aims which in turn can help with the improvement of social and motor functions. In addition, it has been noted that people with higher self-efficacy make more efforts to manage pain. Empowering patients with persistent pain through arthritis self-management education can lead to improvements in pain self-efficacy (PSE) and opioid misuse measures, especially when such education is given alongside standard medical care.,
Nurses have the opportunity of spending much time with patients, thus have a unique chance to identify patients problems during their interactions with patients. By identifying factors associated with limited mobility, they can help develop strategies to prevent disability. According to Bandura's cognitive-social theory, individuals' beliefs about their level of performance can predict their function. A relationship has been established between self-efficacy and exercise function in adults and children. It has been reported that self-efficacy positively influences physical activities in patient with knee OA and can lead to improvements in activities such as walking and climbing of stairs. In patients with knee OA, high self-efficacy reduces the amount of patient's complaints of poor physical performance., In one study, patients participating in an educational program with the aim of self-efficacy promotion experienced a decline in physician's visits over a period of 4 years.,
Some studies conducted in some countries show the relationship between self-efficacy and unrelieved pain as well as with motor function in patients with knee OA,, no such study exists in the Iranian women health care context. Therefore, this study aimed todetermine the relationship between pain of OA and BMI, age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in a cohort of Iranian women with advanced OA referred to educational hospitals in Tabriz, Iran.
| Subjects and Methods|| |
A cross-sectional study design was used for this study to determine whether pain of OA was significantly associated with BMI, age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in Iranian women with OA.
Participants consisted of 150 women with radiologically confirmed knee OA, who had been being referred to the rheumatology units of educational hospitals in Tabriz, located in the Northwest of Iran and had been selected using a convenient sampling method. The inclusion criteria included (i) female sex, (ii) age ≥18 years (iii) having no hearing disorder and other background diseases that might hinder participation in the study, and (iv) willingness to participate in the study. The exclusion criteria included any history of previous surgeries on the knee and medical disorders that led to the prohibition of physical activity and exercise in the patients. Given the standard deviation of self-efficacy reported by a pilot study, alpha of 0.05, a 95% confidence interval, and 0.05 acceptable errors around the mean, the least number of sample size was determined to be 150 women. The following sampling formula was used to determine the sample size: n = z2 × σ2/d2.
The study was approved by the ethical review board from Tabriz University of Medical Sciences, Tabriz, Iran (Ethical code: TBZMED.1394.526). Permission to enter the research zones was obtained. The women were informed of the study aim and processes. They were assured of the anonymity of their identities and confidentiality of data collection. Of those women who agreed to participate in this study, written informed consent was obtained. The duration of data collection was from November 2015 to February 2016.
Short-form McGill pain questionnaire
The short-form McGill pain questionnaire (SF-MPQ) which is a modification of the long-form, both designed by Melzack in 1987 and 1975, respectively was used to assess the patients' pain. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) that are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate, or 3 = severe and a score range of between 0 and 45. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective, and total descriptors. The SF-MPQ also includes the present pain intensity (PPI) and a visual analogue scale (VAS). It has a Cronbach's coefficient alpha of 0.76.
Pain self-efficacy questionnaire
The PSE questionnaire consists of 10 items with a 6-point Likert scale and a score range of between 1 and 60. It was designed by Nickolas according to the Bandura's theory of self-efficacy, and the Cronbach's coefficient alpha for this questionnaire was 0.93.
Self-efficacy for exercise scale
The self-efficacy for exercise (SEE) scale was developed by Resnick and Jenkins. This questionnaire measured the participants' perceived ability to exercise in various conditions such as bad weather, the feeling of depression, and fatigue. The filling out this questionnaire needed the patients to estimate their self-trust for participation in exercise three times a week and for 20 min. The range of scores was from 0 to 90 with higher scores indicating higher SEE. The reliability of this questionnaire has been confirmed to have an internal consistency (Cronbach's coefficient alpha) of 0.99.
Self-efficacy for functional activities scale
The self-efficacy for functional activities (SEFA) scale initially included 27 items focusing on efficacy expectations related to performance of each ADL (bathing, dressing, transferring, ambulating, and stair climbing) independently, with adaptive equipment and with the help of another person. After initial pilaf testing, the scale was revised to include 9 items that focused on efficacy expectations related to performance of each ADL independently or with the help of another person. The range of its score was from 0 to 90 and the scores of 0 and 10 indicating a lack of ability and having the ability, respectively. The Cronbach's coefficient alpha for this questionnaire was 0.82.
The questionnaires were administered by a research assistant after translation to the official language of Persian and the local language of Azerbaijani Turkish and following validation.
A demographic characteristics' form designed by the authors was used to collect variables such as age, weight and height, BMI, educational level, occupation, marital status, and pain control strategies.
The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 16. Descriptive and correlational analyses (means, standard deviations, Pearson correlation coefficient, and linear regression) were used to describe and examine relationships between self-efficacy beliefs and self-reported functional performance and pain. The P value less than 0.05 was considered statistically significant.
| Results|| |
The majority of the respondents were housewives (87.3%), married (93.3%), and illiterate (61.3%) with a mean age of 64.96 years. The majority of participants (52.7%) have age 61 to 70 year. In addition, majority (81.3%) had a prior history of unrelated surgery, and 80% were using both orthodox and complementary and alternative therapies as pain control strategies. More information on the demographic characteristics of the respondents is summarized in [Table 1].
Descriptive data of sensory and affective components of pain, PPI, and VAS: [Table 2] presents the description of the sensory and affective components of the pain experienced by the women. A total of 145 (96.7%) women reported an “aching” sensation that was of severe intensity, whereas 134 women (89.3%) reported the feeling of “sickening” pain that was largely severe in intensity. The total mean of sensory and affective components of pain was 34.76 out of 45. Regarding PPI, majority of the women (74.7%) described their pain as excruciating (mean [SD] = 4.71[.53]), whereas with VAS, the pain score in majority of the patients (72.0%) was 10. In addition, the mean score of pain was 9.58 with a range of 6 to 10 [Table 3].
|Table 3: Descriptive data of present pain intensity and visual analogue scale in women with OA|
Click here to view
Descriptive data of pain self-efficacy, self-efficacy for exercise, and self-efficacy for functional activities
The mean of PSE was 31.08 with a range of 0 to 60. In addition, the mean of SEE was 17.28 with a range between 0 and 90. With regard to SEFA, the reported mean was 57.63 with a range between 0 and 90.
Correlation between pain components, present pain intensity, visual analogue scale, pain self-efficacy, self-efficacy for exercise, self-efficacy for functional activities, and independent variables
The sensory and affective components of pain had statistically significant inverse relationships with age (P < 0.05). In addition, there was a statistically significant relationship between pain control strategies with sensory and affective components of pain, VAS, PPI, and SEFA (P < 0.01). The Tukey post hoc test showed that those women who used complementary medicine (CM) for pain control reported less pain and higher SEFA compared with those who used orthodox medications alone and those who used complementary and alternative medicine (CAM) along with modern medicine (P < 0.01). The body mass index (BMI) had a statistically significant direct relationship with sensory and affective components of pain (P < 0.05), whereas there was a statistically significant inverse relationship with self-efficacy for pain control (P < 0.01).
The results of analysis in [Table 4] show a statistically significant direct relationship between the sensory and affective components of pain, VAS, and PPI (P < 0.001). Although a statistically significant inverse relationship was found between the sensory and affective components of pain and self-efficacy for pain control strategies and functional activities (P < 0.01), no statistically significant relationship was seen with SEE (P > 0.05). A statistically significant inverse relationship was found between the VAS and self-efficacy for pain control and functional activities (P < 0.001). However, no such a relationship was found with SEE (P > 0.05). We found a statistically significant inverse relationship between the PPI and SEFA (P< 0.001), but no relationship was reported between self-efficacy for pain control and SEE (P > 0.05).
|Table 4: Correlation coefficients between sensory and affective components of pain, PPI, VAS, PSE, SEE, and SEFA|
Click here to view
In the multiple analysis, self-efficacy for pain control as the dependent variable and all other variables as independent variables were entered in stepwise multiple regression. As seen in [Table 5], 13% of the observed variance of the scores of self-efficacy for pain control was explained by the VAS (B = −3.87, 95% of CI = −5.78-1.96, P < 0.001) and BMI (B = −0.42, 95% of CI = −0.77-0.08, P = 0.01). In addition, sensory and affective components of pain (B = −0.24, 95% of CI = −0.53-0.03, P > 0.05) had no statistically significant influence on the model. In other words, one score increases in the VAS, reduced self-efficacy for pain control for 3.87 times. Additionally, one score increase in BMI led to the reduction of self-efficacy for 0.42 times.
|Table 5: Regression model showing factors related to pain self-efficacy and self-efficacy for functional activity in women with OA|
Click here to view
With the consideration of the same condition for data analysis mentioned above, SEE as the dependent variable was analyzed using the regression analysis model. However, none of the independent variables had any predictive relationship with SEE. In addition, SEFA was analyzed using the regression analysis model and found that 27% of the observed variance in the scores of SEFA was predicted by the VAS (B = −4.02, 95% of CI = −6.20-1.83, P < 0.001) and sensory and affective components of pain (B = −0.47, 95% of CI = −0.73-0.20, P < 0.001) [Table 5]. In other words, one score increase in the VAS reduced 4.02 times SEFA. In addition, one score increase in sensory and affective components of pain led to the reduction of SEFA of 0.47 times.
| Discussion|| |
This study aimed to investigate the relationship between several variables (age, BMI, pain control strategies, and self-efficacy) and pain in women with advanced knee OA. Our participants experienced severe pain in sensory and affective components of pain. The results of other studies are similar to our findings.,, We theorize from this study that certain lifestyle habits and customs may influence patients' perception of their pain.
Some of these practices include the practice of using squat toilet rather than sitting where the toilet pan or bowl is at floor level, which is synonymous with Muslim practices of the religious ritual of anal cleansing and the strict religious ban of contact with urine and faeces. In addition, the practice of eating and sitting on the floor cross-legged instead of on a sofa or chair, sleeping on the flat rather than bed which is considered a Sunnah, a practice of the faithful of the holy Prophet Mohammed, as well as a low participation of women in exercise activities in the Iranian culture, may also be contributory.
Other factors observed to influence pain in this study was age and BMI. With the mean score for age of subjects in this study at 64.96, and being majority of participants in the age group of 61–70 years. This concurs with other studies that indicate a higher prevalence of knee OA occurs among women older than 50 years, a trait attributed to postmenopausal decline in the hormone, estrogen. Pain and age had a statistically significant inverse relationship together, which was a trend observed in the findings of Rittger et al. in patients with cardiac diseases. The mean BMI of 29.35 obtained in this study seems to indicate that many of the women were overweight. In addition, a statistically significant direct relationship was found in this study between BMI and pain that is consistent with the findings of Stone et al. who reported that the people who are obese are considerably more prone to have daily pain. In contrast, with our result is that of Jabalameli et al. who reported that there was no significant relationship between BMI and VAS for chronic pain. In the Spector study, obesity was the most important factor related to incident OA, and 47% of women with OA were obese. Foy et al. were able to document significant improvements in physical function for overweight subjects with OA who were subjected to an intensive lifestyle intervention, and several other studies, involving overweight and obese adults with painful knee OA have demonstrated the ability of physical activity to significantly impact on the pain, physical function, and health-related quality of life in this subset of patients. Hence, educational and lifestyle interventions involving exercise and encourage OA patients to set achievable physical activity goals can be recommended for our subjects with far-reaching and positive consequences for their knee pain.
In this study, the majority of patients used CAM along with orthodox medication to control their pain. The main methods were hot compress composed of bag of salt derived from the Urmia lake, vegetable oils such as olive oil produced in North of Iran, cold therapy, relaxation, and diversion of thoughts. The meta-analysis of randomized controlled trials by Chen et al. indicated a predominant use of Chinese herbs, (chines oral drugs) by patients which were produced in their own region for reducing osteoarthritic pain. It is believed that patients' living location, culture of origin, and life style have some influence on the methods of pain management. In a study in Iran, 42% of people used CM, which were mostly herbs, massage therapy, and relaxation for reliving their pain. Another study showed that the quantity of CAM used was comparable to the use of opioids. According to our results, those women who used CM reported less pain compared with those who used other methods of pain control. These results are in agreement with some studies,,,,, whereas another study reported that mind-body intervention had no effect on pain. The findings of the Reid study indicate a correlation between CM users and gender, with reports of a higher rate of use from females than males, and CM users are more likely to seek CM services for a range of chronic conditions such as pain control.
We also found that the method of pain control affected the patients' self-efficacy. Those patients who used CAM had better SEFA. According to Menzies et al., imagination is a suitable strategy for relieving patients' pain. Pain had a statistically significant inverse relationship with self-efficacy, and these findings of ours are supported by other the findings from other studies.,,
We found that our subjects had a low level of self-efficacy for pain control, exercise, and functional activities. These results are consistent with some other studies., In addition, the finding that study subjects had the worst scores in SEE is similar to findings of Shin et al. and a low mean score for exercise self-efficacy implies that patients will tend toward inactivity with the attendant consequences of overweight and obesity and subsequent worsening of knee pain. The findings of Avazeh et al. in Iran showed that patients were fairly well informed of the positive effects of exercise on the reduction of cardiovascular diseases, but they were not interested in the incorporation of exercise into their daily activities.
In addition, the severity of pain and BMI could predict self-efficacy for pain control in our patients. This finding is also is in line with Pells et al. finding that self-efficacy is important in understanding pain and behavioral adjustment in overweight or obese patients with OA. The severity of pain and perception of pain could predict SEFA that were in line with Shelby et al. finding that showed higher pain catastrophizing contributed to greater pain and disability through lower domain-specific self-efficacy.
Generalization of the results of this study by researchers will be difficult as our women population were derived from Northwest Iran. Hence, these findings may not translate to women of other ethnicities. Despite this, the study results might still be widely applicable as they will help with patient-specific treatment of advanced knee OA in all parts of the world.
Implications for healthcare team and practice
Given the influence of BMI on pain and self-efficacy as illuminated through this study, there is a need to teach women with advanced knee OA to adjust their lifestyle, paying key attention to appropriate nutrition (such as reducing caloric intake), and increasing physical activity. Because older women have more problems with pain control, they need more attention by nurses during the designation of supportive-educational programs. In addition, considering the effect of CAM on self-efficacy and pain, there is a need to inform patients of non-pharmacological methods of pain control through education and also encourage the integration of these methods into women healthcare. Medical and nursing curricula can be revised to integrate complementary and alternative methods of pain control, and CAM can be incorporated in care plans in clinical practice. Further, studies are warranted on the influence of CAM therapies on pain intensity and self- efficacy in similar cohort but different socio-economic, cultural, and religious contexts.
| Conclusion|| |
Iranian women with knee OA are known to have poor quality of life, because they live in constant pain, have poor SEFA, and exercise and may sometimes look for help through using herbal treatments and other remedies for pain relief depending on local products of their own region, living location, culture, and life style, as revealed by this study. The clinical implementation of educational and lifestyle interventions to encourage these women with chronic knee pain OA are recommended as they may serve as a veritable instrument to increase self-efficacy in those domains and reduce pain.
Financial support and sponsorship
This study was supported by Tabriz University of Medical Sciences. The study was approved by the ethical review board from Tabriz University of Medical Sciences, Tabriz, Iran (Ethical code: TBZMED.1394.526).
Conflicts of interest
There are no conflicts of interest.
AG, MB, and NM prepared study concept and design. AG and MAJ analyzed and interpreted data, drafted the manuscript, and prepared the tools used in the data gathering. NM and JGS had the responsibility of data gathering. AG and TO revised the manuscript, and the whole process was under supervision of AG, MB, and FJ.
| References|| |
Ahmed AF. Effect of sensorimotor training on balance in elderly patients with knee osteoarthritis. J Adv Res 2011;2:305-11.
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010;26:355-69.
Lee YC, Shmerling RH. The benefit of nonpharmacologic therapy to treat symptomatic osteoarthritis. Curr Rheumatol Rep 2008;10:5-10.
Michael J, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int 2010;107:152-62.
Di Domenica F, Sarzi-Puttini P, Cazzola M, Atzeni F, Cappadonia C, Caserta A, et al.
Physical and rehabilitative approaches in osteoarthritis. Semin Arthritis Rheum 2005;34(Suppl 2):62-9.
Conley S, Rosenberg A, Crowninshield R. The female knee: Anatomic variations. J Am Acad Orthop Surg 2007;15(Suppl 1):S31-6.
Toda Y, Tsukimura N. A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Arthritis Rheum 2004;50:3129-36.
Ansari S, Elmieh A, Hojjati Z. Effects of aquatic exercise training on pain, symptoms, motor performance, and quality of life of older males with knee osteoarthritis. Ann Appl Sport Sci 2014;2:29-38.
Williams MK, Spector TD. Osteoarthritis. Medicine 2006;34:364-8.
Salavati M, Mazaheri M, Negahban H, Sohani S, Ebrahimian M, Ebrahimi I, et al
. Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis Cartilage 2008;16:1178-82.
Maly MR, Costigan PA, Olney SJ. Determinants of self efficacy for physical tasks in people with knee osteoarthritis. Arthritis Rheum 2006;55:94-101.
Chuang SH, Huang MH, Chen TW, Weng MC, Liu CW, Chen CH. Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis. Kaohsiung J Med Sci 2007;23:405-11.
Peyron J, Altman R. The epidemiology of osteoarthritis. Osteoarthritis Diagnosis and Treatment Philadelphia, PA: WB Saunders; 1984. p. 9-27.
Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. CMAJ 2008;178:681-7.
Novicoff WM, Saleh KJ. Examining sex and gender disparities in total joint arthroplasty. Clin Orthop Relat Res 2011;469:1824-8.
Zamanzadeh V, Ahmadi F, Foolady M, Behshid M, Irajpoor A. The health seeking behaviors and perceptions of Iranian patient with osteoarthritis about pain management: A qualitative study. J Caring Sci 2017;6:81-93.
Hadorn F, Comte P, Foucault E, Morin D, Hugli O. Task-shifting using a pain management protocol in an emergency care service: Nurses' perception through the eye of the Rogers's diffusion of innovation theory. Pain Manag Nurs 2016;17:80-7.
Asgharimoghaddam MA. The prevalence rate of chronic pain and some of its associations among the employees of a big industrial company in Tehran. Daneshvar Raftar 2004;11:1-14.
McMurray SD, Johnson G, Davis S, McDougall K. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. Am J Kidney Dis 2002;40:566-75.
Meredith P, Strong J, Feeney JA. Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain 2006;123:146-54.
Bandura A, Wood R. Effect of perceived controllability and performance standards on self-regulation of complex decision making. J Pers Soc Psychol 1989;56:805-14.
Leventhal H. Systems as frameworks, theories and models: From the abstract to the concrete instance. J Health Psychol 1997;2:160-2.
Somers TJ, Shelby RA, Keefe FJ, Godiwala N, Lumley MA, Mosley-Williams A, et al
. Disease severity and domain-specific arthritis self-efficacy: Relationships to pain and functioning in patients with rheumatoid arthritis. Arthritis Care Res 2010;62:848-56.
Gaines JM, Talbot LA, Metter EJ. The relationship of arthritis self-efficacy to functional performance in older men and women with osteoarthritis of the knee. Geriatr Nurs (New York, NY) 2002;23:167-70.
Dworkin RH, Breitbart W. Psychosocial Aspects of Pain: A Handbook for Health Care Providers. International Assn for the Study of Pain; 2004.
Wilson M, Roll JM, Corbett C, Barbosa-Leiker C. Empowering patients with persistent pain using an internet-based self-management program. Pain Manag Nurs 2015;16:503-14.
Goeppinger J, Lorig KR, Ritter PL, Mutatkar S, Villa F, Gizlice Z. Mail-delivered arthritis self-management tool kit: A randomized trial and longitudinal followup. Arthritis Rheum 2009;61:867-75.
Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, et al
. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. Arthritis Rheum 1995;38:1541-6.
Zamanzadeh V, Rassouli M, Abbaszadeh A, Nikanfar A, Alavi-Majd H, Ghahramanian A. Factors influencing communication between the patients with cancer and their nurses in oncology wards. Indian J Palliat Care 2014;20:12-20.
] [Full text]
Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health 1998;13:623-49.
Schunk DH. Self-efficacy, motivation, and performance. J Appl Sport Psychol 1995;7:112-37.
Harrison AL. The influence of pathology, pain, balance, and self-efficacy on function in women with osteoarthritis of the knee. Phys Ther 2004;84:822-31.
Sharma L, Song J, Hayes K, Pai YC, Dunlop D. Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. Arthritis Rheum 2003;48:3359-70.
Maly MR, Costigan PA, Olney SJ. Contribution of psychosocial and mechanical variables to physical performance measures in knee osteoarthritis. Phys Ther 2005;85:1318-28.
Lorig K, Lubeck D, Kraines RG, Seleznick M, Holman HR. Outcomes of self-help education for patients with arthritis. Arthritis Rheum 1985;28:680-5.
Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993;36:439-46.
Wallis JA, Webster KE, Levinger P, Fong C, Taylor NF. A pre-operative group rehabilitation programme provided limited benefit for people with severe hip and knee osteoarthritis. Disabil Rehabil 2014;36:2085-90.
Shelby RA, Somers TJ, Keefe FJ, Pells JJ, Dixon KE, Blumenthal JA. Domain specific self-efficacy mediates the impact of pain catastrophizing on pain and disability in overweight and obese osteoarthritis patients. J Pain 2008;9:912-9.
Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:191-7.
Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277-99.
Mason ST, Arceneaux LL, Abouhassan W, Lauterbach D, Seebach C, Fauerbach JA. Confirmatory factor analysis of the Short Form McGill Pain Questionnaire with burn patients. Eplasty 2008;8:123.
Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain 2007;11:153-63.
Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977;84:191-215.
Resnick B, Jenkins LS. Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res 2000;49:154-9.
Resnick B. Reliability and validity testing of the self-efficacy for functional activities scale. J Nurs Meas 1999;7:5-20.
Dehgan M. Effects of adding vitamin B to Diclofenac on knee osteoarthritis pains. J Qazvin Univ Med Sci 2015;19:18-26.
Ferrara PE, Rabini A, Maggi L, Piazzini DB, Logroscino G, Magliocchetti G, et al.
Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty. Clin Rehabil 2008;22:977-86.
Naderi Z, Mozaffari-Khosravi H, Dehghan A, Fallah Hosseini H, Nadjarzadeh A. The effect of ginger (zingiber officinale) powder supplement on pain in patients with knee osteoarthritis: A double-blind randomized clinical trial. JSSU 2013;20:657-67.
Behshid M. The Adaptation Process of Iranian Patients with Osteoarthritis Iran. Tabriz: Tabriz University of Medical Sciences; 2014.
Nawab B, Nyborg IL, Esser KB, Jenssen PD. Cultural preferences in designing ecological sanitation systems in North West Frontier Province, Pakistan. J Environ Psychol 2006;26:236-46.
Tehrani-Banihashemi A, Davatchi F, Jamshidi AR, Faezi T, Paragomi P, Barghamdi M. Prevalence of osteoarthritis in rural areas of Iran: A WHO-ILAR COPCORD study. Int J Rheum Dis 2014;17:384-8.
Rittger H, Rieber J, Breithardt OA, Ducker M, Schmidt M, Abbara S, et al
. Influence of age on pain perception in acute myocardial ischemia: A possible cause for delayed treatment in elderly patients. Int J Cardiol 2011;149:63-7.
Stone AA, Broderick JE. Obesity and pain are associated in the United States. Obesity 2012;20:1491-5.
Jabalameli M, Taheri S, Masih S. Correlation of body mass index and chronic pain in medical centers workers in Isfahan. JQUMS 2009;12:34-6.
Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: The effect of obesity. Ann Rheum Dis 1994;53:565-8.
Foy CG, Lewis CE, Hairston KG, Miller GD, Lang W, Jakicic JM, et al
. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD trial. Obesity 2011;19:83-93.
Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al
. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277:25-31.
Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al
. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 2004;50:1501-10.
Chen B, Zhan H, Marszalek J, Chung M, Lin X, Zhang M, et al
. Traditional Chinese medications for knee osteoarthritis pain: A meta-analysis of randomized controlled trials. Am J Chin Med 2016;44:677-703.
Moeini M, Khadibi M, Bekhradi R, Mahmoudian SA, Nazari F. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2010;15:234-9.
Salehy K, Mohammady E, Torkkaman G, Movassaghy SH. The effect of transcutaneous electrical nerve stimulation through the skin on the pain and quality of life in patients with knee osteoarthritis. Daneshvar 2007;14:59-66.
Callahan LF, Wiley-Exley EK, Mielenz TJ, Brady TJ, Xiao C, Currey SS, et al
. Use of complementary and alternative medicine among patients with arthritis. Prev Chronic Dis 2009;6:A44.
Jordan K, Sawyer S, Coakley P, Smith H, Cooper C, Arden N. The use of conventional and complementary treatments for knee osteoarthritis in the community. Rheumatology 2004;43:381-4.
Qingguang Z, Jianhua L, Min F, Li G, Wuquan S, Nan Z. Effect of Chinese massage (Tui Na) on isokinetic muscle strength in patients with knee osteoarthritis. J Tradit Chin Med 2016;36:314-20.
Zochling J, March L, Lapsley H, Cross M, Tribe K, Brooks P. Use of complementary medicines for osteoarthritis—a prospective study. Ann Rheum Dis 2004;63:549-54.
Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. J Altern Complement Med 2006;12:23-30.
Reid R, Steel A, Wardle J, Trubody A, Adams J. Complementary medicine use by the Australian population: A critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC Complement Altern Med 2016;16:176.
Peleg R, Liberman O, Press Y, Shvartzman P. Patients visiting the complementary medicine clinic for pain: a cross sectional study. BMC Complement Altern Med 2011;11:36.
Hsiao-Wei Lo G, Balasubramanyam AS, Barbo A, Street RL, Suarez-Almazor ME. Mediated by self-efficacy status, positive clinician conveyed expectations of treatment effect reduces pain in knee osteoarthritis. Arthritis Care Res 2015.
Barlow JH, Cullen LA, Rowe IF. Educational preferences, psychological well-being and self-efficacy among people with rheumatoid arthritis. Patient Educ Couns 2002;46:11-9.
Brekke M, Hjortdahl P, Kvien TK. Changes in self-efficacy and health status over 5 years: A longitudinal observational study of 306 patients with rheumatoid arthritis. Arthritis Care Res 2003;49:342-8.
Turner JA, Ersek M, Kemp C. Self-efficacy for managing pain is associated with disability, depression, and pain coping among retirement community residents with chronic pain. J Pain 2005;6:471-9.
Shin YH, Hur HK, Pender NJ, Jang HJ, Kim MS. Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis. Int J Nurs Stud 2006;43:3-10.
Avazeh A, Jafari N, Rabie siahkali S, Mazloomzadeh S. Knowledge level attitude and performance of women on diet and exercise and their relation with cardiovascular diseases risk factors. ZUMS J 2010;18:51-60.
Pells JJ, Shelby RA, Keefe FJ, Dixon KE, Blumenthal JA, Lacaille L, et al
. Arthritis self-efficacy and self-efficacy for resisting eating: Relationships to pain, disability, and eating behavior in overweight and obese individuals with osteoarthritic knee pain. Pain 2008;136:340-7.
Ghasemi GA, Golkar A, Marandi SM. Effects of Hata yoga on knee osteoarthritis. Int J Prev Med 2013;4(Suppl 1):S133-8.
Dahaghin S, Tehrani-Banihashemi S, Frouzanfar M, Barghamdi M, Norollahzadeh E, Gholami J, et al
. Risk factors of knee osteoarthritis, WHO-ILAR-COPCORD study. Tehran University Medical J 2009;66:721-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]