According to the World Health Organisation (WHO), osteoarthritis of the knee (OA), affects 80% of the population over 65 years of age in industrialised countries and is the most important cause of functional disability of the locomotor system in all races and geographical areas.1–3 Osteoarthritis is a degenerative joint disease that causes pain, deformity and inability to perform daily activities.4,5 Health education is a basic element in the treatment of any disease; in the case of OA, it enables patients to take care of themselves and perform daily activities. This influences the recovery process as an integral part of medical care.6–8 All guidelines agree that education, access to quality information, good postural habits, avoiding forced body positions that misalign anatomical segments, adequate exercise and weight loss are effective general measures applicable to any patient with knee OA of any degree. grado2,9,10 To this end, it would be useful for clinicians to have a tool that assesses their perception of patients’ educational needs (ENs).

The Educational Needs Assessment Tool (ENAT) is a self-administered questionnaire developed in the United Kingdom and validated in several European countries (Spain, Portugal, Germany, Poland, Holland, Norway and Sweden), giving rise to the Spanish version of SpENAT.11,12

Due to the lack of systematic evolution of EN in patients with OA, it was proposed to carry out this study in order to assess ENs using the SpENAT questionnaire and to identify the source of information on this disease.

An observational, descriptive and cross-sectional study was conducted in patients with a diagnosis of OA who attended the protocolised consultation of the Rheumatology service at the Hospital Clínico Quirúrgico Hermanos Ameijeiras, during the period from January 2017 to September 2020. The inclusion criteria were: patients over 18 years of age with a diagnosis of OA according to the criteria of the American College of Rheumatology (ACR), who gave their consent to participate. Patients with a diagnosis of neoplastic disease and any other known rheumatic condition, as well as patients psychologically unable to respond, were excluded. Demographic data were recorded comparing needs by domain according to sex, age, occupation, schooling, nutritional status, evolution of symptoms and most frequently used sources of information related to rheumatological problems.

SpENAT consists of 39 questions grouped into 7 domains: pain management (6 questions), movement (5 questions), feelings (4 questions), osteoarthritis process (7 questions), medical treatment (7 questions), non-medical treatment (6 questions) and help (4 questions). The answers are based on a 5-point Likert-type scale: “not important at all”, “a little important”, “quite important”, “very important” and “extremely important”.

In the present study, no significant differences were found in the ENs according to age, sex, symptom evolution, occupation, nutritional status and educational level. In a universe of 297 patients under study, the sample consisted of 215 patients diagnosed with OA. Table 1 shows that 72.6% of the research sample was female. The mean age was 59.47 years (SD 13.06).

When looking at the responses obtained in the SpENAT questionnaire, higher EDs were obtained in the domains of movement, help, pain and feeling (Table 2). Women showed higher ENs than men in the movement domain (P = .056); patients ≥ 50 years presented higher ENs in the osteoarthritis domain (P = .218), and those > 9th grade of study showed higher ENs in movement (P = .790) and helping (P = .405) domains. Patients with normal weight presented higher ENs in the domains of pain (P = .416), movement (P = .188) and medical treatment (P = .278). In terms of time of evolution, patients with over one year had higher ENs in the movement domain (P = .083). No statistically significant differences were observed in each of the domains.

Regarding information sources to which patients usually turn (Fig. 1), the most frequently consulted source of information was the rheumatologist (91.6%).

Fig. 1.

Information source.

(0.21MB).

The present study evaluated the educational needs of patients in Cuba with a diagnosis of OA, and found a high level of education in relation to this entity, which could be related to the high educational level of the patients who participated in this study. In Cuba, the educational level is ninth grade.13 In addition, it could be linked to the proximity to health services where every 120 families have a basic working group made up of a doctor and nurse, as well as primary level care specialists.14

Studies on the prevalence and incidence of OA vary according to the geographical area and country of origin of the population, the joint studied, as well as genetic and environmental risk factors. Women over 50 years of age are the most affected afectadas,5,15–17 coinciding with our study.

According to the results obtained, Cuban women with OA who attend rheumatology consultations are interested in movement, results that are similar to those reported by other authors.18–20 This could be due to the need for movement in the Cuban population in general, where daily life requires activities such as carrying buckets of water, as well as shopping baskets. However, all patients surveyed have a greater interest in receiving information in the domains of movement, help, pain, feeling, illness, as expressed in other studies.11,21,22 This could be related to the inability to perform daily activities due to the pain caused by OA, and the psychological impact this can have on the lack of knowledge about the disease.

Assessing the daily routine of the patient's life, it was observed that the duration in the evolution of OA has a progressive impact on the decrease in functional capacity, presenting higher ENs in the movement domain, in line with what is reported in other rheumatological diseases, such as rheumatoid arthritis where patients present an increase in difficulties regarding daily activities in a short period of time after the diagnosis of the disease, as suggested by Ambriz Murillo et al.,23 which could be related to the activity of the disease during that short period of time.

It was evident that patients whose level of education exceeded the ninth grade had higher ENs in the domains of movement and helping, similarly suggested by Sierakowska et al.;24 given the level of education shown by the patients, it could be related to the need to seek knowledge about the behaviour of their disease and the impact of their disease on daily activities.

It was observed that the main source of information obtained by the patient was the rheumatologist, coinciding with the results obtained in other studies.2,7

Reporting bias cannot be ruled out, as the questionnaire was administered in the rheumatology consultation room, due to the extensive training of the rheumatologist and the free access of patients to rheumatology services.

On the other hand, not having measured knowledge needs using the SpENAT at the onset of OA diagnosis or during the first rheumatology consultation could be taken as a limitation of this study, as this knowledge could modify individual ENs.

The level of knowledge in OA patients needs to be improved, and although in other contexts a multidisciplinary team is suggested,25,26 in Cuba and especially in this study, the rheumatology specialist plays a fundamental role, and can identify the best scenarios for transmitting information about the disease.

This research has not received specific support from public sector agencies, or commercial not-for-profit entities.

The authors have no conflicts of interest to declare.