%0 Journal Article
%T Feasibility of using quadriceps-strengthening exercise to improve pain and sleep in a severely demented elder with osteoarthritis ¨C a case report
%A Pao-Feng Tsai
%A Kathy Richards
%A Richard FitzRandolph
%J BMC Nursing
%D 2002
%I BioMed Central
%R 10.1186/1472-6955-1-1
%X The subject was an elderly man with severe cognitive impairment (Mini-Mental Status Exam score 4) and knee OA (Kellgren-Lawrence radiographic grade 4). He was enrolled in a 5-week, 10-session standardized progressive-resistance training program to strengthen the quadriceps, and completed all sessions. Pain was assessed with the Western Ontario and MacMaster OA Index (WOMAC) pain subscale, and sleep was assessed by actigraphy.The patient was able to perform the exercises, with a revision to the protocol. However, the WOMAC OA pain subscale proved inadequate for measuring pain in a patient with low cognitive functioning, and therefore the effects on pain were inconclusive. Although his sleep improved after the intervention, the influence of his medications and the amount of daytime sleep on his nighttime sleep need to be considered.A quadriceps-strengthening exercise program for treating OA of the knee is feasible in severely demented elders, although a better outcome measure is needed for pain.Osteoarthritis (OA) is a highly prevalent, disabling condition afflicting 16 million older adults in the United States [1]. Nearly 70% of the elderly population show radiographic evidence of OA [2], and the prevalence of OA increases with age [3]. Chronic pain and suffering from OA account for $15.5 billion annually (in 1994 dollars) in health care expenditures [4]; and among all the potentially painful disorders in older persons, OA accounts for the greatest proportion of pain complaints [5]. Pain is an important predictor of functional limitation in persons with OA of the knee [6].Some 45% to 65% of elderly nursing home residents suffer from OA [7,8]. The knee is one of the most commonly affected sites [9]. Undertreatment of pain in nursing home residents has serious consequences for the quality of their sleep [10], and the combination of unrelieved pain and sleep disturbance further exacerbates existing cognitive impairment [11] and leads to depression [12] and disruptive be
%U http://www.biomedcentral.com/1472-6955/1/1