الفهرس 
Shape of the Knee JointOnly 14 pages are availabe for public view
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Abstract
Osteoarthritis is known as degenerative joint disease and typically the result of wear and tear and progressive loss of articular cartilage. OA is most common in the elderly. OA can be divided into two types, primary and secondary. Primary OA is articular degeneration without any apparent underlying reason. Secondary OA is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage. OA is typically a progressive disease which may eventually lead to disability (Hsu &Siwiec, 2022).
The aim of the present study was to evaluate the effect of health behavior modification based on trans theoretical model among osteoarthritis patients. Therefore, this study was undertaken to assess patients` knowledge and practices and behaviors. Design and apply trans theoretical model for patients to modify behavior of patients with osteoarthritis and evaluate effect of trans theoretical model on osteoarthritis patients knowledge, practices and behaviors.
Research design:
A quasi – experimental design was utilized to conduct this study.
This study was conducted at Orthopedic Outpatient Clinic affiliated at Benha University Hospital in Benha City, Egypt because this place receives large attendance of patients with osteoarthritis. Orthopedic Outpatient Clinic at Benha University Hospital constituted one room, located at next to Administration Office and includes two nurses, three physicians every day to meet needs of patients. A purposive sample used in this study and involved 112 patients with osteoarthritis at Orthopedic Outpatient Clinic at Benha University Hospital for 12 months from beginning of January 2022 to end of December 2022 with the following criteria: Diagnosed with osteoarthritis, free from any handicap and accepting to participate in the study.
Tools of data collection:
Tool I: A structured interviewing questionnaire: It was developed by the researcher based on reviewing related literature and past available national and international references related literature about osteoarthritis by using journal, text book and internet searcher and revised by supervisors. It was written in simple clear Arabic language and composed of three parts to assess the following:
First part: It included two items
A: It was concerned with demographic characteristics of patients with osteoarthritis involved in the study. It included 8 closed end questions age, sex, marital status, level of education, occupation, residence, monthly income and type of family.
B: It was concerned with the medical history of patients with osteoarthritis, which included 3 closed end questions; duration of osteoarthritis, the aid patients use during walking and the diseases patients suffer from.
Second part: It included two items
A: It was concerned with the knowledge of patients with osteoarthritis which included 9 closed end questions; meaning of osteoarthritis, causes of osteoarthritis, risk factors, types of osteoarthritis, symptoms and signs, measures for diagnosis of osteoarthritis, treatment of osteoarthritis, the goals of treatment of osteoarthritis and complications of osteoarthritis.
B: It was concerned with the knowledge of trans theoretical model for health behavior modification, it was included 3 closed end questions; meaning of the trans theoretical model for health behavior modification, the stages of the trans theoretical model for health behavior modification, the goals of applying the trans theoretical model to modify healthy behavior and source of information.
Third part: It included two parts
A- It was concerned with reported practices of patients with osteoarthritis which included four sections that divided into - Nutrition which included (14) statements; eating three basic meals of the day in a regular fixed time, eating and drinking products of milk as cheese and yogurt because it has calcium, avoiding foods that contain fats and cholesterol, eating dark leafy vegetables and foods that contain vitamin D such as dates and oats, using oils in cooking, eating meals of fish that contain omega 3, eating nuts like almonds that enhance immunity, avoiding drinking sugars, cola and alcohol drinks, avoiding smoking and stay away from passive smoking, eating soy products because they reduce inflammation such as soybeans, using olive oil as it contains anti-inflammatory, drinking green tea because it is rich in antioxidants that slow down the erosion of cartilage, eating foods that contain vitamin C, such as oranges, guavas, and lemons, because they help build cartilage and adding turmeric to food because it reduces joint stiffness and reduces pain.
- Exercise which included (5) statements: Doing exercises for osteoarthritis on a regular basis, such as walking, practicing relaxation exercises, meditation and sitting in an open and quiet place such as yoga, practicing deep and slow breathing exercises, paying attention to exercises that strengthen joint bones to relieve pain in these joints, as well as movement exercises that help maintain and improve joint flexibility and reduce muscle stiffness and doing simple and slow stretching exercises for the joints because it improves flexibility and reduces stiffness and pain.
- Compliance of medication and follow-up which included (4) statements; taking medication at regular time, consulting doctor in case of side effects of medications, following-up on a regular basis and doing the instruction prescribed by the doctor during follow-up.
- General practices for patients with osteoarthritis which included (10) statements; avoid standing for long periods of time to avoid putting pressure on the joints, avoid bending the knee sharply, which negatively affects the joint, sitting on a comfortable chair of suitable height, avoiding squatting for long periods, using warm water compresses on the joints to reduce pain, avoiding using stationary or mobile bikes to avoid increased friction, avoiding working out for long periods of time, using a stick to reduce pressure on the joint, climbing the stairs one step at a time and avoid climbing too quickly and using appropriate athletic shoes while walking.
B: It was concerned with the healthy behaviors adapted from (McKay et al., 2019(, which included 10 statements; setting goals to motivate health development, making a plan to follow the health system, ready to do whatever it takes to restore vital and daily functions, understanding the relationship between behavior now and the results in the future, assessing healthy behavior through daily activities, finding improvement in health by continuing healthy behaviors and practices, making alternatives to resist the obstacles encounters, avoiding everything that distracts from paying attention to health, sharing healthy actions with others and restructuring the physical or social environment to suit health capabilities.
Tool (II): Questionnaire of the trans theoretical model of behavior modification through the stages of modified change adapted from (Hashemzadeh et al., 2019).
1- Precontemplation stage which included (10) statements: Avoiding changing lifestyle, taking a lot of effort to perform healthy behaviors work hours and need additional time to perform tasks, seeing that adopting healthy behaviors is a waste of time, missing the ability to stick to a certain routine, seeing that health will deteriorate because of these practices, have tried many methods, but no positive result achieved, it’s better to watch TV than to exercise, missing the motivation that drives me to healthy practices, staying away from healthy behaviors because of the fear of failure and lacking of self-confidence to adhere to certain practices.
2- Contemplation stage which included (7) statements: Know that healthy behaviors improve the quality of life, healthy behaviors and practices require a little time and effort, healthy behaviors increase self-confidence and sense of self, healthy behaviors reduce feelings of negativity, healthy behaviors increase enjoyment of life with others, healthy behaviors and practices improve pain and healthy behaviors increase task completion at work and at home.
3- Preparation stage which included (4) statements: Preparing self for good behaviors and healthy practices, planning to go to the gym, getting ready to eat a proper diet and planning to follow up regularly and follow the doctor’s instructions.
4- Action stage which included (10) statements: Practicing all healthy behaviors that improve joint health, participating in healthy behaviors and practices and adhere to them because feeling of becoming a burden on family, following a proper diet, eating foods that reduce arthritis, avoiding actual or passive smoking ,doing exercises that are suitable for joint stiffness, doing relaxation exercises and sit in a quiet place, taking medicine regularly, following the instructions given by the doctor and doing follow up regularly.
5- Maintenance stage which included (4) statements: Adhering to all healthy practices and behaviors for more than 6 months, have been exercising for more than 6 months, have been following a healthy diet for more than 6 months and avoid situations and stress that lead to relapse.
The main findings of this study were summarized as follows:
• Regarding to demographic characteristics, 57.1% of the studied patients were aged 50 years or more with a mean age of 52.03±15.28 years, 64.3% of them were females. Regarding to their educational level; 53.6% of the studied patients had university education or more, 39.3% of them were employed, and 53.6% of them had enough monthly income and 71.4% of them lived in nuclear family.
• As regard to medical history, 46.4% of the studied patients suffered from osteoarthritis since one year and more, while 48.2% of them used crutch and 57.1%, of studied patients suffered from hypertension.
• Regarding to total knowledge of the studied patients, 27.7% of studied patients had good knowledge pre application of TTM which increased to 81.3% post application of TTM, while 38.4% of them had poor knowledge at pre application of TTM, and then this percentage decreased to 7.1% post application of TTM.
• Regarding to total practices of the studied patients, 23.2% of the studied patients had satisfactory practices pre application of TTM, and then this percentage increased to 71.4% post application of TTM.
• Concerning to the total health behaviors, 16.7% of the studied patients have positive health behaviors pre application of TTM, and then this percentage increased to 72.8% post application of TTM.
• As regard to the total level of application of trans-theoretical model, 30.4% of the studied patients applied TTM pre application of TTM and this percentage increased to 79.5% after application of TTM.
• There were statistically positive correlations between knowledge, practices, behaviors and TTM pre and post application of TTM.
Based on the results of the present study and answering of research hypothesis, the following can be concluded:
The trans theoretical model succeeded to improve knowledge, practices and behaviors of the studied patients. Majority of the studied patients had good knowledge post application of trans theoretical model compared by less than third pre application of trans theoretical model, more than two thirds of the studied patients had satisfactory practices post application of trans theoretical model compared by less than third pre application of trans theoretical, and more than two thirds of the studied patients accepted healthy behaviors post application of trans theoretical model compared by less than one fifth pre application of trans theoretical model. More than three quarters of the studied patients applied trans theoretical model compared by more than one fifth pre application of trans theoretical There were statistically positive correlations between knowledge, practices, behaviors and TTM pre and post application of TTM.
Based on the findings of this study, followin