Pain of Osteoarthritis in Women: Environment Research

Abstract

Older women with osteoarthritis (OA) need effective pain management strategies. Distraction, a strategy known to be effective, may be facilitated through environmental stimuli (specifically, multi-sensory stimuli from nature). The study aims were to explore outdoor symptom experiences of women with OA, compare pain symptom experiences in outdoor spaces with a higher versus lower level of multi-sensory nature (M-SN), describe amount of time spent in higher/lower M-SN spaces by women (based on OA, bodily pain, and functional status), and develop a situation-specific model for future research. This cross-sectional descriptive study, using Symptom Management Theory as the conceptual framework, involved four retirement community study sites with two outdoor spaces (e.g., a courtyard) measured objectively as having higher/lower M-SN levels. Qualitative (directed content analysis of interview texts) and quantitative (statistical analysis of self-administered survey items) methods were then used. Integration of qualitative and quantitative findings enabled development of a situation-specific model. Analysis of qualitative data (N=16 women with OA) provided descriptive themes regarding outdoor experiences of older women with OA and uncovered two concepts: Sense of Well-being Outdoors and Person-Environment Relation. However, these data were insufficient to compare OA pain experiences in higher/lower M-SN spaces. Quantitative data (N=276 women with/without OA), analyzed with two-way fixed-effects ANOVA, showed no difference in the amount of time spent in higher/lower M-SN spaces by person factors (OA, bodily pain or functional status) analyzed separately. Exploratory analyses showed that women spent significantly less overall time outdoors if they had OA (p=.03), greater bodily pain (p=.001), or lower functional status (p<.001). Additionally, t-tests demonstrated that women with OA reported spending significantly fewer days outdoors per week (p=.005), but a similar amount of time outdoors on days when they went outside (p=.27). A situation-specific model of an environment-based pain management strategy for older women with OA, derived from Symptom Management Theory, was developed. The negative impact of OA on women's overall time spent outdoors and the use of multi-sensory stimuli to distract from OA pain merit further study. Ultimately, this work may lead to strategies for pain self-management involving outdoor environments and evidenced-based design recommendations for senior-living communities.