Weight loss counseling and physical exercise for osteoarthritis pain management

Weightloss Counseling and Physical Exercise

PHASE II Search Paper

Scholarly Project

Dana Delatush RN BSN ONC

"I pledge my honor that I have neither given nor received inappropriate aid on this assignment."

Abstract Comment by Patricia: Place the abstract on a separate page for your final search paper

This paper is focused on the literature search related to the PICOT question: Does weight loss counseling and physical exercise improve pain and mobility in obese patients with a BMI >25 suffering from osteoarthritis? To answer this clinical question, six databases were searched including the Cumulative Index of Nursing and Allied health Literature (CINAHL), The Cochrane Library, PubMed/Medline, Google Scholar, PsycInfo®, and ProQuest Nursing and Allied Health Source™. The paper describes the search methodology. Keywords: osteoarthritis, obesity, weight loss counseling, pain, mobility

Introduction to Search Strategy

I will be creating a search strategy to help me clarify what information I need, and what keywords can be used to yield relevant information. The search strategy I will articulate will result in precise and refined outcomes of many relevant articles. The first step in my search strategy is to define my topic in a complete phrase or sentence. This was accomplished through the development of the PICOT question. PICOT Question: Does weight loss counseling and physical exercise improve pain and mobility in obese patients with a BMI >25 suffering from osteoarthritis? Next, I identified the keywords that I will use at the beginning stage of the search: Comment by Patricia: Avoid using the first person in scholarly writing

Osteoarthritis, obesity, weight loss counseling, physical exercise, reduce pain, increase mobility, BMI >25. Then, I identified some synonyms for the keywords listed above: Comment by Patricia: Comment by Patricia: Lists are not appropriate for this paper. Use paragraph format

Osteoarthritis: arthritis, swollen joints, painful joints, autoimmune disease

Obesity: overweight, body mass, BMI>25, fat

Weight loss counseling: diet, nutrition, guidance

Physical exercise: activity, fitness, flexibility

Reduce pain: comfort, anti-inflammatory, painkiller

Increase mobility: daily living, ambulation, independence

Additional considerations included decisions that I needed to make about the following:

Would I exclude any languages or include any particular languages? I determined that I would only use the English language in my searches. Comment by Patricia: Questions you asked yourself should not be included. Parameters you set for the search should be identified

Would I use controlled vocabulary? I determined that I would not use controlled vocabulary since I would be reviewing articles from researchers and felt this limitation would constrain my search.

How would I define my inclusion and exclusion criteria? I had determined that the articles needed to be scholarly, no older than five years, be available in full text format, be peer-reviewed articles from a juried journal, and written by practitioners or researchers.

Did I have any ideas at this stage in the search about any limits that I might set? I decided to use the functions in the CINAHL search platform to determine any limits, and assumed that I would quickly learn how well this was working after a few search attempts. If I needed to further articulate limits, I decided I would do so further into the study.

Would I search for grey literature? I decided that I would search for grey literature, as I was particularly interested in any current working papers from research groups on my topic. It was here, I thought, that I might best learn about innovative practices that were not yet mainstream.

I next moved on to finding the CINAHL headings and subject headings for my keywords and synonyms. After watching a Elton B. Stephens Co. (EBSCO) tutorial on the process (http://support.ebsco.com/training/flash_videos/cinahl_mesh/cinahl_mesh.html), I followed the steps outlined below.

Step 1: Defining Concepts

Step 2: Finding CINAHL Headings

Step 3: CINAHL Heading Options

Step 4: Adding the Heading to the Search

Step 5: Adding More Concepts to the Search

Step 6: Combining Search Terms

Step 7: Refining Results with Limits (Optional) Comment by Patricia: The step-by-step approach you used, while essential to a thorough search, should not be included in this paper. It is assumed that you did this.

As I built the list of documents to review, I considered the requirements for the articles that I would focus on to conduct my research. Moreover, I wanted to be sure to search within at least five different databases to ensure my initial search was comprehensive, while remaining manageable. The databases I decided to search include the following:

CINAHL

Google Scholar

MEDLINE

Proquest Nursing & Allied Health

PsycINFO

PubMed

The Cochrane Library

At this point, I was ready to commence my search. Once I had compiled a good collection of articles, I applied the rapid critical appraisal strategy to the articles. This means that I selected six research studies that I belief provide the best evidence to support the implementation of my project. Comment by Patricia: Again, no need to describe the step-by-step

I made a reference sheet to guide me in my efforts to select articles that were represented the levels of hierarchy of evidence that I felt I needed to ensure a robust search of the literature. I used the following definitions of Levels I through VII: Comment by Patricia: No need to reiterate the levels here

Level I Evidence from a systematic review of all relevant randomized controlled trials (RCTs) or evidence-based clinical practice guidelines based on systematic reviews of RCTs.

Level II Evidence obtained from at least one well-designed randomized controlled trial (RCT).

Level III Evidence obtained form well-designed controlled trials without randomization, quasi-experimental.

Level IV Evidence from well-designed case-controlled and cohort studies.

Level V Evidence from systematic reviews of descriptive and qualitative studies.

Level VI Evidence from a single descriptive or qualitative study.

Level VII Evidence from the opinion of authorities and/or reports of expert committees.

I marked each article that I printed out with the level of the hierarchy of evidence so that I would have ready access to the information when I was ready to record the information on the evaluation table in Phase III.

Search Results: Comment by Patricia: No lists. Report how many articles you found from each database. List the articles on the reference page

PubMed

Do, B., Hootman, D., Helmick, C.G., & Brady, T.J. (2011). Monitoring healthy people 2010 arthritis management objectives: education and clinician counseling for weight loss and exercise. American Family Medicine, 9(2), 136-141. doi: 10.1370/afm.1210 Retrieved http://www.ncbi.nlm.nih.gov/pubmed/21403140

Fineout-Overholt, E., Hofstetter, S., Shell, L., & Johnston, L. (2005). Teaching EBP: getting to the gold: how to search for the best evidence. Worldviews Evidence-Based Nursing, 2(4), 207-11. Comment by Patricia: Did this article come from your search of PubMed? This is an excellent reference for the paper. List on reference page

Fontaine, K.R., Haaz, S., & Bartlett, S.J. (2007). Are overweight and obese adults with arthritis being advised to lose weight? Journal of Clinical Rheumatology, 13(1), 12-15. Retrieved http://www.ncbi.nlm.nih.gov/pubmed/17278942

McInnis, K., Franklin, B.A., & Rippe, J.M. (2003). Counseling for Physical Activity in Overweight and Obese Patients, American Family Physician, 67(6), 1249-1256. Retrieved http://www.aafp.org/afp/2003/0315/p1249.html Comment by Patricia: Lowercase rule

Sartori-Cintra, A.R., Aikawa, P., an&d Cintra, D.E. (2014). Obesity vs. osteoarthritis: beyond the mechanical overload. Einstein (Sao Paulo), 0:0. [Epub ahead of print] Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25184806

MEDLINE

Sowers, M.R. And Karvonen-Guiterrez, C.A. (2010, Sept.). The evolving role of obesity in knee osteoarthritis. Current Opinions Rheumatology, 22(5), 533 -- 537. doi: 10.1097/BOR.0b013e32833b4682. PMCID: PMC3291123. NIHMSID: NIHMS358648

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice, step-by-step: asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110 (3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79 Comment by Patricia: Did this article come from your search of PubMed? This is an excellent reference for the paper. List on reference page

PsychINFO

Cushing, C.C. And Steele, R.G. (2014). Evidence-based obesity management for primary care. Public Interest Directorate. American Psychological Association. Retreived from http://www.apa.org/pi/families/resources/primary-care/obesity-management.aspx?item=1

Google Scholar

Edwards, C., Rogers, A., Lynch, S., et al. (2012). The effects of bariatric surgery weight loss on knee pain in patients with osteoarthritis of the knee. Arthritis, 2012, [Clinical Study]. http://dx.doi.org/10.1155/2012/504189 Comment by Patricia: How many authors? See APA format for citing multiple authors