@article{MAKHILLRJBS20138111388,
    title = {Improve Pain and Sleep in a Demented Elder with Osteoarthritis: A Case Report Study in Iran},
    journal = {Research Journal of Biological Sciences},
    volume = {8},
    number = {1},
    pages = {17-21},
    year = {2013},
    issn = {1815-8846},
    doi = {rjbsci.2013.17.21},
    url = {https://makhillpublications.co/view-article.php?issn=1815-8846&doi=rjbsci.2013.17.21},
    author = {Sima and},
    keywords = {Osteoarthritis,nursing home,WOMAC,exercise program,Iran},
    abstract = {Osteoarthritis (OA) of the knee which is prevalent among older 
  adults in nursing homes, causes significant pain and suffering including disturbance 
  of nocturnal sleep. One nonpharmacologic treatment option is quadriceps-strengthening 
  exercise, however the feasibility of such a treatment for reducing pain from 
  OA in severely demented elders has not been studied. This study describes the 
  test of the feasibility of such an exercise program, together with its effects 
  on pain and sleep in a severely demented nursing home resident. 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 5 weeks, 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.}
    }