Effects of patient education on knee joint injections and the impact on patient care and satisfaction in rural Guatemala





Chronic knee pain, Intra-articular knee joint injections, Knee pain management, Osteoarthritis, Patient care, Prevalence, Rural Guatemala, Sports medicine, Surveys


Background: As the rates of osteoarthritis increase among the elderly population across the world, the number of intra-articular corticosteroid injections has also steadily increased. The objective of this research study was to compare the ratings of anxiety level, pain level, and education about glucocorticoid injections between the group who received expansive education about joint injections and the group who received minimal education about joint injections.

Methods: Each participant was given a pre-injection survey allowing them to rate their anxiety level, pain level, prior education level on knee injections, and duration and severity of symptoms. Each participant completed a post-injection survey following the procedure. Rating data were analyzed using a paired t-test to compare each of the groups to themselves and unpaired t-tests were used to compare the two groups. Demographic and survey data were analyzed using Fisher’s exact test.

Results: Statistical significance was noted when a paired t-test was run between pain levels before and after the knee injection was administered in group A and between pain levels before and after the knee injection was administered in group B (p<0.001). A paired t-test also showed statistical significance when comparing the educational levels before and after the knee injection was administered in group A (p=0.04).

Conclusions: This research study showed that increased education on corticosteroid knee injections prior to the procedure demonstrated increased education on corticosteroid knee injections after the injection and decreased pain levels following the injection in participants with osteoarthritis in rural Guatemala.


Iqbal U, Rabrenovic M, Li YJ. Health care quality challenges in low- and middle-income countries. Int J Qual Health Care. 2019;31(3):165.

Langlois EV, McKenzie A, Schneider H, Mecaskey JW. Measures to strengthen primary health-care systems in low- and middle-income countries. Bull World Health Organ. 2020;98(11):781-791.

Nachiappan N, Mackinnon S, Ndayizeye JP, Greenfield G, Hargreaves D. Barriers to accessing health care among young people in 30 low-middle income countries. Health Sci Rep. 2022;5(4):e733.

Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries Lancet. 2018;392(10160):2203-12.

Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatr. 2017;17(1):151.

Qin VM, McPake B, Raban MZ, Cowling TE, Alshamsan R, Chia KS, et al. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res. 2020;20(1):372.

Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31-38.

Kotani K. Transportation issues in rural healthcare. J Prev Med Public Health. 2020;53(2):149-50.

Varela C, Young S, Mkandawire N, Groen RS, Banza L, Viste A. Transportation barriers to access health care for surgical conditions in Malawi a cross sectional nationwide household survey. BMC Public Health. 2019;19(1):264.

Aljassim N, Ostini R. Health literacy in rural and urban populations: a systematic review. Patient Educ Couns. 2020;103(10):2142-54.

WE, Scaife SL, Francis ML. Health literacy skills in rural and urban populations. Am J Health Behav. 2009;33(5):550-7.

Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health. 2014;30(1):79-88.

Hamood R, Tirosh M, Fallach N, Chodick G, Eisenberg E, Lubovsky O. Prevalence and incidence of osteoarthritis: a population-based retrospective cohort study. J Clin Med. 2021;10(18):4282.

Long H, Liu Q, Yin H, Wang K, Diao N, Zhang Y, et al. Prevalence trends of site‐specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Arth Rheumatol. 2022;74(7):1172-83.

Chen A, Gupte C, Akhtar K, Smith P, Cobb J. The global economic cost of osteoarthritis: how the UK compares. Arthritis. 2012;2012:698709.

Bedenbaugh AV, Bonafede M, Marchlewicz EH, Lee V, Tambiah J. Real-world health care resource utilization and costs among US patients with knee osteoarthritis compared with controls. Clinicoecon Outcomes Res. 2021;13:421-35.

Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, et al. Osteoarthritis: an overview of the disease and its treatment strategies. InSeminars in arthritis and rheumatism 2005;35(1):1-10.

Kraus VB, Blanco FJ, Englund M, Karsdal MA, Lohmander LS. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarth Cartil. 2015;23(8):1233-41.

Osteoarthritis. orthoinfo- AAOS. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis. Accessed on 28 February 2023.

Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):134-8.

Zhang Y, Jordan JM. Epidemiology of osteoarthritis Clin Geriatr Med. 2010;26(3):355-69.

Mohammed A, Alshamarri T, Adeyeye T, Lazariu V, McNutt LA, Carpenter DO. A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data. Prev Med Rep. 2020;20:101242.

Luong ML, Cleveland RJ, Nyrop KA, Callahan LF. Social determinants and osteoarthritis outcomes. Aging health. 2012;8(4):413-37.

Wang ST, Ni GX. Depression in osteoarthritis: current understanding. Neuropsychiatr Dis Treat. 2022;18:375-89.

Swain S, Sarmanova A, Coupland C, Doherty M, Zhang W. Comorbidities in osteoarthritis: a systematic review and meta-analysis of observational studies. Arth Care Res. 2020;72(7):991-1000.

Samuels J, Pillinger MH, Jevsevar D, Felson D, Simon LS. Critical appraisal of intra-articular glucocorticoid injections for symptomatic osteoarthritis of the knee. Osteoarth Cartil. 2021;29(1):8-16.

Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328(7444):869.

Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17(10):638-46.

Lenhard NK, Williams EE, Lape EC, MacFarlane LA, Losina E, Katz JN. Patient perspectives surrounding intraarticular injections for knee osteoarthritis: A qualitative study. Arth Care Res. 2022;74(3):410-9.

Efird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8(1):15-20.

Educational challenges in Guatemala and consequences for Human Capital and Development. The Dialogue. Available at: https://www.thedialogue.org/analysis/educational-challenges-in-guatemala-and-consequences-for-human-capital-and-development/. Accessed on 4 March 2023.

Ayhan E. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthoped. 2014;5(3):351.






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