Inquiry Health Care: Evaluating Fish Oil for Osteoarthritis Treatment

This report addresses the PICO question of whether fish oil is an effective treatment option for older women with osteoarthritis. It begins with an introduction to the case study of a 65-year-old woman, Peggy, suffering from knee osteoarthritis, and formulates a clinical question to compare the efficacy of fish oil to alternative treatments. The report then details the methodology, including the use of PubMed and CINAHL databases, along with the search terms and limiters used to retrieve relevant articles. Two key research articles are summarized: Hill et al. (2016), a randomized clinical trial comparing high and low doses of fish oil, and Senftleber et al. (2016), a systematic review and meta-analysis. The findings suggest that fish oil may be beneficial in reducing pain associated with arthritis. The conclusion recommends the use of fish oil as an additional treatment for Mrs. Peggy, while also highlighting the need for further research.

Running Head: INQUIRY HEALTH CARE
Inquiry Health Care
Name of the Student
Name of the University
Author Note

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Introduction
The paper deals with the PICO question generated in response to the case study of
Peggy, a 65 year old lady suffering from degenerative osteoarthritis in her Knees. In response
to the PICO question the paper performs database search to retrieve relevant articles. The
findings from the two best research results will be summarised in the paper.
PICO question
In older women (P) with osteoarthritis is fish oil (I) an effective treatment option (O)?
The clinical question is designed to compare the effectiveness of taking fish oil
degenerative osteoarthritis in older women (Peggy) to those not taking or relying on alternate
remedy such as medication. The question is designed with the aim to obtain clinical evidence
on improvement of arthritis on taking fish oil. Based on the real evidence obtained the patient
can be advocated or recommended to take fish oil. The rationale for the study is the million
of Australians consuming fish oil as remedy for arthritis (Pittaway et al., 2015).
Two databases have been used to search for the evidence based on the question. It
includes PubMed and Cochrane.
PubMed is the reliable database for more than 27 million articles. This free search
engine allows to access other databases such as MEDLINE to conduct research on nursing,
dental, medical, health care and selected life science journals. The other advantages include
automatic term mapping that marked the search more comprehensive when compared to
other versions. It gives quick access to new articles published and allows for efficient
information retrieval by the end users (Patten, 2017). The other database CINAHL is the
definitive research tool. It is the most comprehensive database for the nursing, medical and

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allied health care. For nurses around the globe it is the most respected research tool (Besner,
2015).
Key words terms/phrases Alternative words
P Osteoarthritis women,
osteoarthritis older adults,
Osteoarthritis patients OR knee
osteoarthritis,
osteoarthritis pain OR knee pain
women
I Fish oil osteoarthritis, fish oil
pain relief, osteoarthritis fish oil
Osteoarthritis patients OR fish
oil,
Fish oil OR osteoarthritis
C High dose fish oil, low dose fish
oil, Dietary fatty acids, omega 3
fish oil, efficacy fish oil
Low dose fish oil OR Dietary
fish oil
Fish oil OR marine oil
O Fish oil knee treatment,
Fish oil arthritis pain relief,
Efficacy fish oil
Omega-3 fatty acid osteoarthritis
relief OR fish oil arthritis relief
Efficacy fish oil Or Pain relief

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For CINAHL
Action Search mode Results Limiters/Expanders
S1 SmartText searching-
Efficacy of fish oil in
osteoarthritis treatment
217 Expander: Apply related
words
S2 SmartText searching-
Fish oil in arthritis
treatment
167 Expander: Apply related
words
S3 Find all my search
terms- Osteoarthritis
patients OR Fish oil
140 Publication type- The
journal of clinical
nutrition
S4 Find any of my search
term - fish oil in
arthritis pain
55 Full text, 2013-2017,
Peer reviewed article
Publication type- The
journal of clinical
nutrition
S5 Boolean/Phrase-
Osteoarthritis patients
AND fish oil,
46 Full text, 2013-2017,
Peer reviewed article
Publication type- The
journal of nutrition,

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health & aging
S6 Boolean Phrase- Fish oil
AND osteoarthritis
treatment
5
Full text, 2013-2017,
Peer reviewed article
(Source: Richardson-Tench et al., 2016)
Relevant results
Two of the research articles were most relevant to the PICO question and appeared to
address the question.
Hill, C. L., March, L. M., Aitken, D., Lester, S. E., Battersby, R., Hynes, K., ... & Jones,
G. (2016). Fish oil in knee osteoarthritis: a randomised clinical trial of low dose
versus high dose. Annals of the rheumatic diseases, 75(1), 23-29.
Hill et al. (2016) conducted a randomised, double bind trial to determine if the high
dose fish oil is effective in treating osteoarthritis. The researcher enrolled 202 patients with
both regular knee pain and those with osteoarthritis. The researchers compared the efficacy of
the high dose fish oil consumption with the low dose. All the participants recruited were
above 40 years with the knee pain score above 20 mm on a 0–100 mm scale. During the run
in period the patients who can tolerate the fish oil were allocated to two treatment arms that is
high dose and low dose. The process involved the computer generated random allocation.
Both the groups showed improvement. When compared with the high dose group, the low
dose group had greater improvement in the pain and function scores when administered for 2
years. Further there was no difference in the loss of cartilage volume, BML core, and quality

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of life. At the differences of one year there was no significant difference between both the
groups. The benefit of using fish oil is noted prominently in the participants however, there is
no remarkable improvement found with the increase in dosage. Overall better efficacy of fish
oil in reducing pain was found in two years of time.
Senftleber, N. K., Nielsen, S. M., Andersen, J. R., Bliddal, H., Tarp, S., Lauritzen, L., ...
& Christense, R. (2016). PT09. 4: Fish Oil Supplements for Arthritis Pain: A
Systematic Review and Meta-Analysis of Randomized Trials. Clinical
Nutrition, 35, S40.
Senftleber et al. (2016), conducted systematic review and met analysis of the
randomised trials to determining the effectiveness of taking fish oil. Six databases were
searched and 30 trials were found to meet the inclusion criteria. There was a substantial
heterogeneity present. Overall the pooled standard mean differences revealed a favourable
effect. The meta analysis results showed a significant effect of fish oil on the rheumatoid
arthritis patients but not on the osteoarthritis (5 trials; SMD, -0.17, 95% CI, -0.57 to 0.24). It
can be concluded that the results showed a moderate quality evidence of the use of fish oil to
alleviate pain in patients with arthritis.
Conclusion
Since strong evidence from quantitative paper and moderate level evidence from the
qualitative paper is found Mrs Peggy can be advocated to take fish oil in addition to normal
treatment. In conclusion there is a need of intense research to determine the effectiveness of
fish oil in osteoarthritis.

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References
Besner, G. E. (2015). This goal of this review was to examine the clinical evidence in support
of commonly utilized measures intended to reduce complications following elective
colorectal surgery. Literature searches were performed to identify relevant studies
from Medline, PubMed, and Cochrane databases. The American Pediatric Surgery
Association Outcomes and Clinical Trials Committee selected eight questions to
address... Journal of Pediatric Surgery, 50(1), 192-200.
Besner, G. E. (2015). This goal of this review was to examine the clinical evidence in support
of commonly utilized measures intended to reduce complications following elective
colorectal surgery. Literature searches were performed to identify relevant studies
from Medline, PubMed, and Cochrane databases. The American Pediatric Surgery
Association Outcomes and Clinical Trials Committee selected eight questions to
address... Journal of Pediatric Surgery, 50(1), 192-200.
Hill, C. L., March, L. M., Aitken, D., Lester, S. E., Battersby, R., Hynes, K., ... & Jones, G.
(2016). Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus
high dose. Annals of the rheumatic diseases, 75(1), 23-29.
Patten, M. L. (2017). Understanding research methods: An overview of the essentials. Taylor
& Francis.
Pittaway, J. K., Chuang, L. T., Ahuja, K. D. K., Beckett, J. M., Glew, R. H., & Ball, M. J.
(2015). Omega-3 dietary Fatty Acid status of healthy older adults in Tasmania,
Australia: an observational study. The journal of nutrition, health & aging, 19(5),
505-510.

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Richardon-Tench, M., & Brown, S. (2014). Meeting the needs of cognitively impaired older
adults in day surgery: a review of literature. Day Surgery Australia, 13(2), 18.
Senftleber, N. K., Nielsen, S. M., Andersen, J. R., Bliddal, H., Tarp, S., Lauritzen, L., ... &
Christense, R. (2016). PT09. 4: Fish Oil Supplements for Arthritis Pain: A Systematic
Review and Meta-Analysis of Randomized Trials. Clinical Nutrition, 35, S40.