“In adults with autoimmune inflammatory arthritis, how does adherence to a Mediterranean diet compared to a standard diet affect pain, stiffness, and inflammatory markers over 12 weeks?”

Purpose: This form guides the EBP
team in developing an answerable EBP question. It is meant to be fluid
and  dynamic as the team engages in the
question development process. As the team becomes familiar with the
evidence  base for the topic of
interest, they revisit, revise, and refine the question, search terms, search
strategy, and sources  of evidence.

What is the local problem? (the response can be a bulleted list or phrases)

●     
High number of adult patients with arthritis
in primary care settings.

●      Patients
experience chronic pain, stiffness, fatigue, and reduced quality of life
despite standard medical treatment.

●      Limited
guidance or education on dietary interventions for arthritis symptom
management in the local clinic.

●     
Patients often rely on self-directed diets or
unverified online advice, leading to inconsistent results.

●      Primary
care providers have limited time and resources to discuss nutrition or
lifestyle modifications with patients.

●      Lack
of evidence-based protocols or recommendations integrating diet to improve
arthritis outcomes in adults.

Why is this problem important and relevant? What
would happen if it was not addressed?

●      Arthritis significantly impacts quality
of life: Chronic joint pain, stiffness, and fatigue limit mobility, daily
functioning, and independence in adults.

●      High prevalence in primary care: Many
adults in the clinic suffer from autoimmune and inflammatory arthritis,
making it a common and pressing issue.

●      Current management may be insufficient:
Standard pharmacologic therapies often control symptoms but do not address
inflammation related to diet or lifestyle, leaving patients with ongoing
discomfort.

●      Potential for non-pharmacologic
improvement: Evidence suggests that diet may influence inflammation and
symptom severity, offering a low-risk, accessible intervention to complement
medical management.

Consequences of inaction:

●     
Patients may continue to experience pain,
functional limitations, and decreased quality of life.

●     
Over-reliance on medications could lead to
side effects and increased healthcare costs.

●     
Missed opportunity for preventing disease
progression and improving overall health outcomes.

●     
Urgency for practice change: Implementing
dietary guidance and education could empower patients,

reduce
symptom burden, and optimize chronic disease management in the primary care
setting.

What is the current practice in the EBP team’s setting? 

●      Focus on pharmacologic management:
Most adult patients with arthritis receive standard medical treatment,
including NSAIDs, DMARDs, or biologic therapies, as per provider preference
and clinical guidelines.

●      Limited dietary counseling: Nutrition
and diet are rarely systematically addressed during routine visits.
Discussion of diet is often brief, patient-initiated, or inconsistent.

●      Lack of structured protocols: There
are no standardized clinic policies or guidelines for assessing dietary
patterns or providing nutrition-based interventions for arthritis patients.

●      Education is ad hoc: Patient
education on lifestyle or diet is variable; some staff provide general
recommendations, while others do not discuss diet at all.

●      Gap or performance issue: There is a
disconnect between evidence suggesting that diet can improve  arthritis symptoms and actual practice in
the clinic. This creates a gap in holistic patient care

●      Staff perception: Most providers
consider pharmacologic therapy and standard symptom management acceptable,
with diet and lifestyle interventions viewed as supplementary rather than
integral.

●     
Alignment
of policy and practice: Current policies focus on medication management,
lab monitoring, and routine follow-up but do not explicitly integrate diet or
lifestyle interventions, resulting in inconsistent practice and missed
opportunities for symptom improvement.

What data from the EBP team’s setting indicates
there is a problem?

1.  Safety and Risk Management Concerns

●      Patients
with arthritis who rely solely on pharmacologic therapy often experience
adverse effects such as gastrointestinal bleeding from NSAIDs or immune
suppression from DMARDs.

●      Lack
of dietary counseling may contribute to increased inflammation, leading to
higher risk of joint damage and functional decline.

2.  Financial Information

●      Frequent
clinic visits for uncontrolled pain or flares increase healthcare costs for
patients and the organization.

●      Absence
of non-pharmacologic interventions such as diet education may result in
higher medication use and more expensive therapies over time. 

3.  Lack of Evidence for Current Practice

●      Clinic
protocols primarily focus on medication management with minimal attention to
nutrition or lifestyle interventions.

●     
No standardized guidelines exist in the clinic
for incorporating dietary strategies into arthritis care, despite evidence
supporting anti-inflammatory and Mediterranean diets.

Identify the relevant elements of the EBP question
(some items may not be used)

Population

●     
Adults diagnosed with autoimmune inflammatory

arthritis (e.g.,
rheumatoid arthritis)

●     
Both male and female patients, typically aged
30 years and older, experiencing pain, stiffness, and reduced mobility

Setting

●      Primary
care clinics where adults receive ongoing management for arthritis.

●      Outpatient
environment with routine follow-up visits and care coordination.

Topic (for broad questions) or   Intervention(s)
(for intervention questions)

●      Dietary
modification, specifically adherence to a Mediterranean diet or other
anti-inflammatory diets.

●     
Comparison: usual diet or standard care
without structured dietary intervention.

Outcomes (as needed)

●      Primary
outcomes: Reduction in joint pain, stiffness, and fatigue; improved
functional status.

●      Secondary
outcomes: Decreased inflammatory markers (CRP, ESR), improved quality of
life, and potential reduction in reliance on pharmacologic therapy.

Use the information above, and the sentence
templates below, to construct the EBP question.

For Intervention EBP Questions: 

According to the evidence, in adults with autoimmune inflammatory arthritis in primary care
settings , what is the impact of adhering to a Mediterranean diet on  pain, stiffness, inflammatory markers, and
quality of life, as compared to a standard
diet?

Record the completed EBP question below.

“According to the evidence, in adults with autoimmune
inflammatory arthritis in primary care settings, what is the impact of
adhering to a Mediterranean diet on pain, stiffness, inflammatory markers,
and quality of life, as compared to a standard diet?”

If needed after a preliminary evidence
search/review, record an updated or revised EBP question here.