PUBLIC HEALTH THREAT Arthritis State of the Science Meeting - PDF document

9/29/2014 Rheumatological Rehabilitation: How are We Doing? Julie J. Keysor, PT, PhD Director, ENACT Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis State of the Science Meeting April 7, 2014 Arthritis: PUBLIC HEALTH THREAT Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 1

9/29/2014 Arthritis State of the Science Meeting April 7, 2014 Why this meeting? Why should rehabilitation professionals care?? Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Why this meeting? ARTHRITIS: Disability Threat Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 2

9/29/2014 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 1) A look to the past 2) Major advances 3) Current gaps and upcoming challenges 4) Future needs Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 3

9/29/2014 Rheumatological Rehabilitation Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis Rehabilitation: 1960s “In 1965, as I started my career as a physical therapist, my first patient was a woman with rheumatoid arthritis, Functional Class IV. She had been treated with high-dose corticosteroids for over 15 years and was admitted to the rehabilitation unit for 2 weeks every summer. Her treatment orders were for mat exercises (passive and active-assisted range of motion.) I had received 1 lecture on rheumatoid arthritis and attended grand rounds about corticosteroids.” Minor MA, The ACR at 75 2009 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 4

9/29/2014 Arthritis Rehabilitation…mid-late 1980s Joint deformity often substantial Treatment supported by limited research Bluestone R. Br Med J. 1970; Katz WA. Am J Med. 1985 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Got Arthritis? ….Rest…ahh…. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 5

9/29/2014 Now: MOVE! ENGAGED IN COMPLEX ROLES Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Major Advances over Past Two Decades Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 6

9/29/2014 Advance #1: Medicine—Inflammatory Conditions • Early diagnosis & treatment • Disease modifying medications • Biological medications • RESULT: Less joint and tissue destruction • No cure • Disability persists Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Advance #2: Exercise Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 7

9/29/2014 People with Osteoarthritis and Rheumatoid Arthritis Can Exercise • Intervention: Walking or Aquatic Exercise • Control: Range of motion • Outcomes: No difference in active joint counts & aerobic capacity and walking speed increased Minor MA et al, Arthritis Care Res, 1989 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 1990s Decade of Exercise Clinical Trials • 21 clinical trials • 11 rheumatoid arthritis • 10 osteoarthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 8

9/29/2014 Systematic Reviews 2000s: Osteoarthritis and Rheumatoid Arthritis Outcomes Effect Level of Evidence Aerobic Pain Small-Moderate Good Function Small-Moderate Good training Strength Strength Moderate Good training Pain Moderate Good Function Small Good Ottowa Panel. Physical Therapy, 84: 2004 & 85: 2005; MOVE Consensus 2005; Jamtvedt et al. Physical Therapy 88:2008; Fransen M., McConnell S. The Cochrane Collaboration, 2009; Wang et al., Ann Inter Med 157: 2012 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 NOW: Knee Osteoarthritis • Strongly recommended: (ACR 2012 Practice Guidelines; EULAR 2013 Practice Guidelines; OARSI 2014 Practice Guidelines) • Aerobic and/or aquatic exercise • Resistance exercises • Moderate aerobic low impact activity 150 minutes/week • Resistance training 2 times/week (CDC 2008) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 9

9/29/2014 J Orthop Sports Phys Ther 2009: 39(4):A1-A25 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 CDC Endorsed Community Exercise Programs • Walk with Ease • Fit and Strong • Arthritis Foundation Exercise • EnhanceFitness Program • Arthritis Foundation Aquatic • Active Living Every Day Program Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 10

9/29/2014 Advance #3: Work Disability Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis Linked to Work Disability 1980s • Work loss recognized as a major health concern among people with rheumatoid arthritis • Disease duration, disease severity, physical function, work- related factors recognized risk factors Yelin et al. Ann Intern Med 1980; Meenan et al., Arthritis Rheum 1981; Pincus et al. J Clin Epidemiol. 1989; Reisine et al., Arthritis Rheum. 1989 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 11

9/29/2014 Arthritis and Work Disability 1990s • “Return” to work: • Related to work/organization factors (Straaton et al., Arthritis Rheum, 1992) • Measurement of work disability • Epidemiology of work loss continued Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis and Work Disability 2000s: Clinical Trials • Vocational rehabilitation approaches • Positive impact on sustaining employment status (Allaire et al, Arthritis Rheum, 2003) • Ergonomic, occupational therapy, and exercise approaches • Positive impact on self-efficacy, fatigue, work performance (Baldwin et al. 2012; Macedo et al., 2009; Verekamp et al. 2011; Nyrop et al. 2011) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 12

9/29/2014 Advance #4: Participation—Involvement in Life Situations Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 International Classification of Functioning, Disability and Health (ICF), WHO 2001 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 13

9/29/2014 BU ENACT ICF Activity and Participation… Activity/Activity Participation/Participation Limitation Restriction • Execution of a task or an • Involvement in life situations activity by an individual 27 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Prevalence of Participation Restriction among Persons with Arthritis • 11% (1 out of 9) of adults with self-reported arthritis report social participation restriction (2009 National Health Interview Data, Theis et al. 2013) • 38% of older adults with symptomatic knee OA and functional limitations had moderate or severe participation restriction (Keysor et al. J. Gerontology 2009) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 14

9/29/2014 Participation in OA: Does it Matter? Extremely important 5 4 3 2 1 Not at all 0 Importance Gignac et al., J Rheumatol 2008 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Participation in OA: Does it Matter? Extremely important/satisfied 5 4 3 2 1 Not at all 0 Importance Satisfaction with time spent Satisfaction with role performance Gignac et al., J Rheumatol 2008 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 15

9/29/2014 Measurement: Participation • PROMIS • OA CAT • Impact on Participation and Autonomy (IPA) • Keele Assessment of Participation (KAP) • Social Role Participation Questionnaire • Participation Objective, Participation Subjective (POPS) • Late Life Disability Instrument Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Outcome Measures in Rheumatology ( OMERACT ) http://www.omeract.org/index.html Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 16

9/29/2014 Advances in Rheumatological Rehabilitation Research and Practice Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 RheumatologicalOutcomes Across the Decades (Number of Studies Identified in Pubmed) 7000 6000 5000 Pain 4000 Function 3000 Disability Social Participation 2000 1000 0 1970s 1980s 1990s 2000s Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 17

9/29/2014 Great Advances …Yet, Gaps Remain Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Gap: Exercise Adherence • 44% of people with arthritis are inactive (compared to 36% older adults) (Shih M et al., Am J Prev Med 2006) • 13% (older adults) engage in recommended levels of strength training activities (Kruger J et al., Prev Chronic Dis. 2007) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 18