Health Care

The Health Care sector encompasses licensed health care professionals working with or serving adults in a variety of settings as providers; certified fitness professionals; public and private insurers; and health care administrators and managers. These professionals can have a major impact on the health of all of their patients with arthritis by counseling and engaging them in safe and effective physical activity.

Table of Contents

  1. Making the case
  2. What can you do?
  3. Strategies
  4. Samples
Action Brief

Health Care Professionals Make a Difference!

 

Making the case

Arthritis is the most common cause of disability in the United States.

  • 54.4 million U.S. adults (22.7%) have arthritis.
  • 8.6 million U.S. adults (19%) report disability due to arthritis. In this context, disability is defined as a limitation or loss of function, most often manifested as difficulty climbing a flight of stairs and walking 3 city blocks (a distance equal to walking from the parking lot to the back of a large store or through a mall).
  • As the number of older Americans contin­ues to grow, and the rates of obesity and overweight increase, the number of people with arthritis will only increase.
To learn more:

Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007–2009. MMWR2010;59(39):1261–1265. html  pdf  [1.61 MB] http://www.cdc.gov/mmwr/PDF/wk/mm5939.pdf

Hootman JM, Brault MW, Helmick CG, Theis KA, Armour BS. Prevalence and Most Common Causes of Disability Among Adults — United States, 2005. MMWR 2009;58(16):421-426. html; pdf  [1.3Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf

Arthritis and other rheumatic conditions costs our nation $128 billion each year – or 1.2% of the gross domestic product (in 2003). $81 billion of that cost is due to health care expenses.

To learn more:

Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997
http://www.ncbi.nlm.nih.gov/pubmed/17469096?dopt=AbstractPlus

CDC arthritis cost statistics
http://www.cdc.gov/arthritis/data_statistics/cost.htm

Arthritis and other conditions of the muscles, bones, joints are the most common causes of work limitation among US adults.

To learn more:

Theis KA, Helmick CG, Hootman JM. Musculoskeletal Conditions Are the Most Common Causes of Work Limitation in U.S. Adults. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :795.  http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=781&id=95541

Adults with arthritis often have other chronic conditions and arthritis makes managing these other conditions more difficult:

  • Of these comorbid conditions — heart disease (49%), chronic respiratory conditions, obesity (31%), diabetes (47%), and stroke are among the most common
To learn more:

About arthritis comorbidity

About arthritis and anxiety and depression

Adults with arthritis are more likely to fall.

Because of physical limitations and disease progression over time, adults with arthritis are prone to falling. This could be because of pain, awkward gait, tripping or slipping easily, or not being able to “catch” themselves if they are off balance. Engaging regularly in balance activities, such as Tai Chi, has been shown to prevent falls and improve stability.

To learn more:

About Tai-chi

CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2nd Edition

Physical activity benefits all adults — INCLUDING adults with arthritis.

  • It offers immediate and measurable health benefits: decreased pain, delayed onset of disability, and improved physical functioning, mood, and independence.
  • It also enhances quality of life, aerobic capacity, and muscle strength.
  • It is a low-cost, effective, and sustain­able approach to arthritis management.

Though health care providers have made significant progress in providing weight counseling for overweight and obese adults with arthritis, they can also have a major impact on the health of all of their patients with arthritis by counseling them about safe and effective physical activity.

To learn more:
People with arthritis can safely engage in physical activity.

Moderate intensity exercise is safe for people with arthritis due to its low risk of injury, and has been shown not to aggravate joint symptoms.  Walking, in particular, has more than half the risk of musculoskeletal injury compared to other vigorous activities like running. A variety of evidence-based physical activity programs have been tested and proven appropriate and safe for adults with arthritis.

To learn more:
Unfortunately, far too few adults with arthritis participate in recommended physical activity.

Adults with arthritis are less likely to be physically active than those without the disease, and this gap widens even further for adults with arthritis who also have diabetes or heart disease or for those who are obese.

To learn more:
  • Hootman JM, Kamil E. Barbour KE, Watson KB, Fulton JE. State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011. MMWR Weekly May 3, 2013 / 62(17);331-334. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a3.htm?s_cid=mm6217a3_w
  • Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh KC, Mysiw WJ, Nevitt MC, Hootman JM. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum. 2011 Jul 26. doi: 10.1002/art.30562. http://www.ncbi.nlm.nih.gov/pubmed/21792835
  • Barbour KE, Hootman JM, Murphy LB, Helmick CG. Arthritis as a Potential Barrier to Physical Activity Among Obese Adults–United States, 2007 and 2009.  MMWR 2011;60(19):614–618. html  pdf  [1.7MB] http://www.cdc.gov/mmwr/pdf/wk/mm6019.pdf
  • Hootman JM, Barbour KE, Watson KB, Harris C.  State-specific prevalence of no leisure-time physical activity among adults with and without doctor-diagnosed arthritis – United States, 2009. MMWR 2011;60(48):1641-1645. html  pdf  [1.10MB] http://www.cdc.gov/mmwr/pdf/wk/mm6048.pdf
  • Bolen J, Murphy L, Greenlund K, , Helmick CG, Hootman J, Brady TJ, Langmaid G, Keenan N. Arthritis as a potential barrier to physical activity among adults with heart disease — United States, 2005 and 2007. MMWR 2009;58(7):165-169. html; pdf  [1.25Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5807.pdf
  • Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a potential barrier to physical activity among adults with diabetes — United States, 2005 and 2007. MMWR 2008;57(18):486-489. html; pdf  [1.3Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5718.pdf
  • Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006 May;30(5):385-93. http://www.ncbi.nlm.nih.gov/pubmed/16627126

What can you do?

 “The healthcare sector is our nation’s largest industry. It is comprised of all the people and physical resources devoted to providing health-related services to individuals. 

Traditionally, health care has focused on diagnosing and treating illness and injury. However, as knowledge of the causes of premature disability and death has advanced, the healthcare sector has increasingly emphasized early intervention and prevention. In their work with individual patients, health care providers have a unique opportunity to encourage adults, children, and families to increase their daily physical activity.”[1]

A few tips—

For health care providers and certified fitness professionals:

  • Avoid thinking of arthritis as a normal part of aging.
  • Familiarize yourself with appropriate types and amounts of physical activity needed for adults with arthritis.
  • Try to address arthritis management routinely for patients with arthritis, even when it is not a patient’s primary reason for being seen on a particular visit. Most patients have some arthritis as a comorbidity but are not being treated unless they have pain in their knee, hip, or other joint.  After addressing their primary issue, say “I’m looking at your history and see that you have some arthritis. Let’s incorporate some physical activity into your treatment program, which will help you going forward with your primary diagnosis and . . . .”

For administrators and insurers:

  • Consider ways to encourage physicians to recommend that their patients with arthritis visit local physical therapists or certified exercise professionals for an individualized physical activity plan.
  • Make it easy for physicians to recommend sources of physical activity to their patients by providing them with a list of local options or offering some of the courses in-house. Strive to identify and address potential barriers of cost, credibility, and convenience.
  • Encourage all staff within the medical office or practice to be a part of the process. No physician can do this alone. Support from management and staff can make a big difference.
  • Take advantage of word of mouth and success; they are your best marketing tools.
To learn more:

Learn the Truth about Arthritis

Zaza S, Harris KW, Briss PA, Task Force on Community Preventive Services (U.S.). The guide to community preventive services: what works to promote health? New York: Oxford University Press; 2005. http://www.thecommunityguide.org/library/book/Front-Matter.pdf

[1] Source: The National Physical Activity Plan (http://www.physicalactivityplan.org/theplan.php)

Strategies

Strategy 1. Incorporate into every visit of your patients with arthritis an assessment of their physical activity levels and specific barriers.

A decade or two ago, physicians did not routinely ask their patients about tobacco habits, alcohol intake, or seat belt use. Today, questions about these health risks and behaviors are expected and serve to raise awareness among patients of the link between certain behaviors and disease, injury, and quality of life. This holds true for arthritis patients and physical activity. Health care providers can change patients’ attitudes and behavior about physical activity simply by asking the right questions, sharing information about the benefits of being more active, and bringing to light the critical barriers they may face. Medical assessments can help patients set appropriate, individualized goals. They can also be used as a “trigger” to indicate when to recommend attending a community physical activity program or seeing a physical therapist.

Tools

Exercise is Medicine® was designed by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) to help improve health and well-being through a regular physical activity prescription from doctors and other health care providers. A toolkit helps you plan for May, Exercise is Medicine Month.

Questions for Assessing Physical Activity

From the CDC Behavioral Risk Factor Surveillance System (BRFSS), modified to include physical activity (see Samples section below).

Physical Activity Calculators

http://www.ehow.com/how_7264020_calculate-physical-activity-level.html

https://www.supertracker.usda.gov/physicalactivitytracker.aspx

Strategy 2. Record physical activity as a vital sign in medical records.

Just as assessment of patients’ physical activity raises awareness of its importance, documenting activity levels in their medical records could help facilitate counseling and monitoring of levels over time.

To learn more:

Kaiser Permanente Study Finds Efforts to Establish Exercise as a Vital Sign Prove Valid: Kaiser Permanente is one of the first health care organizations to establish a systematic method for recording patients’ physical activity into their electronic health records. press release

Strategy 3. Design electronic systems to record and monitor physical activity levels of your patients with arthritis and their receipt of physical activity information and recommendations.

Efforts are underway at a national level to get physical activity included in electronic medical records.

To learn more:

Kaiser Permanente Study Finds Efforts to Establish Exercise as a Vital Sign Prove Valid: Kaiser Permanente is one of the first health care organizations to establish a systematic method for recording patients’ physical activity into their electronic health records. press release

A Physical Activity Toolkit for Registered Dietitians: Utilizing Resources of Exercise is Medicine®

Strategy 4. Recommend that your patients with arthritis participate in community-based physical activity interventions, other physical activity appropriate for adults with arthritis, or rehabilitation therapies as needed.

Advice from providers about being more physically active should be very specific, or patients are likely not to listen. Just saying “go to the gym more often” will not produce desired behavior change. Instead, recommendations about the type and frequency of activity must be as precise as possible.

In addition, giving the patient a list of locally available sites for recommended activity (e.g., local Y’s, community centers, fitness centers, physical therapists) could increase the odds that the patient will actually follow through. Perhaps your medical office or practice could even become a host site for physical activity interventions.

Samples

Prescription Print Pad from California (see Samples section below)

Patient Information Sheet (see Samples section below)

Tools

Strategy 5. Empower your patients with arthritis with skills to perform their own self-assessment, or refer them to a trained professional to develop a personalized plan for physical activity.

With support and encouragement, patients can take charge of their health and how it is impacted by physical activity.  The more engaged they are, the more likely they will be able to sustain recommended activity levels over time.

Tools

Strategy 6. In healthcare insurance packages, include reimbursement and financial incentives to support screening and participation in evidence-based physical activity among adults with arthritis.

Six physical activity programs have been proven to enhance the symptoms, function, and quality of life of adults with arthritis. In addition, CDC has developed a guidance document to help select the appropriate interventions for your situation.

Tools

Samples

Questions from the OA Risk Assessment Tool.

  • During the past year have you had any pain, aching, or discomfort in or around your knees when squatting?
  • At any time during the past year have you had knee swelling that lasted more than one day?
  • At any time during the past year have you felt grinding or heard clicking or any other type of noise when either knee moved?
  • Have you ever had knee surgery or talked about having knee surgery with a doctor?
  • At any time during the past year have you had stiffness in your knee(s), lasting less than 20 minutes

Questions to Assess Physical Activity, Modified from BRFSS

The Behavioral Risk Factor Surveillance System (BRFSS) is a longstanding national telephone survey that collects data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. The following questions are included in that survey. Questions 7 and 8 directly address physical activity for adults with arthritis. The other questions are valuable for learning more about a person’s diagnosis, activity limitation, symptoms, and prior recommendations from health professionals.

  1. Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?
  2. In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?
  3. During the past 30 days, to what extent has your arthritis or joint symptoms interfered with your normal social activities, such as doing physical activity or going shopping, to the movies, or to religious or social gatherings? (READ 1-3)
    1. A lot;
    2. A little or;
    3. Not at all.
  4. Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.
  5. Thinking about your arthritis or joint symptoms, which of the following best describes you TODAY?
    (Read responses 1- 4)
    I can do everything I would like to do;
    I can do most things I would like to do;
    I can do some things I would like to do;
    I can do hardly anything I would like to do.
  6. Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
  7. Has a doctor or other health professional EVER suggested physical activity or exercise to help your arthritis or joint symptoms?
  8. Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?

Source: BRFSS, 2009

Prescription Print Pad, California

Prescription print pad

Patient Information Sheet

Exercise is good for you because it increases your strength, boosts your immune system, helps with balance, and improves your cardiovascular health.

Patient Name:

Recommended Physical Activity:

  • Type: Walk around your block for 15 minutes
  • Frequency: Once every day

What to do before physical activity?

What to do after physical activity?

  • Put ice on knee for X minutes