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January 19^th, 2022

Title: Expanding the Arthritis Appropriate Evidence-Based Intervention (AAEBI) Menu

Presenter: Ellen Schneider, MBA

Associate Director of Policy & Strategic Alliances, UNC Center for Aging and Health
University of North Carolina at Chapel Hill
North Carolina State University

INTRODUCTION

(Katie Huffman) Hello, and welcome to the Osteoarthritis Action Alliance Lunch and Learn webinar for January 19, 2022. Our presenter today is Ellen Schneider. Ms. Schneider is the associate director of policy and strategic alliances for the UNC Center for Aging and Health and is a previous Member of the Osteoarthritis Action Alliance team. Her areas of focus include evidence-based health promotion and disease prevention programming healthy aging and brain health. Ms. Schneider managed the national process to review programs for potential recognition as arthritis appropriate evidence-based interventions. This process was led by the OA action alliance and was funded by the Centers for Disease Control and Prevention. She also has previously managed the administration for Community livings title 3D evidence-based health promotion and disease prevention program review process. She has worked extensively with state health departments and the aging services network to build infrastructure and implement healthy aging policy guidelines and programming. She has presented at numerous national and statewide conferences across the country. Ms. Schneider received her undergraduate and graduate degrees from Penn State University and Graduate certificate and aging from UNC Chapel Hill. Ms. Schneider’s talk today is titled Expanding the Arthritis-Appropriate Evidence Eased Intervention (AAEBI) Menu.

PRESENTATION

(Ellen Schneider) Great thanks so much Katie and I appreciate the opportunity to be here today to talk with all of you about expanding the arthritis appropriate evidence-based intervention or AAEBI menu of programs. It was my honor to manage the AAEBI review process and to work with so many wonderful people to make this process happen. As part of my presentation, I’m not only going to let you know about what the newly recognized AAEBI’s are but I’m also going to give you a peek behind the curtain on how the programs were added to the recognized list. And just so we’re all on the same page with what AAEBIs are, they are well defined structured evidence-based interventions that are proven to be effective, specifically for people with arthritis. And we’ll get into more details about what makes a program an AAEBI in a few minutes, but I wanted to mention that definition right up front.

The Osteoarthritis Action Alliance, Centers for Disease Control and Prevention, Arthritis Foundation and many other organizations have recognized the importance of AAEBIs is for people with arthritis. In fact, in the National Public Health Agenda for Osteoarthritis 2020 update lovingly referred to AAEBIs the agenda. The very first strategy listed is to promote evidence based self-management programs and behaviors as non-drug interventions for adults with OA now, and even though that strategy is specific to osteoarthritis, it certainly applies to other types of arthritis as well.

So, with that groundwork, let’s look at the agenda for today’s Lunch and Learn program about expanding the menu of AAEBIs. So, during the first part we will look at the background of purpose of the review process and, as I had mentioned will take a peek behind the curtain at how the AAEBI criteria and processes for recognition were established. We’ll then look at the list of newly recognized programs in all its glory, get a snapshot of each of the newly recognized programs, and hear about next steps for anyone who might be interested in having a specific program reviewed.

So, the CDC previously conducted the AAEBI review process, and you might have also heard them referred to as lifestyle management programs for arthritis. There were five recognized physical activity programs and 2 recognized self-management programs, and we will make sure you know what those five recognized physical activity programs are that were already on the list. Several programs were on the promising or watch list and as part of the review process we looked at all of those programs on the promising and watch list. The CDC Arthritis Program funded the Action Alliance to update and conduct a new AAEBI review process in late 2020 and the La action alliance conducted that review process and built on the CDC previous process to do that. So, what’s the what’s the purpose of the review process?
Well, we know it’s important to keep adding to new menu of AAEBIs, and as we’ve mentioned expanding the menu is identified as a priority in the agenda. We also know that terrific work is being done at universities and other organizations to create research and implement new programs, so we wanted to identify those programs that meet criteria established for AAEBIs. It’s also very important that we continue to reach different underserved diverse populations and address different risk factors for arthritis.

So, let’s look at the AAEBI criteria. Well, in order to be recognized as an AAEBI, the program research had to be published in a peer reviewed journal article or articles. The program’s pilot study or studies had to include about 75 or more subjects in the treatment group. The research had to include pre and post-test measurements and at least three months post or a more rigorous design and that. The program research had to have measured at least two arthritis relevant outcomes, and those outcomes could have been health status, pain, stiffness, balance, or function. That function could be physical, psychological, or work weight management, injury prevention, injury, or disability. And the program research had to have had statistically significant changes in at least two of those arthritis relevant outcomes. The program research also must have included people with arthritis, and there should have been consistency of evidence. Particularly if more than one article was submitted there could have been up to three research articles that were included as part of the review. The studies documenting evidence had to have been judged to have reasonable rigor, and infrastructure must have been in place to support the program for dissemination. The availability of training manuals, dissemination materials, ways to receive technical assistance on an ongoing basis, supports and guidelines available, again what an organization might need to be able to implement the Program are very important.

So, let’s take a look at the review process itself. And again, this is just a quick overview of the steps we took to carry out the AAEBI review process so that you have an idea of the attention and detail that went into it. And don’t worry I’m not going to go into excruciating detail on any of these steps, but let’s start. At the beginning, we determine the High-Level program criteria for inclusion as an AAEBI, then we, as the OA Action Alliance identified programs for a review that was done through an extensive lit review. Again, looking at that CDC promising and watch program list for AAEBI programs and also programs that were suggested to us to review. We conducted a high-level review for programs that met minimum AAEBI criteria, but it was up to the reviewers to actually decide which programs would be recognized. And speaking of reviewers, we identified and recruited expert reviewers with three reviewers looking at each Program. So, reviewer selection criteria in case you were curious about that, meant they had to have in depth knowledge about arthritis and arthritis research, in-depth knowledge about AAEBI evaluation, and experience and familiarity with AAEBIs or other evidence-based program implementation. We gather to pilot information for the reviewers for the screening, so the research articles and other information they would need. We also made sure the reviewers didn’t have any conflicts of interest with programs that they would be reviewing. Then we completed the intervention summaries so gathering information about whether what the program had done to address that a bit AAEBI criteria that we just talked about previously. We then sent those summaries to the program developers, so they would have a chance to review the summaries and see if there were any updates or changes that needed to be made in those, so they then updated them as needed returned them to us. And then we sent all the program materials, evaluation forms, and research articles out to the reviewers so that the reviewers could then evaluate and complete their evaluation forms and submit their recommendations. We engage secondary reviewers if there was not unanimous agreement across all three reviewers for what program should be recognized. Then when the final recommendation for each intervention was made the reviewers, the program developers, and the CDC were made aware of the results. We then announced and promoted the new recognized AAEBIs and of course this webinar is part of that recognition and promotion.

Here is the list of updated recognized AAEBIs and at the top or programs that were already recognized. So, for the physical activity programs, you can see that the programs already on the recognized list: Arthritis Foundation Aquatic Program, Active Living Every Day, Enhance Fitness, Fit and Strong, and Walk with Ease-Group. Now the newly recognized physical activity programs are: AEA Arthritis Foundation Exercise Program, Camine Con Gusto, Fit and Strong! Plus, Tai Chi for Arthritis, Tai Ji Quan: Moving for a Better Balance, and Walk with Ease Self-Directed. For self-management programs, we had the Chronic Disease Self-Management Program and Tomando Control de su Salud already on a pro already on the list. The newly recognized self-management programs are Better Choices Better Health, Chronic Pain Self-Manager Program, The Program to Encourage Active Rewarding Lives or PEARLS and Workplace Chronic Disease Self-Management Program, and more information is about those programs it’s on the OA Action Alliance website.

So, let’s take a look at the programs that were added to the recognized list. Starting with newly recognized physical activity programs, the arthritis foundation exercise program is for adults with arthritis. It is a low impact recreational exercise program that incorporates a brief educational component. The class meets for one hour two to three times a week, and although was developed as an eight-to-12-week program it can be extended to include ongoing classes.

Next, we have Camine Con Gusto, which is the Spanish version of Walk with Ease self-directed program. And the primary audience is adults who have been either self or medically diagnosed with arthritis or have other chronic conditions and wish to be more physically active. Now the guidebook leads participants through the program including setting goals, identifying barriers, conducting self-assessments, stretching, strengthening exercises, and of course walking. Participants are encouraged to walk at least three times per week working up to 30 minutes per session or more.

Our next program is Fit and Strong! Plus, and that’s the program for adults with lower extremity arthritis or osteoarthritis. And it is a physical activity, plus weight loss version of the fitness term program. The program has 24 90-minute classes, consisting of 60 minutes of physical activity and 30 minutes of health education goal setting and group problem solving. And the goals of Fit and Strong! Plus are to help adults with lower extremity arthritis adopt healthy eating habits, in addition to physical activity to manage their weight and osteoarthritis.

Our next program is Tai Chi for arthritis which is for adults with or without arthritis rheumatic disease or related conditions. It was developed to improve health, with an emphasis on evidence-based efficacy and safety, and tai chi style was used for its ability to improve help relieve arthritis pain function and ease of use for older adults. Movements are performed at higher standards to make it easier for older participants and those with arthritis and disabilities.  Participants should attend a minimum of one hour per week for 16 weeks or two hours per week for eight weeks.

Next, we have Tai Ji Quan: Moving for Better Balance and this program is designed for older adults at risk of falling and people with balance disorders. The program transforms martial arts movements into a therapeutic regimen aimed at improving postural stability awareness and mindful control, body positioning, functional walking movement symmetry, and coordination range of motion around the ankle and hip joints lower extremity muscles, and strength and global cognitive function. The program is delivered during two one-hour sessions each week for 24 weeks.

Next, we have Walk with Ease Self-Directed, this will sound very familiar since it’s similar to Camine Con Gusto and its primary audience is adults who may be either self or medically diagnosed with arthritis who have chronic conditions and wish to be more physically active. The guidebook leads participants through the program again looking at setting goals identifying barriers conducting self-assessments. And again, of course, walking and participants are encouraged to walk at least three times a week working up to 30 minutes per session or more.

So those are our newly recognized physical activity programs let’s take a look at the newly recognized self-management programs.

First, is Better Choices Better Health, which is an Internet based group workshop that uses content from the Chronic Disease Self-Management Program. It focuses on Chronic Disease Management Decision-Making Problem-Solving an action planning. And participants log on at their convenience two to three times per week for a total of approximately two hours and trained pure coaches, facilitate the group, dynamic and provide additional support to workshop participants.

The Chronic Pain Self-Management Program was delivered for people who have a primary or secondary diagnosis of chronic pain, and the program is held at during a two-and-a-half-hour session once a week over six-week period. Classes are highly participatory with mutual support and success built on the participants confidence in their ability to manage their health and maintain active and fulfilling lives, the classes are led two trained leaders, one or both of whom are non-health professionals with chronic pain themselves. The program can be offered by telephone, video or in person in Spanish or in English.

Our next program is Enhanced Wellness, and this program is for adults aging with disability and older adults with one or more chronic conditions, excluding dementia. The program connects participants with a trained personal health and wellness coach to improve physical, emotional, and social well-being. Enhanced Wellness uses motivational interviewing techniques and validated assessment tools to guide health action plan creation and accountability. The goal of the program is to maintain or increase the health and functional status of older adults with chronic conditions and people aging with disability.

Our next newly recognized self-management program is the Program to Encourage Active Rewarding Lives or PEARLS and this program is an intervention for adults and older adults with depression. And it aims to reduce symptoms of depression and improve quality of life, which is so important for people with arthritis. The process is delivered in six-to-eight one-hour sessions by a trained health or social service professional that can be a social worker case manager or community health worker and it’s delivered in the client’s home or other community-based setting. Sessions are initially held weekly and become less frequent over a four-to-five-month period. During sessions clients choose the problems they would like to discuss and the trained coach guides, teaches, and supports them and developing action plans that are implemented by the client between sessions to address those problems.

And finally, the last newly recognized self-management program is the Workplace Chronic Disease Self-Management Program. This program is a translated version of the Chronic Disease Self-Management Program for use in the workplace, and the primary goals and objectives are for the program are to improve self-management skills in employees with one or more chronic conditions.

They also aim to improve physical and mental health indicators in employees who participate in the program and improve work performance and productivity indicators of employees to participate in the Program. The program is conducted and a small-group workshop during a 50-to-55-minutes session with two sessions held per week for six weeks. And the programs are available in English and in Spanish

So again, this was just a taste of the newly approved AAEBIs and for more information, I encourage you to go to the OA Action Alliance website listed on this slide again (oaaction.unc.edu/aaebi/) there’s more information there, and there are links to all of the programs to learn more about them.

So, what’s on the road ahead for expanding the AAEBI menu? Well, the big change is that program developers will have the opportunity to apply for the review process. We’re guessing that there are programs out there that didn’t pop up on our radar screen for any number of reasons when we conducted the last review process. So, this will give developers the chance to have their programs reviewed if they think they meet the AAEBI criteria. So, information about the process will be available in late January on the OA Action Alliance website. Applications will be open as of April first applications will close April 29, and the program applicants will be notified by September 13^th this year. So, before we go to questions, I want to thank the CDC for funding the review process, the members of the OA Action Alliance staff, the reviewers, the program developers, and everyone else who contributed to making the review process happen to expand the menu of AAEBIs.

I also hope that your organization will consider offering one of these terrific Arthritis-Appropriate Evidence-Based Interventions, so that your clients can benefit from the outcomes of the programs offer. It was my privilege to manage the review process, and I’m now handing over the baton to Emma Deane, who will be managing the process in the future, and Emma’s email address is listed here on the slide. And with that, Katie, I will turn it back over to you for any questions that people on the webinar might have.

QUESTION AND ANSWER:

Thank you so much for your presentation, Ellen, it’s really great to see so many program options for individuals with arthritis and I’m excited to see where this takes us and new programs that may come along. We do have time for some questions today so as a reminder to our participants in the webinar today, you can type any questions into the chat box, and I will read them aloud. And we will also have a poll pop up on your screen, just before the end of the webinar if you’ll take time to answer those questions for us, we’d appreciate it.

QUESTION: If someone wanted to join any of these programs (to participate in the programs) that you described- are they available for people to participate in?

ANSWER: Ellen Schneider: Yes, yes, they are available, and I would encourage people to contact the program developers if they are interested in the offering any of the programs, and if they want to join the programs, they will need to probably the best place to start would be contacting their area agency on aging or their local or state public health department.

(Katie Huffman) All right, thank you for that information, a couple of questions here about Tai Ji Quan.

QUESTION: Was the Tai Ji Quan program that was reviewed during this review process that you described the one that was developed by Fuzhong Li at the Oregon Research Institute or the YMCA version of Moving for a Better Balance.

ANSWER: Ellen Schneider: Yeah, it’s the Dr. Li version that was developed at the Oregon Research Institute.

QUESTION: Okay, great! Thank you. Someone is interested in finding out if that program is available in eastern North Carolina.

ANSWER: Ellen Schneider: I don’t know that for sure, but again I would contact you were your AAA your area agency on aging or there’s also a healthy aging website that list programs that are available, so you could take a look there. And I do want to mention something that I should have mentioned, with Better Choices Better Health, folks can log on as often as they want and whenever they want for the six weeks and all interaction is in writing so.

QUESTION: And there’s another question here Ellen, are there references available about the programs on the Action Alliance website.

ANSWER: Ellen Schneider: I’m not sure I understand the question is, are reverence references available, but I’m guessing you mean for the research articles, and if so, the program developers certainly have those research articles that show the outcomes. And if you’re just interested in the websites, then those are on the OA website.

FOLLOW UP QUESTION: Andrew Bartlett: Part of the review process was the rigor and the, you know, pilot and all that, I was wondering if the references for that were available, I can certainly dig it out as well, just wondering if it was easily accessible.

ANSWER: Ellen Schneider: Yeah, I don’t think those are not included on the OA Action Alliance website. And it would probably be easiest to contact the specific program developer if you’re interested in in those research articles. But that’s something that that Action Alliance could certainly consider, adding if they want…Okay, Kirsten just mentioned that the peer reviewed articles are not on the website, but we have direct links to each program to learn more.

(Katie Huffman) Great and if anyone has any other questions we have a couple more minutes here, where we can take some last-minute questions.

QUESTION: One question I was thinking of Ellen is do you have any idea whether, since this is a new process, whether the AAEBI criteria will change at any point.

ANSWER: Ellen Schneider: That’s a great question, Katie, thank you. So, we don’t anticipate any changes to the criteria this year, but we will be reviewing it periodically just to make sure that we keep up with the research and the science, so the AAEBI criteria definitely will be reviewed again just to make sure that we’re keeping up with the science that that’s out there.

(Katie Huffman) Great, and we do have a comment here from Kate Laura she says for anyone that wants any of the src programs, they can go to program locator which you can find on the homepage of their website, which is listed there in her chat and all of the reference they submitted are also under the website under their resources, thank you for sharing that.

CLOSING REMARKS:

(Katie Huffman) All right, well I’m going to launch the poll here and I just want to thank Ellen again for your great presentation today. I really appreciate that, and thanks to all of you for attending today’s webinar. We hope you’ll join us next month for our February 16th Lunch and Learn featuring Mandy Shintani who will present “Is Nordic Walking a Superior Approach for Hip and Knee OA Rehabilitation?”  Thank you again so much.