Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-30 (of 30 Records) |
Query Trace: Brady TJ [original query] |
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All-cause opioid prescriptions dispensed: The outsized role of adults with arthritis
Murphy LB , Cisternas MG , Theis KA , Brady TJ , Bohm MK , Guglielmo D , Hootman JM , Barbour KE , Boring MA , Helmick CG . Am J Prev Med 2020 59 (3) 355-366 INTRODUCTION: Limited estimates of prescribed opioid use among adults with arthritis exist. All-cause (i.e., for any condition) prescribed opioid dispensed (referred to as opioid prescription in the remainder of this abstract) in the past 12 months among U.S. adults aged ≥18 years (n=35,427) were studied, focusing on adults with arthritis (n=12,875). METHODS: In 2018-2019, estimates were generated using Medical Expenditure Panel Survey data: (1) 2015 prevalence of 1 or more opioid prescriptions to U.S. adults overall and by arthritis status and (2) in 2014-2015, among adults with arthritis, multivariable-adjusted associations between 1 or more opioid prescriptions and sociodemographic characteristics, health status, and healthcare utilization characteristics. RESULTS: In 2015, the age-standardized prevalence of 1 or more opioid prescriptions among adults with arthritis (29.6%) was almost double of that for all adults (15.4%). Adults with arthritis represented more than half of all adults (55.3%) with at least 1 opioid prescription; among those with 1 or more prescriptions, 43.2% adults had 4 or more prescriptions. The strongest multivariable-adjusted associations with 1 or more opioid prescriptions were ambulatory care visits (1-4: prevalence ratios=1.9-2.0, 5-8: prevalence ratios=2.5-2.7, 9 or more: prevalence ratios=3.4-3.7) and emergency room visits (1: prevalence ratios=1.6, 2-3: prevalence ratios=1.9-2.0, 4 or more: prevalence ratios=2.4); Ref for both: no visits. CONCLUSIONS: Adults with arthritis are a high-need target group for improving pain management, representing more than half of all U.S. adults with 1 or more opioid prescriptions. The association with ambulatory care visits suggests that providers have routine opportunities to discuss comprehensive and integrative pain management strategies, including low-cost evidence-based self-management approaches (e.g., physical activity, self-management education programs, cognitive behavioral therapy). Those with multiple opioid prescriptions may need extra support if transitioning to nonopioid and nonpharmacologic pain management strategies. |
Where have all the patients gone Profile of US adults who report doctor-diagnosed arthritis but are not being treated
Theis KA , Brady TJ , Sacks JJ . J Clin Rheumatol 2019 25 (8) 341-347 BACKGROUND: Patients only benefit from clinical management of arthritis if they are under the care of a physician or other health professional. OBJECTIVES: We profiled adults who reported doctor-diagnosed arthritis who are not currently being treated for it to understand better who they are. METHODS: Individuals with no current treatment (NCT) were identified by "no" to "Are you currently being treated by a doctor or other health professional for arthritis or joint symptoms?" Demographics, current symptoms, physical functioning, arthritis limitations and interference in life activities, and level of agreement with treatment and attitude statements were assessed in this cross-sectional, descriptive study of noninstitutionalized US adults aged 45 years or older with self-reported, doctor-diagnosed arthritis (n = 1793). RESULTS: More than half of the study population, 52%, reported NCT (n = 920). Of those with NCT, 27% reported fair/poor health, 40% reported being limited by their arthritis, 51% had daily arthritis pain, 59% reported 2 or more symptomatic joints, and 19% reported the lowest third of physical functioning. Despite NCT, 83% with NCT agreed or strongly agreed with the importance of seeing a doctor for diagnosis and treatment. CONCLUSIONS: Greater than half of those aged 45 years or older with arthritis were not currently being treated for it, substantial proportions of whom experienced severe symptoms and poor physical function and may benefit from clinical management and guidance, complemented by community-delivered public health interventions (self-management education, physical activity). Further research to understand the reasons for NCT may identify promising intervention points to address missed treatment opportunities and improve quality of life and functioning. |
Supporting self-management education for arthritis: Evidence from the Arthritis Conditions and Health Effects Survey on the influential role of health care providers
Murphy LB , Theis KA , Brady TJ , Sacks JJ . Chronic Illn 2019 17 (3) 1742395319869431 OBJECTIVE: Self-management education programs are recommended for many chronic conditions. We studied which adults with arthritis received a health care provider's recommendation to take a self-management education class and who attended. METHODS: We analyzed data from a 2005--2006 national telephone survey of US adults with arthritis >/=45 years (n = 1793). We used multivariable-adjusted prevalence ratios (PR) from logistic regression models to estimate associations with: (1) receiving a health care provider recommendation to take a self-management education class; and (2) attending a self-management education class. RESULTS: Among all adults with arthritis: 9.9% received a health care provider recommendation to take an self-management education class; 9.7% attended a self-management education class. Of those receiving a recommendation, 52.0% attended a self-management education class. The strongest association with self-management education class attendance was an health care provider recommendation to take one (PR = 8.9; 95% CI = 6.6-12.1). CONCLUSIONS: For adults with arthritis, a health care provider recommendation to take a self-management education class was strongly associated with self-management education class attendance. Approximately 50% of adults with arthritis have >/=1 other chronic conditions; by recommending self-management education program attendance, health care providers may activate patients' self-management behaviors. If generalizable to other chronic conditions, this health care provider recommendation could be a key influencer in improving outcomes for a range of chronic conditions and patients' quality of life. |
Associations of arthritis-attributable interference with routine life activities: A modifiable source of compromised quality-of-life
Theis KA , Brady TJ , Helmick CG , Murphy LB , Barbour KE . ACR Open Rheumatol 2019 1 (7) 412-423 Objective: Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. Method(s): Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. Result(s): An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). Conclusion(s): Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life. |
Arthritis prevalence: which case definition for surveillance
Murphy LB , Sacks JJ , Helmick CG , Brady TJ , Boring MA , Moss S , Barbour KE , Guglielmo D , Hootman JM , Theis KA . Arthritis Rheumatol 2018 71 (1) 172-175 In the article titled "Updated Estimates Suggest a Much Higher Prevalence of Arthritis in United States Adults than Previous Ones", Jafarzadeh and Felson present an alternative estimate of arthritis prevalence. (1) Specifically, using a new case definition for arthritis and applying Bayesian methods to correct for misclassification, Jafarzadeh and Felson analyzed National Health Interview Survey (NHIS) data and estimated that in 2015, 91.2 million US adults had arthritis. In contrast, CDC had estimated from the 2013-2015 NHIS that 54.4 million US adults had doctor-diagnosed arthritis. (2) In this letter, we make two observations about their methods and discuss implications for public health surveillance of arthritis. This article is protected by copyright. All rights reserved. |
Marketing self-management education: Lessons on messaging and framing
Brady TJ , Ledskya R , Lafontant B , Baker TN . Am J Health Behav 2018 42 (5) 3-20 Objectives: Self-management education (SME) refers to educational interventions that help individuals with chronic diseases maintain or improve their quality of life. To help increase SME participation, the US Centers for Disease Control and Prevention conducted audience research to assess feasibility of a campaign to market SME as a chronic disease management strategy and increase future receptivity to specific SME programs. Methods: Twenty focus groups were conducted in 3 rounds across 8 cities with men and women ages 45-75 with a variety of, or multiple, chronic conditions. Data were analyzed to identify cross-cutting themes and assess differences by sex, race/ethnicity, and location. Results: Findings revealed that although people with chronic disease are not aware of SME, it is feasible to deliver motivating messages about SME, and content need not be condition- or intervention-specific. Concepts viewed most positively by focus groups incorporated positive tone, empowering language, specific references to health, relatable images, and a website for more information. Conclusions: This qualitative work suggests SME marketing strategies will be most effective by providing background information, framing messages positively, using clear relatable language, and making it easy for potential participants to find a program. |
Operationalizing surveillance of chronic disease self-management and self-management support
Brady TJ , Sacks JJ , Terrillion AJ , Colligan EM . Prev Chronic Dis 2018 15 E39 Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS-related research. |
Geographic variations in arthritis prevalence, health-related characteristics, and management - United States, 2015
Barbour KE , Moss S , Croft JB , Helmick CG , Theis KA , Brady TJ , Murphy LB , Hootman JM , Greenlund KJ , Lu H , Wang Y . MMWR Surveill Summ 2018 67 (4) 1-28 PROBLEM/CONDITION: Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. REPORTING PERIOD: 2015. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System is an annual, random-digit-dialed landline and cellular telephone survey of noninstitutionalized adults aged >/=18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. RESULTS: In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%-33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%-42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%-19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%-61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%-53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; >/=14 physically unhealthy days during the past 30 days; >/=14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking. INTERPRETATION: The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county. PUBLIC HEALTH ACTION: The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities. |
Intercountry consensus building: Lessons from developing a chronic-conditions self-management support framework
Mills SL , Ziabakhsh S , Brady TJ , Jayanthan J , Sargious PM . Health Promot Pract 2018 19 (4) 1524839917746147 Self-management support initiatives that aim to improve the self-care of chronic conditions are considered a key part of a health promotion strategy for addressing the impacts of long-term illness. Given the growth of these activities and still evolving evidence base, thoughtful intercountry collaborations with subject matter experts can be an effective way to expedite building self-management support capacity, promoting the advancement of evidence, and developing effective policies and programs. The challenge is to find an effective consensus building process that promotes linkages between researchers and health promotion decisions makers across vast geographical boundaries and limited resources. This paper describes the international, multistage, face-to-face, and online process that was used for developing an international framework for self-management support by researchers, educators, health care providers, policy makers, program managers/directors, program planners, consultants, patient group representatives, and consumers in 16 countries. We reflect on key lessons from this international initiative and discuss how this type of process may be useful for other health promotion groups trying to exchange knowledge and build consensus on how to move a field of research, policy, and/or practice forward, and advance the evidence-base of practice and the relevance of research. |
Health care provider counseling for physical activity or exercise among adults with arthritis - United States, 2002 and 2014
Hootman JM , Murphy LB , Omura JD , Brady TJ , Boring M , Barbour KE , Helmick CG . MMWR Morb Mortal Wkly Rep 2018 66 (5152) 1398-1401 Arthritis affects an estimated 54 million U.S. adults and, as a common comorbidity, can contribute arthritis-specific limitations or barriers to physical activity or exercise for persons with diabetes, heart disease, and obesity (1). The American College of Rheumatology's osteoarthritis management guidelines recommend exercise as a first-line, nonpharmacologic strategy to manage arthritis symptoms (2), and a Healthy People 2020 objective is to increase health care provider counseling for physical activity or exercise among adults with arthritis.* To determine the prevalence and percentage change from 2002 to 2014 in receipt of health care provider counseling for physical activity or exercise (counseling for exercise) among adults with arthritis, CDC analyzed 2002 and 2014 National Health Interview Survey (NHIS) data. From 2002 to 2014, the age-adjusted prevalence of reporting health care provider counseling for exercise among adults with arthritis increased 17.6%, from 51.9% (95% confidence interval [CI] = 49.9%-53.8%) to 61.0% (CI = 58.6%-63.4%) (p<0.001). The age-adjusted prevalence of reporting health care provider counseling for exercise among persons with arthritis who described themselves as inactive increased 20.1%, from 47.2% (CI = 44.0%-50.4%) in 2002 to 56.7% (CI = 52.3%-61.0%) in 2014 (p = 0.001). Prevalence of counseling for exercise has increased significantly since 2002; however, approximately 40% of adults with arthritis are still not receiving counseling for exercise. Improving health care provider training and expertise in exercise counseling and incorporating prompts into electronic medical records are potential strategies to facilitate counseling for exercise that can help adults manage their arthritis and comorbid conditions. |
Leisure time physical activity among U.S. adults with arthritis, 2008-2015
Murphy LB , Hootman JM , Boring MA , Carlson SA , Qin J , Barbour KE , Brady TJ , Helmick CG . Am J Prev Med 2017 53 (3) 345-354 INTRODUCTION: In 2016, leisure time physical activity among U.S. adults aged ≥18 years with and without arthritis was studied to provide estimates using contemporary guidelines (2008 Physical Activity Guidelines for Americans) and population-based data (U.S. National Health Interview Survey). METHODS: Estimated prevalence of: (1) meeting aerobic, muscle strengthening, and both aerobic and muscle strengthening guidelines, by arthritis status, from 2008 to 2015; and (2) meeting guidelines across selected sociodemographic characteristics and health status and behaviors, among adults with arthritis, in 2015. RESULTS: In 2015, 36.2%, 17.9%, and 13.7% of adults with arthritis met aerobic, muscle strengthening, and both guidelines, respectively; age-standardized prevalence of meeting each guideline was significantly lower among those with arthritis versus those without (e.g., 41.9% [95% CI=39.5%, 44.3%] and 52.2% [95% CI=51.2%, 53.2%] met the aerobic guideline, respectively; p<0.001). From 2008 to 2015, meeting aerobic guideline rose modestly (3 percentage points) among those with arthritis compared with larger gains (7 percentage points) among those without arthritis; the percentage of adults with arthritis meeting muscle strengthening and both guidelines remained the same in contrast to modest (statistically significant) increases among those without arthritis. Among adults with arthritis, age-standardized percentage meeting each guideline was highest among those with at least a university degree. CONCLUSIONS: Percentage meeting each guideline was persistently low among adults with arthritis. The lower prevalence among adults with arthritis versus those without suggests that adults with arthritis need additional strategies to address potential barriers (e.g., pain, psychological distress, inadequate medical support) to physical activity. |
Prevalence of arthritis and arthritis-attributable activity limitation by urban-rural county classification - United States, 2015
Boring MA , Hootman JM , Liu Y , Theis KA , Murphy LB , Barbour KE , Helmick CG , Brady TJ , Croft JB . MMWR Morb Mortal Wkly Rep 2017 66 (20) 527-532 Rural populations in the United States have well documented health disparities, including higher prevalences of chronic health conditions (1,2). Doctor-diagnosed arthritis is one of the most prevalent health conditions (22.7%) in the United States, affecting approximately 54.4 million adults (3). The impact of arthritis is considerable: an estimated 23.7 million adults have arthritis-attributable activity limitation (AAAL). The age-standardized prevalence of AAAL increased nearly 20% from 2002 to 2015 (3). Arthritis prevalence varies widely by state (range = 19%-36%) and county (range = 16%-39%) (4). Despite what is known about arthritis prevalence at the national, state, and county levels and the substantial impact of arthritis, little is known about the prevalence of arthritis and AAAL across urban-rural areas overall and among selected subgroups. To estimate the prevalence of arthritis and AAAL by urban-rural categories CDC analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS). The unadjusted prevalence of arthritis in the most rural areas was 31.8% (95% confidence intervals [CI] = 31.0%-32.5%) and in the most urban, was 20.5% (95% CI = 20.1%-21.0%). The unadjusted AAAL prevalence among adults with arthritis was 55.3% in the most rural areas and 49.7% in the most urban. Approximately 1 in 3 adults in the most rural areas have arthritis and over half of these adults have AAAL. Wider use of evidence-based interventions including physical activity and self-management education in rural areas might help reduce the impact of arthritis and AAAL. |
Vital Signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015
Barbour KE , Helmick CG , Boring M , Brady TJ . MMWR Morb Mortal Wkly Rep 2017 66 (9) 246-253 BACKGROUND: In the United States, doctor-diagnosed arthritis is a common and disabling chronic condition. Arthritis can lead to severe joint pain and poor physical function, and it can negatively affect quality of life. METHODS: CDC analyzed 2013-2015 data from the National Health Interview Survey, an annual, nationally representative, in-person interview survey of the health status and behaviors of the noninstitutionalized civilian U.S. adult population, to update previous prevalence estimates of arthritis and arthritis-attributable activity limitations. RESULTS: On average, during 2013-2015, 54.4 million (22.7%) adults had doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitations (an age-adjusted increase of approximately 20% in the proportion of adults with arthritis reporting activity limitations since 2002 [p-trend <0.001]). Among adults with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.3%, 47.1%, and 30.6%, respectively; the prevalences of arthritis-attributable activity limitations among adults with these conditions and arthritis were 54.5% (heart disease), 54.0% (diabetes), and 49.0% (obesity). CONCLUSIONS AND COMMENTS: The prevalence of arthritis is high, particularly among adults with comorbid conditions, such as heart disease, diabetes, and obesity. Furthermore, the prevalence of arthritis-attributable activity limitations is high and increasing over time. Approximately half of adults with arthritis and heart disease, arthritis and diabetes, or arthritis and obesity are limited by their arthritis. Greater use of evidence-based physical activity and self-management education interventions can reduce pain and improve function and quality of life for adults with arthritis and also for adults with other chronic conditions who might be limited by their arthritis. |
No one dies of old age anymore: A coordinated approach to comorbidities and the rheumatic diseases
Theis KA , Brady TJ , Helmick CG . Arthritis Care Res (Hoboken) 2017 69 (1) 1-4 Any idiot can face a crisis; it's the day-to-day living that wears you out, so said Anton Chekhov, himself a practicing physician, as well as a prolific author. For a growing number of people, day-to-day living means managing long-term conditions that co-exist and often exacerbate other ailments, resulting in multiple morbidities, multiple chronic conditions, or comorbidities. Whatever they are labeled, co-existing, co-occurring, etc., “the simultaneous presence of two (or more) chronic diseases or conditions in a person,” is a substantial medical and public health challenge. This special theme issue in Arthritis Care & Research spotlights this under-recognized and under-addressed problem, which has significant impact on people, medicine, and public health. | Comorbidities are a common problem in the US and internationally, and arthritis and other rheumatic diseases are among the most common comorbidities. Failure to recognize and address comorbidities leads to, at best, diminished quality-of-life, and, at worst, increased mortality. Our editorial addresses comorbidities first from the exceptional perspective of rheumatic diseases, and then from a more general perspective, which is influenced by the high prevalence and impact of rheumatic disease. We use the term “comorbidities” and its derivatives throughout, with the exception of some specific quotes, to mirror the language of the original call for submissions that Arthritis Care & Research published on the theme of Comorbidities and the Rheumatic Diseases. |
Self-management education participation among US adults with arthritis: Who's attending?
Murphy LB , Brady TJ , Boring MA , Theis KA , Barbour KE , Qin J , Helmick CG . Arthritis Care Res (Hoboken) 2016 69 (9) 1322-1330 OBJECTIVE: Self-management education (SME) programs teach people with chronic conditions skills to manage their health conditions. We examined patterns in SME program participation among US adults with arthritis age ≥ 18 years. METHODS: Respondents with arthritis were those who reported ever being diagnosed with arthritis by a doctor or health care provider. We analyzed 2014 National Health Interview Survey (NHIS) data to estimate: 1) percentage (unadjusted and age-standardized) who ever attended a SME program overall and for selected subgroups, 2) representativeness of SME participants relative to all adults with arthritis, and 3) trends in SME course participation. RESULTS: In 2014, 1 in 9 US adults with arthritis (percentage=11.3; 95% CI=10.4-12.3); age-standardized percentage=11.4; [95% CI=10.0-12.9]) had ever participated in a SME program. SME participation (age-standardized) was highest among those with ≥ 8 health care provider visits in the past 12 months (16.0%; 95% CI=13.1 - 19.4). Since 2002, the number of adults with arthritis who have ever participated in SME has increased by 1.7 million but the percentage has remained constant. CONCLUSION: Despite its many benefits, SME participation among US adults with arthritis remains persistently low. By recommending that their patients attend SME programs, health care providers can increase the likelihood that their patients experience SME program benefits. This article is protected by copyright. All rights reserved. |
Do program implementation factors or fidelity affect chronic disease self-management education programs' outcomes?
Brady TJ , Murphy LB , O'Colmain BJ , Hobson RD . Am J Health Promot 2016 31 (5) 422-425 PURPOSE: To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. DESIGN: Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. SETTING: Community. PARTICIPANTS: N = 10 792. MEASURES: Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. ANALYSIS: Meta-analysis using pooled effect sizes. RESULTS: Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. CONCLUSION: Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness. |
Expanding the reach of evidence-based self-management education and physical activity interventions: Results of a cross-site evaluation of state health departments
Brady TJ , Brick M , Berktold J , Sonnefeld J , Gaddes R , Bartenfeld T . Health Promot Pract 2016 17 (6) 871-879 Participation in community-based self-management education and physical activity interventions has been demonstrated to improve quality of life for those who have arthritis and other chronic diseases. The Centers for Disease Control and Prevention Arthritis Program funded 21 state health departments to expand the reach (defined as the number of people who participate in interventions) of 10 evidence-based interventions in community settings. The Arthritis Centralized Evaluation assessed the strategies and tactics used by state health departments to expand the reach of these evidence-based interventions. The evaluation compared and contrasted processes used by the states to expand reach. Engaging multisite delivery system partners, prioritizing reach, embedding interventions within partners' routine operations, and collaborating across chronic disease program areas were all dissemination strategies that were correlated with expanded intervention reach. However, states also encountered challenges that limited their ability to successfully engage delivery systems as partners. These barriers included difficulty identifying delivery system partners and the lengthy time periods partners needed to adopt and embed the interventions. |
Toward consensus on self-management support: the international chronic condition self-management support framework
Mills SL , Brady TJ , Jayanthan J , Ziabakhsh S , Sargious PM . Health Promot Int 2016 32 (6) 942-952 Self-management support (SMS) initiatives have been hampered by insufficient attention to underserved and disadvantaged populations, a lack of integration between health, personal and social domains, over emphasis on individual responsibility and insufficient attention to ethical issues. This paper describes a SMS framework that provides guidance in developing comprehensive and coordinated approaches to SMS that may address these gaps and provides direction for decision makers in developing and implementing SMS initiatives in key areas at local levels. The framework was developed by researchers, policy-makers, practitioners and consumers from 5 English-speaking countries and reviewed by 203 individuals in 16 countries using an e-survey process. While developments in SMS will inevitably reflect local and regional contexts and needs, the strategic framework provides an emerging consensus on how we need to move SMS conceptualization, planning and development forward. The framework provides definitions of self-management (SM) and SMS, a collective vision, eight guiding principles and seven strategic directions. The framework combines important and relevant SM issues into a strategic document that provides potential value to the SMS field by helping decision-makers plan SMS initiatives that reflect local and regional needs and by catalyzing and expanding our thinking about the SMS field in relation to system thinking; shared responsibility; health equity and ethical issues. The framework was developed with the understanding that our knowledge and experience of SMS is continually evolving and that it should be modified and adapted as more evidence is available, and approaches in SMS advance. |
Impact of arthritis and multiple chronic conditions on selected life domains - United States, 2013
Qin J , Theis KA , Barbour KE , Helmick CG , Baker NA , Brady TJ . MMWR Morb Mortal Wkly Rep 2015 64 (21) 578-582 About half of U.S. adults have at least one chronic health condition, and the prevalence of multiple (two or more) chronic conditions increased from 21.8% in 2001 to 25.5% in 2012. Chronic conditions profoundly affect quality of life, are leading causes of death and disability, and account for 86% of total health care spending. Arthritis is a common cause of disability, one of the most common chronic conditions, and is included in prevalent combinations of multiple chronic conditions. To determine the impact of having arthritis alone or as one of multiple chronic conditions on selected important life domains, CDC analyzed data from the 2013 National Health Interview Survey (NHIS). Having one or more chronic conditions was associated with significant and progressively higher prevalences of social participation restriction, serious psychological distress, and work limitations. Adults with arthritis as one of their multiple chronic conditions had higher prevalences of adverse outcomes on all three life domains compared with those with multiple chronic conditions but without arthritis. The high prevalence of arthritis, its common co-occurrence with other chronic conditions, and its significant adverse effect on life domains suggest the importance of considering arthritis in discussions addressing the effect of multiple chronic conditions and interventions needed to reduce that impact among researchers, health care providers, and policy makers. |
Arthritis among veterans - United States, 2011-2013
Murphy LB , Helmick CG , Allen KD , Theis KA , Baker NA , Murray GR , Qin J , Hootman JM , Brady TJ , Barbour KE . MMWR Morb Mortal Wkly Rep 2014 63 (44) 999-1003 Arthritis is among the most common chronic conditions among veterans and is more prevalent among veterans than nonveterans. Contemporary population-based estimates of arthritis prevalence among veterans are needed because previous population-based studies predate the Persian Gulf War, were small, or studied men only despite the fact that women comprise an increasing proportion of military personnel and typically have a higher prevalence of arthritis than men. To address this knowledge gap, CDC analyzed combined 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System (BRFSS) data among all adults aged ≥18 years, by veteran status, to estimate the total and sex-specific prevalence of doctor-diagnosed arthritis overall and by sociodemographic categories, and the state-specific prevalence (overall and sex-specific) of doctor-diagnosed arthritis. This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans' health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of arthritis (e.g., pain and depression) and its common comorbidities (e.g., heart disease and diabetes). |
Chronic condition self-management surveillance: what is and what should be measured?
Ruiz S , Brady TJ , Glasgow RE , Birkel R , Spafford M . Prev Chronic Dis 2014 11 E103 INTRODUCTION: The rapid growth in chronic disease prevalence, in particular the prevalence of multiple chronic conditions, poses a significant and increasing burden on the health of Americans. Maximizing the use of proven self-management (SM) strategies is a core goal of the US Department of Health and Human Services. Yet, there is no systematic way to assess how much SM or self-management support (SMS) is occurring in the United States. The purpose of this project was to identify appropriate concepts or measures to incorporate into national SM and SMS surveillance. METHODS: A multistep process was used to identify candidate concepts, assess existing measures, and select high-priority concepts for further development. A stakeholder survey, an environmental scan, subject matter expert feedback, and a stakeholder priority-setting exercise were all used to select the high-priority concepts for development. RESULTS: The stakeholder survey gathered feedback on 32 candidate concepts; 9 concepts were endorsed by more than 66% of respondents. The environmental scan indicated few existing measures that adequately reflected the candidate concepts, and those that were identified were generally specific to a defined condition and not gathered on a population basis. On the basis of the priority setting exercises and environmental scan, we selected 1 concept from each of 5 levels of behavioral influence for immediate development as an SM or SMS indicator. CONCLUSION: The absence of any available measures to assess SM or SMS across the population highlights the need to develop chronic condition SM surveillance that uses national surveys and other data sources to measure national progress in SM and SMS. |
A meta-analysis of health status, health behaviors, and healthcare utilization outcomes of the Chronic Disease Self-Management Program
Brady TJ , Murphy L , O'Colmain BJ , Beauchesne D , Daniels B , Greenberg M , House M , Chervin D . Prev Chronic Dis 2013 10 E07 INTRODUCTION: The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program's effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. METHODS: We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. RESULTS: Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months CONCLUSION: Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy. |
Cost implications of self-management education intervention programmes in arthritis
Brady TJ . Best Pract Res Clin Rheumatol 2012 26 (5) 611-25 The purpose of this review is to examine cost implications, including cost-effectiveness analyses, cost-savings calculated from health-care utilisation and intervention delivery costs of arthritis-related self-management education (SME) interventions. METHODS: Literature searches, covering 1980-March 2012, using arthritis, self-management and cost-related terms, identified 487 articles; abstracts were reviewed to identify those with cost information. RESULTS: Three formal cost-effectiveness analyses emerged; results were equivocal but analyses done from the societal perspective, including out-of-pocket and other indirect costs, were more promising. Eight studies of individual, group and telephone-delivered SME calculated cost-savings based on health-care utilisation changes. These studies had variable results but the costs-savings extrapolation methods are questionable. Meta-analyses of health-care utilisation changes in two specific SME interventions demonstrated only one significant result at 6 months, which did not persist at 12 months. Eleven studies reported intervention delivery costs ranging from $35 to $740 per participant; the variability is likely due to costing methods and differences in delivery mode. CONCLUSIONS: Economic analysis in arthritis-related SME is in its infancy; more robust economic evaluations are required to reach sound conclusions. The most common form of analysis used changes in health-care utilisation as a proxy for cost-savings; the results are less than compelling. However, other value metrics, including the value of SME as part of health systems' self-management support efforts, to population health (from improved self-efficacy, psychological well-being and physical activity), and to igniting patient activation, are all important to consider. |
Anxiety is more common than depression among US adults with arthritis
Murphy LB , Sacks JJ , Brady TJ , Hootman JM , Chapman DP . Arthritis Care Res (Hoboken) 2012 64 (7) 968-76 BACKGROUND: There has been limited characterization of the burden of anxiety and depression, especially the former, among US adults with arthritis in the general population. The study objective was to estimate the prevalence and correlates of anxiety and depression among US adults with doctor-diagnosed arthritis. METHODS: The study sample comprised US adults aged ≥ 45 years with doctor-diagnosed arthritis (n=1,793) from Arthritis Condition and Health Effects Survey (a cross-sectional, population based, random digit dialed telephone interview survey). Anxiety and depression were measured using separate and validated subscales of the Arthritis Impact Measurement Scales. Prevalence was estimated for the sample overall and stratified by subgroups. Associations between correlates and each condition were estimated with prevalence ratios and 95% confidence intervals using logistic regression models. RESULTS: Anxiety was more common than depression (31% and 18% respectively); overall, a third of respondents reported at least one of the two conditions. Most (84%) of those with depression also had anxiety. Multivariable logistic regression modeling failed to identify a distinct profile of characteristics of those with anxiety or/and depression. Only half of respondents with anxiety and/or depression had sought help for their mental health condition in the past year. CONCLUSIONS: Despite the clinical focus on depression among people with arthritis, anxiety was almost twice as common as depression. Given their high prevalence, profound impact on quality of life, and range of effective treatments available, we encourage health care providers to screen all people with arthritis for both anxiety and depression. (c) 2012 by the American College of Rheumatology. |
News from the CDC: scaling up sustainable intervention delivery - lessons learned from the CDC Arthritis Program
Brady TJ , Sniezek J , Ramsey LA . Transl Behav Med 2012 2 (1) 3-5 Expanding behavior change programs into widespread use with meaningful population impact is a public health challenge. This report described the CDC Arthritis Program's strategic approach to fostering widespread availability and sustainability of community-based self-management education and physical activity interventions, and reviews common errors observed in efforts to disseminate and implement these interventions. The Arthritis Program strategic approach focuses on embedding interventions in delivery systems to facilitate spread and sustainability. Minimizing common implementation errors, such as pay-to-play partnerships, unsustainable delivery models, non-strategic growth strategies, non-selective training, imbalance between delivery and demand, infrequent interventions, and inadequate attention to data collection, can also enhance scaling up and sustaining behavior change interventions. (2011 Society of Behavioral Medicine.) |
A public health approach to addressing arthritis in older adults: the most common cause of disability
Hootman JM , Helmick CG , Brady TJ . Am J Public Health 2012 102 (3) 426-433 Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors (e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions. |
Measures of self-efficacy: Arthritis Self-Efficacy Scale (ASES), Arthritis Self-Efficacy Scale-8 Item (ASES-8), Children's Arthritis Self-Efficacy Scale (CASE), Chronic Disease Self-Efficacy Scale (CDSES), Parent's Arthritis Self-Efficacy Scale (PASE), and Rheumatoid Arthritis Self-Efficacy Scale (RASE)
Brady TJ . Arthritis Care Res (Hoboken) 2011 63 S473-S485 Enhancing self-efficacy has become an essential feature of many arthritis management interventions because of its robust relationships with health behaviors and health status. Empirical studies document that self-efficacy predicts health behaviors such as physical activity, eating behaviors, and pain coping strategies (1). In rheumatoid arthritis and osteoarthritis, self-efficacy has also been correlated with measures of health status such as daily pain and mood ratings (2), pain, stiffness, function, and physical and mental well-being (3); it has also been correlated with changes in pain, function, and depression (4). Adherence with medications and other health recommendations has also been associated with self-efficacy (5, 6). In addition to evidence that self-efficacy is associated with health behaviors, current and future health status, and adherence to health recommendations, the fact that self-efficacy can change through efficacy-enhancing interventions makes it a rich target of arthritis interventions (1). | Self-efficacy, defined in Bandura's seminal 1977 article as “the conviction that one can successfully execute the behavior required to produce the outcomes” (7), was hypothesized to influence whether a behavior was initiated and sustained despite obstacles or adverse experiences, and to influence the level of effort invested in the behavior. Bandura's definition of self-efficacy evolved slightly over time; in his 1997 publication, Bandura defined self-efficacy as “belief in one's capability to organize and execute the courses of action required to produce given attainments” (8). Bandura has consistently described self-efficacy as domain specific and distinct from other constructs in social learning theory such as outcome expectations, defined as a person's estimate that a given behavior will lead to certain outcomes (7). Self-efficacy beliefs are also conceptualized as distinct from actual ability to perform a task (e.g., can I ride a bicycle), actual task performance (e.g., do I ride a bicycle), or intention to perform task (e.g., do I intend to ride a bicycle) (8, 9). These different types of beliefs are clearly distinguished in Gecht et al's survey of exercise beliefs and habits among people with arthritis (10). In that survey, respondents were asked about their self-efficacy expectations regarding exercise (“If I want to exercise, I know I can do it”), and their outcome expectations regarding exercise (“regular exercise will probably make my arthritis worse in the future”); they were also asked to report their actual behavior (how often they did specific exercises in the past 2 weeks). Self-efficacy theory hypothesizes that both efficacy expectations and outcome expectations influence whether or not an individual will initiate and sustain a specific behavior (7). Gecht et al found that positive outcome expectations and self-efficacy for exercise were associated with participation in exercise (10). Conversely, self-efficacy theory predicts that if a patient believes that they can exercise (self-efficacy expectation) but also believes that exercise will be harmful for their arthritis (outcome expectation), the patient would be less likely to exercise than if they expected positive outcomes from exercise (7). Social learning theory suggests that it is important for clinicians and others hoping to help a person adopt health behaviors to understand both whether the person believes they can perform the behavior, and whether they believe that behavior will lead to positive outcomes. |
Monitoring healthy people 2010 arthritis management objectives: education and clinician counseling for weight loss and exercise
Do BT , Hootman JM , Helmick CG , Brady TJ . Ann Fam Med 2011 9 (2) 136-41 PURPOSE: Our goal was to monitor the progress of 3 Healthy People 2010 (HP2010) objectives encouraging self-management education and clinician counseling for weight loss and physical activity among adults with doctor-diagnosed arthritis. METHODS: Using the national 2002 and 2006 National Health Interview Survey (NHIS) and state-based 2003 and 2007 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the change in proportion of persons counseled for each objective, overall and by selected characteristics. RESULTS: Nationally, the proportion of overweight and obese adults with doctor-diagnosed arthritis who were counseled by their clinician to lose weight to lessen their arthritis symptoms increased significantly from 35.0% (95% confidence interval [CI], 32.8%-37.2%) in 2002 to 41.3% (95% CI, 38.7%-44.0%) in 2006 but have yet to reach the 2010 target of 46%. There was no change in the proportion of adults with doctor-diagnosed arthritis who had ever taken a self-management education class (approximately 11%) or who had been counseled to engage in physical activity (approximately 52%), whose targets for 2010 are 13% and 67%, respectively. States had variable findings. CONCLUSIONS: Nationally, significant progress has been made by clinicians for weight counseling of overweight and obese adults with doctor-diagnosed arthritis but not for the other 2 arthritis management objectives. Because clinician counseling can have important effects on the latter, this discrepancy suggests a need to focus on barriers to physician counseling for these outcomes. |
An organizing framework for translation in public health: the knowledge to action framework
Wilson KM , Brady TJ , Lesesne C . Prev Chronic Dis 2011 8 (2) A46 A priority for the Centers for Disease Control and Prevention (CDC) is translating scientific knowledge into action to improve the public's health. No area has a more pressing need for translation than the prevention and control of chronic diseases. Staff from CDC's National Center for Chronic Disease Prevention and Health Promotion worked across disciplines and content areas to develop an organizing framework to describe and depict the high-level processes necessary to move from discovery into action through translation of evidence-based programs, practices, or policies. The Knowledge to Action (K2A) Framework identifies 3 phases (research, translation, and institutionalization) and the decision points, interactions, and supporting structures within the phases that are necessary to move knowledge to sustainable action. Evaluation undergirds the entire K2A process. Development of the K2A Framework highlighted the importance of planning for translation, attending to supporting structures, and evaluating the public health impact of our efforts. |
Public health interventions for arthritis: expanding the toolbox of evidence-based interventions
Brady TJ , Jernick SL , Hootman JM , Sniezek JE . J Womens Health (Larchmt) 2009 18 (12) 1905-17 BACKGROUND: Since 1999, the Centers for Disease Control and Prevention's (CDC) Arthritis Program has worked to improve the quality of life for people with arthritis, in part by funding state health departments to disseminate physical activity (PA) and self-management education (SME) interventions. Initially, only one SME and two PA interventions were considered evidence-based and appropriate for people with arthritis. The purposes of this article are to describe the processes and criteria used to screen new or existing intervention programs and report the results of that screening, including an updated list of recommended intervention programs. METHODS: A series of three sets of screening criteria was created in consultation with subject matter experts: arthritis appropriateness, adequacy of the evidence base, and implementability as a public health intervention. Screening interventions were categorized as Recommended, Promising Practices, Watch List, Future Possibility, or Unlikely to Meet criteria based on how well the intervention met the screening criteria. RESULTS: A total of 15 packaged PA interventions and six SME interventions were screened. Three PA and three SME interventions met all three sets of criteria and were added to the list of recommended public health interventions for use by CDC-funded state arthritis programs. An additional two SME interventions are developing the infrastructure for public health dissemination and were categorized as Promising Practices, and six PA interventions have evaluations underway and are on the Watch List. CONCLUSIONS: The CDC Arthritis Program identified arthritis-appropriate interventions that can be used effectively and efficiently in public health settings to improve the quality of life of people with arthritis. The screening criteria used offer a guide to intervention developers on necessary characteristics of interventions for use in public health settings. The expanded menu of interventions is beneficial to clinical care and public health professionals and, ultimately, to people with arthritis. |
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