Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 47 Records) |
Query Trace: Hootman JM [original query] |
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Trends in office visits during which opioids were prescribed for adults with arthritis: United States, 2006-2015
Santo L , Schappert SM , Hootman JM , Helmick CG . Arthritis Care Res (Hoboken) 2020 73 (10) 1430-1435 OBJECTIVE: To analyze trends in opioid prescriptions during visits to office-based physicians made by adults with arthritis in the US from 2006 to 2015. METHODS: We analyzed nationally representative data on patient visits to office-based physicians from the National Ambulatory Medical Care Survey (NAMCS) 2006-2015. Visit percentages for first- and any-listed diagnosis of arthritis by age groups and sex are reported. Time points were grouped into 2-year intervals to increase the reliability of estimates. Annual percentage point change and 95% CI were reported from linear regression models. RESULTS: During 2006-2015, the percentage of visits to office-based physicians by adults with a first-listed diagnosis of arthritis increased from 4.1% (95%CI: 3.5%-4.7%) in 2006-2007 to 5.1% (95% CI: 3.9%-6.6%) in 2014-2015 (p=.033). Among these visits, the percentage of visits with opioids prescribed increased from 16.5% (95%CI: 13.1%-20.5%) in 2006-2007 to 25.6% (95%CI: 17.9%-34.6%) in 2014-2015 (p=.017). The percentage of visits with any-listed diagnosis of arthritis increased from 6.6% (95%CI: 5.9%-7.4%) in 2006-2007 to 8.4% (95%CI: 7.0%-10.0%) in 2014-2015 (p=.001). Among these visits the percentage of visits with opioids prescribed increased from 17.4% (95%CI: 14.6%-20.4%) in 2006-2007 to 25.0% (95%CI: 19.7%-30.8%) in 2014-2015 (p=.004). CONCLUSION: During 2006-2015, the percentage of arthritis visits by adults to office-based physicians increased and the percentage of opioids prescribed at these visits increased as well. NAMCS data will allow continued monitoring of these trends after guidelines were implemented. |
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. |
When you can't walk a mile: Walking limitation prevalence and associations among middle-aged and older US adults with arthritis: A cross-sectional, population-based study
Theis KA , Murphy LB , Baker NA , Hootman JM . ACR Open Rheumatol 2019 1 (6) 350-358 Objective: We examined walking limitations and associated characteristics among middle-aged and older US adults with arthritis, overall, and by sex. Method(s): Using 2005-2006 Arthritis Conditions and Health Effects Survey (ACHES) data (n = 1793), we estimated "a lot" and "any" ("a lot" or "a little" combined) walking limitation for more than 1 mile (1.6 km) among US adults 45 years or older with arthritis and examined associations (sociodemographics, arthritis symptoms and effects, psychosocial measures, and physical health) with walking limitations in unadjusted and multivariable (MV) adjusted logistic regression models using prevalence ratios (PRs) and 95% confidence intervals, accounting for the complex survey design. Result(s): Respondents frequently reported "a lot" (48%) and "any" (72%) limitation for more than 1 mile. Women reported higher prevalence of all levels of walking limitation versus men (eg, 51% vs 42% for "a lot" overall); additionally, the gap for walking limitations between women and men widened with age. Limitation was high for both sexes at all ages, affecting 1-in-3 to 4-in-5, depending on level of walking limitation. The strongest MV associations for "a lot" of walking limitation among all respondents included substantial and modest arthritis-attributable life interference (PR = 2.5 and 1.6, respectively), age 75 years or older (PR = 1.5), and physical inactivity and fair/poor self-rated health (PR = 1.4 for both). Conclusion(s): Walking limitations among middle-aged and older adults are substantial. Existing proven interventions that improve walking ability and physical function may help this population to reduce and delay disability. |
State-specific severe joint pain and physical inactivity among adults with arthritis - United States, 2017
Guglielmo D , Murphy LB , Boring MA , Theis KA , Helmick CG , Hootman JM , Odom EL , Carlson SA , Liu Y , Lu H , Croft JB . MMWR Morb Mortal Wkly Rep 2019 68 (17) 381-387 An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis (arthritis) (1). Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations (2,3). CDC analyzed 2017 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate current state-specific prevalence of arthritis and, among adults with arthritis, the prevalences of severe joint pain and physical inactivity. In 2017, the median age-standardized state prevalence of arthritis among adults aged >/=18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions.* Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Physical inactivity prevalence among those with severe joint pain (47.0%) was higher than that among those with moderate (31.8%) or no/mild joint pain (22.6%). Self-management strategies such as maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability. Evidence-based physical activity and self-management education programs are available that can improve quality of life among adults with arthritis. |
One hour a week: Moving to prevent disability in adults with lower extremity joint symptoms
Dunlop DD , Song J , Hootman JM , Nevitt MC , Semanik PA , Lee J , Sharma L , Eaton CB , Hochberg MC , Jackson RD , Kwoh CK , Chang RW . Am J Prev Med 2019 56 (5) 664-672 INTRODUCTION: Physical activity guidelines recommend minimum thresholds. This study sought to identify evidence-based thresholds to maintain disability-free status over 4 years among adults with lower extremity joint symptoms. METHODS: Prospective multisite Osteoarthritis Initiative accelerometer monitoring cohort data from September 2008 through December 2014 were analyzed. Adults (n=1,564) aged >/=49 years at elevated disability risk because of lower extremity joint symptoms were analyzed for biennial assessments of disability-free status from gait speed >/=1meter/second (mobility disability-free) and self-report of no limitations in activities of daily living (activities of daily living disability-free). Classification tree analyses conducted in 2017-2018 identified optimal thresholds across candidate activity intensities (sedentary, light, moderate-vigorous, total light and moderate-vigorous activity, and moderate-vigorous accrued in bouts lasting >/=10 minutes). RESULTS: Minimal thresholds of 56 and 55 moderate-vigorous minutes/week best predicted disability-free status over 4 years from mobility and activities of daily living disabilities, respectively, across the candidate measures. Thresholds were consistent across sex, BMI, age, and knee osteoarthritis presence. Mobility disability onset was one eighth as frequent (3% vs 24%, RR=0.14, 95% CI=0.09, 0.20) and activities of daily living disability onset was almost half (12% vs 23%, RR=0.55, 95% CI=0.44, 0.70) among people above versus below the minimum threshold. CONCLUSIONS: Attaining an evidence-based threshold of approximately 1-hour moderate-vigorous activity/week significantly increased the likelihood of maintaining disability-free status over 4 years. This minimum threshold tied to maintaining independent living abilities has value as an intermediate goal to motivate adults to take action towards the many health benefits of a physically active lifestyle. |
Leisure time and transportation walking among adults with and without arthritis in the United States, 2010
Hootman JM , Theis KA , Barbour KE , Paul P , Carlson SA . Arthritis Care Res (Hoboken) 2019 71 (2) 178-188 OBJECTIVE: Walking is a joint-friendly activity for adults with arthritis. The aim of this study was to estimate, among adults with arthritis, the prevalence of leisure and transportation walking overall (by arthritis status and by sociodemographic and health characteristics), the number of total minutes walking per week in each domain, and the distributions of walking bout length (i.e., short periods of activity) in minutes. METHODS: Data were obtained from the 2010 National Health Interview Survey. Prevalence estimates (percentages and 95% confidence intervals [95% CIs]) of leisure and transportation walking in the past 7 days and walking bout times were calculated (in minutes), as were multivariable Poisson regression models, which account for the complex sample design. RESULTS: Prevalence of leisure walking was 45.9% (95% CI 44.2-47.6) for adults with arthritis versus 51.9% (95% CI 50.9-52.9) for those without. Transportation walking prevalence was 23.0% (95% CI 21.7-24.4) for adults with arthritis versus 32.0% (95% CI 31.0-33.0) for those without. The total time of leisure walking per week did not differ in adults with arthritis compared to those without (77.3 versus 78.3 minutes, respectively; P = 0.62), while total time of transportation walking did differ (49.8 versus 58.1 minutes, respectively; P = 0.03). The most common walking bout length differed between leisure (26-40 minutes) and transportation (10-15 minutes) walking, but not by arthritis status. In separate adjusted multivariable models, obesity was consistently negatively associated with both walking outcomes, and being physically active was positively associated with both; lower extremity joint pain was not associated. CONCLUSION: By adding short bouts, leisure and transportation walking could be adopted by large proportions of adults with arthritis. Existing evidence-based programs can help increase physical activity. |
Self-directed Walk With Ease workplace wellness program - Montana, 2015-2017
Silverstein RP , VanderVos M , Welch H , Long A , Kabore CD , Hootman JM . MMWR Morb Mortal Wkly Rep 2018 67 (46) 1295-1299 Arthritis occurs in 27% of adults in Montana, among whom 50% have activity limitations, 16% have social participation restrictions, and 23% have severe joint pain attributable to arthritis (1). Physical activity is beneficial in managing arthritis symptoms and in preventing other chronic diseases (2). Walk With Ease is a 6-week evidence-based physical activity program recommended by CDC to increase physical activity and help improve arthritis symptoms (3). In 2015, Walk With Ease was added to an ongoing workplace wellness program for Montana state employees; the results for five outcomes (minutes spent walking, engaging in other physical activity [including swimming, bicycling, other aerobic equipment use, and other aerobic exercise], stretching, pain, and fatigue) were analyzed by the Montana Department of Public Health and Human Services and CDC. Outcomes at baseline (pretest), 6 weeks after the program (posttest), and 6 months later (follow-up) were analyzed by self-reported arthritis status at the time the participant enrolled in the program. Significant increases (p<0.05) in the mean number of minutes spent per week walking and engaging in other physical activity were observed among participants with and without arthritis at the 6-week posttest. Time spent stretching did not change significantly at posttest for either group. Mean pain levels among participants without arthritis increased significantly both at the 6-week posttest and 6-month follow-up; however, pain and fatigue decreased significantly at posttest and follow-up for participants with or without arthritis who began the program with moderate or severe pain and fatigue levels. The data from these analyses suggest that, as a component of a workplace wellness program, self-directed Walk With Ease might be effective in increasing physical activity not only among adults with arthritis, but also among persons without arthritis. |
Prevalence of arthritis among adults with prediabetes and arthritis-specific barriers to important interventions for prediabetes - United States, 2009-2016
Sandoval-Rosario M , Nayeri BM , Rascon A , Boring M , Aseret-Manygoats T , Helmick CG , Murphy LB , Hootman JM , Imperatore G , Barbour KE . MMWR Morb Mortal Wkly Rep 2018 67 (44) 1238-1241 An estimated 54.4 million U.S. adults have doctor-diagnosed arthritis (arthritis), and this number is projected to rise to 78.4 million by 2040 (1,2). Physical inactivity and obesity are two factors associated with an increased risk for developing type 2 diabetes,* and arthritis has been determined to be a barrier to physical activity among adults with obesity (3). The prevalence of arthritis among the 33.9% (estimated 84 million)(dagger) of U.S. adults with prediabetes and how these conditions are related to physical inactivity and obesity are unknown. To examine the relationships among arthritis, prediabetes, physical inactivity, and obesity, CDC analyzed combined data from the 2009-2016 National Health and Nutrition Examination Surveys (NHANES). Overall, the unadjusted prevalence of arthritis among adults with prediabetes was 32.0% (26 million). Among adults with both arthritis and prediabetes, the unadjusted prevalences of leisure-time physical inactivity and obesity were 56.5% (95% confidence intervals [CIs] = 51.3-61.5) and 50.1% (CI = 46.5-53.6), respectively. Approximately half of adults with both prediabetes and arthritis are either physically inactive or have obesity, further increasing their risk for type 2 diabetes. Health care and public health professionals can address arthritis-specific barriers( section sign) to physical activity by promoting evidence-based physical activity interventions.( paragraph sign) Furthermore, weight loss and physical activity promoted though the National Diabetes Prevention Program can reduce the risk for type 2 diabetes and reduce pain from arthritis. |
Symptoms of anxiety and depression among adults with arthritis - United States, 2015-2017
Guglielmo D , Hootman JM , Boring MA , Murphy LB , Theis KA , Croft JB , Barbour KE , Katz PP , Helmick CG . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1081-1087 An estimated 54.4 million (22.7%) U.S. adults have doctor-diagnosed arthritis (1). A report in 2012 found that, among adults aged >/=45 years with arthritis, approximately one third reported having anxiety or depression, with anxiety more common than depression (2). Studies examining mental health conditions in adults with arthritis have focused largely on depression, arthritis subtypes, and middle-aged and older adults, or have not been nationally representative (3). To address these knowledge gaps, CDC analyzed 2015-2017 National Health Interview Survey (NHIS) data* to estimate the national prevalence of clinically relevant symptoms of anxiety and depression among adults aged >/=18 years with arthritis. Among adults with arthritis, age-standardized prevalences of symptoms of anxiety and depression were 22.5% and 12.1%, respectively, compared with 10.7% and 4.7% among adults without arthritis. Successful treatment approaches to address anxiety and depression among adults with arthritis are multifaceted and include screenings, referrals to mental health professionals, and evidence-based strategies such as regular physical activity and participation in self-management education to improve mental health. |
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. |
Work-related injury and management strategies among certified athletic trainers
Kucera KL , Lipscomb HJ , Roos KG , Dement JM , Hootman JM . J Athl Train 2018 53 (6) 606-618 CONTEXT: Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs). OBJECTIVE: To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies. DESIGN: Cross-sectional study. SETTING: Population-based online survey. PATIENTS OR OTHER PARTICIPANTS: Of the 29 051 ATs currently certified by the Board of Certification, Inc, who "opted in" to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey. MAIN OUTCOME MEASURES: An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies. RESULTS: A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval [CI] = 19.6, 23.7) and injury prevalence of 13.5% (95% CI = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care; 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury. CONCLUSIONS: More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work. |
Health care provider counseling for weight loss among adults with arthritis and overweight or obesity - United States, 2002-2014
Guglielmo D , Hootman JM , Murphy LB , Boring MA , Theis KA , Belay B , Barbour KE , Cisternas MG , Helmick CG . MMWR Morb Mortal Wkly Rep 2018 67 (17) 485-490 In the United States, 54.4 million adults report having doctor-diagnosed arthritis (1). Among adults with arthritis, 32.7% and 38.1% also have overweight and obesity, respectively (1), with obesity being more prevalent among persons with arthritis than among those who do not have arthritis (2). Furthermore, severe joint pain among adults with arthritis in 2014 was reported by 23.5% of adults with overweight and 31.7% of adults with obesity (3). The American College of Rheumatology recommends weight loss for adults with hip or knee osteoarthritis and overweight or obesity,* which can improve function and mobility while reducing pain and disability (4,5). The Healthy People 2020 target for health care provider (hereafter provider) counseling for weight loss among persons with arthritis and overweight or obesity is 45.3%.(dagger) Adults with overweight or obesity who receive weight-loss counseling from a provider are approximately four times more likely to attempt to lose weight than are those who do not receive counseling (6). To estimate changes in the prevalence of provider counseling for weight loss reported by adults with arthritis and overweight or obesity, CDC analyzed National Health Interview Survey (NHIS) data.( section sign) Overall, age-standardized estimates of provider counseling for weight loss increased by 10.4 percentage points from 2002 (35.1%; 95% confidence interval [CI] = 33.0-37.3) to 2014 (45.5%; 95% CI = 42.9-48.1) (p<0.001). Providing comprehensive behavioral counseling (including nutrition, physical activity, and self-management education) and encouraging evidence-based weight-loss program participation can result in enhanced health benefits for this population. |
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. |
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. |
Physical activity as a vital sign: A systematic review
Golightly YM , Allen KD , Ambrose KR , Stiller JL , Evenson KR , Voisin C , Hootman JM , Callahan LF . Prev Chronic Dis 2017 14 E123 INTRODUCTION: Physical activity (PA) is strongly endorsed for managing chronic conditions, and a vital sign tool (indicator of general physical condition) could alert providers of inadequate PA to prompt counseling or referral. This systematic review examined the use, definitions, psychometric properties, and outcomes of brief PA instruments as vital sign measures, with attention primarily to studies focused on arthritis. METHODS: Electronic databases were searched for English-language literature from 1985 through 2016 using the terms PA, exercise, vital sign, exercise referral scheme, and exercise counseling. Of the 838 articles identified for title and abstract review, 9 articles qualified for full text review and data extraction. RESULTS: Five brief PA measures were identified: Exercise Vital Sign (EVS), Physical Activity Vital Sign (PAVS), Speedy Nutrition and Physical Activity Assessment (SNAP), General Practice Physical Activity Questionnaire (GPPAQ), and Stanford Brief Activity Survey (SBAS). Studies focusing on arthritis were not found. Over 1.5 years of using EVS in a large hospital system, improvements occurred in relative weight loss among overweight patients and reduction in glycosylated hemoglobin among diabetic patients. On PAVS, moderate physical activity of 5 or more days per week versus fewer than 5 days per week was associated with a lower body mass index (-2.90 kg/m(2)). Compared with accelerometer-defined physical activity, EVS was weakly correlated (r = 0.27), had low sensitivity (27%-59%), and high specificity (74%-89%); SNAP showed weak agreement (kappa = 0.12); GPPAQ had moderate sensitivity (46%) and specificity (50%), and SBAS was weakly correlated (r = 0.10-0.28), had poor to moderate sensitivity (18%-67%), and had moderate specificity (58%-79%). CONCLUSION: Few studies have examined a brief physical activity tool as a vital sign measure. Initial investigations suggest the promise of these simple and quick assessment tools, and research is needed to test the effects of their use on chronic disease outcomes. |
Reply
Hootman JM , Helmick CG . Arthritis Rheumatol 2017 69 (8) 1702-1703 We appreciate the opportunity to respond to Drs. Jafarzadeh and Felson’s comments on our projected arthritis prevalence estimates. We have reviewed the letter from the authors arguing that 1) our estimates are subject to misclassification bias and 2) this bias can be corrected by incorporating the sensitivity/specificity of the self-report case definition using a Bayesian approach. We would like to provide 3 points of response. | | First, conceptually Drs. Jafarzadeh and Felson do not provide corrected estimates of “self-reported doctor-diagnosed arthritis” as suggested in their title. Rather, they seek to modify those estimates to develop a “true prevalence” of “arthritis.” | | Second, misclassification in the surveillance (and projections) for most any condition arises from many sources because of the tradeoffs required. For example, the case definition that we used purposefully excludes the back and neck because of the difficulty respondents would have attributing those problems to arthritis, nor does it list all types of arthritis. | | Third, their complex methods require many assumptions that may introduce their own error. NHIS estimates vary from year to year, which is why we use 3-year averages; Drs. Jafarzadeh and Felson used only 1 year (2015) for their adjustments, assuming that it was fully representative. It is not clear that they used weighted data (they cite only unweighted 2015 data); weighted data must be used in complex survey designs like the NHIS. They assumed sex differences not provided in the validation study underlying their analysis (1). They projected prevalence to 2060—20 years beyond what we think is reasonable due to Census assumptions (2) about changing demographics of the population (e.g., immigration/emigration) that are increasingly susceptible to error the further out one projects. | | Surveillance is a rough but practical exercise in understanding and predicting burden to educate the public, inform policymakers, target resources, and evaluate intervention programs (3). Among the key elements for surveillance are simplicity, representativeness, and stability (4), which we believe our current approach meets. Our previous 2030 projections have tracked relatively well with the actual prevalence (5,6), which suggests that our simple method of projecting arthritis prevalence is a reasonable approach that can be used over time to project and monitor what all would agree is a large and growing public health problem. |
Objectively measured physical activity and risk of knee osteoarthritis
Qin J , Barbour KE , Nevitt MC , Helmick CG , Hootman JM , Murphy LB , Cauley JA , Dunlop DD . Med Sci Sports Exerc 2017 50 (2) 277-283 PURPOSE: To examine the association between objectively measured physical activity and risk of developing incident knee osteoarthritis (OA) in a community-based cohort of middle-aged and older adults. METHODS: We used data from the Osteoarthritis Initiative (OAI), an ongoing prospective cohort study of adults aged 45 to 83 at initial enrollment with elevated risk of symptomatic knee OA. Moderate-vigorous physical activity (MVPA) was measured by a uniaxial accelerometer for seven continuous days in two data collection cycles, and was categorized as inactive (<10 minutes/week), low activity (10-<150 minutes/week), and active (≥150 minutes/week). Incident knee OA based on radiographic and symptomatic OA and joint space narrowing were analyzed as outcomes over four years of follow-up. Participants free of the outcome of interest in both knees at study baseline were included (sample sizes ranged from 694 to 1,331 for different outcomes). We estimated hazard ratio (HR) and its 95% confidence intervals (CI). RESULTS: In multivariate adjusted analyses, active MVPA participation was not significantly associated with risk of incident radiographic knee OA (HR: 1.52; 95% CI: 0.68-3.40), symptomatic knee OA (HR: 1.17; 95% CI: 0.44-3.09), or joint space narrowing (HR: 0.87; 95% CI: 0.37-2.06), when compared with inactive MVPA participation. Similar results were found for participants with low activity MVPA. CONCLUSION: MVPA was not associated with the risk of developing incident knee OA or joint space narrowing over four years of follow-up among OAI participants who are at increased risk of knee OA. |
Is participation in certain sports associated with knee osteoarthritis? A systematic review
Driban JB , Hootman JM , Sitler MR , Harris KP , Cattano NM . J Athl Train 2017 52 (6) 497-506 OBJECTIVE: Information regarding the relative risks of developing knee osteoarthritis (OA) as a result of sport participation is critical for shaping public health messages and for informing knee-OA prevention strategies. The purpose of this systematic review was to investigate the association between participation in specific sports and knee OA. DATA SOURCES: We completed a systematic literature search in September 2012 using 6 bibliographic databases (PubMed; Ovid MEDLINE; Journals@Ovid; American College of Physicians Journal Club; Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Database of Abstracts of Reviews of Effects; and Ovid HealthStar), manual searches (4 journals), and reference lists (56 articles). STUDY SELECTION: Studies were included if they met the following 4 criteria: (1) an aim was to investigate an association between sport participation and knee OA; (2) the outcome measure was radiographic knee OA, clinical knee OA, total knee replacement, self-reported diagnosis of knee OA, or placement on a waiting list for a total knee replacement; (3) the study design was case control or cohort; and (4) the study was written in English. Articles were excluded if the study population had an underlying condition other than knee OA. DATA EXTRACTION: One investigator extracted data (eg, group descriptions, knee OA prevalence, source of nonexposed controls). DATA SYNTHESIS: The overall knee-OA prevalence in sport participants (n = 3759) was 7.7%, compared with 7.3% among nonexposed controls (referent group n = 4730, odds ratio [OR] = 1.1). Specific sports with a significantly higher prevalence of knee OA were soccer (OR = 3.5), elite-level long-distance running (OR = 3.3), competitive weight lifting (OR = 6.9), and wrestling (OR = 3.8). Elite-sport (soccer or orienteering) and nonelite-sport (soccer or American football) participants without a history of knee injury had a greater prevalence of knee OA than nonexposed participants. CONCLUSIONS: Participants in soccer (elite and nonelite), elite-level long-distance running, competitive weight lifting, and wrestling had an increased prevalence of knee OA and should be targeted for risk-reduction strategies. |
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. |
Bone mineral density and the risk of hip and knee osteoarthritis: The Johnston County Osteoarthritis Project
Barbour KE , Murphy LB , Helmick CG , Hootman JM , Renner JB , Jordan JM . Arthritis Care Res (Hoboken) 2017 69 (12) 1863-1870 OBJECTIVES: To address knowledge gaps regarding the relationship between bone mineral density (BMD) and incident hip or knee osteoarthritis (OA); specifically, lack of information regarding hip OA or symptomatic outcomes. METHODS: Using data (N=1,474) from the Johnston County Osteoarthritis (JoCo OA) Project's first (1999-2004) and second follow-up (2005-2010) of participants aged ≥45 years we examined the association between total hip BMD and both hip and knee OA. Total hip BMD was measured using dual-energy X-ray absorptiometry, and participants were classified into sex-specific quartiles (low, intermediate low, intermediate high, and high). Radiographic osteoarthritis (ROA) was defined as development of Kellgren-Lawrence grade ≥2. Symptomatic ROA (sROA) was defined as onset of both ROA and symptoms. Weibull regression modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CIs). RESULTS: Median follow-up time was 6.5 (range=4.0-10.2) years. In multivariate models, and compared with participants with low BMD, those with intermediate high and high BMD were less likely to develop hip sROA (HR (95% CIs) 0.52 (0.31- 0.86) and 0.56 (0.31 - 0.86), respectively; p-trend = 0.024); high BMD was not associated (0.69 (0.45-1.06)) with risk of hip ROA. Compared with participants with low BMD, those with intermediate low and intermediate high total hip BMD were more likely to develop knee sROA (2.15 (1.40-3.30) and 1.65 (1.02-2.67), respectively; p-trend=0.325); similar associations were seen with knee ROA. CONCLUSIONS: Our findings suggest that higher BMD may reduce the risk hip sROA, while intermediate levels may increase the risk of both knee sROA and ROA. |
Reply
Hootman JM , Helmick CG . Arthritis Rheumatol 2016 68 (12) 3044-3045 Drs. Wolfe and Walitt argue that fibromyalgia may have been overdiagnosed in the NHIS, and that this may pose a problem with regard to updating the projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation. We appreciate the opportunity to explain these issues in greater detail. | | First, we used a self-report case definition that has been used since 2002 (i.e., “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?”), which was designed to capture conditions that would be treated by a rheumatologist or considered arthritis or a rheumatic condition by health care providers, the public, and decision makers. In our article we do indicate by citation that this broad case definition question was cognitively tested and validated for population surveillance purposes (1), but we make no such claim for self-reported diagnosis of specific conditions such as fibromyalgia. In fact, it is well recognized that selfreport of specific rheumatic conditions is a problem and results in misclassification (2–5), and our own experience with developing questions for the Behavioral Risk Factor Surveillance System suggested that the majority of respondents did not know what type of arthritis they had. Such misclassification was part of the original rationale for developing the broad case definition used, which assumes that self-reported specific rheumatic conditions may be misclassified, but that the correct classification is likely within the bounds of the broad case definition. Wolfe and Walitt may well be correct in saying that fibromyalgia is overdiagnosed in the NHIS, but the underlying medical condition is likely something that should be captured, albeit difficult to ascertain. | | Second, there is a need for estimating the burden and impact of arthritis (broadly defined) using self-reported surveys because many people do not mention their arthritis when interacting with the health care system, so it is not captured by medical records or claims-based administrative data. Surveillance using self-reported survey data is essential to better document and not underestimate the real population burden. Therefore, this broad definition is not for clinical purposes where a diagnosis is critical for determining the appropriate treatment plan. Rather the definition is for public health purposes which have different objectives, such as informing policymakers, targeting resources, and evaluating intervention programs (6). | | Third, Wolfe and Walitt raise the very interesting issue of “the creation and expansion of disease,” which might compromise surveillance efforts. Our previous projections of arthritis prevalence, based on 2003 NHIS data (7), were closely matched later by cross-sectional rolling estimates using the 2010–2012 NHIS (8), suggesting that our broad case definition has not yet been affected by that possible trend. | | For those interested in broad case definitions of arthritis, changes are coming. The NHIS is in the midst of a major redesign that will take effect in 2018; it is currently unknown how changes to the survey may impact arthritis case definitions or trends over time. With the use of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes in medical records since October 1, 2015, and in other national health care utilization surveys, a new ICD-based case definition will be needed. |
Work-related illness and injury claims among nationally certified athletic trainers reported to Washington and California from 2001 to 2011
Kucera KL , Roos KG , Hootman JM , Lipscomb HJ , Dement JM , Silverstein BA . Am J Ind Med 2016 59 (12) 1156-1168 BACKGROUND: Little is known about the work-related injury and illnesses experienced by certified athletic trainers (AT). METHODS: The incidence and characteristics of injury/illness claims filed in two workers' compensation systems were described from 2001 to 2011. Yearly populations at risk were estimated from National Athletic Trainers' Association membership statistics. Incidence rate ratios (IRR) were reported by job setting. RESULTS: Claims were predominantly for traumatic injuries and disorders (82.7%: 45.7% sprains/strains, 12.0% open wounds, 6.5% bruises) and at these body sites (back 17.2%, fingers 12.3%, and knee 9.6%) and over half were caused by body motion and overexertion (51.5%). Compared with school settings, clinic/hospital settings had modestly higher claim rates (IRR = 1.29, 95% CI: 1.06-1.52) while other settings (e.g., professional or youth sport, nursing home) had lower claim rates (IRR = 0.63, 95% CI: 0.44-0.70). CONCLUSIONS: These first known estimates of work-related injuries/illnesses among a growing healthcare profession help identify occupational tasks and settings imposing injury risk for ATs. |
Obesity trends among adults with doctor-diagnosed arthritis - United States, 2009-2014
Barbour KE , Helmick CG , Boring M , Qin J , Pan L , Hootman JM . Arthritis Care Res (Hoboken) 2016 69 (3) 376-383 Objective Arthritis and obesity are common co-occurring conditions which can increase disability and risk of adverse outcomes (e.g., total knee replacement). Methods We estimated recent obesity trends among adults with arthritis from 2009 to 2014, overall, and by various sociodemographic and health characteristics using data from National Health Interview Survey, an ongoing, nationally representative, in-person household self-reported survey of the noninstitutionalized civilian U.S. A secondary aim was to examine the distribution of body mass index (BMI) categories among adults with and without arthritis. Results Obesity prevalence did not change significantly over time among middle-aged and younger adults with doctor-diagnosed arthritis either overall (p-trend=0.925 for both groups), or by demographic and health characteristics. Among older adults with doctor-diagnosed arthritis the unadjusted obesity prevalence was 29.4% in 2009 and 34.3% in 2014; after adjusting for all demographic and health characteristics there was a significant relative increase in obesity prevalence (15% (95% CI: 6-25)) and over time (p-trend=0.001). The 2014 distribution of BMI categories for adults with doctor-diagnosed arthritis (compared with adults without doctor-diagnosed arthritis) was skewed toward the obese category and its subclasses, but there were no significant changes in these relationships from 2009. Conclusions Obesity increased significantly over time among older adults with arthritis and remains high when compared with adults without arthritis. Greater dissemination of interventions focused on physical activity and diet are needed to reduce the adverse outcomes associated with obesity and arthritis. |
Athletic Training and Public Health Summit
Hoffman M , Bovbjerg V , Hannigan K , Hootman JM , Johnson ST , Kucera KL , Norcross MF . J Athl Train 2016 51 (7) 576-80 OBJECTIVE: To introduce athletic trainers to the benefits of using a population-based approach to injury and illness prevention and to explore opportunities for partnering with public health professionals on these initiatives. BACKGROUND: Athletic trainers play leading roles in individual injury and illness prevention but are less familiar with policy development, evaluation, and implementation from a population-level standpoint. The Athletic Training and Public Health Summit was convened to understand, explore, and develop the intersection of athletic training and public health. CONCLUSIONS: To further the integration of athletic training within the public health arena, athletic trainers must expand their professional focus beyond the individual to the population level. |
Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040
Hootman JM , Helmick CG , Barbour KE , Theis KA , Boring MA . Arthritis Rheumatol 2016 68 (7) 1582-7 OBJECTIVE: To update projections of arthritis prevalence and arthritis-attributable activity limitations (AAAL) for adults using a newer baseline. METHODS: Baseline prevalence data were obtained from the 2010-2012 National Health Interview Survey. Arthritis was defined as a "yes" response to "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?" AAAL was defined as a "yes" response to "Are you limited in any way in any of your usual activities because of arthritis or joint symptoms." The baseline prevalence of arthritis and AAAL was stratified by age (18-34, 35-44, 45-54, 55-64, 65-74, 75-84, and 85+) and sex and statistically weighted to account for the complex survey design. Projected arthritis and AAAL prevalence was calculated by multiplying the US Census projected age and sex population estimates for 2015-2040 (in 5-year intervals) by the baseline estimates, and summed to provide the total prevalence estimates for each year. RESULTS: In 2010-2012 there were 52.5 million (22.7%) US adults with doctor-diagnosed arthritis, of whom 22.7 million (9.8% of all adults) had AAAL. By 2040 the prevalence of doctor-diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of adults). The number of adults with AAAL will also increase 52% to 34.6 million (11.4% of all adults). CONCLUSION: Updated projections suggest arthritis and AAAL will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs. |
Hip osteoarthritis and the risk of all-cause and disease-specific mortality in older women: population-based cohort study
Barbour KE , Lui LY , Nevitt MC , Murphy LB , Helmick CG , Theis KA , Hochberg MC , Lane NE , Hootman JM , Cauley JA . Arthritis Rheumatol 2015 67 (7) 1798-805 OBJECTIVES: Determine the risk of all-cause and disease-specific mortality among older women with hip OA and identify mediators in the causal pathway. METHODS: Data were from the Study of Osteoporotic Fractures, a US population-based cohort study of 9704 white women, aged ≥65 years. The analytic sample included women with hip radiographs at baseline (N=7,889) and year 8 (N=5,749). Mortality was confirmed through October 2013 by death certificates and hospital discharge summaries. Radiographic hip OA (RHOA) was defined as having Croft grade ≥2 in at least 1 hip (definite joint space narrowing or osteophytes plus 1 other radiographic feature). RESULTS: Mean follow-up time was 16.1 +/-6.2 years. Baseline and year 8 prevalence of RHOA was 8.0% and 11.0%, respectively. Cumulative incidence (proportion of deaths during study period) was 67.7% for all-cause mortality, 26.3% for cardiovascular disease (CVD) mortality, 11.7% for cancer mortality, 1.9% for gastrointestinal disease mortality, and 27.8% for all other mortality causes. RHOA was associated with an increased risk of all-cause (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.05-1.24), and CVD (HR, 1.24; 95% CI, 1.09-1.41) mortality adjusted for age, body mass index, education, smoking, health status, diabetes, and stroke. These associations were partially explained by physical function (mediating variable). CONCLUSION: RHOA was associated with an increased risk of all-cause and CVD mortality among older white women followed for 16 years. Dissemination of evidence-based physical activity and self-management interventions for hip OA in community and clinical settings can improve physical function and might also contribute to lower mortality. |
The Steps to Health Randomized Trial for Arthritis: a self-directed exercise versus nutrition control program
Wilcox S , McClenaghan B , Sharpe PA , Baruth M , Hootman JM , Leith K , Dowda M . Am J Prev Med 2014 48 (1) 1-12 BACKGROUND: Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE: To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN: Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS: Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(R)) or nutrition control program (Steps to Healthy Eating). INTERVENTION: Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES: Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS: Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS: The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327. |
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). |
Falls and fall injuries among adults with arthritis - United States, 2012
Barbour KE , Stevens JA , Helmick CG , Luo YH , Murphy LB , Hootman JM , Theis K , Anderson LA , Baker NA , Sugerman DE . MMWR Morb Mortal Wkly Rep 2014 63 (17) 379-83 Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year, resulting in direct medical costs of nearly $30 billion. Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities. Although the burden of falls among older adults is well-documented, research suggests that falls and fall injuries are also common among middle-aged adults. One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis. In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45-64 years) (30.2%) and older adults (aged ≥65 years) (49.7%), and these populations account for 52% of U.S. adults. Moreover, arthritis is the most common cause of disability. To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged ≥45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice. |
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