Association of Disease Activity and Disability With Rehabilitation Utilization in African American Adults With Rheumatoid Arthritis

Thoma, Louise M.; Cleveland, Rebecca J.; Jonas, Beth; Bridges, S. Louis; Callahan, Leigh F.

doi:10.1002/acr.24797

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…A high dose of rehabilitation was associated with more favorable changes in physical function, pain, and fatigue compared to a low dose of rehabilitation; however, only the association with physical function changes were maintained in the adjusted models. Rehabilitation utilization for RA in the US is low (14-15% in 6 months [22,23]) and varies greatly. Iversen et al reported that 28% of those who used PT reported attending 1-4 visits, while 53% reported attending >8 visits (22).…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known regarding rehabilitation utilization patterns in adults with RA in the US. Two cross-sectional studies reported that 14-15% of adults with RA used PT over a 6-month period (22,23). These rates of PT utilization likely overestimate utilization for RA, specifically because people often use PT for reasons unrelated to RA (22).…”

Section: Introductionmentioning

confidence: 99%

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Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

Thoma

Wellsandt

Wipfler

et al. 2023

Arthritis Care & Research

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Objective. To evaluate the association of baseline factors with rehabilitation dose and the association of rehabilitation dose with meaningful change in physical function, pain, and fatigue over 6 months among adults with rheumatoid arthritis (RA).Methods. Using data from the National Databank for Rheumatic Diseases registry, we extracted baseline characteristics and self-reported physical function (Health Assessment Questionnaire), pain (visual analog scale [VAS]), fatigue (VAS), rehabilitation dose (low: 1-2 visits, medium: 3-8 visits, high: >8 visits), and follow-up outcomes 6 months later. Changes in clinical outcomes were categorized as improved, no change, or worsened. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) using proportional odds logistic regression models to examine the association of the baseline factors with rehabilitation dose and the association of rehabilitation dose with changes in clinical outcomes, adjusting for potential confounders.Results. The sample included 1,381 adults with a new episode of rehabilitation (dose: low 27%, medium 42%, high 31%). Worse baseline physical function (adjusted OR 1.29 [95% CI 1.04-1.60]), but not pain (adjusted OR 1.04 [95% CI 0.99-1.10]) or fatigue (adjusted OR 0.98 [95% CI 0.93-1.03]), were associated with a higher rehabilitation dose. A high rehabilitation dose was associated with a favorable change in physical function ), pain ), and fatigue (OR 1.45 [95% CI 1.06-1.99]) compared to a low dose; only the association with physical function change persisted in adjusted models (adjusted OR 1.41 [95% CI 1.03-1.92]).Conclusion. Using real-world data, this study supports a higher rehabilitation dose to improve physical function in adults with RA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

Thoma

Wellsandt

Wipfler

et al. 2023

Arthritis Care & Research

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“…Yet, our collective experiences speaking with persons with RA, including patient advisory board members for organizations, patient panel participants, and individuals, consistently reflect a general lack of awareness of physical therapy and an absence of physical therapy in the therapeutic options presented by their rheumatology provider to address common and persistent functional limitations. These anecdotal experiences are supported by the finding that 50% of a US cohort of older adults with longstanding RA (median 10 years since diagnosis) reported they had never used physical therapy or occupational therapy (9).…”

Section: What Are the Recommendations For Physical Therapy?mentioning

confidence: 92%

“…Evidence-based guidance on the use of physical therapy and exercise in the integrative care of patients with RA is only useful if patients are aware of these options. Multiple studies using various methodologies demonstrate consistently low utilization of physical therapy among adults with RA, with estimates ranging from 10% to 15% in the prior 6 to 12 months (9)(10)(11). Indeed, utilization of formal physical therapy services are not necessary for all patients at all times.…”

Section: Challenges and Recommendations For Guideline Implementationmentioning

confidence: 99%

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Thoma

White

et al. 2023

Arthritis Care & Research

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The medical management of rheumatoid arthritis (RA) has improved remarkably over the last 50 years. Today, diseasemodifying antirheumatic drugs are staples of RA management and alone, or in combination with a plethora of biologic therapies, have reduced overall RA disease activity and related joint destruction. Under the treat-to-target approach, treatment is escalated until a target of remission or low disease activity is reached and promptly escalated when the target is no longer met (1,2). These advances have greatly reduced disease activity, yet functional limitation, such as difficulty with housework, getting up from a chair, or walking, still impairs the quality of life of adults with RA, including those whose disease is in remission. Physical therapists are experts in improving and preserving physical function and optimizing quality of life for people with functional limitations, including those with RA. In this issue of Arthritis Care & Research, the 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis by England et al (3) presents the first systematic effort by the ACR to evaluate the contribution of physical therapy interventions to the comprehensive care of adults with RA. As physical therapists and researchers who are experts in rheumatology and who have played various roles on the guideline team, we see this guideline as a critical step toward meaningful progress in integrating physical therapy into routine care for adults with RA. To facilitate the use of this guideline by physical therapists in patient care, it is important to consider the context in which it will be used. In this editorial, we discuss the guideline's recommendations as they apply to physical therapy, challenges to implementation, and practical steps moving forward in advancing the integrative care for adults with RA.

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“…The medicines used for this purpose are primarily immunosuppressive or immune-modulating drugs. 7 These immunosuppressive medications include Methotrexate, Leflunomide, Sulfasalazine, Hydroxy-chloroquine, Azathioprine, and Mycophenolate mofetil. 8,9 Since these medicines suppress or modify the immune system, they are not without side effects.…”

Section: Introductionmentioning

confidence: 99%

Anti-Inflammatory Drugs and Immunosuppressants in Rheumatological and Musculoskeletal Diseases

Mustafa

Durrani

Adnan

et al. 2023

PAFMJ

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Objective: To determine drug compliance among patients with rheumatological and musculoskeletal diseases and to identify the reasons behind poor compliance. Study Design: Cross-sectional study. Place and Duration of Study: Department of Rheumatology Lady Reading Hospital, Peshawar Pakistan, from Aug 2020 to Feb 2021. Methodology: All patients aged 16 to 70, of either gender with inflammatory rheumatic diseases who were prescribed conventional DMARDs for at least six months were included in the study. Results: Two hundred and eighteen patients were included in the study. There were 59(27.1%) males and 159(72.9%) females with a mean age of 38.56±4.75years. There were 156 SPRA patients (71.5%), while SLE and SNIA accounted for 22(10.1%) and 17(7.8%) cases, respectively. Methotrexate was the most commonly prescribed medicine, 158(72.5%) while 90(41.3%) patients were prescribed Hydroxychloroquine and 43(19.7%) patients were prescribed Sulfasalazine. Regarding compliance, 112 (51.4%) patients were found to have good drug adherence. On the other hand, side effects and lack of awareness were found to be the most common cause of poor medication adherence. Conclusion: We concluded that adherence to medication among patients with inflammatory rheumatic and musculoskeletal diseases is poor

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Association of Disease Activity and Disability With Rehabilitation Utilization in African American Adults With Rheumatoid Arthritis

Cited by 4 publications

References 14 publications

Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Anti-Inflammatory Drugs and Immunosuppressants in Rheumatological and Musculoskeletal Diseases

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