Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older

Educational Attainment, Health Status, and Program Outcomes in Latino Adults With Arthritis Participating in a Walking Program

Introduction

Latinos are disproportionately likely to lack a high school diploma, compared with non-Hispanic whites, a trend associated with worse outcomes in arthritis and indicating a need for health interventions. Camine Con Gusto (CCG) is the Spanish version of the evidence-based Walk With Ease program for arthritis. This study compared baseline health status and examined differences in program efficacy and adherence among Latino adults with and without a high school diploma enrolled in a pre−post evaluation of CCG.

Methods

CCG participants (n = 233) were classified into 2 groups: high school diploma or more (n = 129) and less than high school diploma (n = 104). We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of education with measures of baseline health and program adherence. We computed effect sizes for the difference between education groups by using mean change scores for arthritis symptoms, physical function, and psychosocial variables.

Results

The group without a high school diploma was more likely to report worse general health (OR = 2.40; 95% CI, 1.28–4.53) and lower levels of arthritis self-efficacy (OR = 1.95; 95% CI, 1.05–3.63) than the group with a high school diploma. CCG improved outcomes for both groups, with no significant between-group differences. The group without a high school diploma was less likely to read most of the program workbook (OR = 0.51; 95% CI, 0.27–0.97), but we found no significant differences in the amount of walking between the 2 groups.

Conclusion

CCG was equally effective among Latinos with and without a high school diploma; however, education did affect participants’ engagement with the program workbook. Adaptation of interventions for Latinos should consider how information can best be conveyed to those with lower levels of formal education.

Evaluation of the Arthritis Foundation's Camine Con Gusto Program for Hispanic Adults With Arthritis

INTRODUCTION

Camine Con Gusto (CCG) is the Hispanic version of an evidence-based walking program for people with arthritis. This study examined CCG outcomes, feasibility, tolerability, safety, and acceptability and potential tailoring.

METHOD

A pre and post 6-week evaluation was conducted in Hispanic people with arthritis. Outcomes included pain, stiffness, fatigue, functional capacity, helplessness, and self-efficacy. A formative evaluation with program participants and key stakeholders explored program tailoring.

RESULTS

Participants' mean age was 46.9 years, 44.4% had a high school degree or less, 2.5% were born in United States, 60.1% spoke only Spanish, and 74.7% were female. Moderate effect sizes were found: 0.50 for pain, 0.75 for fatigue, 0.49 for stiffness, 0.33 for function, 0.26 for helplessness, and 0.24 for self-efficacy. There were 285 participants recruited with an 82% 6-week retention (feasibility), no adverse events were reported (safety), and 98% reported program satisfaction (acceptability). Recommended adaptations included simpler language, more pictures and content addressing nutrition and chronic conditions, shortened materials, and inclusion of motivational strategies.

CONCLUSION

CCG showed improvement in outcomes in Hispanic individuals comparable to those noted in non-Hispanic White and Black individuals with arthritis.

Impact of the Arthritis Foundation's Walk With Ease Program on arthritis symptoms in African Americans

Introduction

Inadequate program design and lack of access to evidence-based programs are major barriers to the management of chronic diseases such as arthritis, particularly for African Americans. This study evaluates the effectiveness of the Arthritis Foundation’s Walk With Ease Program (WWE) in a subsample of African Americans who were part of a larger study that established evidence of the program’s efficacy.

Methods

Participants were African Americans (N = 117) with self-reported arthritis who chose to participate in either a self-directed (n = 68) or group (n = 49) 6-week WWE program. Arthritis-related symptoms (ie, pain, fatigue, stiffness; measured using visual analog scales) were assessed at baseline, 6 weeks, and 1 year. Independent samples t tests were conducted to examine group differences (ie, self-directed vs group) in arthritis-related symptoms at baseline, and paired sample t tests were conducted to examine differences over time (ie, baseline to 6 weeks and baseline to 1 year) in symptoms. Satisfaction was examined by descriptive statistics.

Results

Younger, more educated individuals chose the self-directed format (P < .001, P = .008; respectively). After the 6-week intervention, participants reported a decrease in pain (P < .001), fatigue (P = .002), and stiffness (P < .001). At 1 year, the decrease in pain (P = .04) and stiffness (P = .002) remained constant. Overall, participants were satisfied with both program formats.

Conclusion

The individualized and group formats of the WWE program improved arthritis-related pain, fatigue, and stiffness in African Americans. Culturally appealing arthritis interventions ultimately may increase the use of existing arthritis interventions.

Activity pacing for osteoarthritis symptom management: study design and methodology of a randomized trial testing a tailored clinical approach using accelerometers for veterans and non-veterans

BACKGROUND

Osteoarthritis (OA) is a prevalent chronic disease and a leading cause of disability in adults. For people with knee and hip OA, symptoms (e.g., pain and fatigue) can interfere with mobility and physical activity. Whereas symptom management is a cornerstone of treatment for knee and hip OA, limited evidence exists for behavioral interventions delivered by rehabilitation professionals within the context of clinical care that address how symptoms affect participation in daily activities. Activity pacing, a strategy in which people learn to preplan rest breaks to avoid symptom exacerbations, has been effective as part of multi-component interventions, but hasn't been tested as a stand-alone intervention in OA or as a tailored treatment using accelerometers. In a pilot study, we found that participants who underwent a tailored activity pacing intervention had reduced fatigue interference with daily activities. We are now conducting a full-scale trial.

METHODS/DESIGN

This paper provides a description of our methods and rationale for a trial that evaluates a tailored activity pacing intervention led by occupational therapists for adults with knee and hip OA. The intervention uses a wrist accelerometer worn during the baseline home monitoring period to glean recent symptom and physical activity patterns and to tailor activity pacing instruction based on how symptoms relate to physical activity. At 10 weeks and 6 months post baseline, we will examine the effectiveness of a tailored activity pacing intervention on fatigue, pain, and physical function compared to general activity pacing and usual care groups. We will also evaluate the effect of tailored activity pacing on physical activity (PA).

DISCUSSION

Managing OA symptoms during daily life activity performance can be challenging to people with knee and hip OA, yet few clinical interventions address this issue. The activity pacing intervention tested in this trial is designed to help people modulate their activity levels and reduce symptom flares caused by too much or too little activity. As a result of this trial, we will be able to determine if activity pacing is more effective than usual care, and among the intervention groups, if an individually tailored approach improves fatigue and pain more than a general activity pacing approach.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01192516.

Ethnic and socioeconomic disparities in health among patients with rheumatic disease

PURPOSE OF REVIEW

To describe recent studies of differences in the occurrence and outcomes of rheumatic diseases and differences in treatment by ethnic group or socioeconomic status.

RECENT FINDINGS

African Americans and Hispanics in the United States have consistently been found to have higher prevalences of arthritis and other rheumatic conditions than whites, and also generally have more activity limitations in the setting of rheumatic disease. Variations in disease occurrence by socioeconomic status have not been studied extensively. African Americans with osteoarthritis were less likely than whites to be treated with narcotic analgesics. Rates of total knee or hip arthroplasty were found to be substantially lower among African Americans and Hispanics than among whites in the United States, and lower among those of low socioeconomic status in the United Kingdom. Ethnic differences in use of arthroplasty have been associated with less willingness of African Americans to have surgery, which has been related to perceptions of uncertain benefits of surgery. Poverty and ethnicity had important associations with the activity of systemic lupus erythematosus, whereas socioeconomic status was a more important predictor of mortality in these patients. Treatment adherence was similar in African American and white patients with systemic lupus erythematosus, but barriers to adherence differed by ethnic group.

SUMMARY

Ethnic disparities in health have been more extensively studied than socioeconomic disparities. Most studies only describe the disparities, but several studies have begun to investigate potential reasons for the disparities.