Self-management strategies in overweight and obese Canadians with arthritis

OBJECTIVE

To estimate the prevalence of overweight and obese Canadians with arthritis and to describe their use of arthritis self-management strategies, as well as explore the factors associated with not engaging in any self-management strategies.

METHODS

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada, a nationally representative sample of 4,565 Canadians age ≥20 years reporting health professional-diagnosed arthritis (including more than 100 rheumatic diseases and conditions), were asked about the impact of their arthritis and how it was managed. Among the overweight (body mass index [BMI] 25-29.9 kg/m(2)) and obese (BMI ≥30 kg/m(2)) individuals with arthritis (n = 2,869), the use of arthritis self-management strategies (i.e., exercise, weight control/loss, classes, and community-based programs) were analyzed. Log binomial regression analyses were used to examine factors associated with engaging in none versus any (≥1) of the 4 strategies.

RESULTS

More than one-quarter (27.4%) of Canadians with arthritis were obese and an additional 39.9% were overweight. The overweight and obese individuals with arthritis were mostly female (59.5%), age ≥45 years (89.7%), and reported postsecondary education (69.0%). While most reported engagement in at least 1 self-management strategy (84.9%), less than half (45.6%) engaged in both weight control/loss and exercise. Factors independently associated with not engaging in any self-management strategies included lower education, not taking medications for arthritis, and no clinical recommendations from a health professional.

CONCLUSION

Fewer than half of the overweight and obese Canadians with arthritis engaged in both weight control/loss and exercise. The provision of targeted clinical recommendations (particularly low in individuals that did not engage in any self-management strategies) may help to facilitate participation.

Arthritis and rheumatism are neglected health priorities: a bibliometric study

OBJECTIVE

To investigate the frequency of publications about arthritis and rheumatic diseases relative to other diseases and to examine which topics received most attention.

METHODS

Available health statistics were used to quantify the burden of illness due to musculoskeletal (MSK) conditions. Next, a bibliographic analysis of MEDLINE was performed comparing disease categories using the MeSH tree structure for 1991 and 1996. Diseases were ranked according to the frequency of citations attributable to them and further analyses were performed for journal categories, MeSH subheadings, and the frequency of citations for specific types of arthritis and rheumatic diseases.

RESULTS

Compared with 9 other causes, MSK diseases are leading contributors to health professional consultations, total health costs, chronic ill health, and disability. In contrast, MSK diseases ranked ninth among twelve major MEDLINE disease categories in 1996 and 1991. These rankings were similarly low across journal categories reflecting basic science research and clinical application. Radiography, rehabilitation, history and embryology were the most frequently used subheadings for MSK diseases. In 1996, there were 16,603 citations for MSK diseases, led by bone diseases (7,304 citations), joint diseases (4,987), muscular diseases (4,236), arthritis (3,555), and rheumatic diseases (3195). Among arthritic and rheumatic diseases, rheumatoid arthritis had the largest number of citations (2,004), followed by systemic lupus erythematosus (927) and osteoarthritis (793).

CONCLUSION

Arthritis and rheumatic diseases receive far less attention in the scientific literature than is warranted by their enormous and growing disease burden. Both research and dissemination are lacking and more adequate resources for these activities are indicated.

The prevalence of low back pain in the elderly. A systematic review of the literature

STUDY DESIGN

The prevalence of low back pain in the older population (> = or 65 years) was reviewed in an analysis of the literature from 1966 to the present.

OBJECTIVE

To determine the prevalence of low back pain in the geriatric population.

SUMMARY OF BACKGROUND DATA

Back pain is one of the most frequently reported conditions affecting the adult population. However, the prevalence of low back pain in the older age population is not accurately known.

METHODS

A methodologic search of five computerized bibliographic databases was performed to identify citations on the prevalence of low back pain in the elderly. Data were summarized, and prevalence studies were critically appraised in detail for their quality.

RESULTS

There is wide variability in the reported prevalence of back pain. Many factors have been proposed to explain these findings including sample source, study design, definitions of back pain, and use of patient-reported data. Comorbidity among older patients also contributes to the variability in the reporting of prevalence of back pain.

CONCLUSION

There is an under-representation of the older population in the back pain literature. The data in the current study suggest that the prevalence of low back pain in this population is not known with certainty and is not comparable with that in the younger population. The authors stress the need for future studies to improve the reporting of age information to make prevalence studies more informative and applicable.

Defining morning stiffness in rheumatoid arthritis

OBJECTIVE

Morning stiffness is a common and clinically important symptom in patients with rheumatoid arthritis (RA); however, it has not performed well as a classification criterion, perhaps due to poor definition. This qualitative study was carried out to identify the characteristics of morning stiffness through the self-reports of patients with RA in order to develop a new patient centered definition.

METHODS

Personal interviews with 24 patients with RA were analyzed independently by 2 reviewers using a grounded theory approach. A mail-out questionnaire was used to validate the information summarized from the interviews.

RESULTS

These findings resulted in the following definition of morning stiffness in RA: slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement.

CONCLUSION

This new patient centered definition of morning stiffness may allow more precise classification of patients with RA.

Outcome of polyarteritis nodosa and Churg-Strauss syndrome. An analysis of twenty-five patients

OBJECTIVE

To compare outcome in patients with polyarteritis nodosa (PAN) and patients with Churg-Strauss syndrome (CSS) followed up at a single center.

METHODS

A retrospective data review of 13 patients with PAN and 12 patients with CSS who were followed up at a vasculitis clinic. Outcome measures included a global damage index, disability and pain dimensions of the Health Assessment Questionnaire, and mortality rate.

RESULTS

Compared with patients with CSS, patients with PAN had a significantly higher mean damage index score (5.15 versus 2.42; P = 0.011), a higher disability score (1.09 versus 0.16; P = 0.007), and a higher pain score (1.04 versus 0.01; P = 0.017). Patients with PAN had more relapses (relative risk = 5.07; P < 0.000) and a higher mortality rate (31%) compared with patients with CSS (8%).

CONCLUSION

PAN and CSS differ in their morbidity and mortality; therefore, they should be considered as distinct clinical entities.

The population health impact of arthritis. POHEM Workshop Group

The workshop was convened to develop quantitative estimates of the incidence of progressional musculoskeletal diseases in order to estimate the population health impact of arthritis. Estimates were developed for (a) the prevalence of arthritis, (b) a weighting strategy to adjust for the quality of life for the range of health states associated with arthritis, and (c) transition probabilities to represent the likelihood of disease onset and progression through the range of possible health states. A simulation "game" was designed to follow the progression of a cohort of 200 healthy persons or persons with arthritis, creating the basis for the estimation of transition probabilities and thus generating simulated longitudinal data that allow calculation of the quantitative estimate of the burden of illness from musculoskeletal diseases within the Canadian population.

Hip arthroplasty: patient satisfaction

A total of 1074 patients, the survivors of a multicentre sample of 1085 who, 9-15 months earlier, had undergone total hip replacement, were asked to complete a questionnaire about their satisfaction with the outcome of surgery. Of 1027 (96%) who responded, 90% were satisfied, 5% were unsure and 3% were dissatisfied with the result--2% failed to answer the question about satisfaction. The highest satisfaction rate was found amongst patients who had undergone bilateral hip replacement (96%) and those with a diagnosis of rheumatoid arthritis (94%). Dissatisfaction was associated with previous surgery to the index hip and additional surgery following total hip replacement. In all but five of the 98 patients who did not express satisfaction an adequate reason could be found either in the case notes or from questionnaire responses.