Objective. To determine prevalence estimates for rheumatoid arthritis (RA) in noninstitutionalized older adults in the US. Prevalence estimates were compared using 3 different classification methods based on current classification criteria for RA.Methods. Data from the Third National Health and Nutrition Examination Survey (NHANES-III) were used to generate prevalence estimates by 3 classification methods in persons 60 years of age and older (n ‫؍‬ 5,302). Method 1 applied the "n of k" rule, such that subjects who met 3 of 6 of the American College of Rheumatology (ACR) 1987 criteria were classified as having RA (data from hand radiographs were not available). In method 2, the ACR classification tree algorithm was applied. For method 3, medication data were used to augment case identification via method 2. Population prevalence estimates and 95% confidence intervals (95% CIs) were determined using the 3 methods on data stratified by sex, race/ethnicity, age, and education.Results. Overall prevalence estimates using the 3 classification methods were 2.03% (95% CI 1.30-2.76), 2.15% (95% CI 1.43-2.87), and 2.34% (95% CI 1.66-3.02), respectively. The prevalence of RA was generally greater in the following groups: women, Mexican Americans, respondents with less education, and respondents who were 70 years of age and older.Conclusion. The prevalence of RA in persons 60 years of age and older is ϳ2%, representing the proportion of the US elderly population who will most likely require medical intervention because of disease activity. Different classification methods yielded similar prevalence estimates, although detection of RA was enhanced by incorporation of data on use of prescription medications, an important consideration in large population surveys.

The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.

Purpose of the Work. This study compared the propulsion biomechanics of manual wheelchair users with and without upper-limb impairment. Subjects and Procedures. Fortyseven manual wheelchair users (15 with upper-limb impairment and 32 without upper-limb impairment) propelled an instrumented wheelchair ergometer while a 3D motion analysis system was used to collect joint kinematic and temporal data, as well as hand rim and joint kinetics. Measures were compared between groups. Results. The group with upper-limb impairment propelled with a higher stroke frequency and reduced contact time; with smaller peak joint angles of the wrist, elbow, and shoulder during the contact phase; with reduced power output; and with reduced hand rim propulsive and resultant forces, moments, and joint compressive forces. Relevance to the Veteran Population. More than 175,000 veterans use manual wheelchairs for mobility, with 44,000 manual wheelchairs distributed annually, according to the Department of Veterans Affairs (VA) Prosthetics National Database. Manual wheelchair users with upper-limb impairment adopt strategies to remain independent, and some of these strategies may protect them from the development of secondary upper-limb pathologies.

Objective To determine the impact of post acute care site on stroke outcomes. Following a stroke, patients may receive post acute care in a number of different sites: inpatient rehabilitation (IRF), skilled nursing facility (SNF), and home health care/outpatient (HH/OP). We hypothesized that patients who received IRF would have better six-month functional outcomes than those who received care in other settings after controlling for patient characteristics. Design Prospective Cohort Study. Setting Four Northern California hospitals which are part of a single health maintenance organization. Participants 222 patients with stroke enrolled between February 2008 and July 2010. Intervention Not Applicable. Main Outcome Measure Baseline and 6 month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC™), a test of self-reported function in three domains: Basic Mobility, Daily Activities, and Applied Cognition. Results Of the 222 patients analyzed, 36% went home with no treatment, 22% received HH/OP care, 30% included IRF in their care trajectory, and 13% included SNF (but not IRF) in their care trajectory. At six months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a SNF in all 3 domains and in two out of three functional domains compared to those who received HH/OP care. Conclusions Patients with stroke may make more functional gains if their post-acute care includes an IRF. This finding may have important implications as post-acute care delivery is reshaped through health care reform.