Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: A pilot study

Abstract

Objective. To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA). Methods. A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean ؎ SD age 75.3 ؎ 7.1 years) participated. At each site, older adults were randomly assigned to 1 of 2 programs: exercise plus AST (Ex ؉ AST) or exercise plus health education (Ex ؉ Ed). The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period, and were conducted concurrently within each site. Pain, total PA and PA intensity (measured objectively by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors questionnaire), arthritis self-efficacy, and physical function were assessed at baseline and posttest. Results. At posttest, participants who received Ex ؉ AST had significantly higher levels of objective peak PA (P ‫؍‬ 0.02) compared with participants who received Ex ؉ Ed. Although not statistically significant, participants in Ex ؉ AST tended to have larger pain decreases, increased total objective and subjective PA, and increased physical function. No effects were found for arthritis self-efficacy. Conclusion. Although participants were involved in identical exercise programs, participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education. Future studies will be needed to examine larger samples and long-term effects of AST.

Arthritis Self-Efficacy Scale Scores in Knee Osteoarthritis: A Systematic Review and Meta-analysis Comparing Arthritis Self-Management Education With or Without Exercise

“…[5][6][7][8]17,18,29,34,35 Intervention 2 was some form of arthritis self-management education that also included exercise (15 studies; subjects, n = 1757; women, n = 1406 [80%]). 16,20,[25][26][27][28][30][31][32]40,47,51,[59][60][61] These interventions included both cohort studies using the ASES pain (10 studies; subjects, n = 1035) 5 37.5% (9 of 24) did not describe a control or placebo group, 41.7% (10 of 24) did not adequately describe study exclusion criteria, and 25% (6 of 24) did not adequately describe subject dropout management. Studies with arthritis self-management education with exercise (intervention 2) displayed significantly higher methodological quality scale scores (76.8  13.1 versus 61.6  19.6, P = .03) compared to studies with arthritis self-management education alone (intervention 1).…”

“…These studies reported a mean effect size of 0.438  0.07. Forest plots were created for randomized controlled studies that used the ASES pain (13 studies, n = 1925), 6,18,20,[26][27][28][29]34,40,51,[59][60][61] other symptoms (13 studies, n = 1976), 6,18,20,[25][26][27][28][29]34,51,[59][60][61] and function (5 studies, n = 428) 18,20,28,29,34 subscales. Small to moderate standardized mean difference effect sizes were noted for both intervention 1 and intervention 2 for ASES pain (0.37  0.47 versus 0.20  0.32, P = .60) (FIGURE 2), other symptoms (0.25  0.17 versus 0.29  0.29, P = .94) (FIGURE 3), and function (0.17  0.11 versus 0.18  0.21, P = .99) (FIG-URE 4) subscales.…”

“…Hartman et al 20 Hughes et al 26 Hughes et al 27 Hunt et al 28 Murphy et al 40 Sullivan et al 51 Wu et al 59 Yip et al 60 Yip et al 61 …”

“…Among studies that used some form of arthritis self-management education with exercise, most reported improved function by the end of treatment, as determined by measures as diverse as isokinetic knee extensor/flexor torque, 28,30 6-minute timed walk, 26,27,30,32,40,47 singleleg stance with eyes open or closed, 18,20 single-leg jumping with eyes open, 18 sit-to-stand testing, 18,20,26,27,47 timed upand-go tests, 25,32,40 and physical activity accelerometry. 40 However, Hansson et al, 18 in a study that relied on arthritis self-management education alone, reported improved standing balance as tested during single-leg standing with eyes closed compared to a control group. Studies that added exercise to arthritis self-management education displayed ASES subscale-score effect sizes comparable to those of studies that relied on arthritis self-management education alone.…”

Defizite der ergotherapeutischen Routineversorgung bei rheumatischen Erkrankungen

“…In der EULAR-("European League Against Rheumatism"-) und ebenso in der NICE-("National Institute for Health and Clinical Excellence"-) Leitlinie für die Behandlung der Arthrose wird dieser Ansatz und die Kombination von Patientenedukation und Übungsbe-handlung explizit empfohlen [8,9]. Murphy et al [15] wiesen in einer randomisierten kontrollierten Studie gesteigerte physische Aktivität durch ein ergotherapeutisches Therapieprogramm bei Patienten mit Hüft-und Kniegelenkarthrose nach. Eine weitere Studie weist auf die Reduktion der Operationsnachfrage durch eine Schienenbehandlung der Hand hin [16].…”