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  • County-by-County Analysis Finds Pockets of High Arthritis Prevalence

    As if the prevalence of arthritis in more than 1 and 5 Americans isn't challenging enough, now comes information that breaks down statistics at the county level to find that prevalence is very uneven across the US, with rates as low as 15.8% in some counties and more than 33% in others.

    The new statistics are part of the US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report set for release on May 20. That report describes the results of a detailed study of the 2014 Behavioral Risk Factor Surveillance System (BRFSS), a survey of 464,444 noninstitutionalized adults across the 50 states, the District of Columbia, and US territories.

    Researchers analyzed the prevalence rates for respondents who answered "yes" to the question "have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" and found that the overall prevalence rate for US adults is 22.7%.

    But that's not all they found. Because data were broken down by county, researchers were able to create a more granular view of just where arthritis was taking a toll. The worst areas: counties along the Appalachian Mountains, the Mississippi River, and the Ohio River. The majority of counties in Alabama, Kentucky, Michigan, Tennessee, and West Virginia registered in the highest quintile for prevalence (27.5%-38.6%).

    At the state level, West Virginia registered the highest overall incidence rate at 35.5% of residents, followed by Kentucky (31.4%), Alabama (31.1%), Michigan (28.7%), and Mississippi (27.1%). The lowest-prevalence state was Hawaii at 18.8%, with Texas not far behind at 19.3%, and California at 19.7%.

    Authors of the study write that the new state and county-level information should help guide health care decisions at the local level.

    "The high prevalence of arthritis in all counties, and the high frequency of arthritis-attributable limitations among adults with arthritis, suggests that states and counties might benefit from expanding underused, evidence-based interventions for arthritis that can reduce arthritis symptoms and improve self-management," authors write. "Few [adults] are aware of interventions that have been shown to reduce their joint pain (eg, physical activity) and help them better manage their arthritis (ie, self-management education)."

    APTA offers multiple resources on arthritis management through community-based programs, including an overview of evidence-based programs, and a decision aid to help physical therapists choose an appropriate program for the patient. Additionally, the US Bone and Joint Initiative (USBJI) offers a series of free public education programs aimed at helping providers increase community awareness of osteoarthritis treatment. APTA is a founding member of USBJI.

    Don't miss the NEXT Conference and Exposition for even more on the subject. Be sure to attend "New Arthritis Foundation Resources for Individuals With Arthritis," presented by Cindy McDaniel, senior vice president of consumer health at the Arthritis Foundation, and Lori Schrodt, PT, PhD, chair of the Health Promotion and Wellness Special Interest Group of the APTA Academy of Geriatric Physical Therapy.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • I have been advocating in my area since CBIC came to California in 2013 and since NHS recently stopped paying for iontophoresis. Given the above findings and the opioid epidemic, I would be very interested to know how I might be able to further help support APTA State Chapter leaders engage/re-engage Noridian Healthcare Solutions, Inc. and other fiscal intermediaries in conversations about the benefits of: 1) iontophoresis + ketoprofen for helping to manage arthritic pain when heat and cold modalities prove to be insufficient; and 2) community platform walkers (e.g. Alpha Basic Dolomite walker, U-step walker with platform accessories) for helping to manage postural collapse compounded by arthritic pain and weakness. Although some fiscal intermediaries pay for iontophoresis as an effective treatment alternative to oral pain medications and corticosteriod injections, as well as pay for community platform-type walkers, NHS does not pay for either of these. This kind of fractured payment support for effective interventions across the U.S.A. does not make sense to me. If NHS and NIH are not satisfied with the available research on iontophoresis and supportive community walking equipment for pain management, perhaps they could be encouraged to consider a minimum year-long trial period, and allow all physical therapists to receive payment for iontophoresis and for community platform walker assessments and patient/caregiver training. I would think NHS and NIH could fairly easily collect population outcome data to help verify or refute the effectiveness of these interventions for reducing arthritis pain and fall risk. Also, physical therapists can train caregivers to help patients (especially those with cognitive impairment/dementia) correctly use this modality and equipment so pain is not a barrier to movement, so pain is not a cause for falling/further deconditioning/more pain, and uncontrolled pain is not such a driver of caregiver distress. FYI: I want to acknowledge there are no direct financial conflicts of interest with regard to the products I mentioned above.

      Posted by Dr. Lise McCarthy, PT, DPT, GCS on 5/20/2016 1:39 PM

    • Why is it that when effective interventions are mentioned that "physical activity" or the like is always mentioned, but manual therapy is rarely mentioned. Personal trainers can do exercise. Why don't we promote something unique to our profession and in my experience is at least as important as exercise for pain relief. Below are a two articles that discuss the importance of manual therapy and they're both over a decade old. Deyle GD, Allison SC, Matekel RL, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005 Dec;85(12):1301-17. Hoeksma HL, Dekker J, Ronday HK, et al. Comparison of Manual Therapy and Exercise Therapy in Osteoarthritis of the Hip: A Randomized Clinical Trial. Arthritis & Rheumatism 2004:51: 722-729.

      Posted by Nick Rainey on 5/26/2016 12:40 AM

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