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  • CDC: 40% of Patients With Arthritis Don't Receive Exercise Counseling From Providers

    Better, but still plenty of room for improvement—that's the US Center for Disease Control and Prevention's (CDC's) take on a recent analysis of the rate at which health care providers are counseling patients with arthritis to engage in physical activity (PA). The good news: the percentage of individuals with arthritis who received provider counseling for exercise grew by 17.6% between 2002 and 2014. The bad news: even after that growth, nearly 4 in 10 patients with arthritis still aren't receiving any information from their providers on the benefits of PA.

    The CDC analysis, which appeared in a recent edition of its Morbidity and Mortality Weekly Report, uses data from the National Health Interview Survey gathered in 2002 and 2014. In those years, the survey included a question on whether respondents had been told they have "arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia," as well as a question asking whether "a doctor or other health professional [has] ever suggested physical activity or exercise to help your arthritis or joint symptoms?"

    According to the CDC, in 2002, 51.9% of individuals with arthritis reported receiving PA counseling from a provider; by 2014, that percentage had grown to 61%—a 17.6% increase.

    The overall percentage in 2014 pushes the percentage slightly above the US Department of Health and Human Services' "Healthy People 2020" target of 57.4%, but the growth isn't uniform across subgroups analyzed, according to CDC. Among differences revealed in the analysis:

    • While the overall rate of exercise counseling was 61%, the rate for underweight or normal-weight individuals with arthritis was only 50%. Other subgroups that registered averages below the overall rate were non-Hispanic other races (53.8%), current smokers (56.9%), persons with no primary care provider (50.7%), and individuals who reported being inactive (56.7%).
    • Among the subgroups that reported higher-than-average rates of PA counseling were individuals with obesity (70%), persons whose activities were limited by arthritis (67.7%), those with 3 or more additional chronic conditions (67.6%), black non-Hispanic (63%) races, and Hispanic races (64.7%).
    • All subgroups recorded improvements in the rate of PA counseling between 2002 and 2014, but the most significant gains were made for males (from 44.8% to 58.3%), individuals with no additional chronic conditions (from 46% to 63.3%), the unemployed (from 47% to 61%), individuals with less than a high school education (from 45.9% to 59%), and individuals who reported 1 to 3 primary care provider visits annually (from 45.2% to 56.4%).

    The CDC report acknowledges the positive trends but references other studies that may shed some light on reasons for the less-than-optimal rates of PA counseling by providers. Among the findings are a 2014 survey that found that fewer than one-third of primary care physicians said they provided exercise counseling for arthritis during office visits, and another survey of health care providers that found that 61% of respondents felt unsure of—or lacked—knowledge and skills to provide counseling on exercise to patients with osteoarthritis or rheumatoid arthritis.

    "Incorporating counseling into clinical training curriculum and continuing education programming…might encourage health care providers to provide exercise counseling," the CDC says in its report. Authors also suggest that providers who feel unsure about counseling should consider referring patients to "evidence-based, community programs" such as Enhance Fitness, Walk with Ease, and Active Daily Living Every Day.

    The bottom line, according to the CDC, is that it's not time to rest on any laurels.

    "Prevalence of health care provider counseling for exercise among adults with arthritis has increased significantly over more than a decade," the report states, "but the prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive."

    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.

    Editor's note: APTA offers resources on encouraging healthy, active lifestyles at APTA's Prevention, Wellness, and Disease Management webpage. Also available: an APTA webpage on arthritis management through community programs. January 2018 also marks the debut of APTA's newest council: The Council on Prevention, Health Promotion, and Wellness in Physical Therapy.


    • What about massage therapy ...aka..."manual therapy"

      Posted by Kay on 1/10/2018 10:23 PM

    • To Kay: Massage therapy is not aka manual therapy. They are different. Massage therapy is to manual therapy as mechanic is to mechanical engineer.

      Posted by Brian Miller on 1/13/2018 8:47 AM

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