Impact of a hospital based exercise program on m usculoskeletal health outcomes in older adults
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Impact of a Hospital-Based Exercise Program on M usculoskeletal Health Outcomes in Older Adults. Sandra Goldsmith, MA, MS, RD Director, Public & Patient Education Titilayo Ologhobo, MPH Public Heath Outcomes Manager, Public & Patient Education Osteoarthritis Action Alliance Lunch & Learn

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Impact of a Hospital-Based Exercise Program on M usculoskeletal Health Outcomes in Older Adults

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Impact of a hospital based exercise program on m usculoskeletal health outcomes in older adults

Impact of a Hospital-Based Exercise Program on Musculoskeletal Health Outcomes in Older Adults

Sandra Goldsmith, MA, MS, RD

Director, Public & Patient Education

Titilayo Ologhobo, MPH

Public Heath Outcomes Manager, Public & Patient Education

Osteoarthritis Action Alliance Lunch & Learn

October 15, 2014


Background

Background

  • Osteoarthritis (OA) is the leading cause of disability in the US, with estimates showing that 27 million Americans have the disease at an estimated cost of $89.1 billion per year1

  • One out of four people suffer from longstanding musculoskeletal conditions2

  • OA affects more than 70% of adults between 55 - 78 years of age3

  • Older adults with knee OA who engage in moderate physical activity at least 3 x/week can reduce the risk of arthritis-related disability by 47%4

Source:

1Leigh, J.P., Seavey, W., & Leistikow, B. (2001). Estimating the costs of job-related arthritis. Journal of Rheumatology, 28(7), 1647-1654.

2The Bone and Joint Decade. (2014). Global Alliance for Musculoskeletal Health. Retrieved on Jan 10, 2014 from http://bjdonline.org/?page_id=11

3Disability Guidelines (2012). Joint Disorders. Retrieved on August 8, 2014 from http://www.mdguidelines.com/joint-disorders

4Centers for Disease Control and Prevention. (2011). Healthy People 2020: Overview of physical activity. Retrieved on August 8, 2012 from http://www.cdc.gov/arthritis/press/questions.htm


Hospital for special surgery hss

Hospital for Special Surgery (HSS)

  • Orthopedic hospital known for its expertise in musculoskeletal and rheumatologic conditions

  • Committed to providing the highest quality patient care, improving mobility, and enhancing the quality of life of the community it serves

  • Longstanding history of providing community service and programs to populations of all socio-demographic backgrounds


Osteoarthritis wellness initiative oawi

Osteoarthritis Wellness Initiative (OAWI)

  • Educate, raise awareness and reduce the impact of OA in the community

  • Educational seminars and workshops

  • Exercise classes (focus of today’s presentation)

  • Free or low-cost programs

  • Open to the public


The oawi team

The OAWI Team

  • Laura Robbins, DSW – Senior Vice President

  • Sandra Goldsmith, MA, MS, RD –Director

  • Titilayo Ologhobo, MPH – Outcomes Manager

  • Robyn Wiesel, CHES – Manager

  • Huijuan Huang, MPA – Senior Program Coordinator

  • Linda Roberts, LCSW – Program Coordinator

  • Madeline Meislin – Assistant Coordinator


Oawi exercise classes

OAWI Exercise Classes

  • Goal: improve musculoskeletal health among exercise class participants by:

    • decreasing musculoskeletal pain, stiffness, fatigue, falls and health limitations

    • improving health status, level of physical activity and self-efficacy for exercise

    • improving balance ratings and reducing losses in balance


Program description

Program Description

  • Exercise classes 1x/week

  • Pilates, Tai Chi, Yoga, Dance, Yogalates

  • Led by certified exercise instructors

  • Participants

    • English-speaking older adults


Methodology

Methodology

  • Pre/post surveys

    • changes in health outcomes

    • program satisfaction

  • Approved by the HSS IRB


Outcomes measures

Outcomes Measures

  • Standardized and validated instruments

  • Self-reported

  • Pain

    • Pain Relief (Yes/No)

    • Pain intensity measured by the Numeric Pain Intensity Scale

    • Pain interference on seven aspects of daily living from the Brief Pain Inventory

  • Stiffness

    • Single-item stiffness rating scale from the Brief Stiffness Inventory


  • Outcomes measures1

    Outcomes Measures

    • Fatigue

      • Single-item fatigue rating scale from the Brief Fatigue Inventory

  • Balance

    • 5-point rating scale

  • Physical Activity (PA)

    • Three-question Physical Activity Assessment


  • Data analysis

    Data Analysis

    • Three levels of analysis

      • Total sample

      • Exercise type

      • Sample with arthritis conditions (OA & RA)

    • Matched pairs

    • Paired sample t-test

    • Chi-square test

    • Demographic data


    Results

    Results

    • Time frame

      • Spring 2011 – Spring 2014

    • Program Reach

      • 803 total participants

      • 204 respondents collected via matched pre/post-surveys

    • Demographic Data

      • Female (91%) and Caucasian (86%)

      • Participants were generally older

        • 65-74 yrs. (25%)

        • 75-84 yrs. (36%)

        • >85 yrs. (31%)


    Results total sample n 204

    Results: Total Sample (n = 204)

    • Pain Relief

      • Pain significantly decreased from pre to post test (56% to 47%, p≤0.001)

    • Pain Intensity

      • Statistically significant reductions (p≤0.001) in mean pain intensity (pre-test = 4.6; post-test = 3.9)


    Results total sample n 2041

    Results: Total Sample (n = 204)

    *denotes statistical significance at p≤0.05

    **denotes statistical significance at p≤0.01

    ***denotes statistical significance at p≤0.001


    Results total sample n 2042

    Results: Total Sample (n = 204)

    Mean Stiffness and Fatigue Levels on an 11-point rating scale

    Pre Vs. Post

    ***denotes statistical significance at p≤0.001

    *denotes statistical significance at p≤0.05


    Results total sample n 2043

    Results: Total Sample (n = 204)

    ***denotes statistical significance at p≤0.001

    ***denotes statistical significance at p≤0.001


    Results exercise type

    Results: Exercise Type

    Pain Interference on Aspects of Daily Living on an 11-point rating scale

    Pre vs. Post

    Pilates (n = 33)

    Yogalates (n = 41)

    *denotes statistical significance at p≤0.05

    **denotes statistical significance at p≤0.01


    Results exercise type1

    Results: Exercise Type

    Balance Ratings (%)

    Pain Relief (%)

    *denotes statistical significance at p≤0.05

    **denotes statistical significance at p≤0.01

    ***denotes statistical significance at p≤0.001


    Results exercise type2

    Results: Exercise Type

    **denotes statistical significance at p≤0.01


    Results sample with arthritis conditions n 20

    Results: Sample with Arthritis Conditions (n = 20)

    • OA and/or RA*

    • Pain Intensity

      • mean pain intensity dropped from 3.6 to 2.9

    • Pain Interference

      • mean pain interference reduced on all aspects of their quality of life

    • Fatigue

      • mean fatigue level dropped from 3.8 to 2.5(p ≤ 0.001)

    • Physical Activity

      • ≥ 20 minutes of vigorous – intensity PA increased from 13% to 25% (p ≤ 0.05)

    *Small sample size because collection of data on musculoskeletal conditions commenced in 2013.


    Program satisfaction

    Program Satisfaction

    98% would recommend the program to a friend or family member


    Qualitative reviews

    Qualitative Reviews

    • “This is a wonderful class, taught by a wonderful teacher”

    • “Superb! An amazing teacher...even her voice is calming”

    • “The exercise classes are terrific”

    • “I recommended this program to many of my friends”

    • “I recommend that HSS could offer the class twice a week”

    • “I have acquired many valuable exercises from this terrific program which I now incorporate into my daily routine”

    • “Excellent class, excellent instructor! We all love it!”


    L imitations

    Limitations

    • Small sample size

    • Survey fatigue

    • Self-reported data

    • Participation in exercise programs outside of study


    Summary

    Summary

    • HSS exercise programs are effective in improving musculoskeletal health outcomes and are associated with positive changes in pain, balance, fatigue, fitness and certain aspects of QOL

    • It is important to identify effective programs that raise awareness and reduce the impact of musculoskeletal conditions


    Next steps

    Next Steps

    • Implement necessary changes to program outcome measures and evaluation methodology based on results

    • Broaden the variety of classes offered and implement other models to increase program reach

    • Explore next phase of program evaluation


    Thank you

    Thank You!


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