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

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
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