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

1

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=113Disability Guidelines (2012). Joint Disorders. Retrieved on August 8, 2014 from http://www.mdguidelines.com/joint-disorders4Centers 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

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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

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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

4

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

5

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

6

7

Program Description

• Exercise classes 1x/week

• Pilates, Tai Chi, Yoga, Dance, Yogalates

• Led by certified exercise instructors

• Participants – English-speaking older

adults

8

Methodology

• Pre/post surveys – changes in health

outcomes – program satisfaction

• Approved by the HSS IRB

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

9

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

10

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

11

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%)

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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)

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Results: Total Sample (n = 204)

General a

ctivit

y*

Mood***

Walki

ng ability*

*

Normal w

ork***

Relations with

other people

Sleep*

Enjoyment o

f life**

00.5

11.5

22.5

3 2.7 2.62.8

2.4

1.5

2.4 2.42.2

1.62 2

1.2

1.7 1.7

Pain Interference on Aspects of Daily Living on an 11-point rating scale Pre vs. Post

PrePost

*denotes statistical significance at p≤0.05**denotes statistical significance at p≤0.01***denotes statistical significance at p≤0.001

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Results: Total Sample (n = 204)

Stiffness*0

0.5

1

1.5

2

2.5

32.8

2.3

PrePost

Fatigue***0

0.5

1

1.5

2

2.5

32.8

2

PrePost

*denotes statistical significance at p≤0.05 ***denotes statistical significance at p≤0.001

Mean Stiffness and Fatigue Levels on an 11-point rating scale Pre Vs. Post

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Results: Total Sample (n = 204)

Fair/Poor Execellent/Very Good/Good

0%

10%

20%

30%

40%

50%

60%

70%

80%

42%

58%

29%

71%

Balance Ratings*** (%)

PrePost

Moderate-intensity (≥ 30 mins)

Vigorous - intensity (≥ 20 mins)

0%

10%

20%

30%

40%

50%

60%

36%

50%

40%

53%

Level of PA*** (%)

PrePost

***denotes statistical significance at p≤0.001 ***denotes statistical significance at p≤0.001

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Results: Exercise Type

General Activ-ity**

Mood* Normal Work*

Enjoyment of Life*

0

0.5

1

1.5

2

2.5

3

3.5

43.8

2.6

3.3 3.2

1.31.1

0.70.5

PrePost

General Ac-tivity**

Mood** Walking Ability*

Enjoyment of Life*

0

0.5

1

1.5

2

2.5

3

3.5

4

2.9

3.5

3 3

2.2

1.7 1.71.9 Pre

Post

Pilates (n = 33) Yogalates (n = 41)

Pain Interference on Aspects of Daily Living on an 11-point rating scale Pre vs. Post

*denotes statistical significance at p≤0.05**denotes statistical significance at p≤0.01

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Results: Exercise Type

Tai Chi** (n=67)

Yoga ** (n=45) Dance (n=18)

0%

10%

20%

30%

40%

50%

60%

70%

63%59%

47%

30%

57%

41%

PrePost

Tai Chi*** (n=67)

Yoga*** (n=45)

Yogalates*** (n=41)

Pilates* (n=33)

Dance (n=18)

0%

20%

40%

60%

80%

100%

55%

39%

74%

68%64%

68%

59%

82%

73%

88%

PrePost

Pain Relief (%) Balance Ratings (%)

*denotes statistical significance at p≤0.05**denotes statistical significance at p≤0.01***denotes statistical significance at p≤0.001

Results: Exercise Type

Pilates (n=33)

Tai Chi (n=67)

Yoga** (n=45)

Dance (n=18)

Yogalates** (n=41)

0

1

2

3

4

5

6

7

5.5

4.5 4.3

6

4.5

2.7

3.6 3.4 3.53.2

Pain Intensity on an 11-point rating scale Pre vs. Post

PrePost

**denotes statistical significance at p≤0.01

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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.

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Program Satisfaction

Overall program Pace of exercise Ability to modify exercise Ability to explain exercise0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

69%66%

82%86%

19%22%

14%10%10% 10%

4% 5%2% 2% 1% 0%0% 0% 0% 0%

Satisfaction Ratings (%)

ExcellentVery GoodGoodFairPoor

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

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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!”

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Limitations

• Small sample size

• Survey fatigue

• Self-reported data

• Participation in exercise programs outside of study

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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

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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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Thank You!

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