9/29/2014 1 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis Rheumatological Rehabilitation: How are We Doing? Julie J. Keysor, PT, PhD Director, ENACT Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis: Arthritis State of the Science Meeting April 7, 2014 PUBLIC HEALTH THREAT
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9/29/2014
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Promoting Activity and Participation Among Persons with Arthritis
Rheumatological Rehabilitation:
How are We Doing?
Julie J. Keysor, PT, PhD
Director, ENACT
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Arthritis:
Arthritis State of the Science Meeting April 7, 2014
PUBLIC HEALTH
THREAT
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Why this meeting?
Arthritis State of the Science Meeting April 7, 2014
Why should rehabilitation
professionals care??
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Why this meeting?
ARTHRITIS:
Disability Threat
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
1) A look to the past
2) Major advances
3) Current gaps and upcoming challenges
4) Future needs
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Promoting Activity and Participation Among Persons with Arthritis
Rheumatological Rehabilitation
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Arthritis Rehabilitation: 1960s
“In 1965, as I started my career as a physical therapist,
my first patient was a woman with rheumatoid
arthritis, Functional Class IV. She had been treated with
high-dose corticosteroids for over 15 years and was
admitted to the rehabilitation unit for 2 weeks every
summer. Her treatment orders were for mat exercises
(passive and active-assisted range of motion.) I had
received 1 lecture on rheumatoid arthritis and
attended grand rounds about corticosteroids.”
Minor MA, The ACR at 75 2009
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Arthritis Rehabilitation…mid-late 1980s
Bluestone R. Br Med J. 1970; Katz WA.
Am J Med. 1985
Treatment supported by
limited research
Joint deformity often substantial
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Got Arthritis? ….Rest…ahh….
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Now:MOVE!
ENGAGED IN
COMPLEX ROLES
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Promoting Activity and Participation Among Persons with Arthritis
Major Advances over Past
Two Decades
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Advance #1: Medicine—Inflammatory
Conditions
• Early diagnosis & treatment
• Disease modifying medications
• Biological medications
• RESULT: Less joint and tissue destruction
• No cure
• Disability persists
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Advance #2:
Exercise
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
People with Osteoarthritis and Rheumatoid
Arthritis Can Exercise
• Intervention: Walking or Aquatic
Exercise
• Control: Range of motion
• Outcomes: No difference in
active joint counts & aerobic
capacity and walking speed
increased
Minor MA et al, Arthritis Care Res, 1989
Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
1990s Decade of Exercise Clinical Trials
• 21 clinical trials
• 11 rheumatoid arthritis
• 10 osteoarthritis
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014