Session Information
Date: Wednesday, November 11, 2015
Title: ARHP V: Physical Activity
Session Type: ARHP Concurrent Abstract Session
Session Time: 9:00AM-10:30AM
Background/Purpose: Walk
with Ease (WWE) is the Arthritis
Foundation’s (AF) 6-week evidence-based walking program for adults with
arthritis that can be offered in 2 formats: 1) a group led by a trained
instructor; 2) or self-directed using only the workbook. Both formats have been shown to improve physical function, pain,
stiffness, fatigue and self-efficacy in non-Hispanic (NH) white and black
individuals with arthritis. The AF translated and modified the workbook for Hispanics,
Camine con Gusto (CCG).
The purpose of this study was to examine feasibility (recruitment),
tolerability (retention, adherence), safety (adverse events), acceptability
(satisfaction), and efficacy (effect sizes [ES]) of the self-directed version of
CCG.
Methods: A simple
pre and post 6-week evaluation with no usual care comparison group was
conducted in 285 Hispanics in North Carolina (NC). Self-reported outcomes
including symptoms (pain, stiffness, and fatigue visual analog scales [VAS]),
performance of activities of daily living (HAQ), perceived helplessness (RAI), and
self-efficacy in arthritis management (ASE) were evaluated. Means and effect
sizes (ES) with 95% confidence intervals were computed for changes in symptoms
between baseline and 6 weeks, adjusted for gender, age, education, body mass
index (BMI), comorbidities, and baseline outcome. Multiple imputation was
carried out for covariates due to a large amount of missing data for BMI (22%).
Results: The mean
age of the participants was 46.9 years, 44% had less than a high school degree,
2% were born in the USA, 60.1% spoke only Spanish, 74.7% were female, 44.6% had
a BMI ≥ 30. Feasibility was
demonstrated by recruitment and retention of 255 (84% completed 6 week
questionnaires) participants, safety established with no adverse events,
acceptability with 98% of participants reporting program satisfaction, and promise
with moderate ES of 0.50 for pain, 0.75 for fatigue, 0.49 for stiffness, 0.33
for the HAQ, 0.26 for RAI, and 0.24 for ASE (see Table). Efficacy was greatest for individuals who
reported walking at least 5 days per week (data not shown).
Conclusion: The self-directed CCG showed promise of self-reported
outcomes in Hispanics comparable to those noted in NH white and black
individuals with self-reported arthritis.
|
Table 1. CCG baseline characteristics of participants who completed the 6-week follow-up* |
|
|
Characteristic |
Statistic |
|
Age, mean ± SD |
46.9 ± 11.0 |
|
Education, % < HS
|
44.4 |
|
Born in USA, % |
2.5 |
|
Only Speak Spanish, % |
60.1 |
|
Female, % |
74.7 |
|
Body mass index, % ≥ 30 kg/m2 |
45.4 |
|
Number of comorbidities, mean ± SD |
1.23 ± 1.54 |
|
Self-reported function
|
|
|
General Health, % fair-poor |
47.3 |
|
HAQ (range 0-3), mean ± SD |
0.41 ± 0.44 |
|
Symptoms VAS (range 0-100), mean ± SD
|
|
|
Pain |
54.2 ± 25.7 |
|
Fatigue |
45.2 ± 30.2 |
|
Stiffness |
44.6 ± 29.1 |
|
Psychosocial
|
|
|
Rheumatology Attitudes Index (range 0-4), mean ± SD |
1.43 ± 0.92 |
|
Arthritis Self Efficacy (range 1-10), mean ± SD |
7.31 ± 2.14 |
|
HAQ: Health Assessment Questionnaire |
|
|
VAS: visual analog scale |
|
|
*Analysis includes only participants who completed follow-up measures at 6 weeks (n=255) |
|
|
Table 2. CCG covariate-adjusted† means (SD) for baseline and follow-up measures¥
|
||
|
Health Status Outcomes
|
Difference from Baseline (95% Confidence Interval) |
Effect Size (95% Confidence Interval) |
|
Symptoms VAS (range 0-100)
|
||
|
Pain
|
n=227 |
|
|
Baseline Mean (±SD) |
57.45 (18.86) |
|
|
Follow-up Mean (±SD) |
40.93 (43.03) |
|
|
Change (95% CI) |
-16.6 (-22.2,-11.0)‡ |
0.50 (0.35,0.65) |
|
Fatigue
|
n=222 |
|
|
Baseline Mean (±SD) |
49.73 (11.93) |
|
|
Follow-up Mean (±SD) |
33.42 (28.14) |
|
|
Change (95% CI) |
-15.5 (-19.2,-11.8)‡ |
0.75 (0.56,0.95) |
|
Stiffness
|
n=219 |
|
|
Baseline Mean (±SD) |
47.56 (27.60) |
|
|
Follow-up Mean (±SD) |
31.71 (36.45) |
|
|
Change (95% CI) |
-15.8 (-20.7,-11.0)‡ |
0.49 (0.31,0.67) |
|
Self-reported Function
|
||
|
HAQ (range 0-3)
|
n=222 |
|
|
Baseline Mean (±SD) |
0.46 (0.54) |
|
|
Follow-up Mean (±SD) |
0.30 (0.39) |
|
|
Change (95% CI) |
-0.16 (-0.21,-0.11)‡ |
0.33 (0.14,0.51) |
|
Psychosocial
|
||
|
Rheumatology Attitudes Index (range 0-4)
|
n=214 |
|
|
Baseline Mean (±SD) |
1.47 (0.56) |
|
|
Follow-up Mean (±SD) |
1.22 (1.19) |
|
|
Change (95% CI) |
-0.22 (-0.38,-0.06)‡ |
0.26 (0.08,0.45) |
|
Arthritis Self Efficacy (range 1-10)
|
n=222 |
|
|
Baseline Mean (±SD) |
7.18 (2.54) |
|
|
Follow-up Mean (±SD) |
7.79 (2.55) |
|
|
Change (95% CI) |
0.66 (0.33,1.00)‡ |
0.24 (0.07,0.42) |
|
†Adjusted for gender, age, education, BMI, comorbidities, and baseline outcome |
||
|
study site adjusted for as a random effect |
||
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¥Sample restricted to those who completed the 6-week follow-up (n=255) |
||
|
‡ p< 0.01 difference from baseline to 6 weeks |
||
|
Missing values for covariates multiply imputed |
||
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HAQ: Health Assessment Questionnaire; VAS: visual analog scale |
||
To cite this abstract in AMA style:
Callahan LF, Rivadeneira A, Altpeter M, Cleveland RJ, Hackney B, Vilen L, Sepulveda V, Reuland DS, Rojas C. Evaluation of a Self-Directed Walking Program in Hispanics with Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-a-self-directed-walking-program-in-hispanics-with-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-a-self-directed-walking-program-in-hispanics-with-arthritis/