Prescribing exs for ppl with RA and outcome measures Flashcards
You are working with a pt with RA, what is some advice you would give them re. RA and exe?
- do not give up leisure this is first thing most ppl do
- being inactive - CV & aerobic issues
- muscle wasting - Rheumatoid Caohexia (muscle break down)
- risk for OP and meds could make this worse for them,
- global fatigue can get better with exs.
Will exs flare them up?
NO
What does exs help to improve in this RA population ?
aerobic cap, fatigue, pain, strength, BMD, function,
What are the best kind of programs for RA pts?
aerobic and strengthening programs
What is a key part of a PT”s plan for RA pts?
ALL pts with RA should have some form of aerobic and resistance exs. training as part of care plan
- need to have balance b/w activity and rest not to over fatigue
- too much rest gets jt. contractor, Ospor., CVD…
- need to progress slowly consider capsule stretch d/t swelling ; consider deformity
What is the effect of strength and aerobic training in an OA group?
+ effect on cartilage morphology
- protective to cartilage
What is improved with OA pt and PA?
P, ROM, strength, aerobic cap, decreased depression, stabilizing or decrease in disease severity
What kind of activities can you do for ppl with OA
pool; walking, low impact, stationary bike, cycling, nmk control, strength
WHat are the red flags with RA and PA
increased AM stiffness / P
- sudden P / jt discomfort
- jt swollen, hot, red soon afater exs (24hrs)
- decreased MSK strength
- neuro signs (C1-2)
- SOB with min exert. (CV distress)
What are the FITT guidelines for RA strength?
F = 2-3/wk
I = 50-80% max load, MMF, progress by 5-10% once adaptation happens
T = 1 set, 8-12 reps, (12 -15 , 50+)
T = 8-10 dynamic exs
- combine strength, endurance, functional
What types of equipment can u use for RA pts. strengthening ?
tubs/bands cuff/free weights pneuamtic or hydraulic electromag balls body weight
What are the FITT guidelines for RA aerobic?
F = 4-7/week almost every day I = 50-70% max HR (65-80% for CV fitness) T = accum 150min, w. min of 10min T = whole body dynamic
What types of exs. for aerobic and RA?
low impact swim/pool work esp if flaring cycling walking/nordic poles - tdmill - step/nu-step/elliptical / rowing/
Flexibility guidelines for RA
F = 2-3/wk (daily if muscle issue) I = into resistance not pain T = 30sec hold 2-4 reps T = static or dynamic PNF
What is the diff. b/w jt pain and DOMS?
jt pain = 24hrs
DOMS = 45-72hrs later
- impt to edu pt on this information
Can you use the overload principal for RA pt?
yes progress slowly and monitor reaction
- accomodate exs if there is P or restriction
- keep it self controlled
What are some ways of keeping adherence to PA programs?
Educate on benefits and risk talk about exs freq enhance self efficacy - problem solve exs issues - set ST goals communicate - exs W friend - journal - best way to keep adherence is to have cont progression of exs.
WHat is an out come measure?
- measure two points/ overtime
- stand. instructions, admin, instructions
What is Validity vs reliability vs responsiveness vs floor and ceiling effects?
Validity = how accurate it measures what its suppose to
Reliable = how uniformly test can be admin on multiple basis
- Intrarater
- interrater
- test-retest (multiple applications)
Responsiveness= how well the measure can detect a change
Floor & ceiling effects = cluster at lower or higher end of scale
WHat is criterion validity
how well measure compares to gold standard
WHat is the significance of responsiveness of a measure?
Tells you the MDC - min detectable change
- smallest change that can be detected by pt
- does not mean its impt. or that its good or bad
MCID- min clinically important diff
- smallest change that represents an impt. diff to the pt.
What are impt features of outcome measures?
- clinical feasibility
- equipment
- acceptable to pt
What are the 6 outcome measures typically used
1) Health Ax Quest (HAQ) (RA)
- how they are doing over past week
* * most widely used one***
2) EQ-5D (general pop, RA, OA)(health status)
- descriptive profile & single index value of health
3) MACTAR (RA, pt centred)
- Macmaster Toronto arth. pt preference disability
- whats impt to pt, pt preferences, Ax disability
- scripted, responsive to change
4) TUG
- Lower body strength, older ad
5) KOOS
- good for young ppl meniscus, OA TKA
- pt relevant outcomes
6) HOOS (similar to KOOS)
- hip disability OA outcome score
What are some different forms of validity?
Face
content
construct
convergent
Divergent
Criterion
Concurrent
Predictive
