Prescribing exs for ppl with RA and outcome measures

Question 1

You are working with a pt with RA, what is some advice you would give them re. RA and exe?

Answer 1

• 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.

Question 2

Will exs flare them up?

Answer 2

NO

Question 3

What does exs help to improve in this RA population ?

Answer 3

aerobic cap, fatigue, pain, strength, BMD, function,

Question 4

What are the best kind of programs for RA pts?

Answer 4

aerobic and strengthening programs

Question 5

What is a key part of a PT”s plan for RA pts?

Answer 5

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

Question 6

What is the effect of strength and aerobic training in an OA group?

Answer 6

+ effect on cartilage morphology

- protective to cartilage

Question 7

What is improved with OA pt and PA?

Answer 7

P, ROM, strength, aerobic cap, decreased depression, stabilizing or decrease in disease severity

Question 8

What kind of activities can you do for ppl with OA

Answer 8

pool; walking, low impact, stationary bike, cycling, nmk control, strength

Question 9

WHat are the red flags with RA and PA

Answer 9

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)

Question 10

What are the FITT guidelines for RA strength?

Answer 10

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

Question 11

What types of equipment can u use for RA pts. strengthening ?

Answer 11

tubs/bands
cuff/free weights
pneuamtic or hydraulic 
electromag
balls
body weight

Question 12

What are the FITT guidelines for RA aerobic?

Answer 12

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

Question 13

What types of exs. for aerobic and RA?

Answer 13

low impact 
swim/pool work esp if flaring 
cycling 
walking/nordic poles 
- tdmill 
- step/nu-step/elliptical / rowing/

Question 14

Flexibility guidelines for RA

Answer 14

F = 2-3/wk (daily if muscle issue) 
I = into resistance not pain 
T = 30sec hold 2-4 reps 
T = static or dynamic  PNF

Question 15

What is the diff. b/w jt pain and DOMS?

Answer 15

jt pain = 24hrs
DOMS = 45-72hrs later
- impt to edu pt on this information

Question 16

Can you use the overload principal for RA pt?

Answer 16

yes progress slowly and monitor reaction

• accomodate exs if there is P or restriction
• keep it self controlled

Question 17

What are some ways of keeping adherence to PA programs?

Answer 17

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.

Question 18

WHat is an out come measure?

Answer 18

• measure two points/ overtime

- stand. instructions, admin, instructions

Question 19

What is Validity vs reliability vs responsiveness vs floor and ceiling effects?

Answer 19

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

Question 20

WHat is criterion validity

Answer 20

how well measure compares to gold standard

Question 21

WHat is the significance of responsiveness of a measure?

Answer 21

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.

Question 22

What are impt features of outcome measures?

Answer 22

• clinical feasibility
• • equipment
• acceptable to pt

Question 23

What are the 6 outcome measures typically used

Answer 23

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

Question 24

What are some different forms of validity?

Answer 24

Face
content
construct
    convergent
    Divergent 
Criterion 
    Concurrent 
    Predictive