ABSTRACT
OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans. DESIGN: Longitudinal cohort study. SETTING: National probability sample. PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up. RESULTS: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans. CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis.
Subject(s)
Activities of Daily Living , Arthritis/ethnology , Arthritis/physiopathology , Black or African American/statistics & numerical data , Geriatric Assessment , Hispanic or Latino/statistics & numerical data , White People/statistics & numerical data , Aged , Female , Health Behavior , Health Services Needs and Demand , Humans , Longitudinal Studies , Male , Predictive Value of Tests , Prospective Studies , Risk Factors , United StatesABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient with osteoporosis and addresses the clinical presentation, assessment, medical management, and rehabilitation approaches to a patient with an acute vertebral fracture. It is part of the study guide on osteoporosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with postmenopausal osteoporosis. OVERALL ARTICLE OBJECTIVE: To summarize the clinical evaluation, medical management, and rehabilitation strategies in women with postmenopausal osteoporosis and acute vertebral fracture presentation.
Subject(s)
Osteoporosis/diagnosis , Osteoporosis/therapy , Alendronate/therapeutic use , Analgesics, Opioid/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Diagnosis, Differential , Humans , Osteoporosis/drug therapy , Osteoporosis/rehabilitation , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/drug therapy , Osteoporosis, Postmenopausal/rehabilitation , Osteoporosis, Postmenopausal/therapy , Pain/drug therapy , Risk Factors , Spinal Fractures/diagnosis , Spinal Fractures/therapy , Tramadol/therapeutic useABSTRACT
UNLABELLED: This self-directed learning module discusses a patient with knee osteoarthritis and addresses the clinical presentation, assessment, medical management, rehabilitation approaches, and surgical options. It is part of the chapter on osteoarthritis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacology, orthotics, exercise interventions, and surgical procedure options for a patient with knee osteoarthritis. OVERALL ARTICLE OBJECTIVE: To summarize diagnostic considerations and management of knee osteoarthritis.
Subject(s)
Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/therapy , Acute Kidney Injury/chemically induced , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Arthroplasty, Replacement, Knee/rehabilitation , Diagnosis, Differential , Disease Management , Exercise Therapy , Gastrointestinal Hemorrhage/chemically induced , Humans , Male , Orthotic Devices , Osteoarthritis, Knee/rehabilitation , Risk FactorsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient who had a total hip arthroplasty. The module addresses the medical management and rehabilitation interventions necessary to direct the postacute care needs of this patient. It is part of the study guide on rehabilitation of the joint replacement patient in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes planning for discharge from the acute care hospital, postacute care medical complications, and rehabilitation program elements germane to the patient with hip joint replacement. OVERALL ARTICLE OBJECTIVE: To summarize the postacute care planning, medical complications, and rehabilitation needs of the patient with hip joint replacement.
Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Aged , Bandages , Female , Humans , Length of Stay , Thromboembolism/prevention & control , Thrombolytic Therapy , Transportation of PatientsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of 2 patients: (1) a woman with bilateral, distal, upper-limb pain assessed by differential diagnosis, laboratory work-up, and treatment of rheumatologic disorders frequently seen in the physiatric practice setting and (2) a 57-year-old man with an acute recurring monoarthritis of the knee and addresses clinical presentation, assessment, medical management, and rehabilitation approaches. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on 2 aspects: (1) the differential diagnosis of polyarthralgia, distal upper-limb pain, criteria for classification of rheumatoid arthritis, synovial fluid analysis, and comprehensive treatment of rheumatoid arthritis, both pharmacologic and nonpharmacologic and (2) the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with calcium pyrophosphate dehydrate-induced monoarthritis of the knee. OVERALL ARTICLE OBJECTIVES: (a) Clinical evaluation, diagnosis, management, and rehabilitation strategies in persons with initial presentations of inflammatory distal upper-limb pain and (b) clinical evaluation of an individual with crystal-induced monoarthritis and differentiation of the pathophysiology, assessment, and treatment of chondrocalcinosis.
Subject(s)
Arthritis, Rheumatoid/rehabilitation , Chondrocalcinosis/rehabilitation , Adult , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Chondrocalcinosis/diagnosis , Diagnosis, Differential , Exercise Therapy , Female , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Radiography , Synovial Fluid/chemistry , Wrist Joint/diagnostic imagingABSTRACT
UNLABELLED: This self-directed learning module highlights the pathoanatomy and pathogenesis of lumbar spinal stenosis. The areas covered include assessment and therapeutic options in the rehabilitation of patients with degenerative lumbar spinal stenosis. It is part of the study guide on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVES: (a) To summarize the evaluation and management of lumbar spinal stenosis and (b) to review the pathoanatomy and pathogenesis of lumbar degenerative spinal stenosis.
