Racial/Ethnic differences in quality of life for people living with arthritis who see a primary care physician.

OBJECTIVE: Previous research suggests that insufficient access to health care may contribute to health disparities in arthritis-related outcomes. The purpose of this article is to document whether racial disparities in health status, health-related quality of life (HRQOL), and activity limitations exist for individuals living with arthritis who have access to a primary care physician. METHODS: Cross-sectional survey data were collected in 2005 and 2008 from individuals seeking care at 11 family practice clinics in North Carolina. Participants self-reported their arthritis status, health status, physical and mental HRQOL, and activity limitations. Analysis of variance was used to determine whether there were differences in demographic and clinical characteristics of White (n= 405), Black (n = 244), and Latino (n = 100) participants who self-reported arthritis. Linear regressions determined whether race/ethnicity was significantly associated with HRQOL and activity limitations; whereas, logistic regression determined whether the odds of poor health were higher for Black and Latino participants, controlling for age, gender, body mass index, marital status, and number of comorbid conditions. RESULTS: Over 50% of participants reported fair/poor health status and more than 8 days of poor physical and mental health and 6 days of activity limitations during the past month. Latino participants were more likely to report fair/poor health status and fewer activity limitations than Whites or Blacks, whereas Black participants reported fewer days of poor mental health. CONCLUSION: Despite access to a primary care physician, racial/ethnic disparities exist. Future research should explore the underlying reasons for the persistence of these disparities.

Evaluation of group and self-directed formats of the Arthritis Foundation's Walk With Ease Program.

OBJECTIVE: To evaluate the effects of a revised 6-week walking program for adults with arthritis, Walk With Ease (WWE), delivered in 2 formats, instructor-led group or self-directed. METHODS: In an observational pre-post study design, 462 individuals with self-reported arthritis selected either a group format (n = 192) or a self-directed (n = 270) format. Performance and self-reported outcomes were assessed at baseline and at 6 weeks. Self-reported outcomes were assessed at 1 year. Adjusted mean outcome values for group and self-directed participants were determined using regression models, adjusting for covariates. RESULTS: At 6 weeks, significant adjusted mean improvements (P < 0.05) were seen for nearly all self-report and performance measures in both formats. Modest to moderate effect sizes (ES) were seen for disability (ES 0.16-0.23), pain, fatigue, and stiffness (ES 0.21-0.40), and helplessness (ES 0.24-0.28). The Arthritis Self-Efficacy (ASE) pain and symptom scales had modest improvements (ES 0.09-0.21). The performance measures of strength (ES 0.29-0.35), balance (ES 0.12-0.36), and walking pace (ES 0.12-0.32) all showed modest to moderate improvements. No adverse events were reported for either format. At 1 year, both formats showed modest improvement in ASE pain, but there were 5 outcomes where self-directed participants showed significant improvement, while the group participants did not. CONCLUSION: The revised WWE program decreases disability and improves arthritis symptoms, self-efficacy, and perceived control, balance, strength, and walking pace in individuals with arthritis, regardless of whether they are taking a group class or doing the program as self-directed walkers. At 1 year, some benefits are maintained, particularly among the self-directed. This is a safe, easy, and inexpensive program to promote community-based physical activity.

Cross-sectional comparison of extended anteroposterior and posteroanterior fixed flexion positioning to assess radiographic osteoarthritis at the knee: the Johnston County Osteoarthritis Project.

OBJECTIVE: To compare values for Kellgren/Lawrence (K/L) scale grade, joint space narrowing (JSN), and osteophytes in anteroposterior (AP) extended and fixed flexion posteroanterior (PA) radiographs obtained during a single clinic visit (the first followup of the Johnston County Osteoarthritis Project). METHODS: All films (n = 1,664 bilateral knees) were read by an experienced musculoskeletal radiologist. For each subject, AP and PA fixed flexion films were read in one sitting. K/L scale grades (range 0-4) and JSN and osteophytes (ranges 0-3) were assessed using standard atlases. Descriptive statistics were calculated for demographic and clinical variables. AP and PA fixed flexion results were compared by contingency table methods to obtain frequencies for K/L scale, JSN, and osteophyte grades using percent agreement and kappa coefficients. Results from the right and left knees were similar; data for the right knee are presented. RESULTS: There was substantial agreement between AP and PA fixed flexion reads for radiographic osteoarthritis, defined as a K/L scale grade ≥ 2 (89% agreement; κ = 0.73, 95% confidence interval 0.69-0.76). Substantial agreement was also seen for tibial osteophytes and medial JSN; slightly lower kappa values were observed for femoral osteophytes and lateral JSN. CONCLUSION: The requirements of large observational cohort studies are different than those of clinical trials, and sensitivity is less of an issue because of longer followup times. In cohort studies such as the Johnston County Osteoarthritis Project, there is substantial agreement by K/L scale grade for AP and PA fixed flexion radiographs, allowing incorporation of older films in longitudinal analyses.

Perceived barriers to physical activity among North Carolinians with arthritis: findings from a mixed-methodology approach.

BACKGROUND: A goal of the North Carolina Arthritis Plan is to reduce arthritis burden through regular physical activity. We identified community and personal factors that influence physical activity in individuals with arthritis. METHODS: In 2004 and 2005, 2479 individuals (53% self-reported arthritis) from 22 North Carolina communities completed a telephone survey (59.5% response rate) assessing health status, neighborhood characteristics, health attitudes, and demographic variables. Qualitative discussions (N=32) were conducted to further examine understanding of community and health and were enhanced with photographs. ANALYSIS: Descriptive analyses were conducted. A 2-sided binomial test (for each reason given for not being physically active) was used to test for significance between individuals with arthritis and the general population, using a Bonferroni test for multiple comparisons. Interviews and photographs were analyzed using qualitative software ATLAS.ti Version 5.0. RESULTS: Quantitative results show similar community-level reasons for physical inactivity (rural environment, heavy traffic, and lack of sidewalks) despite arthritis status. Yet personal reasons differed as individuals with arthritis more often cited physical inability and illness. In qualitative discussions, walking surfaces emerged as a primary barrier for those with arthritis. LIMITATIONS: Findings from this exploratory study may have limited generalization and warrant further study. CONCLUSIONS: The built environment and personal barriers should be considered when examining physical activity in individual with arthritis.

Estimation of Trends in Atmospheric Concentrations of Sulfate in the Northeastern United States.

Daily atmospheric concentrations of sulfate collected at six locations in the northeastern United States are regressed against meteorological factors, ozone, seasonal cycles, and time in order to determine if a significant trend in sulfate can be detected. The data used in this analysis were collected during the Sulfate Regional Experiment (SURE, 1977-1978) and the Eulerian Model Evaluation Field Study (EMEFS, 1988-1989). Ozone, specific humidity, and seasonal terms (reflecting the potential of the atmosphere for oxidation of sulfur dioxide) emerged as important explanatory variables. After accounting for the variability explained by environmental factors, the median estimated change in sulfate concentration from the six locations over the 11-year period is -22% (or -28% if ozone is not used as an explanatory variable). Although there are wide variations among locations, these changes are commensurate with an estimated 25% decline in sulfur emissions in the northeastern U.S. during the same period. These analyses provide insight into methods for detecting reductions in sulfate that may be expected to occur as a result of the Clean Air Act Amendments of 1990. Uncertainties in the estimates, with consideration of serial correlation in the data, imply a minimum detectable reduction of 10% using this modeling procedure with similar data availability.