Physicians Not Following Arthritis Guidelines and Recommendations

March 15, 2011

Clinicians are providing weight-loss counseling to arthritis patients, but must improve in terms of exercise counseling and arthritis self-management education.

Clinicians are providing weight-loss counseling to arthritis patients, but must improve when it comes to exercise counseling and arthritis self-management education.

Study results published in the March/April issue of Annals of Family Medicine show that although physicians have made progress in following the recommendations outlined in Healthy People 2010 regarding weight-loss counseling for overweight patients with arthritis, they are doing a worse job when it comes to the other two recommendations of exercise counseling and arthritis self-management education.

According to the authors of “Monitoring Healthy People 2010 Arthritis Management Objectives: Education and Clinician Counseling for Weight Loss and Exercise,” although “statistically significant improvement has been made at the national level in clinician weight counseling of obese, but not overweight, adults with doctor-diagnosed arthritis,” there has been no significant improvement in physical activity counseling or arthritis education.

Healthy People 2010 (HP2010) included three arthritis-specific objectives: weight counseling among persons who were overweight and obese, physical activity counseling, and arthritis education. The objectives called for, by 2010, the proportion of adults with doctor-diagnosed arthritis having had arthritis education to reach 13%, the proportion of those receiving counseling for physical activity to reach 67%, and the proportion of patients who are overweight or obese to receive weight counseling to reach 46%.

To measure clinicians’ progress in meeting these goals, the authors “used data on adults aged 18 years and older with doctor-diagnosed arthritis from the 2002 and 2006 National Health Interview Survey (NHIS) to make national estimates and from the 2003 and 2007 Behavioral Risk Factor Surveillance survey (BRFSS) to make state-based estimates.” The reported prevalence of doctor-diagnosed arthritis was 20.7% of US adults, with a higher prevalence “observed in older adults, women, and those who were overweight or obese, whereas a lower prevalence was observed in those of Hispanic or other race/ethnicity.”

The authors reported that “the proportion of weight counseling of overweight and obese adults with doctor-diagnosed arthritis improved significantly from 2002 to 2006,” driven largely by “the increase observed among those who were obese, who comprised approximately 50% of the group.” Patients who were age 45 to 64 years, women, obese, or non-Hispanic black were most likely to have received weight counseling. They found that neither the proportion of physical activity counseling of adults with doctor-diagnosed arthritis nor the proportion of arthritis education of adults with doctor-diagnosed arthritis showed any statistically significant change.

In their discussion of these results, the authors wrote that the “lack of progress in clinician counseling for physical activity by people with diagnosed arthritis is problematic for two reasons: physical activity is well documented in reducing joint pain, and counseling by clinicians is one of the strongest predictors of higher physical activity levels of adults with arthritis.” Although the barriers to physical activity counseling by clinicians are well-known (lack of time, inadequate billing procedures, low reimbursement, lack of physician knowledge), the authors stated that “overcoming these barriers is important since several counseling interventions have been shown to be effective for increasing patients’ physical activity levels.” Likewise, the lack of progress in arthritis education is a missed opportunity as well,” because studies have shown that “arthritis self-management education programs can result in small to moderate reductions in pain and disability at little risk of adverse effects.”

HCPLive wants to know:

Do you incorporate weight-loss counseling and education into your treatment plan for obese or overweight patients with arthritis?

Do you also incorporate exercise counseling and discuss arthritis self-management education with your patients?

In your opinion, why are physicians and other clinicians falling short in these goals?

What resources would you recommend to your colleagues who want to improve the weight loss, exercise, and self-management education and counseling they provide to their patients?

Leave a comment below!