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Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: A dissemination and implementation study
Author(s) -
van der Giesen F. J.,
van Lankveld W.,
HopmanRock M.,
de Jong Z.,
Munneke M.,
Hazes J. M. W.,
van Riel P. L. C. M.,
Peeters A. J.,
Ronday H. K.,
Vlieland T. P. M. Vliet
Publication year - 2010
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20138
Subject(s) - medicine , reimbursement , audit , physical therapy , population , intervention (counseling) , rheumatoid arthritis , scale (ratio) , nursing , health care , environmental health , business , economics , economic growth , physics , accounting , quantum mechanics
Objective To evaluate the implementation of an intensive group exercise program in patients with rheumatoid arthritis (RA). Methods In 4 regions in The Netherlands, the Rheumatoid Arthritis Patients In Training exercise program was implemented on a limited scale. Evaluation using the RE‐AIM model included: Reach, the proportion of the target population participating; Efficacy, effects on muscle strength, aerobic capacity, functional ability, and psychological functioning; Adoption, program adoption by stakeholders; Implementation, intervention quality (quality audits); and Maintenance, stakeholders' willingness to continue the program in the future. Results Twenty‐five physical therapists from 14 practices were trained to provide the program. In total, 150 RA patients were recruited (by estimation, 2% of the target population). Of the 81 patients who had finished the 12‐month intervention and were available for followup directly after the intervention, 62 patients provided clinical data. Muscle strength improved significantly, whereas aerobic capacity, functional ability, psychological functioning, and disease activity did not change. All 9 informed local patient organizations facilitated patient recruitment, and 35 of 51 rheumatologists involved referred one or more patients. All 10 approached health insurance companies funded the program for 12 months. The quality audits showed sufficient quality in 9 of 12 practices. All of the providers of the program were willing to provide the program in the future, whereas future reimbursement by health insurance companies remained unclear. Conclusion The implementation of an intensive exercise program for RA patients on a limited scale can be considered successful regarding its reach, adoption, and implementation. The limited effectiveness and the limited data regarding maintenance warrant additional research.

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