Abstract
BackgroundIn this study, we examined the implementation and efficacy of Operation Change, a community-based, culturally sensitive program to stimulate behavioral changes in activity level and improve musculoskeletal health in African-American (AA) and Hispanic/Latina (H/L) women with obesity and early-stage osteoarthritis.MethodsSixty-two women (32 AA and 30 H/L), 40–75 years old, with nontraumatic knee pain and body mass index values > 30, participated in a 12-week program of presentations, motivational interviewing, goal setting, and physical activities. Assessments (at 0, 6, and 12 weeks) included a demographic questionnaire, physical assessment, timed 50-ft walking test, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form-36 Health Survey (SF-36), 8-Item Physical Health Questionnaire (PHQ-8), and motivational interview assessment.ResultsWalking time improved significantly for H/L women (P < 0.0001) but not AA women (P = 0.0759). Both groups had significant mean weight loss (P < 0.05) with high variability among individuals. WOMAC scores for both groups indicated decreased pain (P < 0.0001) and stiffness (P < 0.0001) and improved physical functioning (P < 0.0001) by 12 weeks. SF-36 results were comparable to those of the WOMAC. PHQ-8 results improved significantly for H/L women (P < 0.0001) but not AA women (P = 0.077). Participants scored the motivational interviewing component of the program favorably.ConclusionsParticipation in Operation Change increased physical activity, resulting in improvements in pain and function scores. This supports a new paradigm for behavioral modification that helps AA and H/L women take an active role in living with osteoarthritis.
Highlights
In the USA, approximately 23% of adults have self-reported, physician-diagnosed arthritis; this rate is 50% for those older than 65 years [1]
According to the Centers for Disease Control and Prevention, a greater proportion of African-Americans (AAs) and Hispanics have activity limitations, work limitations, and severe joint pain compared with non-Hispanic whites [3]
The natural history of OA involves a vicious cycle of joint pain and limited mobility and is associated with comorbidities such as diabetes, fatigue, depression, and obesity
Summary
Ninety-two women (54 AA and 38 H/L) were screened. Twenty-two failed the screening (16 AA and 6 H/L), and 8 dropped out of the study (6 AA and 2 H/L), 1 of whom dropped out after completing 6 weeks of the program. For the WOMAC, significant improvements in pain, stiffness, and physical functioning subscores (all P < 0.0001) were observed for both AA and H/L groups (Fig. 3) during the 12-week period. All differences in mean WOMAC scores were greater than the minimal clinically important differences for each subscore [25]. At 12 weeks, AA women showed significant improvements in SF-36 subscores for physical functioning, bodily pain, and vitality (all P < 0.01). Improvements were observed for role-physical, social functioning, and role-emotional, but these changes were not significant (Fig. 4a). H/L women showed significant improvement for all SF-36 subscores by 12 weeks (Fig. 4b), with the exception of general health (P = 0.298). Many AA participants (53%) were in the range indicating no significant depression symptoms (score 0–4) for all three time periods. On a 10-point visual analog scale, the mean values of each component exceeded 9 points at 6 and 12 weeks
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