Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: A dissemination and implementation study
Article first published online: 23 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 6, pages 865–872, June 2010
How to Cite
van der Giesen, F. J., van Lankveld, W., Hopman-Rock, M., de Jong, Z., Munneke, M., Hazes, J. M. W., van Riel, P. L. C. M., Peeters, A. J., Ronday, H. K. and Vlieland, T. P. M. V. (2010), Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: A dissemination and implementation study. Arthritis Care Res, 62: 865–872. doi: 10.1002/acr.20138
- Issue published online: 28 MAY 2010
- Article first published online: 23 FEB 2010
- Accepted manuscript online: 23 FEB 2010 12:00AM EST
- Manuscript Accepted: 9 FEB 2010
- Manuscript Received: 20 OCT 2008
- Dutch Arthritis Association. Grant Number: IMP-03-1
To evaluate the implementation of an intensive group exercise program in patients with rheumatoid arthritis (RA).
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.
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.
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.