Presented by Dr. Iversen in partial fulfillment of the requirements for a Doctor of Science Degree, Harvard University, Boston, MA.
How rheumatologists and patients with rheumatoid arthritis discuss exercise and the influence of discussions on exercise prescriptions
Version of Record online: 5 FEB 2004
Copyright © 2004 by the American College of Rheumatology
Arthritis Care & Research
Volume 51, Issue 1, pages 63–72, 15 February 2004
How to Cite
Iversen, M. D., Eaton, H. M. and Daltroy, L. H. (2004), How rheumatologists and patients with rheumatoid arthritis discuss exercise and the influence of discussions on exercise prescriptions. Arthritis & Rheumatism, 51: 63–72. doi: 10.1002/art.20168
- Issue online: 5 FEB 2004
- Version of Record online: 5 FEB 2004
- Manuscript Accepted: 20 JUN 2003
- Manuscript Received: 11 DEC 2002
- Doctoral Dissertation Award from the National Arthritis Foundation
- National Institutes of Health. Grant Number: AR36308
- Exercise prescriptions;
- Patient-provider communication;
To describe how patients and their rheumatologists discuss exercise, and to identify predictors of exercise prescriptions.
Twenty-five rheumatologists and 132 patients with rheumatoid arthritis completed questionnaires and were audiotaped during a subsequent clinic visit. Chi-square and t-tests assessed associations between variables. Principal components analysis identified patterns of talk about exercise. Multivariate logistic regression identified predictors of an exercise prescription.
Seventy of the 132 patients (53%) discussed exercise. Of these, 18 (26%) received an exercise prescription. Principal components analysis identified 3 patterns of talk about exercise. Aerobic exercise discussions contained more information about drawbacks, side effects, pain, and bargaining than did discussions about general exercises, and referral to physical therapy for exercise. Significant predictors of a prescription included rheumatologist-initiated discussion about exercise (odds ratio [OR] 4.6; P = 0.03); talk about exercise in improving function, exercise instructions, opinions about the usefulness of exercise (OR 3.1; P = 0.01); and discussions about non-exercise treatments (OR 1.6; P = 0.01).
Exercise and referral to physical therapy for exercise are discussed differently and are 4 times more likely to occur when the rheumatologist initiates the discussion. These discussions strongly impact on the likelihood a patient receives an exercise prescription.