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Community-Based Healthy Aging Interventions for Older Adults with Arthritis and Multimorbidity

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Abstract

Examine the impact of programs led by community health workers on health and function in older adults with arthritis and other health conditions. We conducted a cluster-randomized trial of the Arthritis Foundation Exercise Program (AFEP) enhanced with the “10 Keys”™ to Healthy Aging compared with the AFEP program at 54 sites in 462 participants (mean age 73 years, 88 % women, 80 % white). Trained Community health workers delivered the 10-week programs. Outcomes assessed after 6 months included physical performance [Short Physical Performance Battery (SPPB)], Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and preventive health behaviors. Both groups experienced improvements. Performance improved by 0.3 SPPB points in the AFEP/“10 Keys”™ group and 0.5 in AFEP alone; WOMAC scores declined by 3.0 and 3.9 points respectively. More participants had controlled hypertension at 6 months in both groups (60.1 % baseline to 76.7 % in AFEP/10 Keys and from 76.5 to 84.9 % in AFEP alone) and greater diabetes control (from 15.0 to 34.9 and 15.5 to 34.1 %, respectively). These community-based programs showed similar improvements in preventive health, mobility and arthritis outcomes.

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Acknowledgments

This project was supported by the Centers for Disease Control, Grant Numbers: U48 DP005001, and U48 DP001918.

Author Contributions

Concept and design: Janice C. Zgibor, Joni Vanderbilt, Steven M. Albert, Anne B. Newman. Analysis and interpretation of data: Lei Ye, Molly B. Conroy, Joni Vanderbilt, Elizabeth (A) Schlenk, Anne (B) Newman. Drafting or revision of manuscript: Janice (C) Zgibor, Lei Ye, Robert M. Boudreau, Molly B. Conroy, Joni Vanderbilt, Elizabeth A. Rodgers, Elizabeth (A) Schlenk, Mini E. Jacob. Approval of the final version of the manuscript: Janice C. Zgibor, Lei Ye, Robert M. Boudreau, Molly (B) Conroy, Joni Vanderbilt, Elizabeth A. Rodgers, Elizabeth (A) Schlenk, Mini E. Jacob, Jane Brandenstein, Steven M. Albert, Anne (B) Newman. Anne B. Newman, Steven M. Albert, Robert M. Boudreau, Jane Brandenstein, Molly B. Conroy, Mini E. Jacob, Elizabeth A. Rodgers, Elizabeth A. Schlenk, Joni Vanderbilt, Lei Ye, Janice (C) Zgibor, all certify that the manuscript represents valid work and that neither the submitted manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA

    Janice C. Zgibor

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA

    Lei Ye, Robert M. Boudreau, Molly B. Conroy, Joni Vander Bilt, Elizabeth A. Rodgers & Anne B. Newman

  3. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA

    Molly B. Conroy

  4. School of Nursing, University of Pittsburgh, Pittsburgh, USA

    Elizabeth A. Schlenk

  5. Boston University, Boston, USA

    Mini E. Jacob

  6. Arthritis Foundation, Great Lakes Region, Pittsburgh, PA, USA

    Jane Brandenstein

  7. Department of Behavioral, Health and Community Science, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA

    Steven M. Albert

  8. Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA

    Anne B. Newman

Authors
  1. Janice C. Zgibor
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  2. Lei Ye
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  4. Molly B. Conroy
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  6. Elizabeth A. Rodgers
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  7. Elizabeth A. Schlenk
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  8. Mini E. Jacob
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  9. Jane Brandenstein
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  10. Steven M. Albert
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  11. Anne B. Newman
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Corresponding author

Correspondence to Anne B. Newman.

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Conflict of Interest

Anne B. Newman, Steven M. Albert, Robert M. Boudreau, Jane Brandenstein, Molly B. Conroy, Mini E. Jacob, Elizabeth A. Rodgers, Elizabeth A. Schlenk, Joni Vanderbilt, Lei Ye, Janice C. Zgibor have no conflicts to disclose.

Human Participation Protection

Human subjects: The University of Pittsburgh Institutional Review Board approved the study. Because the intervention was a research study that took place in community sites and was delivered by a lay member of the community, instructors were required to complete training in ethical conduct of research, which was provided by CAPH-PRC research staff. The training consisted of a 1-h session on ethics in human subject research. The content included materials available from the Institutional Review Board and those developed by CAPH-PRC specific to the research study. Subject matter included the Belmont Principles (United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research., 1978), informed consent, social and educational research concepts, confidentiality, and study design. Case studies reflecting anticipated challenges of the research study were presented and discussed.

Additional information

The CONSORT Statement: The trial is registered at ClinicalsTrials.gov: NCT01616433. Figure 2 is the Consort Flow Diagram.

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Zgibor, J.C., Ye, L., Boudreau, R.M. et al. Community-Based Healthy Aging Interventions for Older Adults with Arthritis and Multimorbidity. J Community Health 42, 390–399 (2017). https://doi.org/10.1007/s10900-016-0268-5

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