Advertisement

Physical Therapy Management of Select Rheumatic Conditions in Older Adults

  • Maura Daly IversenEmail author
  • Madhuri K. Kale
Chapter

Abstract

Rheumatic diseases and their resultant musculoskeletal and cardiopulmonary impairments are primary conditions limiting activity and function in older adults. Certain rheumatologic conditions such as polymyalgia rheumatica, degenerative spinal stenosis, and osteoporosis occur later in life. Other conditions such as rheumatoid arthritis, osteoarthritis (OA), and ankylosing spondylitis manifest at younger ages but their clinical manifestations may exacerbate with advancing age and concomitant changes in the musculoskeletal and sensory–motor systems, and with the coexistence of multiple comorbidities and polypharmacy. In fact, studies (Dunlop et al., Arthritis Rheum 44:212–221, 2001; Covinsky et al., J Am Geriatr Soc 56:23–28, 2008) indicate that older adults with arthritis are more limited in mobility and activities of daily living. Physical therapy interventions focus on restoration, maintenance, and promotion of maximal physical function (American Physical Therapy Association, Guide to physical therapist practice, 2003). The physical therapy model of practice is based on the International Classification of Function (ICF) [World Health Organization, International Classification of Functioning, Disability, and Health (ICF): ICF full version, 2001] and addresses patients’ needs at multiple levels across a continuum of care (Fig. 12.1). Physical therapy interventions for older adults with rheumatologic conditions aim to reduce pain; increase and maximize joint mobility; muscle strength; flexibility; aerobic capacity and to prevent functional loss. Interventions consist of exercise, physical modalities (e.g. heat, cold), skilled techniques such as joint mobilization/manipulation, and use of orthotics and assistive devices, combined with patient education. This chapter discusses the physical therapy management of six rheumatic conditions: polymyalgia rheumatica, spinal stenosis, osteoporosis, rheumatoid arthritis, OA, and ankylosing spondylitis.

Keywords

Physical therapy Older adults Arthritis Polymyalgia rheumatica Spinal stenosis Osteoporosis Rheumatoid arthritis Osteoarthritis Ankylosing spondylitis 

References

  1. 1.
    Dunlop DD, Manheim LM, Song J, Chang RW. Arthritis prevalence and activity limitations in older adults. Arthritis Rheum. 2001;44:212–21.PubMedCrossRefGoogle Scholar
  2. 2.
    Covinsky KE, Lindquist K, Dunlop DD, Gill TM, Yelin E. Effect of arthritis in middle age on older-age functioning. J Am Geriatr Soc. 2008;56:23–8.PubMedCrossRefGoogle Scholar
  3. 3.
    American Physical Therapy Association (APTA). Guide to physical therapist practice. 2nd ed. Alexandria, VA: APTA; 2003.Google Scholar
  4. 4.
    World Health Organization. International Classification of Functioning, Disability, and Health (ICF). ICF full version. Geneva: World Health Organization; 2001.Google Scholar
  5. 5.
    Paget S, Spiera RF. Polymyalgia rheumatica. In: Bartlett S, editor. Clinical care text in rheumatic diseases. Atlanta, GA: American College of Rheumatology; 2006. p. 153–6.Google Scholar
  6. 6.
    Nothnagl T, Leeb BF. Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica. Drugs Aging. 2006;23:391–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Dasgupta B, Matteson EL, Maradit-Kremers H. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol. 2007;25 Suppl 47:130–6.PubMedGoogle Scholar
  8. 8.
    Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther. 2001;81:1110–7.PubMedGoogle Scholar
  9. 9.
    Iversen MD, Liang MH, Bae S. Selected arthrides: rheumatoid arthritis, osteoarthritis, spondyloarthopathies, systemic lupus erythematosus, polymyositis/dermatomyositis, and systmeic sclerosis. In: Frontera WR, Dawson DM, Slovik DM, editors. Exercise in rehabilitation medicine. Champaign, IL: Human Kinetics; 1999.Google Scholar
  10. 10.
    Alvarez JA, Hardy Jr RH. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician. 1998;57:1839–40.Google Scholar
  11. 11.
    Chad DA. Lumbar spinal stenosis. Neurol Clin. 2007;25:407–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Jonsson B, Annertz M, Sjoberg C, Stromqvist B. A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine. 1997;22:2932–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Katz JN, Dalgas M, Stucki G, Lipson SJ. Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am. 1994;20:471–83.PubMedGoogle Scholar
  14. 14.
    Lin SI, Lin RM. Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance. J Orthop Sports Phys Ther. 2005;35:220–6.PubMedGoogle Scholar
  15. 15.
    Iversen MD, Katz JN. Examination findings and self-reported walking capacity in patients with lumbar spinal stenosis. Phys Ther. 2001;81:1296–306.PubMedGoogle Scholar
  16. 16.
    Whitehurst M, Brown LE, Eidelson SG, D’Angelo A. Functional mobility performance in an elderly population with lumbar spinal stenosis. Arch Phys Med Rehabil. 2001;82:464–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res. 2001;384:144–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Iversen MD, Fossel AH, Katz JN. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Arch Phys Med Rehabil. 2003;84:1324–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Watters WC, Baisden J, Gilbert TJ, Kreiner S. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008;8:305–10.PubMedCrossRefGoogle Scholar
  20. 20.
    Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil. 1998;79:700–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Wencel J, Olson KA. Lumbar spinal stenosis: a literature review. J Man Manip Ther. 1999;7:141–8.CrossRefGoogle Scholar
  22. 22.
    Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:198–207.PubMedCrossRefGoogle Scholar
  23. 23.
    Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach for patients with lumbar spinal stenosis. Phys Ther. 1997;77:962–97.PubMedGoogle Scholar
  24. 24.
    Onel D, Sari H, Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine. 1993;18:291–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine. 2006;31:2541–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord. 2006;7:16.PubMedCrossRefGoogle Scholar
  27. 27.
    Pua Y-H, Cai C_C, Lim K-C. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother. 2007;53:83–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine lumbar spine study. Spine. 2005;30:936–43.PubMedCrossRefGoogle Scholar
  29. 29.
    Braithwaite RS, Nandana F, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51:364–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Harris ST, Watson NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis. JAMA. 1999;282:1344–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Solomon DH, Avorn J, Katz JN, et al. Compliance with osteoporosis medications. Arch Intern Med. 2005;165:2414–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Nguyen TV, Center JR, Eisman JA. Osteoporosis in elderly men and women: effects of dietary calcium, physical activity and body mass index. J Bone Miner Res. 2000;15:322–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Nelson ME, Fiatarone MA, Morganti CM, et al. Effects of high-intensity strength training on multiple risk factors for osteoporotic fracture: a randomized controlled trial. JAMA. 1994;272:1909–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Hartard M, Haber P, Ilieva D, et al. Systematic strength training as a model of therapeutic intervention: a controlled trial in postmenopausal women with osteopenia. Am J Phys Med Rehabil. 1996;75:21–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Iwamoto J, Takeda T, Ichimura S. Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis. J Orthop Sci. 2001;6:128–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Rhodes EC, Martin AD, Taunton JE, et al. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. Br J Sports Med. 2000;34:18–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Korpelainen R, Keinanen-Kiukaanniemi S, Heikkinen J, et al. Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int. 2006;17:109–18.PubMedCrossRefGoogle Scholar
  38. 38.
    Yamazaki S, Ichimura J, Takeda T, et al. Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis. J Bone Miner Metab. 2004;22:500–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Ebrahim S, Thompson PW, Baskaran V, Evans K. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing. 1997;26:253–60.PubMedCrossRefGoogle Scholar
  40. 40.
    The National Osteoporosis Foundation website. http://www.nof.org. Accessed 30 Apr 2008.
  41. 41.
    Gornisiewicz M, Moreland LW. Rheumatoid arthritis. In: Robbins L, Burckhardt CS, Hannan MT, DeHoratius RJ, editors. Clinical care in the rheumatic disease. Atlanta, GA: Association of Rheumatology Health Professionals; 2001. p. 89–96.Google Scholar
  42. 42.
    Ordu-Gokkaya NK, Koseoglu F, Albayrak N. Reduced aerobic capacity in patients with severe osteoporosis: a cross-sectional study. Eur J Phys Rehabil Med. 2008;44:141–7.PubMedGoogle Scholar
  43. 43.
    Iversen MD, Steiner L. Management of osteoarthritis and rheumatoid arthritis. In: Frontera WR, Slovnik DM, Dawson DM, editors. Exercise in rehabilitation medicine. Champaign, IL: Human Kinetics; 2005. p. 253.Google Scholar
  44. 44.
    Hillstrom HJ, Whitney K, McGuire J, Mahan KT, Lemont H. Evaluation and management of the foot and ankle. Rheumatoid arthritis. In: Robbins L, Burckhardt CS, Hannan MT, DeHoratius RJ, editors. Clinical care in the rheumatic diseases. Atlanta, GA: Association of Rheumatology Health Professionals; 2001. p. 203–11.Google Scholar
  45. 45.
    Semble EL, Loeser RF, Wise CM. Therapeutic exercise for rheumatoid arthritis and osteoarthritis. Semin Arthritis Rheum. 1990;20:32–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Gerber LH. Exercise and arthritis. Bull Rheum Dis. 1990;39:1–9.PubMedGoogle Scholar
  47. 47.
    Luck J. Enhancing functional ability. In: Robbins L, Burckhardt CS, Hannan MT, DeHoratius RJ, editors. Clinical care in the rheumatic diseases. 2nd ed. Atlanta, GA: American College of Rheumatology; 2001. p. 197.Google Scholar
  48. 48.
    Iversen MD, Fossel AH, Daltroy LH. Rheumatologist–patient communication about exercise and physical therapy in the management of rheumatoid arthritis. Arthritis Care Res. 1999;12:180–92.PubMedCrossRefGoogle Scholar
  49. 49.
    Moe RH, Haavardsholm EA, Christie A, et al. Effectiveness of nonpharmacological and nonsurgical interventions for hip osteoarthritis: an umbrella review of high-quality systematic reviews. Phys Ther. 2007;87:1574–6.CrossRefGoogle Scholar
  50. 50.
    Hicks JE. Exercise in rheumatoid arthritis. Phys Med Rehabil Clin N Am. 1994;5:701.Google Scholar
  51. 51.
    Byers PH. Effect of exercise on morning stiffness and mobility in patients with rheumatoid arthritis. Res Nurs Health. 1985;8:275–81.PubMedCrossRefGoogle Scholar
  52. 52.
    Kjeken I, Moller G, Kvien TK. Use of commercially produced elastic wrist orthoses in chronic arthritis: a controlled study. Arthritis Care Res. 1995;8:108–13.PubMedCrossRefGoogle Scholar
  53. 53.
    Stern EB, Ytterberg SR, Krug HE, Mullin GT, Mahowald ML. Immediate and short-term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis. Arthritis Care Res. 1996;9:42–50.PubMedCrossRefGoogle Scholar
  54. 54.
    Janisse DJ. Prescription footwear for arthritis of the foot and ankle. Clin Orthop Relat Res. 1998;349:100–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M. Metatarsalgia and rheumatoid arthritis – a randomized, single blind, sequential trial comparing 2 types of foot orthoses and supportive shoes. J Rheumatol. 2000;27:1643–7.PubMedGoogle Scholar
  56. 56.
    Ottawa P. Ottawa panel evidence-based clinical practice guidelines for electrotherapy and thermotherapy interventions in the management of rheumatoid arthritis in adults. Phys Ther. 2004;84 :1016–43.Google Scholar
  57. 57.
    Bilberg A, Ahlmen M, Mannerkorpi K. Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Rheumatology. 2005;44:502–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Hall J, Skevington SM, Maddison PJ, Chapman K. A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Care Res. 1996;9:206–15.PubMedCrossRefGoogle Scholar
  59. 59.
    de Jong Z, Munneke M, Jansen LM, et al. Differences between participants and nonparticipants in an exercise trial for adults with rheumatoid arthritis. Arthritis Rheum. 2004;51:593–600.PubMedCrossRefGoogle Scholar
  60. 60.
    de Jong Z, Vlieland TP. Safety of exercise in patients with rheumatoid arthritis [review]. Curr Opin Rheumatol. 2005;17:177–82.PubMedCrossRefGoogle Scholar
  61. 61.
    Sharma L. Local factors in osteoarthritis [review]. Curr Opin Rheumatol. 2001;13:441–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Pai YC, Rymer WZ, Chang RW, Sharma L. Effect of age and osteoarthritis on knee proprioception. Arthritis Rheum. 1997;40:2260–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br. 1991;73:53–6.PubMedGoogle Scholar
  64. 64.
    Klippel JH et al. Osteoarthritis. In: Klippel JH, Croford LJ, Stone JH, Weyand CM, editors. Primer on rheumatic diseases. Atlanta, GA: Arthritis Foundation; 2001. p. 280–93.Google Scholar
  65. 65.
    Lozada CJ, Altman RD. Osteoarthritis. In: Robbins L, Burckhardt CS, Hannan MT, DeHoratius RJ, editors. Clinical care in the rheumatic diseases. 2nd ed. Atlanta, GA: Association of Rheumatology Health Professionals; 2001.Google Scholar
  66. 66.
    Hoeksma HL, Dekker J, Ronday HK, et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum. 2004;51:722–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Bischoff HA, Roos EM. Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. Curr Opin Rheumatol. 2003;15:141–4.PubMedCrossRefGoogle Scholar
  68. 68.
    Fisher NM, Pendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil. 1991;72:367–74.PubMedGoogle Scholar
  69. 69.
    Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989;32:1396–405.PubMedCrossRefGoogle Scholar
  70. 70.
    Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 1992;116:529–34.PubMedGoogle Scholar
  71. 71.
    Ettinger Jr WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the fitness arthritis and seniors trial (FAST) [see comment]. JAMA. 1997;277:25–31.PubMedCrossRefGoogle Scholar
  72. 72.
    Mangione KK, McCully K, Gloviak A, et al. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci. 1999;54:M184–90.PubMedCrossRefGoogle Scholar
  73. 73.
    Elyan M, Khan MA. Spondyloarthropathies. In: Bartlett SJ, Bingham CO, editors. Clinical care in the rheumatic diseases. Atlanta, GA: American College of Rheumatology; 2006. p. 117–85.Google Scholar
  74. 74.
    François RJ, Braun J, Khan MA. Entheses and enthesitis: a histopathologic review and relevance to spondyloarthritides. Curr Opin Rheumatol. 2001;13:255–64.PubMedCrossRefGoogle Scholar
  75. 75.
    Uhrin Z, Kuzis S, Ward MM. Exercise and changes in health status in patients with ankylosing spondylitis. Arch Intern Med. 2000;160:2969–75.PubMedCrossRefGoogle Scholar
  76. 76.
    Dagfinrud H, Hagen KB, Kvien TK. The Cochrane review of physiotherapy interventions for ankylosing spondylitis. J Rheumatol. 2005;32:1899–906.PubMedGoogle Scholar
  77. 77.
    Kraag G, Stokes B, Groh J, Helewa A, Goldsmith C. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis: an 8-month follow-up. J Rheumatol. 1994;21:261–3.PubMedGoogle Scholar
  78. 78.
    Hidding A, van der Linden S, de Witte L. Therapeutic effects of individual physical therapy in ankylosing spondylitis related to duration of disease. Clin Rheumatol. 1993;12:334–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Northeastern UniversityBostonUSA

Personalised recommendations