Doctors' Arthritis Counseling Often Falls Short
Mar. 16, 2011 - Doctors are getting better at advising arthritis patients that they need to shed a few pounds - meeting one of the three goals set a decade ago by the federal government.
But physicians are missing the other two goals for arthritis care:
• Encouraging patients to learn more about managing their condition by taking a pain-management class
• Urging patients to exercise
The goals were set by the U.S. government in 2000 as part of a program called Healthy People 2010. Weight loss, arthritis education, and exercise have been shown to improve pain and quality of life for people with arthritis.
Researchers at the CDC recently assessed how well those goals had been met. Using data compiled from two national surveys involving more than 100,000 U.S. adults with arthritis, they found no change in the percentage of patients who took an arthritis pain-management class - 11 percent -- or who said they had been advised to start exercising -- 52 percent -- between 2002 and 2006. The goals for 2010 were 13 percent for self-care classes and 67 percent for exercise.
But the number of obese arthritis patients whose doctors told them to lose weight to help with pain management rose significantly -- from 35 percent in 2002 to 41 percent in 2006. That's only 5 percentage points away from the 2010 target of 46 percent.
Weight loss is an important goal in arthritis treatment. About 66 percent of arthritis patients are overweight or obese. The extra pounds increase stress on the joints, leading to chronic pain. Losing just 13 pounds can significantly reduce disability from knee osteoarthritis, according to the study, which was published in the March/April issue of Annals of Family Medicine.
"Doctors are pressed for time and may be focused on medications rather than behaviors," says lead author Charles Helmick, M.D., at the CDC. "They may not know how to connect people with the right sort of education or exercise programs."
But arthritis education programs can have an impact. They can "improve the health of an adult ... by 15 to 30 percent more than medication alone," the study says.
And, says Dr. Helmick, "there is good evidence that being physically active reduces pain in the long run, so it's just a matter of getting over the initial hump."
Low-impact exercises like walking, swimming, tai chi, and aquatic exercise are recommended for people with arthritis.
James Barber, M.D., at Coffee Regional Medical Center in Douglas, Ga., says the study findings reflect a very real doctor-patient communication gap.
Doctors hesitate to tell patients something obvious -- such as the need to lose weight - because they feel uncomfortable discussing the subject, Dr. Barber says.
"It's safe to say that the things this study measured -- education, weight loss, exercise -- we know they help patients. But how do we get doctors to talk freely and easily with patients?" he says.