Objective
To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease‐modifying ...antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA).
Methods
An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results
The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions.
Conclusion
This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team‐based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision‐making when applying these recommendations.
Objective
To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease‐modifying ...antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA).
Methods
An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results
The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions.
Conclusion
This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team‐based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision‐making when applying these recommendations.
Historically, the management of patients in the intensive care unit (ICU) has involved immobilization and sedation, with care focused on physiological impairments and survival. Because more ICU ...patients are now surviving their hospital stay, it is imperative that their ICU care be managed with the goal of long-term health, wellness, and functioning. The evidence confirms that mobilization and exercise are feasible in the ICU and demonstrates that the benefits of early mobilization include reduced length of stay in the ICU and hospital. In 2010, the Society of Critical Care Medicine (SCCM) invited key stakeholder groups, including the American Physical Therapy Association (APTA), to identify strategies to improve long-term consequences following ICU discharge, including early mobilization in the ICU and integration of the physical therapist as a member of the ICU team. This model appears to be successful in some institutions, but there is variation among institutions. The SCCM Task Force developed major areas of focus that require multidisciplinary action to improve long-term outcomes after discharge from an ICU. This article describes physical therapist practice in the management of ICU survivors, the importance of long-term follow-up after ICU discharge, and how APTA is taking steps to address the major areas of focus identified by the SCCM Task Force to improve long-term outcomes after ICU discharge.
Surviving critical illness is associated with persistent and severe physical, cognitive, and psychological morbidities. The Society of Critical Care Medicine has developed pain, agitation, and ...delirium guidelines and promoted mobility to improve care of critically ill patients. A task force has developed tools to facilitate and rapidly implement the translation of guideline care recommendations into practice. The Society of Critical Care Medicine has also assembled a task force to assess the long-term consequences of critical illness. This article will explore relationships between the pain, agitation, and delirium guidelines, mobility recommendations, and post-intensive care syndrome initiative. Implementation of the pain, agitation, and delirium guidelines taking into account current data regarding post-intensive care syndrome outcomes and potential interventions are an important first step toward improving outcomes for patients and their families. Research is needed to reduce the impact of long-term negative consequences of critical illness and to fully understand the best within- and post-ICU interventions, along with the optimal timing and dose of such interventions to produce the best long-term outcomes.
BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health ...status which may last for months and years after hospital discharge.
OBJECTIVES:To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families.
PARTICIPANTS:Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge.
DESIGN:Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems.
MEASUREMENTS AND MAIN RESULTS:Three major themes emerged from the conference regarding(1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member.
CONCLUSIONS:Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.
BACKGROUND:Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The ...post–intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families.
OBJECTIVES:To report on engagement with non–critical care providers and survivors during the 2012 Society of Critical Care Medicine post–intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes.
PARTICIPANTS:Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members.
DESIGN:Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences.
MEETING OUTCOMES:Future steps were planned regarding 1) recognizing, preventing, and treating post–intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post–intensive care syndrome across the continuum of care, including explicit “functional reconciliation” (assessing gaps between a patient’s pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post–intensive care syndrome research topic areas were identified across the continuum of recoverycharacterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families.
CONCLUSIONS:Raising awareness of post–intensive care syndrome for the public and both critical care and non–critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.
Osteoporosis is both preventable and treatable with exercise playing an important role in osteogenesis. The purpose of this systematic review was to determine which specific exercise programs ...utilizing weights were effective in maintaining or increasing bone mineral density (BMD) in postmenopausal women.
A computerized search of the MEDLINE, CINAHL, EMBASE, PEDro, and Science Citation databases was conducted for the period 1990 through February 2005. The search was performed using English language-only keyword searches using MESH terms osteoporosis, postmenopausal, exercise, weight training, and bone mineral density. A total of 20 articles was critically evaluated for the quality of an intervention study using the criteria developed by MacDermid. An expert on the topic was asked to review the list of articles for omissions.
The review revealed evidence to support the effectiveness of weight training exercises to increase BMD in postmenopausal women. The increases in BMD were site-specific and required high loading with a training intensity of 70% to 90% of 1 RM for 8 to 12 repetitions of 2 to 3 sets performed over one year duration.
Weighted exercises can help in maintaining BMD in postmenopausal women and increasing BMD of the spine and hip in women with osteopenia and osteoporosis. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women.
The Work Group consisted of APTA staff and staff-appointed physical therapist members representing a broad range of clinical expertise, practice settings, and patient populations. Since the 2014 ...publication of APTA's Choosing Wisely list, there has been some confusion about the interpretation of the terms "passive" and "physical agents" in Recommendation 1.
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