Criteria for meeting a quality indicator for osteoarthritis and the corresponding items on the questionnaire.
| Arthritis Foundation Quality Indicators for OA | Eligibility for the “IF” Statement | Eligibility for the “THEN” Statement | Rationale and Limitation |
|---|---|---|---|
| 1. Advice to exercise IF an ambulatory patient has had a diagnosis of symptomatic OA of the knee or hip for > 3 months AND has no contraindication to exercise and is physically and mentally able to exercise THEN a directed or supervised muscle-strengthening or aerobic exercise program should have been prescribed at least once and reviewed at least once per year | Had a diagnosis of hip and/or knee OA Answered “No” to: “Because of any condition or health problem, do you need the help of another person in personal care such as washing, dressing, or eating?” | Had seen a PT in the past year OR Had attended a land-based or pool exercise program OR Had used fitness facilities | Rationale: Those with OA would have participated in directed or supervised exercise at least once if they had seen a PT and/or attended a land-based/pool exercise program Limitations: The criteria would not identify individuals with severe dementia or other conditions that would preclude them from participating in programs. Those included in the analysis might or might not have had their exercise reviewed in the past year. Also, not all fitness facilities provide supervised programs |
| 2. Advice to lose weight IF a patient has symptomatic OA of the knee or hip and is overweight (BMI > 27 kg/m2) | Had a diagnosis of hip and/or knee OA and had BMI > 27 kg/m2 | Had used a weight-loss program or visited a dietician | Rationale: Those who used a weight-loss program or saw a dietician would have received weight-loss counseling |
| THEN the patient should be advised to lose weight at least annually AND the benefit of weight loss on the symptoms of OA should be explained to thepatient | Limitation: The “IF” criteria would not identify those who had been advised to lose weight and had successfully lost weight in the past year. Also, they would not include those who had been advised to lose weight by other health professionals; hence, the pass rate may be underestimated. Conversely, among those who received counseling, the visit might have been more than a year ago. In this case, the pass rate might be overestimated | ||
| 3. Assessment for ambulatory function: IF a patient has had symptomatic OA of the knee or hip and reports difficulty walking to accomplish activities of daily living for more than 3 months THEN the patient’s walking ability should be assessed for need for ambulatory assistive devices | Had a diagnosis of hip and/or knee OA Answered “severe” or “extreme” to (in the past 4 weeks): “How much pain did you have in your hip or knee walking on a flat surface?” | Had one or more visits to a PT or OT in the past year | Rationale: The criteria were modified to include people with severe or extreme pain within the past 4 weeks. There is evidence supporting the use of ambulatory assistive devices as early as possible to improve mobility. Those who saw a PT or OT would have been assessed for walking ability Limitation: The criteria would not identify people who had been assessed for ambulatory assistive devices by other health professionals. Also, the criteria would not identify those who had “severe” or “extreme” pain longer than 4 weeks, but visited a PT or OT in the past year and improved |
| 4. Assessment for nonambulatory function: IF a patient has a diagnosis of OA and reports difficulties with nonambulatory activities of daily living THEN the patient’s functional ability with problem tasks should be assessed for need of nonambulatory assistive devices to aid with problem tasks | Had a diagnosis of hip and/or knee OA Answered “severe” or “extreme” to: “What degree of difficulty do you have with rising from sitting, and/or putting on socks/stockings, and/or taking off socks/stockings, and/or getting in/out of bath, and/or getting on/off toilet?” | Had one or more visits to an OT in the past year | Rationale: The criteria were modified to include people with severe or extreme difficulties with nonambulatory activities at the time of the assessment. Our assumptions were that individuals reporting severe/extreme disabilities would have experienced problems with the activities months prior to the survey, and that during this time they should have been assessed by an OT for assistive devices Limitation: The “IF” criteria would not identify people who had severe or extreme difficulties with nonambulatory activities, but had improved when they completed the questionnaire. Also, it did not identify those who had been assessed for assistive devices by other health professionals |
OA: osteoarthritis; PT: physical therapist; OT: occupational therapist; BMI: body mass index.