Expanding Intervention Toolbox Screening Criteria for Approved Interventions

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Expanding Intervention ToolboxScreening
Criteria for Approved Interventions

• Jennifer M. Hootman, PhD
• Arthritis Program, CDC

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Session Overview

• Flow of intervention identification and screening
  process
• Definition of criteria
• Arthritis appropriateness
• Adequacy of evidence base
• Criteria for implementation
• Status of potential new interventions

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Interventions identified through environmental
scan
Unable to Screen
No
Program characteristics and implementation
details identified through publications, reports,
and supplemental materials
Extensive resources required
Unlikely to meet criteria
Yes
Meets arthritis appropriateness criteria
No
Not Recommended
Yes
Meets criteria for adequacy of evidence-base
Future Possibility
No
No, evaluation underway
Watch List
Yes
Meets criteria for implementation as a public
health intervention
Promising Practice
No
Yes
Recommended
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Physical Activity Interventions
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Criteria 1Arthritis Appropriateness
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Characteristics of the Intervention Study Design

• Participant control over activity intensity,
  frequency, duration
• Instructor training reinforces participant
  control
• Instruction is hands-off (no touch)
• Provide background information on fitness
• Flexible measures of success (participant feels
  competent and successful)

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Characteristics of the Physical Activity

• No contact/collision sports
• No competitive sports
• No jumping or high joint impact activity

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Characteristics of the Research

• Data available on general adult population (e.g.
  not elite athletes, military, pediatric)
• Dropout rates and reasons reported (e.g.
  injuries)
• No safety or injury concerns raised

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Criteria 2Adequacy of the Evidence Base
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Adequacy of the Evidence Base

• Intervention evaluated in present form
• Measured arthritis-relevant outcomes (e.g. pain,
  function, health status, PA level)
• Documentation of evidence
• Published journal article or written report
• Sample size minimum 75 in treatment group
• Pre-post measurements or more rigorous design
• Consistent trends in study results
• Overall study judged to have reasonable rigor

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Criteria 3Implementability as a Public Health
Intervention
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Implementability as a Public Health Intervention

• Leader/implementer requirements
• Academic degree not required
• Leader training available (as necessary)
• Site requirements
• No special facilities beyond a community room or
  pool for aquatics
• Equipment requirements
• No special equipment more expensive than a
  pedometer (lt15)

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Implementability as a Public Health Intervention
(contd)

• Cost to participants lt50
• Implementation guide available
• Supporting structures judged to be adequate to
  support wide implementation
• Training
• Technical assistance

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Self-Management Education Interventions
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Criteria 1Arthritis Appropriateness
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Characteristics of the Intervention Study Design

• Addresses content and outcomes of the importance
  in managing arthritis (pain, disability, and
  physical, psychological, or work function)
• Based on sound behavioral theory that enhances
  behavior change

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Characteristics of the Self-Management Education

• Fosters skills important in managing arthritis
  such as, goal setting, decision-making, problem
  solving and self-monitoring
• Consists of more than information dissemination
  (e.g. printed materials, oral instructions)

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Characteristics of the Research

• Data available on the general adult population
• Drop out rates and reasons reported
• No concerns raised regarding participant harm

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Criteria 2Adequacy of the Evidence Base
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Adequacy of the Evidence Base

• Intervention evaluated in present form
• Measured arthritis-relevant outcomes (e.g. pain,
  function, health status, PA level)
• Documentation of evidence
• Published journal article or written report
• Sample size minimum 75 in treatment group
• Pre-post measurements or more rigorous design
• Consistent trends in study results
• Overall study judged to have reasonable rigor

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Criteria 3Implementability as a Public Health
Intervention
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Implementability as a Public Health Intervention

• Leader/Implementer requirements
• No academic degree required
• Leader training available (as necessary
• Site requirements
• No special facilities beyond a community room
• Equipment requirements
• None required more expensive than a book, CD/DVD,
  or videotape

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Implementability as a Public Health Intervention
(contd)

• Cost to participants lt50
• Implementation guide available
• Supporting infrastructure (e.g. training,
  technical assistance) judged to be adequate to
  support wide implementation

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Expanding Intervention ToolboxStatus of
Potential New Physical Activity Interventions
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Recommended

• AF Exercise Program
• AF Aquatics Program
• EnhanceFitness
• Active Living Every Day
• Fit Strong!

Arthritis appropriate, adequate evidence base
and implementation infrastructure.
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Fit Strong!

• Developed for adults with OA
• Combined exercise (60 min) and education (30 min)
• Flexibility, strengthening, and aerobic walking
• 3 days x 90 min sessions for 8 weeks
• Leaders are Certified Exercise Instructors
• Improvements in self-efficacy, symptoms, exercise
  behavior, strength
• University of Illinois Chicago

www.fitandstrong.org
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Promising Practices

• None at this time

Arthritis appropriate, adequate evidence base,
building implementation infrastructure.
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Watch List

• Walk With Ease
• Fitness and Exercise for People with Arthritis
• People Exercising Program (Strong Living)
• AF Tai Chi
• First Step to Active Health
• A Matter of Balance

Arthritis appropriate, building evidence base
through evaluations in process.
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Future Possibilities

• Strong for Life/Faith in Action
• Strong Women
• Growing Stronger
• CHAMPS II
• Active Choices (not screened yet)

Arthritis appropriate, need additional evidence
base and implementation infrastructure.
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Unlikely to Meet Criteria

• CHAMPS I
• Diabetes Prevention Program

May be arthritis appropriate and have some
evidence base and implementation infrastructure
but are too intensive or require a lot of
resources.
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Expanding Intervention ToolboxStatus of
Potential New Self-Management Education
Interventions
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Recommended

• Arthritis Self-Management Program
• Chronic Disease Self-Management Program
• Spanish Arthritis Self-Management Program
• (Programa de Manejo Personal de la Artritis)
• Spanish Chronic Disease Self-Management Program
• (Tomando Control de su Salud)

Arthritis appropriate, adequate evidence base
and implementation infrastructure.
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Spanish Arthritis Self-Management Program

• 6 week, similar to ASMP
• Developed to be culturally appropriate
• Delivered in Spanish, no translators
• Improved self-rated health, pain, disability,
  depression and exercise behaviors.
• Stanford Patient Education Research Center
  (training), Bull Publishing (materials)

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Promising Practices

• The Arthritis Toolkit
• Healthier Living with Arthritis (Internet ASMP)

Arthritis appropriate, adequate evidence base,
building implementation infrastructure.
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Watch List

• None at this time.

Arthritis appropriate, building evidence base
through evaluations in process.
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Future Possibilities

• Internet-based CDSMP
• Translated CDSMP (e.g. Spanish)

Arthritis appropriate, need additional evidence
base and implementation infrastructure.
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Unlikely to Meet Criteria

• None at this time.

May be arthritis appropriate and have some
evidence base and implementation infrastructure
but are too intensive or require a lot of
resources.
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