Arthritis is quite a broad umbrella for over 100 different variations that effect the joints and connective tissue. The most common being osteoarthritis which some studies suggest affects one in three people over 45. With three quarters of these people reporting constant pain.
Of course the personal impact of living with this pain is substantial and on top of this it has a significant economic consequence. One in eight family doctor consultations are for musculoskeletal issues and the estimate of cost to the economy in time off for arthritis related issues is $308 billion per year. [1]
This issue is of course not just limited to the US, with the UK, Canada and other nations reporting a similar upswing in the issue. [2]
At this point it is understandable, that arthritis has become a concern for employers as well as public officials, as it is of course now a serious public health concern. So the question remains, what exactly should local governments be doing to improve the quality of life of constituents with arthritis as well as helping to minimize the economic impact on their areas.
The Need for a Comprehensive Public Health Approach
Given that arthritis is a growing burden, having a comprehensive and affordable approach is essential. Whilst traditional treatment options do help, they have limitations and potentially harmful side effects. [3] This is where public health officials can help with the shift towards integrated systems and an emphasis on supported self management.
And for public health officials and government this comes largely down to supporting physical activity as an intervention to reducing pain. [4]
Muscle strengthening and activity-related exercises have been proven to be highly beneficial and typically have minimal negative effects. [5] These exercises not only improve physical health but also have positive effects on cardiovascular health, mental well-being, and overall quality of life. However many physical activity programs don’t meet the needs of individuals with painful musculoskeletal conditions. And in many areas facilities are lacking.
The Role of Local Authorities in Supporting Physical Activity
Local authorities play a crucial role in supporting their local populations to engage in physical activity. Not only in maintaining facilities that are appropriate for people with said conditions (pools are a particularly notable inclusion, as well as maintaining low difficulty walking trails). But, by partnering with other local organizations local authorities can ensure that physical activity programs are accessible and tailored to the needs of individuals with arthritis. Whilst there are several examples, there is one from the UK’s Greenwich area that was particularly effective.
Case Study: The Royal Borough of Greenwich Healthwise Physical Activity Referral Scheme
A successful example of a comprehensive physical activity program is the Royal Borough of Greenwich's Healthwise Physical Activity Referral Scheme. Whilst there are some limitations to this in the US due to the differences in healthcare services, it is still not overly impractical if time is spent working with local physicians.
The scheme in question provided support and motivation for Greenwich residents with long-term and painful conditions.
Participants are referred by their GP or nurse and receive an individually tailored exercise program and access to various classes across the borough.
Key statistics from last year's program indicate the positive impact of the Healthwise scheme. A significant number of GPs and Allied Health Professionals referred patients to the service, and the completion rate was 58%. Participants reported increased awareness, confidence, knowledge, and skills, with 80% of participants increasing their physical activity levels.
Furthermore, 65% of participants showed improvements in health outcomes.
This of course suggests that education is of course a substantial issue when it comes to managing arthritis. And of course with some cost issues prevalent in the US, relatively inexpensive alternatives can be provided.
Guides to rehabilitation exercise, or arthritis groups can be funded to achieve similar results. It seems most likely that if funding is tight the ideal solution would be to use a small amount of qualified physiotherapists in a group setting.
For example, a group for people with hand related arthritis would only require 1 physio for 10-30 participants for around an hour to be shown several exercises with household objects. Videos can also be found online, however, having the programs personalized and having an in person element is likely crucial to the success of such programs for many people. However, even simple pamphlets guiding people to useful information is better than nothing.
A Tiered Approach to Physical Activity Interventions
To make sure as many people as possible are reached, a tiered approach is recommended. This approach provides a basic framework, which we’d recommend running through our practical policy evaluation.
Tier 1: Self-Directed Physical Activity
Many individuals with reasonable mobility can benefit from self-directed physical activity using accessible community facilities.
Staff at these facilities should be trained to understand the needs of individuals with arthritis and similar conditions and ensure that the facilities are equipped accordingly.
Tier 2: Supervised Physical Activity
Some individuals may require supervised physical activity, including land- and water based exercise groups such as T'ai Chi, pilates, walking groups, or aqua aerobics as we suggested in the comments about maintaining appropriate facilities. These supervised programs provide additional support and guidance to ensure the safety and effectiveness of the exercises.
Tier 3: Structured Rehabilitation Programs
For individuals with significant joint issues, structured rehabilitation programs may be necessary. These programs would require much more supervision and may not be so easily implemented as a public health measure in the US.
Conclusion
As arthritis is a significant and growing problem that affects millions of individuals and places a substantial burden on healthcare systems and society as a whole, it is essential that policy makers consider what can be done to help those effected.
Physical activity interventions have proven to be effective at improving quality of life and reducing pain. As such it is important to consider what can be done to address the growing issue of arthritis and improve the quality of life for those affected.
References
1 - https://health.gov/healthypeople/about/workgroups/arthritis-workgroup
2 - https://www.local.gov.uk/case-studies/using-physical-activity-help-people-arthritis
3 - https://pubmed.ncbi.nlm.nih.gov/8660395/
4 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487631/
5 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352468/
