Exploring the Public Health Impact of an Intensive Exercise Program for Patients With Rheumatoid Arthritis: A Dissemination and Implementation Study

Objective. To evaluate the implementation of an intensive group exercise program in patients with rheumatoid arthritis (RA). Methods. In 4 regions in The Netherlands, the Rheumatoid Arthritis Patients In Training exercise program was implemented on a limited scale. Evaluation using the RE-AIM model included: Reach, the proportion of the target population participating; Efficacy, effects on muscle strength, aerobic capacity, functional ability, and psychological functioning; Adoption, program adoption by stakeholders; Implementation, intervention quality (quality audits); and Maintenance, stakeholders' willingness to continue the program in the future. Results. Twenty-five physical therapists from 14 practices were trained to provide the program. In total, 150 RA patients were recruited (by estimation, 2% of the target population). Of the 81 patients who had finished the 12-month intervention and were available for followup directly after the intervention, 62 patients provided clinical data. Muscle strength improved significantly, whereas aerobic capacity, functional ability, psychological functioning, and disease activity did not change. All 9 informed local patient organizations facilitated patient recruitment, and 35 of 51 rheumatologists involved referred one or more patients. All 10 approached health insurance companies funded the program for 12 months. The quality audits showed sufficient quality in 9 of 12 practices. All of the providers of the program were willing to provide the program in the future, whereas future reimbursement by health insurance companies remained unclear. Conclusion. The implementation of an intensive exercise program for RA patients on a limited scale can be considered successful regarding its reach, adoption, and implementation. The limited effectiveness and the limited data regarding maintenance warrant additional research

Bone tissue stiffness in the mandibular condyle is dependent on the direction and density of the cancellous structure.

Contains fulltext : 57238.pdf (publisher's version ) (Closed access)Variation in the apparent stiffness of cancellous bone is generally ascribed to variation in cancellous structure and density, while the bone tissue stiffness is assumed to be constant. The purpose of the present study was to examine whether the bone tissue stiffness is dependent on the direction and density of the cancellous structure. Bone tissue stiffness was estimated by combining mechanical testing and micro-finite element (micro-FE) modeling on cylindrical bone specimens obtained from the human mandibular condyle. One set of specimens was tested in the vertical direction of the condyle (n = 39) and another set in the transverse direction (n = 30). The cancellous structure of the specimens was characterized by micro-CT. The apparent bone stiffnesses predicted by the FE model correlated strongly (r2 = 0.91) with the measured apparent bone stiffnesses. Apparent bone stiffness in the transverse direction was considerably smaller than that in the vertical direction. In contrast, the predicted bone tissue stiffness was significantly larger in the transverse direction (E = 13.70 GPa) than in the vertical direction (E = 11.87 GPa). In addition, bone tissue stiffness correlated negatively with the bone volume fraction and directional sensitivity of the bone tissue stiffness increased with a decrease of bone volume fraction. The results suggest that the transversely oriented trabeculae in the mandibular condyle are stiffer and more mineralized than the vertically oriented trabeculae and that bone loss is compensated by an increase in the degree of mineralization