Lauren M. Abbate

Background/Objectives: The educational needs of individuals with OA and obesity can drive personalized resources for effective dietary interventions that align patient interests with weight and disease management. Therefore, the purpose of the present study was to evaluate differences in nutritional education topics of interest between patients with OA who are characterized as having higher (≥30 kg/m²; HBMI) and lower BMI (2; LBMI). Methods: Cross-sectional survey data (n = 296) were dichotomized into HBMI (n = 172; BMI: 38.67 ± 6.59 kg/m²) and LBMI (n = 124; BMI: 25.59 ± 3.00 kg/m²) groups. A mixed-method approach examined group differences across four primary domains: (i) strategies for weight management and healthy lifestyle, (ii) interest in vitamins and supplements, (iii) foods and nutrient with anti-inflammatory properties, and (iv) dietary patterns for weight loss. Logistic regression models compared topic interests between groups. Thematic analysis of open-ended responses captured additional insights. Results: Compared to LBMI participants, those in the HBMI group showed greater interest in weight loss strategies, emotional eating, and diets such as low-carbohydrate and ketogenic approaches, but less interest in general supplement information and plant-based diets. HBMI also had greater interest in practical strategies (e.g., feeling full, affordable foods) and reduced interest in certain anti-inflammatory foods. Both groups expressed a desire for evidence-based resources on foods that promote joint health. Conclusions: BMI-specific differences in nutritional education preferences highlight the need for tailored, patient-centered strategies in OA management. Addressing these differences may improve the effectiveness of education interventions and enhance patient–provider communication around diet and lifestyle in OA care.

Exercise is an established intervention for the management of arthritis, but it is unclear whether general exercise programs, such as Gerofit clinical exercise program for older veterans, are effective for arthritis. This secondary data analysis of previously collected Gerofit data evaluated the effect 3 months of participation had on physical function by self-reported arthritis status (ie, no arthritis, any arthritis, lower body arthritis, or both upper and lower body arthritis). Veterans aged ≥ 65 years from 5 sites were included. Physical function measures included 10-meter walk test for usual gait speed (m/s), 30-second arm curl test, 30-second chair stand test, and 6-minute walk distance test (m). Linear models estimated the change from baseline to 3 months, adjusting for arthritis status, age, and body mass index. This study included 737 patients. At 3 months, each group improved physical function across all 4 measures with no differences across any arthritis status group. Gerofit exercise was associated with functional gains, regardless of arthritis status. Participation in 3 months of supervised outpatient exercise programs, such as Gerofit, can improve physical function for older adults, regardless of arthritis status. These programs may increase access to exercise programming that is beneficial for common conditions affecting older adults, such as arthritis.

Objectives: We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals. Methods: Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change. Results: Active and inactive participants differed in their perspectives about how Gerofit impacted their progress toward meeting personal health goals. Active participants noted program features (e.g., schedule, staffing) as facilitators and suggested greater self-efficacy about program participation compared to inactive participants. Both groups perceived the camaraderie with other veterans as a facilitator. Conclusions: Exercise program features, including camaraderie, are important factors that affect the ability of older veterans to participate in exercise and achieve personal health goals.

Background: There are 8.8 million American veterans aged >65 years. Older veterans often have multiple health conditions that increase their risk of social isolation and loneliness, disability, adverse health events (eg, hospitalization and death), mental illness, and heavy health care use. This population also exhibits low levels of physical function and daily physical activity, which are factors that can negatively influence health. Importantly, these are modifiable risk factors that are amenable to physical therapy intervention. We used a working model based on the dynamic biopsychosocial framework and social cognitive theory to conceptualize the multifactorial needs of older veterans with multiple health conditions and develop a novel, 4-component telehealth program to address their complex needs. Objective: This study aims to describe veterans’ experiences of a multicomponent telehealth program and identify opportunities for quality and process improvement. We conducted qualitative interviews with telehealth program participants to collect their feedback on this novel program; explore their experience of program components; and document perceived outcomes and the impact on their daily life, relationships, and quality of life. Methods: As part of a multimethod program evaluation, semistructured interviews were conducted with key informants who completed ≥8 weeks of the 12-week multicomponent telehealth program for veterans aged ≥50 years with at least 3 medical comorbidities. Interviews were audio recorded and transcribed. Data were analyzed by a team of 2 coders using a directed content analysis approach and Dedoose software was used to assist with data analysis. Results: Of the 21 individuals enrolled in the program, 15 (71%) met the inclusion criteria for interviews. All 15 individuals completed 1-hour interviews. A total of 6 main conceptual domains were identified: technology, social networks, therapeutic relationship, patient attributes, access, and feasibility. Themes associated with each domain detail participant experiences of the telehealth program. Key informants also provided feedback related to different components of the program, leading to adaptations for the biobehavioral intervention, group sessions (transition from individual to group sessions and group session dynamics), and technology supports. Conclusions: Findings from this program evaluation identified quality and process improvements, which were made before rigorously testing the intervention in a larger population through a randomized controlled trial. The findings may inform adaptations of similar programs in different contexts. Further research is needed to develop a deeper understanding of how program components influence social health and longer-term behavior change.

While there is some research investigating whole foods or diets that are easily understood and accessible to patients with osteoarthritis, specific nutrients or nutraceuticals are more commonly identified. Unfortunately, guidelines and evidence surrounding individual nutrients, extracts, and nutraceuticals are conflicting and are more difficult to interpret and implement for patients with osteoarthritis. The purpose of this umbrella review is to provide a comprehensive understanding of the existing evidence of whole foods and dietary patterns effects on osteoarthritis-related outcomes to inform evidence-based recommendations for healthcare professionals and identify areas where more research is warranted. A literature search identified relevant systematic reviews/meta-analyses using five databases from inception to May 2022. Five systematic reviews/meta-analyses were included in the current umbrella review. Most evidence supported the Mediterranean diet improving osteoarthritis-related outcomes (e.g., pain, stiffness, inflammation, biomarkers of cartilage degeneration). There was little to no evidence supporting the effects of fruits and herbs on osteoarthritis-related outcomes; however, there was some suggestion that specific foods could potentiate symptom improvement through antioxidative mechanisms. The overall lack of homogeneity between the studies limits the conclusions that can be made and highlights the need for quality research that can identify consumer-accessible foods to improve osteoarthritis-related symptoms.

BACKGROUND There are 8.8 million American veterans aged >65 years. Older veterans often have multiple health conditions that increase their risk of social isolation and loneliness, disability, adverse health events (eg, hospitalization and death), mental illness, and heavy health care use. This population also exhibits low levels of physical function and daily physical activity, which are factors that can negatively influence health. Importantly, these are modifiable risk factors that are amenable to physical therapy intervention. We used a working model based on the dynamic biopsychosocial framework and social cognitive theory to conceptualize the multifactorial needs of older veterans with multiple health conditions and develop a novel, 4-component telehealth program to address their complex needs. OBJECTIVE This study aims to describe veterans’ experiences of a multicomponent telehealth program and identify opportunities for quality and process improvement. We conducted qualitative interviews with telehealth program participants to collect their feedback on this novel program; explore their experience of program components; and document perceived outcomes and the impact on their daily life, relationships, and quality of life. METHODS As part of a multimethod program evaluation, semistructured interviews were conducted with key informants who completed ≥8 weeks of the 12-week multicomponent telehealth program for veterans aged ≥50 years with at least 3 medical comorbidities. Interviews were audio recorded and transcribed. Data were analyzed by a team of 2 coders using a directed content analysis approach and Dedoose software was used to assist with data analysis. RESULTS Of the 21 individuals enrolled in the program, 15 (71%) met the inclusion criteria for interviews. All 15 individuals completed 1-hour interviews. A total of 6 main conceptual domains were identified: technology, social networks, therapeutic relationship, patient attributes, access, and feasibility. Themes associated with each domain detail participant experiences of the telehealth program. Key informants also provided feedback related to different components of the program, leading to adaptations for the biobehavioral intervention, group sessions (transition from individual to group sessions and group session dynamics), and technology supports. CONCLUSIONS Findings from this program evaluation identified quality and process improvements, which were made before rigorously testing the intervention in a larger population through a randomized controlled trial. The findings may inform adaptations of similar programs in different contexts. Further research is needed to develop a deeper understanding of how program components influence social health and longer-term behavior change. CLINICALTRIAL

Background: Older veterans have greater medical complexity, lower physical function, and less daily physical activity compared to age-matched civilians. Telehealth programs offer promising approaches to address these complex needs and improve access for diverse patient populations. Objective: The purpose of this program evaluation was to understand veterans’ experiences of the telehealth program’s quality, feasibility, safety, and effectiveness. Methods: Interviews were conducted by a provider and external evaluator who had expertise in qualitative methods; veterans were interviewed following completion of the 12-week program. Questions were designed to explore both positive and negative experiences of the program and its 4 components, which were physical therapy, biobehavioral intervention (coaching), social support, and technology. Interviews were audio recorded and transcribed verbatim. Team-based–directed content analysis, using deductive and inductive thematic analysis, was conducted to identify themes; analysis was supported by structured debriefs following each interview and using Dedoose software. Results: Twenty-one veterans enrolled in the program (n=14 completed). All 14 completers and 1 withdrawer completed the interviews (mean 60.4, SD 8.2 minutes); interviewees were mostly male (73.3%), White (60.0%), and non-Hispanic (86.7%). The following 6 domains were identified (subthemes to follow): (1) technology, (2) social network, (3) therapeutic relationship, (4) access, (5) feasibility, and (6) patient characteristics. Technology—although veterans noted varying levels of technology competency and satisfaction, most felt encouraged and held accountable to being active by the technology. Social Network—this domain highlighted themes surrounding veterans’ social support both within and outside of the program, which reportedly enhanced motivation and commitment to regular exercise. Therapeutic Relationship—interviewees shared specific ways that providers significantly contributed to their overall experience and their progress. Access—older veterans described the pros and cons of telehealth and noted the program made it possible to begin physical therapy sooner than they would have in person. Telehealth also made it easier for them to fit physical therapy sessions into their workdays, and for some, it provided a solution to overcome mental and physical health issues precluding in-person care. Feasibility—themes of preparedness, fit with daily routine, manageability, and outcomes of the program emerged. Patient Characteristics—motivation, self-efficacy, attitudes and beliefs, and expectations influenced the perceived benefits, overall experience, and therapeutic relationship experienced by the veterans. Finally, many veterans provided constructive feedback to improve the program (eg, organizing group sessions based on functional ability and further integrating technology and wearable data). Conclusions: This program evaluation identified impactful aspects of the telehealth program and mechanisms of how those aspects contributed to participants’ satisfaction and outcomes. Veterans offered suggestions to inform ongoing quality and operational improvements, with implications for staffing, training, and patient engagement. Qualitative feedback from the program evaluation identified additional questions to explore through rigorous qualitative research.