Rheumatologist-patient communication about exercise and physical therapy in the management of rheumatoid arthritis

Objective. Little is known about the features and role of exercise discussi ons between rheumatologists and patients. The goals of this study were to: 1) describe rheumatologists' and patients' attitudes and beliefs regarding exercise and physical therapy for rheumatoid arthritis (RA); 2) describe fr equency and length of exercise discussions; 3) determine the accuracy of re call for exercise discussions; and 4) assess the influence of attitudes reg arding exercise on communication about exercise. Methods, Goals 1-3 were addressed with analysis of baseline questionnaires and audiotaped encounters. The influence of attitudes and beliefs regarding exercise on the frequency and length of exercise discussions was assessed prospectively, patients and rheumatologists were enrolled from a large tert iary care institution. Clinical encounters were audiotaped, transcribed, co ded, and analyzed to identify specific characteristics of the exercise disc ussions. Results. One hundred thirty-two patients and 25 rheumatologists participate d in the study. Rheumatologists and patients discussed exercise in 53% of t he encounters. Rheumatologists' beliefs regarding the usefulness of exercis e for RA varied, with file least positive beliefs being reported for aerobi c exercise. Exercise discussions were more likely to occur if the patient w as currently exercising, odds ratio (OR) = 2.4; 95% confidence interval (CI ) (1.2-4.9), and when the rheumatologist believed aerobic exercises were us eful in managing RA, OR = 1.4; 95% CI (1.1-1.9). Current exercise behavior was associated with patients' positive attitude toward exercise (chi(1)(2) = 8.4; P = 0.004) and perceived social support for exercise (chi(1)(2) = 4. 5; P = 0.04). When rheumatologists initiated exercise discussions, there wa s nearly twice as much discussion (beta = -8.4: P = 0.001). Conclusions, Exercise talk was influenced by patient's and rheumatologists' beliefs and attitudes regarding the effectiveness of exercise and physical therapy in managing RA, patient experience with exercise, and by character istics of the rheumatologist.