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Butera KA, Fox EJ, Bishop MD, Coombes SA, George SZ. Empirically derived back pain subgroups differentiated walking performance, pain, and disability. Pain 2021; 162:1806-1815. [PMID: 33306502 PMCID: PMC8765081 DOI: 10.1097/j.pain.0000000000002167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Low back pain (LBP) is a leading cause of disability. However, the processes contributing to disability are not well understood. Therefore, this study (1) empirically derived LBP subgroups and (2) validated these subgroups using walking performance, pain, and disability measures. Seventy adults with LBP underwent testing for a priori determined sensory (temporal summation; conditioned pain modulation), psychological (positive affect/coping; negative coping), and motor (trunk extensor muscle activation during forward bending and walking) measures. A hierarchical cluster analysis determined subgroups that were then validated using walking (walking speed; Timed Up and Go [TUG]; TUG-Cognitive [TUG-Cog]; obstacle negotiation) and clinical (Brief Pain Inventory; Oswestry Disability Index; low back pressure pain threshold) measures. Two subgroups were derived: (1) a "Maladaptive" subgroup (n = 21) characterized by low positive affect/coping, high negative coping, low pain modulation, and atypical trunk extensor activation and (2) an "Adaptive" subgroup (n = 49) characterized by high positive affect/coping, low negative coping, high pain modulation, and typical trunk extensor activation. There were subgroup differences on 7 of 12 validation measures. The Maladaptive subgroup had reduced walking performance (slower self-selected walking speed, TUG completion, and obstacle approach and crossing speed) and worse clinical presentation (higher pain intensity, pain interference, and disability) (moderate to large effect sizes; P's < 0.05). Findings support the construct validity of this multidimensional subgrouping approach. Longitudinal studies are needed to determine whether the Maladaptive subgroup is predictive of poor outcomes, such as pain chronicity or persistent disability.
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Affiliation(s)
- Katie A. Butera
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL
- Brooks Rehabilitation, Jacksonville, FL
| | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Stephen A. Coombes
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC
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202
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Anderson CB, Wurdeman SR, Miller MJ, Christiansen CL, Kittelson AJ. Development of a physical mobility prediction model to guide prosthetic rehabilitation. Prosthet Orthot Int 2021; 45:268-275. [PMID: 33840752 PMCID: PMC8422855 DOI: 10.1097/pxr.0000000000000001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prosthetic rehabilitation decisions depend on estimating a patient's mobility potential. However, no validated prediction models of mobility outcomes exist for people with lower-limb amputation (LLA). OBJECTIVES To develop and test predictions for self-reported mobility after LLA, using the Prosthetic Limb Users Survey of Mobility (PLUS-M). STUDY DESIGN This is a retrospective cohort analysis. METHODS Eight hundred thirty-one patient records (1,860 PLUS-M observations) were used to develop and test a neighbors-based prediction model, using previous patient data to predict the 6-month PLUS-M T-score trajectory for a new patient (based on matching characteristics). The prediction model was developed in a training data set (n = 552 patients) and tested in an out-of-sample data set of 279 patients with later visit dates. Prediction performance was assessed using bias, coverage, and precision. Prediction calibration was also assessed. RESULTS The average prediction bias for the model was 0.01 SDs, average coverage was 0.498 (ideal proportion within the 50% prediction interval = 0.5), and prediction interval was 8.4 PLUS-M T-score points (40% improvement over population-level estimates). Predictions were well calibrated, with the median predicted scores falling within the standard error of the median of observed scores, across all deciles of the data. CONCLUSIONS This neighbors-based prediction approach allows for accurate estimates of PLUS-M T-score trajectories for people with LLA.
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Affiliation(s)
- Chelsey B. Anderson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO
| | - Shane R. Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE
| | - Matthew J. Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO
- Department of Geriatrics, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
| | - Andrew J. Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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203
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Margolis SA, Kelly DA, Daiello LA, Davis J, Tremont G, Pillemer S, Denby C, Ott BR. Anticholinergic/Sedative Drug Burden and Subjective Cognitive Decline in Older Adults at Risk of Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:1037-1043. [PMID: 32886748 DOI: 10.1093/gerona/glaa222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), has been linked to cognitive impairment in older adults. Subjective cognitive decline (SCD) may be among the first symptoms patients with Alzheimer's disease (AD) experience. We examined whether DBI values are associated with SCD in older adults at risk of AD. We hypothesized that increased DBI would be associated with greater SCD at older ages. METHOD Two-hundred-six community-dwelling, English-speaking adults (age = 65 ± 9 years) at risk of AD (42% apolipoprotein ε4 carriers; 78% with AD family history) were administered a single question to ascertain SCD: "Do you feel like your memory is becoming worse?" Response options were "No"; "Yes, but this does not worry me"; and "Yes, this worries me." DBI values were derived from self-reported medication regimens using older adult dosing recommendations. Adjusting for relevant covariates (comorbidities and polypharmacy), we examined independent effects of age and DBI on SCD, as well as the moderating effect of age on the DBI-SCD association at mean ± 1 SD of age. RESULTS Both SCD and anticholinergic/sedative drug burden were prevalent. Greater drug burden was predictive of SCD severity, but age alone was not. A significant DBI*Age interaction emerged with greater drug burden corresponding to more severe SCD among individuals age 65 and older. CONCLUSION Anticholinergic/sedative drug exposure was associated with greater SCD in adults 65 and older at risk for AD. Longitudinal research is needed to understand if this relationship is a pre-clinical marker of neurodegenerative disease and predictive of future cognitive decline.
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Affiliation(s)
- Seth A Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Dana A Kelly
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Lori A Daiello
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Sarah Pillemer
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Charles Denby
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence
| | - Brian R Ott
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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204
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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205
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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206
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Kittelson AJ, Schmiege SJ, Maluf K, George SZ, Stevens-Lapsley JE. Determination of Pain Phenotypes in Knee Osteoarthritis Using Latent Profile Analysis. PAIN MEDICINE 2021; 22:653-662. [PMID: 33367906 DOI: 10.1093/pm/pnaa398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify clinical phenotypes of knee osteoarthritis (OA) using measures from the following domains: 1) multimorbidity; 2) psychological distress; 3) pain sensitivity; and 4) knee impairment or pathology. DESIGN Data were collected from 152 people with knee OA and from 31 pain-free individuals. In participants with knee OA, latent profile analysis (LPA) was applied to the following measures: normalized knee extensor strength, Functional Comorbidity Index (FCI), Pain Catastrophizing Scale (PCS), and local (knee) pressure pain threshold. Comparisons were performed between empirically derived phenotypes from the LPA and healthy older adults on these measures. Comparisons were also made between pheonotypes on pain intensity, functional measures, use of health care, and history of knee injury. RESULTS LPA resulted in a four-group solution. Compared with all other groups, group 1 (9% of the study population) had higher FCI scores. Group 2 (63%) had elevated pain sensitivity and quadriceps weakness relative to group 4 and healthy older adults. Group 3 (11%) had higher PCS scores than all other groups. Group 4 (17%) had greater leg strength, except relative to healthy older adults, and reduced pain sensitivity relative to all groups. Groups 1 and 3 demonstrated higher pain and worse function than other groups, and group 4 had higher rates of knee injury. CONCLUSION Four phenotypes of knee OA were identified using psychological factors, comorbidity status, pain sensitivity, and leg strength. Follow-up analyses supported the replicability of this phenotype structure, but future research is needed to determine its usefulness in knee OA care.
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Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Sarah J Schmiege
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Katrina Maluf
- Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Denver, Colorado, USA
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207
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Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial. Aust Crit Care 2021; 34:217-225. [DOI: 10.1016/j.aucc.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
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208
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Disability-adjusted life expectancy lost due to pain severity and usual analgesic treatment among older adults with osteoarthritis in Spain. Aging Clin Exp Res 2021; 33:1285-1295. [PMID: 32562211 DOI: 10.1007/s40520-020-01630-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is a seriously debilitating disease, which prevalence is growing in aging population becoming a substantial burden (BoD) to society. AIM To assess disability-adjusted life expectancy (DALE) lost by pain severity and usual analgesic treatment among OA adults 65 + year in Spain. METHODS The National Health Survey, a large, nationally representative, cross-sectional general health survey administered to 23,089 individuals was the data source. Data on subjects of 65 + years with a self-reported physician diagnosis of OA were analysed. Records were cross-classified by pain severity (no pain/mild pain, moderate pain and severe pain) and use of usual analgesics. DALE lost was used as a summary measure of BoD and expressed as both number of years of healthy life-expectancy lost due to disability and percentage of life-expectancy lost. RESULTS 3389 records were analysed [women 73.3%; age 77.4 (SD 7.5) years]. Older OA patients showed a mean (95% CI) DALE loss of 3.5 (3.3-3.7) years, that represented on average a loss of 35.6% (33.8-37.4) as a percentage of life expectancy. Higher pain severity and analgesic treatment was statistically linked to more years of DALE lost; from 2.8 (2.3-3.2), in no/mild, to 9.0 (8.6-9.4) years in severe pain, and from 32.2% (27.5-36.9) to 90.9% (86.5-95.3) of life expectancy, respectively. DISCUSSION In Spain, older adults with moderate to severe OA pain receiving usual analgesics showed a substantial BoD in terms of years of DALE lost and percentage of life expectancy lost. CONCLUSIONS Patients with treated moderate to severe pain showed a more significant burden in term of DALE lost despite analgesic treatment, which apparently fails to meet pain management needs.
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209
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Rat AC, Brignon M, Beauvais C, Beranger M, Boujut E, Cohen JD, Delannoy C, Griffoul-Espitalier I, Kivits J, Poivret D, Thevenot C, Trope S, Untas A, Vioulac C, Alleyrat C, Giraudet-Le Quintrec JS. Patients and spouses coping with inflammatory arthritis: Impact of communication and spousal perceived social support and burden. Joint Bone Spine 2021; 88:105125. [DOI: 10.1016/j.jbspin.2020.105125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
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210
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Smith AG, Bardach SH, Barber JM, Williams A, Rhodus EK, Parsons KK, Jicha GA. Associations of Future Cognitive Decline with Sexual Satisfaction among Married Older Adults. Clin Gerontol 2021; 44:345-353. [PMID: 33583362 PMCID: PMC8897809 DOI: 10.1080/07317115.2021.1887420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives: This study sought to explore changes in longitudinal cognitive status in relation to baseline measures of intimacy and sexuality in cognitively intact, married older adults.Methods: Baseline intimacy and sexuality survey data from 155, cognitively intact, married, older adults were collected using a novel survey instrument that explored the domains of: 1) romance with one's partner, 2) sexual satisfaction, 3) beliefs about sexuality, and 4) social support and emotional intimacy. These data were analyzed in relation to change in cognitive status over a 10-year follow-up period using binary logistic regression modeling. Exploratory factor analysis was used to assess the shared variance of survey items attributable to intimacy and sexuality without specification of an a priori hypothesis regarding the association of intimacy and sexuality with future change in cognitive status.Results: Over the 10-year study period, 33.5% (n = 52) of individuals developed cognitive impairment. Participants with greater sexual satisfaction scores at baseline were statistically less likely to convert from cognitively intact to mild cognitive impairment or dementia in the future (p = .01). The domains of romance with one's partner, beliefs about sexuality, and social support/emotional intimacy were not predictive of future longitudinal changes in cognitive status.Conclusions: Sexual satisfaction is associated with longitudinal cognitive outcomes in cognitively intact, married, older adults.Clinical implications: Clinicians should routinely assess for sexual satisfaction among older adults and refer to appropriate providers, such as couples or sex therapists, when appropriate.
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Affiliation(s)
- Allison G Smith
- Department of Family Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Shoshana H Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.,Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky, USA
| | - Justin M Barber
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Andrea Williams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth K Rhodus
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly K Parsons
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
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211
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Gill AS, Ashby S, Oakley GM, Steele TO, Menjivar D, Orlandi RR, Alt JA. Comorbidities Known to Affect Physical Function Negatively Impact Baseline Health-Related Quality-of-Life in Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2021; 36:25-32. [PMID: 33906469 DOI: 10.1177/19458924211013610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Medical comorbidities are commonly encountered in chronic rhinosinusitis (CRS) and may impact both physical function and patient reported health-related quality-of-life (HRQOL). The functional comorbidity index (FCI) is designed to elucidate the role of comorbidities on functional prognosis. The objective of this study was to understand the impact of comorbidities known to impact physical function on baseline HRQOL using the FCI.Methodology: Patients meeting diagnostic criteria for CRS were prospectively enrolled in a cross-sectional study. Responses from the Sinonasal Outcomes Test-22 (SNOT-22), a measure of patient HRQOL, as well as the Lund-Kennedy and Lund-Mackay scores were recorded at enrollment. FCI was calculated retrospectively using the electronic medical record. Information was collected and compared for patients without (CRSsNP) and with nasal polyps (CRSwNP) using chi-square and t-tests. Spearman's correlations, followed by multivariate regression analysis, were used to assess the association between FCI and SNOT-22 scores. RESULTS One hundred and three patients met inclusion criteria for analysis. There were no significant differences in age, gender, and SNOT-22 scores between patients with CRSsNP and those with CRSwNP. FCI was significantly and independently associated with worse SNOT-22 scores (P = .012). FCI did not correlate with endoscopy and computed tomography scores. The mean FCI for patients with CRSsNP and CRSwNP was 2.02 and 2.24, respectively, and did not differ significantly between the two cohorts (P = .565). CONCLUSIONS Major medical comorbidities known to affect physical function are associated with worse SNOT-22 scores in patients with CRS as measured by the FCI.
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Affiliation(s)
- Amarbir S Gill
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.,Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Shaelene Ashby
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Gretchen M Oakley
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Dennis Menjivar
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard R Orlandi
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
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212
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Keay L, Palagyi A, Do V, White A, Lamoureux E, Ivers RQ, Pesudovs K, Stapleton F, Boufous S, Mccluskey P. Vision and driving status of older Australians with cataract: an investigation of public hospital waiting lists. Clin Exp Optom 2021; 99:449-55. [DOI: 10.1111/cxo.12414] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lisa Keay
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Anna Palagyi
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Vu Do
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
| | - Andrew White
- Westmead Hospital, Sydney, New South Wales, Australia,
- Westmead Millennium Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia,
- Singapore Eye Research Institute, Singapore,
- Duke‐NUS Graduate Medical School, Singapore,
| | - Rebecca Q Ivers
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia,
| | - Konrad Pesudovs
- NHMRC Centre for Clinical Eye Research, Discipline of Optometry, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia,
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
| | - Soufiane Boufous
- Australia Transport and Road Safety Research, University of New South Wales, Kensington, New South Wales, Australia,
| | - Peter Mccluskey
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
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213
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Perracini MR, de Amorim JSC, Lima CA, da Silva A, Trombini-Souza F, Pereira DS, Pelicioni PHS, Duim E, Batista PP, dos Santos RB, de Lima MDCC. Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study. Front Public Health 2021; 9:643640. [PMID: 33898378 PMCID: PMC8062747 DOI: 10.3389/fpubh.2021.643640] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The COVID-19 pandemic hit Brazil in a scenario of substantial socioeconomic and health inequalities. It is unknown the immediate impact of social restriction recommendations (i.e., lockdown, stay-at-home) on the life-space mobility of older people. Objective: To investigate the immediate impact of COVID-19 pandemic on life-space mobility of community-dwelling Brazilian older adults and examine the social determinants of health associated with change in life-space mobility. Design: Baseline data from a prospective cohort study (REMOBILIZE Study). Setting: Community. Subject: A convenience snowball sample of participants aged 60 and older (n = 1,482) living in 22 states in Brazil. Methods: We conducted an online and phone survey using an adapted version of the Life-Space Assessment (LSA). Linear regression models were used to investigate social determinants of health on the change in LSA score. Results: Regardless of their gender and social determinants of health, participants showed a significant reduction in life-space mobility since COVID-19 pandemic outbreak. Life-space mobility reduction was higher among black individuals, those living alone and aged between 70 and 79. Other variables associated with change in life-space mobility, to a lesser extent, were sex, education and income. Conclusion: Social restriction measures due to pandemic caused substantial reduction in older adults' life-space mobility in Brazil. Social inequalities strongly affected vulnerable groups. Concerted actions should be put in place to overcome the deterioration in life-pace mobility amongst these groups. Failure in minimizing health inequalities amplified by the pandemic may jeopardize the desired achievements of the Decade of Healthy Aging.
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Affiliation(s)
- Monica R. Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Camila Astolphi Lima
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Alexandre da Silva
- Department of Collective Health, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - Francis Trombini-Souza
- Master's and Doctoral Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, Petrolina, Brazil
| | - Daniele Sirineu Pereira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Etiene Duim
- Department of Diagnostic and Ambulatory Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Renato Barbosa dos Santos
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Maria do Carmo Correia de Lima
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
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214
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Regression Model for the Prediction of Risk of Pelvic Floor Muscle Weakness Among Older Adults. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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215
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Leung YY, Orbai AM, de Wit M, Balanescu A, Dernis E, Soubrier M, Eder L, Smolen JS, Coates LC, Gossec L. Comparing the Patient-Reported Physical Function Outcome Measures in a Real-Life International Cohort of Patients With Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2021; 73:593-602. [PMID: 31961492 PMCID: PMC7371516 DOI: 10.1002/acr.24139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We evaluated the psychometric properties of 3 patient-reported outcome measures to assess the physical function in psoriatic arthritis (PsA). METHODS Data were available for the Health Assessment Questionnaire disability index (HAQ DI), the 12-item Short Form instrument physical component summary (SF-12 PCS), and the Psoriatic Arthritis Impact of Disease instrument functional capacity score (PsAID-FC). Data came from a longitudinal study in 14 countries of consecutive adults with definite PsA with ≥2 years of duration. The score distribution, construct validity, responsiveness, and thresholds of meaning of the patient-reported outcome measures were evaluated. RESULTS At baseline, 414 subjects (52% male) were analyzed. The mean ± SD age was 52.4 ± 12.5 years and duration of illness was 10.9 ± 8.1 years. Ceiling effects were noted in 31% and 21% of patients for HAQ DI and PsAID-FC, respectively; floor effects were minimal. All 3 patient-reported outcome measures met a priori hypotheses for construct validity. After a median follow-up of 4.1 (interquartile range 2.7) months in 350 patients, 27%, 54%, and 18% of patients reported themselves improved, not changed, and worsened, respectively. Change scores were statistically different for groups for worsening versus no-change for all patient-reported outcome measures. PsAID-FC was more sensitive to change than the other 2 patient-reported outcome measures. Comparing groups with worsening condition to no-change, the standardized response mean square ratios were HAQ DI 29.9, SF-12 PCS 16.7, and PsAID-FC 40.1. CONCLUSION HAQ DI, SF-12 PCS, and PsAID-FC are valid measures of physical function for PsA. PsAID-FC, a single question, performed similarly to the other patient-reported outcome measures and may be an additional option to measure PsA-specific physical function.
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Affiliation(s)
- Ying Ying Leung
- Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore
| | | | - Maarten de Wit
- Patient Research Partner, VU Medical Center, Amsterdam, The Netherlands
| | - Andra Balanescu
- Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | | | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP, Paris, France
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216
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Soh CH, Hassan SWU, Sacre J, Lim WK, Maier AB. Do morbidity measures predict the decline of activities of daily living and instrumental activities of daily living amongst older inpatients? A systematic review. Int J Clin Pract 2021; 75:e13838. [PMID: 33202078 PMCID: PMC8047900 DOI: 10.1111/ijcp.13838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Older adults often suffer from multimorbidity, which results in hospitalisations. These are often associated with poor health outcomes such as functional dependence and mortality. The aim of this review was to summarise the current literature on the capacities of morbidity measures in predicting activities of daily living (ADL) and instrumental activities of daily living (IADL) amongst inpatients. METHODS A systematic literature search was performed using four databases: Medline, Cochrane, Embase, and Cinahl Central from inception to 6th March 2019. Keywords included comorbidity, multimorbidity, ADL, and iADL, along with specific morbidity measures. Articles reporting on morbidity measures predicting ADL and IADL decline amongst inpatients aged 65 years or above were included. RESULTS Out of 7334 unique articles, 12 articles were included reporting on 7826 inpatients (mean age 77.6 years, 52.7% females). Out of five morbidity measures, the Charlson Comorbidity Index was most often reported. Overall, morbidity measures were poorly associated with ADL and IADL decline amongst older inpatients. CONCLUSION Morbidity measures are poor predictors for ADL or IADL decline amongst older inpatients and follow-up duration does not alter the performance of morbidity measures.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Syed Wajih Ul Hassan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Julian Sacre
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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217
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Loures FB, Góes RFDA, Gusmão CV, Albuquerque RSPE, Labronici PJ. Perfil epidemiológico e clínico dos pacientes submetidos a artroplastia total do joelho. Rev Bras Ortop 2021; 57:223-229. [PMID: 35652014 PMCID: PMC9142232 DOI: 10.1055/s-0041-1724080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective
To define the epidemiological profile and the associated comorbidities of patients submitted to total knee arthroplasty (TKA) in two reference hospitals.
Materials and Methods
During the present cross-sectional observational study, 294 patients submitted to TKA were evaluated in 2 tertiary care hospitals. The diagnosis of self-reported comorbidities was collected by direct interview. The Functional Comorbidity Index (FCI) and the 5-Factor Modified Frailty Index (mFI-5) were calculated. The incidence of comorbidities and their relationship with the calculated indexes were evaluated.
Results
Most of the patients in the sample were women (
p
= 0.000) between the seventh and eighth decades of life. Systemic arterial hypertension was the most common pathology, followed by obesity and diabetes mellitus. The FCI presented a direct relationship with females (
p
= 0.038) and obesity (
p
< 0.001). The mFI-5 was only associated to obesity (
p
= 0.022), demonstrating a higher chance of complications in this group.
Conclusion
Patients undergoing TKA are essentially carriers of clinical comorbidities that can negatively influence functional results and compromise the safety of the procedure. The identification of risk factors can contribute to the safety and better selection of TKA candidates.
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Affiliation(s)
- Fabrício Bolpato Loures
- Hospital Santa Teresa, Petrópolis, RJ, Brasil
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Pedro José Labronici
- Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
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218
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Blackwood J, Rybicki K. Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors. Integr Cancer Ther 2021; 20:15347354211006462. [PMID: 33784836 PMCID: PMC8020039 DOI: 10.1177/15347354211006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors. METHODS Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls. RESULTS The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65. CONCLUSION When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.
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219
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García-López S, Llopart-Carles N, Castro-Domínguez F, Rejas-Gutierrez J. Patient self-reported functioning by pain severity and usual analgesic treatment among older adults with osteoarthritis: analysis of the 2017 Spanish National Health Survey. Eur Geriatr Med 2021; 12:989-1001. [PMID: 33772742 DOI: 10.1007/s41999-021-00488-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Osteoarthritis (OA) pain is among the leading causes of disability worldwide in older people. Since its prevalence is growing in aging, a significant burden for society is expected. This work ascertained whether level of disability in self-reported functioning differs by pain severity and usual analgesic treatment among older OA patients in Spain. METHODS The Spanish-National-Health-Survey, a large, nationally representative, cross-sectional general health survey including 23,089 persons, was analyzed. Patients aged 65 + years with a self-reported physician OA diagnosis were classified according to severity of pain (no/mild, moderate or severe pain) and treated or untreated with analgesia. Assessment of function included basic and instrumental activities-of-daily-living (BADL, IADL), mental, social, and cognitive functions, scored on a 0% (no limitation) to 100% (complete limitation) standardized metric. Caregiver need for BADL and IADL was also recorded. RESULTS A total of 3526 patients were analyzed (women 73.3%; age 77.4 [SD: 7.5]). Adjusted functioning scores showed significant association with pain severity, and for BADL, IADL and social function. Patients with severe pain and treated with analgesia had higher limitation scores, ranging on average between 31.5% on BADL, 34.1% on IADL, 45.0% on mental, 42.2% on social, and 23.4% in cognitive domain. The proportions of patients needing a caregiver for BADL (43.4%) and IADL (56.2%) were also the highest in patients with severe pain and treated with analgesia. CONCLUSIONS Regardless of usual utilization of analgesics, the severity of pain seemed to be the major determinant of functional impairment, and caregiving need, in all domains of functioning in older OA patients in Spain. Existing treatment strategies are analgesics based and do not meet patient needs for adequate pain management.
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Affiliation(s)
- Sofía García-López
- Master in Health Assessment and Market Access, Universidad Carlos III, Madrid, Spain
| | | | - Francisco Castro-Domínguez
- Rheumatology Unit, Centro Médico Teknon, Grupo Quirónsalud, Barcelona, Spain.,Rheumatology Department, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, Barcelona, Spain
| | - Javier Rejas-Gutierrez
- Master in Health Assessment and Market Access, Universidad Carlos III, Madrid, Spain. .,Department of Pharmaco-Economics and Health Outcomes Research, Pfizer, S.L.U., Avda. de Europa, 20-B, 28108, Alcobendas (Madrid), Spain.
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220
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Quantifying Circadian Aspects of Mobility-Related Behavior in Older Adults by Body-Worn Sensors-An "Active Period Analysis". SENSORS 2021; 21:s21062121. [PMID: 33803510 PMCID: PMC8002888 DOI: 10.3390/s21062121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023]
Abstract
Disruptions of circadian motor behavior cause a significant burden for older adults as well as their caregivers and often lead to institutionalization. This cross-sectional study investigates the association between mobility-related behavior and subjectively rated circadian chronotypes in healthy older adults. The physical activity of 81 community-dwelling older adults was measured over seven consecutive days and nights using lower-back-worn hybrid motion sensors (MM+) and wrist-worn actigraphs (MW8). A 30-min and 120-min active period for the highest number of steps (MM+) and activity counts (MW8) was derived for each day, respectively. Subjective chronotypes were classified by the Morningness-Eveningness Questionnaire into 40 (50%) morning types, 35 (43%) intermediate and six (7%) evening types. Analysis revealed significantly earlier starts for the 30-min active period (steps) in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p ≤ 0.01). The 120-min active period (steps) showed significantly earlier starts in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p = 0.02). The starting times of active periods determined from wrist-activity counts (MW8) did not reveal differences between the three chronotypes (p = 0.36 for the 30-min and p = 0.12 for the 120-min active period). The timing of mobility-related activity, i.e., periods with the highest number of steps measured by hybrid motion sensors, is associated to subjectively rated chronotypes in healthy older adults. The analysis of individual active periods may provide an innovative approach for early detecting and individually tailoring the treatment of circadian disruptions in aging and geriatric healthcare.
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221
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Liu-Ambrose T, Dao E, Crockett RA, Barha CK, Falck RS, Best JR, Hsiung GYR, Field TS, Madden KM, Alkeridy WA, Boa Sorte Silva NC, Davis JC, Ten Brinke LF, Doherty S, Tam RC. Reshaping the path of vascular cognitive impairment with resistance training: a study protocol for a randomized controlled trial. Trials 2021; 22:217. [PMID: 33736706 PMCID: PMC7971404 DOI: 10.1186/s13063-021-05156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Subcortical ischemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment in older adults, due to its modifiable risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities (WMHs), research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, the primary aim of this proof-of-concept randomized controlled trial is to investigate the efficacy of a 12-month, twice-weekly progressive resistance training program on cognitive function and WMH progression in adults with SIVCI. We will also assess the efficiency of the intervention. Methods Eighty-eight community-dwelling adults, aged > 55 years, with SIVCI from metropolitan Vancouver will be recruited to participate in this study. SIVCI will be determined by the presence of cognitive impairment (Montreal Cognitive Assessment < 26) and cerebral small vessel disease using computed tomography or magnetic resonance imaging. Participants will be randomly allocated to a twice-weekly exercise program of (1) progressive resistance training or (2) balance and tone training (i.e., active control). The primary outcomes are cognitive function measured by the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-13 with additional cognitive tests) and WMH progression. Discussion The burden of SIVCI is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and WMH progression among adults with SIVCI. Slowing the rate of cognitive decline and WMH progression could preserve functional independence and quality of life. This could lead to reduced health care costs and avoidance of early institutional care. Trial registration ClinicalTrials.gov NCT02669394. Registered on February 1, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05156-1.
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Affiliation(s)
- Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada. .,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada. .,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - Elizabeth Dao
- Department of Radiology, UBC, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Rachel A Crockett
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John R Best
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada
| | - Ging-Yeuk R Hsiung
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Division of Neurology, UBC, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Division of Neurology, UBC, Vancouver, British Columbia, Canada.,Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Kenneth M Madden
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Division of Geriatric Medicine, Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Walid A Alkeridy
- Division of Neurology, UBC, Vancouver, British Columbia, Canada.,Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Narlon C Boa Sorte Silva
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Social and Economic Change Laboratory, Faculty of Management, UBC-Okanagan, Kelowna, British Columbia, Canada
| | - Lisanne F Ten Brinke
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Stephanie Doherty
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Roger C Tam
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Department of Radiology, UBC, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, UBC, Vancouver, British Columbia, Canada
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222
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Dao E, Tam R, Hsiung GYR, Ten Brinke L, Crockett R, Barha CK, Yoo Y, Al Keridy W, Doherty SH, Laule C, MacKay AL, Liu-Ambrose T. Exploring the Contribution of Myelin Content in Normal Appearing White Matter to Cognitive Outcomes in Cerebral Small Vessel Disease. J Alzheimers Dis 2021; 80:91-101. [PMID: 33523006 DOI: 10.3233/jad-201134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myelin damage is a salient feature in cerebral small vessel disease (cSVD). Of note, myelin damage extends into the normal appearing white matter (NAWM). Currently, the specific role of myelin content in cognition is poorly understood. OBJECTIVE The objective of this exploratory study was to investigate the association between NAWM myelin and cognitive function in older adults with cSVD. METHODS This exploratory study included 55 participants with cSVD. NAWM myelin was measured using myelin water imaging and was quantified as myelin water fraction (MWF). Assessment of cognitive function included processing speed (Trail Making Test Part A), set shifting (Trail Making Test Part B minus A), working memory (Verbal Digit Span Backwards Test), and inhibition (Stroop Test). Multiple linear regression analyses assessed the contribution of NAWM MWF on cognitive outcomes controlling for age, education, and total white matter hyperintensity volume. The overall alpha was set at ≤0.05. RESULTS After accounting for age, education, and total white matter hyperintensity volume, lower NAWM MWF was significantly associated with slower processing speed (β = -0.29, p = 0.037) and poorer working memory (β= 0.30, p = 0.048). NAWM MWF was not significantly associated with set shifting or inhibitory control (p > 0.132). CONCLUSION Myelin loss in NAWM may play a role in the evolution of impaired processing speed and working memory in people with cSVD. Future studies, with a longitudinal design and larger sample sizes, are needed to fully elucidate the role of myelin as a potential biomarker for cognitive function.
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Affiliation(s)
- Elizabeth Dao
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Roger Tam
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Department of Radiology, UBC, Vancouver, Canada.,School of Biomedical Engineering, UBC, Vancouver, Canada
| | - Ging-Yuek R Hsiung
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Division of Neurology, UBC Hospital, Vancouver, Canada
| | - Lisanne Ten Brinke
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Rachel Crockett
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Cindy K Barha
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | - Walid Al Keridy
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Division of Neurology, UBC Hospital, Vancouver, Canada.,Department of Medicine, King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Stephanie H Doherty
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Cornelia Laule
- Department of Radiology, UBC, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, UBC, Vancouver, Canada.,Department of Physics and Astronomy, UBC, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Alex L MacKay
- Department of Radiology, UBC, Vancouver, Canada.,UBC MRI Research Centre, UBC, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey. Health Expect 2021; 24:819-832. [PMID: 33662180 PMCID: PMC8235898 DOI: 10.1111/hex.13221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Consistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions. Methods Cross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression. Results 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions. Conclusions Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients. Patient or public contribution The questionnaire was piloted among a convenience sample prior to distribution.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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224
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Sears JM, Schulman BA, Fulton-Kehoe D, Hogg-Johnson S. Workforce Reintegration After Work-Related Permanent Impairment: A Look at the First Year After Workers' Compensation Claim Closure. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:219-231. [PMID: 32651725 PMCID: PMC7796860 DOI: 10.1007/s10926-020-09912-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to descriptively quantify experiences of injured workers with permanent impairment during their first year of work reintegration. Methods A representative survey was conducted to characterize health, disability, pain, employment, reinjury, and economic outcomes for 598 workers with permanent impairment who had returned to work during the year after workers' compensation claim closure. Survey responses were summarized by degree of whole body impairment (< 10% vs. ≥ 10%). Results Injured workers who had returned to work reported that permanent impairment made it difficult to get a job (47%) and to keep their job (58%). A year after claim closure, 66% reported moderate to very severe pain; 40% reported pain interference with work. About 13% reported new work injuries; over half thought permanent impairment increased their reinjury risk. Asked to compare current to pre-injury work status, workers with a higher degree of impairment more frequently reported working fewer hours (OR 1.60; 95% CI 1.06, 2.42), earning less (OR 1.56; 95% CI 1.04, 2.36), and being at higher risk of losing their current job due to their impairment (OR 1.66; 95% CI 1.01, 2.71). Conclusions Injured workers with permanent impairment face long-term challenges related to health limitations, chronic pain, work reintegration, and economic impacts. Workers with a higher degree of impairment more frequently reported several economic and job security challenges. Developing workplace and workers' compensation-based interventions that reduce return-to-work interruption and reinjury for workers with permanent impairment should be prioritized as an important public health and societal goal.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA.
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.
- Institute for Work and Health, Toronto, ON, Canada.
| | - Beryl A Schulman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sheilah Hogg-Johnson
- Institute for Work and Health, Toronto, ON, Canada
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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225
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Davis JC, Rhodes RE, Khan KM, Mansournia MA, Khosravi A, Chan P, Zhao M, Jehu DA, Liu-Ambrose T. Cognitive Function and Functional Mobility Predict Exercise Adherence in Older Adults Who Fall. Gerontology 2021; 67:350-356. [PMID: 33631742 DOI: 10.1159/000513452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Strength and balance exercises prevent falls. Yet, exercise adherence is often low. To maximize the benefit of exercise on falls prevention, we aimed to identify baseline cognitive and mobility factors that predict adherence to the Otago Exercise Program (OEP) - a home-based exercise program proven to prevent falls. METHODS We conducted a secondary longitudinal analysis of data from a randomized clinical trial (RCT) (OEP compared with usual care) among 172 participants who were assigned to the OEP intervention of the RCT. Adherence to the OEP was calculated as a percent score (i.e., [frequency of strength and balance retraining session per week/3 strength and balance retraining sessions per week] × 100). Executive function (i.e., mental flexibility) was measured using the Trail Making Tests (Part A and B: TMT B - TMT A) and the Digit Symbol Substitution Test (DSST). Short-term memory and encoding was measured using the Verbal Digits Forward test. Executive function (i.e., inhibition and working memory) was measured using the Stroop Color-Word Test and the Verbal Digits Forward minus Verbal Digits Backward test. Mobility was assessed using the Short Performance Physical Battery and the Timed Up and Go test. We used general estimation equations analysis to determine the predictors of adherence to the OEP. RESULTS Better set shifting (β = -0.06, z = -2.43, [SE = 0.02] p = 0.018] predicted greater OEP adherence. Greater attention and short-term memory (β = -6.99, z = -2.37 [SE = 2.95]) predicted poorer OEP adherence. Response inhibition, processing speed, working memory, and mobility assessed by the SPPB were not associated with adherence. Poorer baseline Timed Up and Go (β = 1.48 z = 1.94, [SE = 0.76]; p < 0.001), predicted better OEP adherence. CONCLUSION Specific cognitive processes (i.e., executive function of set shifting, attention, and short-term memory) and functional mobility predicted exercise adherence. Further research needs to explore the pathways that explain why better attention and short-term memory predicted lower adherence and why poorer functional mobility led to better OEP adherence.
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Affiliation(s)
- Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada, .,Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada,
| | - Ryan E Rhodes
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Behavioural Medicine Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Karim M Khan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Patrick Chan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Zhao
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah A Jehu
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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226
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A 'case-mix' approach to understand adherence trajectories for a falls prevention exercise intervention: A longitudinal cohort study. Maturitas 2021; 147:1-6. [PMID: 33832641 DOI: 10.1016/j.maturitas.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We identified adherence-based case-mixes from participants' longitudinal adherence to falls prevention exercise interventions over 12 months. Second, we identified modifiable baseline predictors (cognition, mobility and functional status) based on participants' case-mix adherence trajectories. STUDY DESIGN AND OUTCOME MEASURES This study was a 12-month longitudinal secondary analysis of data from 172 participants who received the Otago Exercise Program (OEP) in a randomized controlled trial. Adherence to the OEP was ascertained monthly via self-report. Case-mixes, groups of individuals who followed similar adherence trajectories, were visually defined using 12-month longitudinal trajectories; we used latent class growth modeling. Baseline predictors of adherence were examined for the following categories: 1) cognition, 2) mobility and 3) functional status. RESULTS Four distinct case-mixes were identified. The "non-adherent" case-mix (18 %) was distinguished by a non-adherent and decreasing adherence trajectory over time. The "low adherence" case-mix (45 %) did not have complete adherence or consistent adherence over the 12-month follow-up. The "moderate adherence" case-mix (27 %) was characterized by a stable (i.e., non-variable) adherence trajectory with a slightly increasing pattern at midpoint. The "high adherence" case-mix (10 %) demonstrated consistent and high adherence over the 12-month follow-up. For individuals with "moderate adherence", the Digit Symbol Substitution Test (DSST) significantly predicted adherence (relative risk ratio (RRR) = 1.12 (0.95 CI: 1.0-1.26); p = 0.049). For individuals with "high adherence", the Digits Forward minus Digits Backward (RRR = 0.43 (0.95 CI: 0.23-0.79); p = 0.002) and Instrumental Activities of Daily Living (RRR = 0.36 (0.95 CI: 0.16-0.81); p = 0.01) significantly predicted adherence. CONCLUSIONS Cognitive profile and activities of daily living at baseline may predict the longitudinal pattern of adherence.
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227
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Abstract
PURPOSE The aim of the study was to examine the reliability, validity, and measurement error of balance confidence and fall-related self-efficacy measures in older breast cancer survivors. DESIGN A cross-sectional study was performed. METHODS The Activities-Specific Balance Confidence Scale (ABC), the shorter, six-item version of the ABC (ABC-6), and the Modified Falls Efficacy Scale (MFES) were completed by 35 older breast cancer survivors. Absolute reliability was examined with Cronbach's alpha, test-retest reliability with intraclass correlation coefficient, and Pearson's correlation coefficient for construct validity. FINDINGS Absolute reliability was good for the ABC. Test-retest reliability was good for the ABC and the ABC-6 and moderate for the MFES. Construct validity was present for all measures. CONCLUSIONS Breast cancer survivors' balance confidence measures should be assessed with either the ABC or the ABC-6, whereas falls self-efficacy should be examined with the MFES. CLINICAL RELEVANCE Nurses and other health professionals who treat breast cancer survivors should include assessing psychological factors associated with falls using the ABC, the ABC-6, or the MFES as low balance confidence or falls self-efficacy contribute to increased falls risk.
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228
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Mehrabi F, Béland F. Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1675. [PMID: 33572443 PMCID: PMC7916171 DOI: 10.3390/ijerph18041675] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.
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Affiliation(s)
- Fereshteh Mehrabi
- School of Public Health (ESPUM), Université de Montréal, 7071 Parc Ave, Montréal, QC H3N 1X9, Canada;
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 7071 Parc Ave, Montréal, QC H3N 1X9, Canada
| | - François Béland
- School of Public Health (ESPUM), Université de Montréal, 7071 Parc Ave, Montréal, QC H3N 1X9, Canada;
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 7071 Parc Ave, Montréal, QC H3N 1X9, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC H3T 1E2, Canada
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229
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Geynisman-Tan J, Helmuth M, Smith AR, Lai HH, Amundsen CL, Bradley CS, Mueller MG, Lewicky-Gaupp C, Harte SE, Jelovsek JE. Prevalence of childhood trauma and its association with lower urinary tract symptoms in women and men in the LURN study. Neurourol Urodyn 2021; 40:632-641. [PMID: 33508156 DOI: 10.1002/nau.24613] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/07/2020] [Accepted: 12/24/2020] [Indexed: 11/12/2022]
Abstract
AIMS To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS). METHODS In this secondary analysis of the Lower Urinary Tract Research Network Observational Cohort Study, participants completed the LUTS tool, childhood trauma events scale (CTES), PROMIS depression and anxiety and perceived stress scale. LUTS tool responses were combined to quantify urinary urgency, frequency, incontinence, and overall LUTS severity. Multivariable linear regression tested associations between trauma and LUTS; mental health scores were tested for potential mediation. RESULTS In this cohort (n = 1011; 520 women, 491 men), more women reported experiencing at least one trauma (75% vs. 64%, p < .001), greater than three traumas (26% vs. 15%, p < .001), and childhood sexual trauma (23% vs. 7%, p < .001), and reported higher impact from traumatic events compared with men (median [interquartile rnage] CTES score = 10 [5-15] vs. 6 [4-12], p < .001). The number of childhood traumatic events was not associated with severity of overall LUTS (p = .79), urinary frequency (p = .75), urgency (p = .61), or incontinence (p = .21). Childhood sexual trauma was significantly associated with higher incontinence severity (adjusted mean difference 4.5 points, 95% confidence interval= 1.11-7.88, p = .009). Mental health was a mediator between trauma and LUTS among those with at least one childhood trauma. CONCLUSION Although total childhood trauma is not associated with LUTS, childhood sexual trauma is associated with urinary incontinence severity. For patients with childhood trauma, half of the effect of CTE Impact score on overall LUTS severity is mediated through the association between trauma and the patient's mental health.
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Affiliation(s)
- Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Margaret Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Margaret G Mueller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | | | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - J Eric Jelovsek
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study. Pain Rep 2021; 5:e830. [PMID: 33490835 PMCID: PMC7808687 DOI: 10.1097/pr9.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This feasibility study of contemporary pain science education to increase activity levels in people with painful knee osteoarthritis supports progression to a larger trial. Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit. Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis. Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback). Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of “physiotherapy”, that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness. Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
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231
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Medina-Mirapeix F, Bernabeu-Mora R, Valera-Novella E, Gacto-Sánchez M, Bernabeu-Mora M, Sánchez-Martínez MP. The five-repetition sit-to-stand test is a predictive factor of severe exacerbations in COPD. Ther Adv Chronic Dis 2021; 12:2040622320986718. [PMID: 33613935 PMCID: PMC7841666 DOI: 10.1177/2040622320986718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Although the six-minute-walk test (6MWT) has been used to predict chronic obstructive pulmonary disease (COPD) exacerbations, additional research is necessary to identify more rapid, simpler tests that are directly associated with exacerbations, such as the five-repetition sit-to-stand (5STS) test and 4-m gait speed (4MGS) test. Aims: To determine the ability of the 5STS and 4MGS tests in predicting severe exacerbations in stable COPD over the following year, and to assess the ability of the best prognostic test to identify patients at high risk of hospital admission correctly. Methods: This prospective study included 137 patients with stable COPD. Multiple logistic regression models were constructed to assess whether the 6MWT, 5STS, and 4MGS tests were associated with severe exacerbations in the year following the test. Receiver-operating characteristic curves and the area under the curve (AUC) were evaluated to determine the accuracy of each test for identifying patients with severe exacerbations. Results: Scores of <350 m for the 6WMT and ⩽2 for the 5STS test were associated with severe exacerbations in the model adjusted for age and the number of exacerbations in the previous year. The 5STS test and the 6MWT had very similar predictive and discriminative abilities. Odds ratios were 3.20 (95% confidence interval [CI] 1.14–8.96) and 3.84 (95% CI 1.14–12.94) and AUCs were 0.793 (95% CI 0.704–0.882) and 0.783 (95% CI 0.686–0.879), respectively. Conclusions: The 5STS test predicted the risk of severe exacerbation within the following year among patients with COPD. The 5STS test could replace the 6MWT for identifying patients at high risk of hospital admission.
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Affiliation(s)
| | - Roberto Bernabeu-Mora
- Hospital General Universitario Jose M Morales Meseguer, Avda Marqués de los Vélez s/n, Murcia, Murcia 30008, Spain
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232
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Drageset J, Eide GE. Loneliness Among Cognitively Intact Residents of Nursing Homes With and Without Cancer: A 6-Year Longitudinal Study. SAGE Open Nurs 2021; 6:2377960820907778. [PMID: 33415270 PMCID: PMC7774416 DOI: 10.1177/2377960820907778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/06/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022] Open
Abstract
Limited information exists regarding the natural development of loneliness and
its determinants among cognitively intact nursing home residents. We aimed to
examine loneliness among nursing home residents by following up for 6 years and
to determine whether sociodemographic factors, diagnosis of cancer, sense of
coherence, social support, and depression symptoms influence loneliness. The
study was longitudinal and prospective and included baseline assessment and
6-year follow-up. After baseline assessment of 227 cognitively intact nursing
home residents (Clinical Dementia Rating score ≤0.5), 52 respondents were
interviewed a second time at the 5-year follow-up and 18 respondents a third
time at the 6-year follow-up. Data from the interviews were recorded using a
global question of loneliness, the Social Provisions Scale, Sense of Coherence
Scale, and Geriatric Depression Scale. Scores on Groll’s index
(p = .02) and the Sense of Coherence Scale
(p = .04) were positively correlated with loneliness and
negatively correlated with geriatric depression (p = .001).
Having a diagnosis of cancer, social support, and age were not correlated with
loneliness 6 years from baseline. Loneliness did not change during the 6 years
of follow-up, and symptoms of depression and the sense of coherence appeared to
be important components of loneliness. Finally, having a diagnosis of cancer and
social support were not associated with loneliness.
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Affiliation(s)
- Jorunn Drageset
- Department of Nursing, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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233
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Miller MJ, Mealer ML, Cook PF, Kittelson AJ, Christiansen CL. Psychometric Assessment of the Connor-Davidson Resilience Scale for People With Lower-Limb Amputation. Phys Ther 2021; 101:6075036. [PMID: 33421074 PMCID: PMC8023555 DOI: 10.1093/ptj/pzab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/12/2020] [Accepted: 12/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) determine the psychometric properties of the 25- and 10-item Connor-Davidson Resilience Scales (CD-RISC25, CD-RISC10) for people with lower-limb amputation (LLA) in middle age or later, and (2) describe relationships of the CD-RISC with biopsychosocial, sociodemographic, and health variables. METHODS Participants were included if their most recent LLA was 1 or more years prior, if they were independently walking with a prosthesis, and if they were between 45 and 88 years of age (N = 122; mean = 62.5 years of age [SD = 8]; 59.5 [mean = 58] months since LLA; 88.5% male; 82.0% with dysvascular etiology; 68.0% with unilateral transtibial LLA). Psychometric analyses included assessment of skewness, floor and ceiling effects, internal consistency, and agreement between versions. Correlation analyses were used to determine associations between the CD-RISC with disability, perceived functional capacity, falls efficacy, life-space, anxiety, depression, self-efficacy, social support, sociodemographic, and health variables. Additionally, quartiles of participants were identified using CD-RISC25 and CD-RISC10 scores and compared using ANOVA and post-hoc comparisons for disability, perceived functional capacity, falls efficacy, and life-space. RESULTS Skewness, floor, and ceiling effects of both CD-RISC versions were acceptable. Both versions of the CD-RISC were internally consistent (CD-RISC25: α = .92; CD-RISC10: α = .89). The CD-RISC25 and CD-RISC10 were highly correlated with disability, perceived functional capacity, falls efficacy, anxiety, depression, and self-efficacy (r = 0.52-0.67). CD-RISC25 and CD-RISC10 quartile differences, especially the lowest quartile, were identified for disability, perceived functional capacity, falls efficacy, and life-space. CONCLUSION The CD-RISC25 and CD-RISC10 have acceptable psychometric properties for use with people who have LLA. CD-RISC scores are associated with clinically relevant biopsychosocial measures targeted by physical therapist intervention following LLA. IMPACT The CD-RISC may be an appropriate tool to measure resilience following LLA.
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Affiliation(s)
| | - Meredith L Mealer
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Mental Illness Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado, USA
| | - Andrew J Kittelson
- School of Physical Therapy, University of Montana, Missoula, Montana, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
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234
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Ten Brinke LF, Best JR, Chan JLC, Ghag C, Erickson KI, Handy TC, Liu-Ambrose T. The Effects of Computerized Cognitive Training With and Without Physical Exercise on Cognitive Function in Older Adults: An 8-Week Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 75:755-763. [PMID: 31054254 DOI: 10.1093/gerona/glz115] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aging is characterized by cognitive changes in specific domains, such as declines in memory and executive functions. Given the world's aging population, it is important to identify and evaluate strategies that promote healthy cognitive aging. Besides exercise, computerized cognitive training (CCT) is a promising approach to promote cognitive function. Moreover, a single bout of exercise immediately prior to CCT may provide additional cognitive benefits. METHODS An 8-week proof-of-concept randomized controlled trial to investigate the effect of a commercial CCT intervention, alone and when preceded by exercise, on cognitive function. Participants (124; aged 65-85 years) performed 8 weeks of: (i) Group-based CCT (Fit Brains) 3×/week for 1 hour plus 3×/week home-based training; (ii) Group-based CCT preceded by exercise (Ex-CCT) 3×/week for 1 hour plus 3×/week home-based training (exercise+CCT); or (iii) Group-based balanced and toned (BAT) classes 3×/week for 1 hour (control). Memory was assessed by the Rey Auditory Verbal Learning Test. Executive functions were assessed using the: (i) Stroop Test, (ii) Trail Making Tests (TMT), (iii) Flanker Test, and (iv) Dimensional Change Card Sort Test (DCCS). RESULTS At trial completion, there were no significant between-group differences in memory (p > .05). However, compared with BAT, CCT, and Ex-CCT significantly improved Stroop performance (-10.72, 95% confidence interval [CI]: -16.53, -4.91; -7.95, 95% CI: -13.77, -2.13, respectively). Moreover, Ex-CCT significantly improved the performance on TMT (-13.65, 95% CI: -26.09, -1.22), the Flanker Test (6.72, 95% CI: 2.55, 10.88), and the DCCS Test (6.75, 95% CI: 0.99, 12.50). CONCLUSION An 8-week CCT program may promote executive functions in older adults and combining it with a bout of exercise may provide broader benefits.
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Affiliation(s)
- Lisanne F Ten Brinke
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Joey L C Chan
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Cheyenne Ghag
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pennsylvania
| | - Todd C Handy
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
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235
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Karssemeijer EGA, de Klijn FH, Bossers WJR, Olde Rikkert MGM, van Heuvelen MJG. Ranking Barriers, Motivators, and Facilitators to Promote Physical Activity Participation of Persons With Dementia: An Explorative Study. J Geriatr Phys Ther 2021; 43:71-81. [PMID: 30095552 DOI: 10.1519/jpt.0000000000000210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Community-dwelling persons with dementia are inactive most of the day. The purpose of this study was to rank the barriers, motivators, and facilitators that hamper or promote physical activity (PA) participation for persons with dementia. This could provide knowledge that can be used to design effective interventions to promote PA participation for persons with dementia. METHODS Twenty community-dwelling persons with dementia, mean (SD) age = 79 (5.4) years, 25% female, mean (SD) Mini-Mental Status Examination score = 23 (3.5); their informal caregivers, N = 20, mean (SD) age = 70 (11.5) years, 85% female; and an expert group of physiotherapists, N = 15, mean (SD) age = 41 (12.4) years, 73% female, were asked to rank preselected barriers, motivators, and facilitators of PA participation for persons with dementia. These statements were categorized at the intrapersonal, interpersonal, and community levels. RESULTS AND DISCUSSION Persons with dementia and their informal caregivers selected only motivators and facilitators as being important for PA participation, with the motivator "beneficial health effects" considered the most important. The experts had a different perspective on PA participation; half of their ranked top 10 most important factors were barriers to PA participation for persons with dementia. This could be explained by the more critical role of a therapist, focusing on symptom control and treatment of disability; in this case, the elimination of barriers to maintain PA participation in their patients. Furthermore, all groups prioritized statements at the intrapersonal level. CONCLUSIONS The results of this study suggest a difference in perspective between the more optimistic view of persons with dementia and their informal caregivers and the more critical view of physiotherapy experts regarding the most important factors that influence PA participation. In addition, there was a strong focus on the individual characteristics that influence PA behavior that warrant personalized interventions to promote PA in persons with dementia.
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Affiliation(s)
- Esther G A Karssemeijer
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Fleur H de Klijn
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Willem J R Bossers
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marieke J G van Heuvelen
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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236
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Mantel J, Chitnis AS, Ruppenkamp J, Holy CE, Daccach J. Healthcare resource utilization and costs for hip dislocation following primary total hip arthroplasty in the medicare population. J Med Econ 2021; 24:10-18. [PMID: 33267624 DOI: 10.1080/13696998.2020.1854989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To estimate 2-year healthcare resource utilization (HCRU) and costs of dislocation following primary total hip arthroplasty (THA). MATERIALS AND METHODS This retrospective evaluation used medical claims from the US Medicare database. Patients were eligible if they were ≥65 years old, underwent a primary elective inpatient THA between 1 January 2010 and 31 December 2016 (index), and had continuous Medicare coverage and enrollment ≥365 days prior to index (baseline). Exclusion criteria were prior THA, concomitant infection, non-Medicare primary payer, or enrolled in Medicare due to end-stage renal disease. One- and 2-year HCRU and costs across all service types and settings of care excluding retail pharmacy were evaluated. Propensity score matching and direct matching adjusted for confounding. RESULTS Among Medicare patients who underwent THA and met inclusion criteria (n = 450,355; mean age ∼74, and two-thirds female), 7,680 (1.7%) had a hip dislocation. After matching, 4,551 patients without and 4,551 patients with dislocation were selected. Percentage utilization, mean days of service, and claims payments amounts were significantly greater for patients with vs without THA dislocation for variables such as THA hospitalization, home health agency, skilled nursing facility, inpatient rehabilitation facility, other inpatient admission, long-term care hospital, and outpatient care. Findings were consistent for 1- and 2-year follow-up, although differences were more pronounced for 1-year. Per-patient-cost increases with dislocation were $19,590 over 1 year and $24,211 over 2 years. Two-thirds of the cost increase was due to other inpatient admission and the remaining one-third was due to skilled nursing facility, outpatient, inpatient rehabilitation facility, and home health agency costs. LIMITATIONS Administrative claims are not collected for research and lack clinical information. Results may not be generalizable to other patients or settings of care. CONCLUSIONS This large US retrospective database study demonstrated the substantial HCRU and cost burden of THA dislocation.
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Affiliation(s)
- Jack Mantel
- Health Economics and Market Access, DePuy Synthes, Leeds, UK
| | - Abhishek S Chitnis
- Medical Devices Epidemiology, Real World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Jill Ruppenkamp
- Medical Devices Epidemiology, Real World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Chantal E Holy
- Medical Devices Epidemiology, Real World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Juan Daccach
- Medical Safety - Global Orthopaedics and Joint Reconstruction, Johnson & Johnson, Warsaw, IN, USA
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237
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Erekson E, Menefee S, Whitworth RE, Amundsen CL, Arya LA, Komesu YM, Ferrando CA, Zyczynski HM, Sung VW, Rahn DD, Tan-Kim J, Mazloomdoost D, Gantz MG, Richter HE. The Design of a Prospective Trial to Evaluate the Role of Preoperative Frailty Assessment in Older Women Undergoing Surgery for the Treatment of Pelvic Organ Prolapse: The FASt Supplemental Trial. Female Pelvic Med Reconstr Surg 2021; 27:e106-e111. [PMID: 32217922 PMCID: PMC7381379 DOI: 10.1097/spv.0000000000000833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We present the rationale for and the design of a prospective trial to evaluate the role of preoperative frailty and mobility assessments in older women undergoing surgery for the treatment of pelvic organ prolapse (POP) as a planned prospective supplemental trial to the ASPIRe (Apical Suspension Repair for Vault Prolapse In a Three-Arm Randomized Trial Design) trial. The Frailty ASPIRe Study (FASt) examines the impact of preoperative frailty and mobility on surgical outcomes in older women (≥65 years) participating in the ASPIRe trial. The primary objective of FASt is to determine the impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgery for POP. METHODS The selection of the preoperative assessments, primary outcome measures, and participant inclusion is described. Frailty and mobility measurements will be collected at the preoperative visit and include the 6 Robinson frailty measurements and the Timed Up and Go mobility test. The main outcome measure in the FASt supplemental study will be moderate to severe postoperative adverse events according to the Clavien-Dindo Severity Classification. CONCLUSIONS This trial will assess impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgical procedures for the correction of apical POP. Information from this trial may help both primary care providers and surgeons better advise/inform women on their individual risks of surgical complications and provide more comprehensive postoperative care to women at highest risk of complications.
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Affiliation(s)
- Elisabeth Erekson
- From the Department of Obstetrics and Gynecology, The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Shawn Menefee
- University of California, San Diego, and Kaiser Permanente, San Diego, CA
| | | | | | - Lily A Arya
- University of Pennsylvania, Philadelphia, PA
| | - Yuko M Komesu
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Cecile A Ferrando
- Department of Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Halina M Zyczynski
- The Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, PA
| | - Vivian W Sung
- Alpert Medical School of Brown University, Providence, RI
| | - David D Rahn
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmine Tan-Kim
- University of California, San Diego, and Kaiser Permanente, San Diego, CA
| | - Donna Mazloomdoost
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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238
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Krumpoch S, Lindemann U, Rappl A, Becker C, Sieber CC, Freiberger E. The effect of different test protocols and walking distances on gait speed in older persons. Aging Clin Exp Res 2021; 33:141-146. [PMID: 32930990 PMCID: PMC7897617 DOI: 10.1007/s40520-020-01703-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Background and aims Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions. Methods For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway. Results A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001). Conclusions Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.
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239
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Galvin JE, Kleiman MJ, Walker M. Using Optical Coherence Tomography to Screen for Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 84:723-736. [PMID: 34569948 PMCID: PMC10731579 DOI: 10.3233/jad-210328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Screening for Alzheimer's disease and related disorders (ADRD) and mild cognitive impairment (MCI) could increase case identification, enhance clinical trial enrollment, and enable early intervention. MCI and ADRD screening would be most beneficial if detection measures reflect neurodegenerative changes. Optical coherence tomography (OCT) could be a marker of neurodegeneration (part of the amyloid-tau-neurodegeneration (ATN) framework). OBJECTIVE To determine whether OCT measurements can be used as a screening measure to detect individuals with MCI and ADRD. METHODS A retrospective cross-sectional study was performed on 136 participants with comprehensive clinical, cognitive, functional, and behavioral evaluations including OCT with a subset (n = 76) completing volumetric MRI. Pearson correlation coefficients tested strength of association between OCT and outcome measures. Receiver operator characteristic curves assessed the ability of OCT, patient-reported outcomes, and cognitive performance measures to discriminate between individuals with and without cognitive impairment. RESULTS After controlling for age, of the 6 OCT measurements collected, granular cell layer-inner plexiform layer (GCL + IPL) thickness best correlated with memory, global cognitive performance, Clinical Dementia Rating, and hippocampal atrophy. GCL + IPL thickness provided good discrimination in cognitive status with a cut-off score of 75μm. Combining GCL + IPL thickness as a proxy marker for hippocampal atrophy with a brief patient-reported outcome and performance measure correctly classified 87%of MCI and ADRD participants. CONCLUSION Multimodal approaches may improve recognition of MCI and ADRD. OCT has the potential to be a practical, non-invasive biomarker for ADRD providing a screening platform to quickly identify at-risk individuals for further clinical evaluation or research enrollment.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J. Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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240
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The Relationship Between Fall Risk and Hospital-Based Therapy Utilization Is Moderated by Demographic Characteristics and Insurance Type. Arch Phys Med Rehabil 2020; 102:1124-1133. [PMID: 33373599 DOI: 10.1016/j.apmr.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate whether indicators of patient need (comorbidity burden, fall risk) predict acute care rehabilitation utilization, and whether this relation varies across patient characteristics (ie, demographic characteristics, insurance type). DESIGN Secondary analysis of electronic health records data. SETTING Five acute care hospitals. PARTICIPANTS Adults (N=110,209) admitted to 5 regional hospitals between 2014 and 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occupational therapy (OT) and physical therapy (PT) utilization. Logistic regression models determined whether indicators of patient need predicted OT and PT utilization. Interactions between indicators of need and both demographic factors (eg, minority status, presence of significant other) and insurance type were included to investigate whether the relation between patient need and therapy access varied across patient characteristics. RESULTS Greater comorbidity burden was associated with a higher likelihood of receiving OT and PT. Relative to those with low fall risk, those with moderate and high fall risk were more likely to receive OT and PT. The relation between fall risk and therapy utilization differed across patient characteristics. Among patients with higher levels of fall risk, those with a significant other were less likely to receive OT and PT; significant other status did not explain therapy utilization among patients with low fall risk. Among those with high fall risk, patients with VA insurance and minority patients were more likely to receive PT than those with private insurance and nonminority patients, respectively. Insurance type and minority status did not appear to explain PT utilization among those with lower fall risk. CONCLUSIONS Patients with greater comorbidity burden and fall risk were more likely to receive acute care rehabilitation. However, the relation between fall risk and utilization was moderated by insurance type, having a significant other, and race/ethnicity. Understanding the implications of these utilization patterns requires further research.
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van Dam PH, Achterberg WP, Husebo BS, Caljouw MAA. Does paracetamol improve quality of life, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia living in long-term care facilities? A randomised double-blind placebo-controlled crossover (Q-PID) trial. BMC Med 2020; 18:407. [PMID: 33342434 PMCID: PMC7751102 DOI: 10.1186/s12916-020-01858-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objectives of this study are to determine the effects of regularly scheduled administration of paracetamol (acetaminophen) on quality of life (QoL), discomfort, pain and neuropsychiatric symptoms of persons with dementia living in long-term care facilities (LTCFs). METHODS A multicentre randomised double-blind placebo-controlled crossover trial for 13 weeks (January 2018 to June 2019) in 17 LTCFs across the west of the Netherlands. Inclusion criteria were age ≥ 65 years, (advanced) dementia and a moderate to low QoL, independent of the presence of pain (QUALIDEM ≤ 70). Exclusion criteria were the use of regular pain treatment, allergies to the study medication, severe liver disease, use of > 4 units of alcohol/day, weight < 50 kg and/or concomitant use of flucloxacillin. Participants received study medication (paracetamol/placebo) in two periods of 6 weeks each (1 week in between as a wash-out period). Randomisation decided in which order participants received paracetamol and placebo. Primary outcomes included QoL (QUALIDEM) and discomfort (DS-DAT), secondary outcomes included pain (MOBID-2) and neuropsychiatric symptoms (NPI-NH). RESULTS Ninety-five LTCF residents (mean age 83.9 years [SD 7.6], 57.9% females) were included. Repeated linear mixed models showed no difference in mean differences of QUALIDEM (paracetamol +1.3 [95% CI -1.0-3.5], placebo +1.5 [95% CI -0.7-3.8]), DS-DAT (paracetamol -0.1 [95% CI -1.4-1.2], placebo 0.6 [95 CI -0.7-1.8]), MOBID-2 (paracetamol 0.0 [95% CI -0.5-0.5], placebo -0.2 [95% CI -0.7-0.3]) and NPI-NH (paracetamol +1.5 [95% CI -2.3-5.4], placebo -2.1 [95% CI -6.0-1.7]) in favour of either paracetamol or placebo. CONCLUSIONS Compared to placebo, paracetamol showed no positive effect on QoL, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia with low QoL. It is important to find out more specifically which individual persons with advanced dementia could benefit from pain treatment with paracetamol, and for clinicians to acknowledge that a good assessment, monitoring and multidomain approach is vital for improving QoL in this vulnerable group. TRIAL REGISTRATION Netherlands Trial Register NTR6766 . Trial registration date: 20 October 2017.
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Affiliation(s)
- Paulien H van Dam
- Department of Public Health and Primary Care, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.,Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,, Municipality of Bergen, Norway
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
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Mobility Measures in Older Cancer Survivors: An Examination of Reliability, Validity, and Minimal Detectable Change. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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243
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Mackney J, Harrold M, Jenkins S, Fehlberg R, Thomas L, Havill K, Jacques A, Hill K. Survivors of Acute Lung Injury Have Greater Impairments in Strength and Exercise Capacity Than Survivors of Other Critical Illnesses as Measured Shortly After ICU Discharge. J Intensive Care Med 2020; 37:202-210. [PMID: 33334223 DOI: 10.1177/0885066620981899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the physical function on ICU discharge in adults who survived an ICU admission for acute lung injury (ALI) with those admitted for a critical illness other than ALI. MATERIALS AND METHODS Two groups were recruited, (i) those who survived an ICU admission for ALI and, (ii) those who survived an ICU admission for a critical illness other than ALI. Within 7 days of discharge from ICU, in all participants, measures were collected of peripheral muscle strength, balance, walking speed and functional exercise capacity. RESULTS Recruitment was challenging and ceased prior to achieving the desired sample size. Participants with ALI (n = 22) and critical illness (n = 33) were of similar median age (50 vs. 57 yr, p = 0.09), sex proportion (males %, 45 vs. 58, p = 0.59) and median APACHE II score (21.5 vs. 23.0, p = 0.74). Compared with the participants with critical illness, those with ALI had lower hand grip (mean ± SD, 18 ± 9 vs. 13 ± 8 kg, p = 0.018) and shoulder flexion strength (10 ± 4 vs. 7 ± 3 kg, p = 0.047), slower 10-meter walk speed (median [IQR], 1.03 [0.78 to 1.14] vs. 0.78 [0.67 to 0.94] m/s, p = 0.039) and shorter 6-minute walk distance (265 [71 to 328] vs. 165 [53 to 220] m, p = 0.037). The Berg balance scores were similar in both groups. CONCLUSIONS Compared with survivors of a critical illness that is not ALI, those with ALI are likely to have greater physical impairment when measured shortly after discharge to the ward.
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Affiliation(s)
- Jennifer Mackney
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, 1649Curtin University, Perth, Australia.,School of Health Sciences, Faculty of Health and Medicine, 5982The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, 37024John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Meg Harrold
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, 1649Curtin University, Perth, Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, 1649Curtin University, Perth, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Australia.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rachel Fehlberg
- School of Health Sciences, Faculty of Health and Medicine, 5982The University of Newcastle, Callaghan, New South Wales, Australia
| | - Lauren Thomas
- Physiotherapy Department, 37024John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Ken Havill
- Department of Intensive Care, 37024John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, 1649Curtin University, Perth, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, 1649Curtin University, Perth, Australia.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia
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Miller MJ, Blankenship JM, Kline PW, Melanson EL, Christiansen CL. Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation. Phys Ther 2020; 101:6039323. [PMID: 33336706 PMCID: PMC7921296 DOI: 10.1093/ptj/pzaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA. METHODS Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30-60, 60-90, and >90 minutes), standing (0-1, 1-5, and >5 minutes), and stepping (0-1, 1-5, and >5 minutes) was also calculated. RESULTS Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}-quartile 3 {Q3} = 67%-84%]), followed by standing (median = 16% [Q1-Q3 = 12%-27%]) and stepping (median = 6% [Q1-Q3 = 4%-9%]). One-quarter (median = 25% [Q1-Q3 = 16%-38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1-Q3 = 34%-54%]; stepping: median = 98% [Q1-Q3 = 95%-99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1-Q3 = 59%-78%]; dysvascular: median = 79% [Q1-Q3 = 73%-86%]) and standing (traumatic: median = 23% [Q1-Q3 = 16%-32%]; dysvascular: median = 15% [Q1-Q3 = 11%-20%]). CONCLUSION Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute. IMPACT High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA.
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Affiliation(s)
| | - Jennifer M Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Edward L Melanson
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
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Tiisanoja A, Kuukasjärvi M, Syrjälä AM, Komulainen K, Knuuttila M, Hartikainen S, Ylöstalo P. Physical ability and comorbidity and oral health among home-dwelling older people in the Finnish population. SPECIAL CARE IN DENTISTRY 2020; 41:218-227. [PMID: 33280155 DOI: 10.1111/scd.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022]
Abstract
AIM To examine how physical ability and comorbidity associate with oral health. METHODS AND RESULTS The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self-perceived oral discomfort (PRR: 1.74, CI: 1.01-3.03; PRR: 1.20, CI: 1.06-1.35; PRR: 1.20, CI: 1.05-1.36, respectively). Furthermore, IADL associated also with poor self-perceived oral health (PRR: 1.27, CI: 1.03-1.57). CONCLUSION Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self-perceived oral health.
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Affiliation(s)
- Antti Tiisanoja
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Matti Kuukasjärvi
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Anna-Maija Syrjälä
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kaija Komulainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Matti Knuuttila
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Kuopio, Finland
| | - Pekka Ylöstalo
- Periodontology and Geriatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Vranas KC, Lapidus JA, Ganzini L, Slatore CG, Sullivan DR. Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer. Chest 2020; 158:2667-2674. [PMID: 32589949 PMCID: PMC7768936 DOI: 10.1016/j.chest.2020.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Palliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on health-care utilization and quality of care is unclear. RESEARCH QUESTION Is palliative care, and the setting in which it occurs, associated with health-care resource utilization and quality of care among patients with advanced lung cancer? STUDY DESIGN AND METHODS This was a retrospective cohort study of 23,142 patients with stage IIIB/IV lung cancer in the Veterans Affairs HealthCare System between 2007 and 2013. Exposures included the receipt of specialist-delivered palliative care, and the setting of the initial palliative care encounter (inpatient or outpatient) received after cancer diagnosis. Primary outcomes included rates of ED visits, along with rates of hospitalization and odds of ICU admission within the last 30 days of life. Secondary outcomes included any health-care utilization (ED, hospital, or ICU) related to chemotherapy toxicity. We used propensity score methods to perform Poisson and logistic regression modeling. RESULTS Among the 23,142 patients, 57% received palliative care, and 36% of initial palliative care encounters were outpatient. Compared with no palliative care, initial palliative care encounter in the outpatient setting was associated with reduced rates of ED visits (adjusted incidence rate ratio [aIRR], 0.86; 95% CI, 0.77-0.96) and hospitalizations in the last 30 days of life (aIRR, 0.64; 95% CI, 0.59-0.70). Initial palliative care encounters in both inpatient (adjusted OR [aOR], 0.63; 95% CI, 0.53-0.75) and outpatient (aOR, 0.42; 95% CI, 0.35-0.52) settings were associated with reduced odds of ICU admission in the last 30 days of life. Palliative care was also associated with reduced health-care utilization related to chemotherapy toxicity (aOR, 0.88; 95% CI, 0.82-0.95). INTERPRETATION Palliative care (particularly in outpatient settings) is associated with reduced health-care utilization at the end of life and may improve the quality of care among patients with advanced lung cancer. These findings support the role of palliative care as an important component of comprehensive cancer care and highlight the potential benefits of outpatient palliative care services.
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Affiliation(s)
- Kelly C Vranas
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Health Services Research & Development, VA Portland Health Care System, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR.
| | - Jodi A Lapidus
- Department of Biostatistics, School of Public Health, Oregon Health & Science University, Portland, OR
| | - Linda Ganzini
- Health Services Research & Development, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Health Services Research & Development, VA Portland Health Care System, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR
| | - Donald R Sullivan
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Health Services Research & Development, VA Portland Health Care System, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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Gustavson AM, Forster JE, LeDoux CV, Stevens-Lapsley JE. Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study. J Am Med Dir Assoc 2020; 21:1920-1925. [DOI: 10.1016/j.jamda.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
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Bitar S, Omorou AY, Van Hoye A, Guillemin F, Rat AC. Five-year Evolution Patterns of Physical Activity and Sedentary Behavior in Patients with Lower-limb Osteoarthritis and Their Sociodemographic and Clinical Correlates. J Rheumatol 2020; 47:1807-1814. [PMID: 32173658 DOI: 10.3899/jrheum.190854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The present study aimed to identify trajectories of physical activity (PA) components (frequency, duration, intensity, and type) and screen-based sedentary behavior (SB) as well as baseline predictors of each trajectory in patients with hip and/or knee osteoarthritis (OA). METHODS We included 878 patients with a 5-year follow-up from the KHOALA cohort. PA and SB were measured by the Modifiable Activity Questionnaire. We used group-based trajectory analysis to identify the trajectories of PA components and screen-based SB, and multivariable logistic regression to determine predictors of the identified trajectories. RESULTS Two groups of trajectories were identified for each PA component and 3 for SB. High and decreasing PA duration was associated with female sex (OR 0.3, 95% CI 0.1-0.5) as was low and stable, more so than high and decreasing prevalence of weight-bearing activities (OR 0.6, 95% CI 0.4-0.9). Patients with impaired patient-reported outcome measures and obese patients often featured low versus high and decreasing prevalence of weight-bearing activities. Predictors of moderate and high versus low and slightly increasing screen-based SB trajectories were male sex, age < 60 years, single status (OR 1.5, 95% CI 1.1-2.1), obesity (OR 2.1, 95% CI 1.4-3.1), smoking (OR 2.0, 95% CI 1.1-3.7), and less physical jobs. Predictors of moderate and high versus low screen-based SB trajectories were all sociodemographic: male sex, age < 60 years, single status, obesity, smoking, and less physical jobs. CONCLUSION Sociodemographic and clinical predictors of trajectories vary between PA components; they are associated mainly with PA frequency and type. No clinical characteristics were associated with screen-based SB.
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Affiliation(s)
- Sarah Bitar
- S. Bitar, MPH, A. Omorou, MD, PhD, F. Guillemin, PU-PH, Université de Lorraine, APEMAC, and CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy;
| | - Abdou Y Omorou
- S. Bitar, MPH, A. Omorou, MD, PhD, F. Guillemin, PU-PH, Université de Lorraine, APEMAC, and CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy
| | | | - Francis Guillemin
- S. Bitar, MPH, A. Omorou, MD, PhD, F. Guillemin, PU-PH, Université de Lorraine, APEMAC, and CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy
| | - Anne-Christine Rat
- A.C. Rat, MD, PhD, Université de Lorraine, APEMAC, Nancy, and Centre Hospitalier Universitaire Caen Normandie, Service de Rhumatologie Département, Caen, France
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Sizeland TJB, Fearon AM, Perriman DM, Gilbert S, Lynch JT, Smith PN, Spratford W. People after gluteal tendon repair have gait characteristics which are similar to those of a healthy cohort. Clin Biomech (Bristol, Avon) 2020; 80:105176. [PMID: 33007675 DOI: 10.1016/j.clinbiomech.2020.105176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gluteal-tendon repair is reported to be effective for relieving pain and improving function in patients with gluteal-tendon tears. However, post-operative three-dimensional gait analysis has never been conducted in gluteal-tendon repair patients. Thus, our primary aim was to investigate how biomechanical gait parameters differ between age- and sex-matched participants with and without gluteal-tendon repair. METHODS Vicon motion analysis technology was used to measure gait characteristics of 25 gluteal-tendon repair participants and 29 matched healthy comparison group participants. A generalised linear multivariate model was used to compare external hip-adduction moment, range of movement in hip adduction and internal rotation, pelvic obliquity, trunk lean, stride length and velocity of both cohorts throughout stance. FINDINGS There were no differences between the groups in external hip adduction moment, pelvic obliquity and range of movement in hip adduction and internal rotation. Gluteal-tendon repair participants had a shorter stride length (P = 0.031) and reduced walking velocity (P = 0.015). Ipsilateral trunk lean was reduced in gluteal-tendon repair participants at the first-peak external hip-adduction moment (P = 0.016), mid-stance minimum external hip-adduction moment (P = 0.029) and second-peak external hip-adduction moment (P = 0.006). INTERPRETATION There were no differences between the gluteal-tendon repair and comparison groups for external hip-adduction moment and pelvic obliquity. This suggests that gluteal-tendon repair may restore hip control in stance. Slower walking speed, reduced stride length and decreased ipsilateral trunk lean may reflect persistence of pre-operatively developed gait adaptations. Future studies of gait biomechanics before and after gluteal-tendon repair would be needed to substantiate this theory.
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Affiliation(s)
| | - Angela M Fearon
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
| | - Diana M Perriman
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Sally Gilbert
- Australian National University Medical School, Canberra, Australia.
| | - Joseph T Lynch
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Paul N Smith
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Wayne Spratford
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
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Orbai AM, Perin J, Gorlier C, Coates LC, Kiltz U, Leung YY, Palominos PE, Cañete JD, Scrivo R, Balanescu A, Dernis E, Tälli S, Ruyssen-Witrand A, Soubrier M, Aydin S, Eder L, Gaydukova I, Lubrano E, Kalyoncu U, Richette P, Husni ME, Smolen JS, de Wit M, Gossec L. Determinants of Patient-Reported Psoriatic Arthritis Impact of Disease: An Analysis of the Association With Sex in 458 Patients From Fourteen Countries. Arthritis Care Res (Hoboken) 2020; 72:1772-1779. [PMID: 31609525 PMCID: PMC7153974 DOI: 10.1002/acr.24090] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Sex differences may modify symptoms, disease expression, and treatment effects. The objective of this study was to evaluate the link between life impact and sex in psoriatic arthritis (PsA). METHODS Remission and Flare in Psoriatic Arthritis (ReFlaP; ClinicalTrials.gov identifier: NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment using the following measures: Disease Activity in Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by sex using t-tests or Wilcoxon tests. The association of PsAID with sex was analyzed using hierarchical generalized linear models. RESULTS Of 458 participants, 50.2% were male and the mean ± SD age was 53.1 ± 12.6 years. The mean ± SD PsA duration was 11 ± 8.2 years, and 51.5% of participants were being treated with biologic disease-modifying antirheumatic drugs. Women, compared to men, had worse mean ± SD Leeds Enthesitis Index scores (0.8 ± 1.7 versus 0.3 ± 0.9), pain on a numerical rating scale (NRS; range 0-10) (4.7 ± 2.7 versus 3.5 ± 2.7), HAQ DI scores (0.9 ± 0.7 versus 0.5 ± 0.6), fatigue on an NRS (5.2 ± 3 versus 3.3 ± 2.8), and PsAID scores (4.1 ± 2.4 versus 2.8 ± 2.3) (P < 0.001 for all). Women were also less frequently at treatment target compared to men according to DAPSA (cutoffs of ≤4 for remission and >4 and ≤14 for low disease activity; mean ± SD score 16.9 ± 14.9 in women versus 12.6 ± 16.6 in men) and MDA (25.7% versus 50.0%; P < 0.001 for all) scores. High life impact (PsAID score ≥4) was associated with female sex (odds ratio [OR] 2.3), enthesitis (OR 1.34), tender joints (OR 1.10)(P < 0.001 for all), and comorbidities (OR 1.22, P = 0.002). CONCLUSION High life impact was independently associated with female sex, enthesitis, comorbidities, and tender joints. At treatment target, women had higher life impact compared to men. It is necessary for life impact to become a part of PsA treat-to-target strategies.
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Affiliation(s)
| | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland
| | - Clémence Gorlier
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne and Ruhr-University, Bochum, Germany
| | - Ying Ying Leung
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | | | | | | | - Andra Balanescu
- Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | | | - Adeline Ruyssen-Witrand
- Toulouse University Hospital, UMR 1027, INSERM, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Sibel Aydin
- University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Inna Gaydukova
- North-western State Medical University, St. Petersburg, Russia
| | | | | | - Pascal Richette
- Hopital Lariboisiere Centre Viggo Petersen, service de Rhumatologie and Universite Paris Diderot UFR de Medecine, INSERM UMR1132 Bioscar, Paris, France
| | | | | | - Maarten de Wit
- Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and Pitié Salpêtrière Hospital, AP-HP, Paris, France
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