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Bihrmann K, Pedersen MT, Hartvigsen J, Wodschow K, Ersbøll AK. Social inequity in chiropractic utilisation - a cross-sectional study in Denmark, 2010 and 2017. Chiropr Man Therap 2024; 32:27. [PMID: 39010107 PMCID: PMC11251339 DOI: 10.1186/s12998-024-00548-x] [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] [Received: 04/26/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Inequity in healthcare utilisation refers to differences between groups that remain after adjustment for need for health care. To our knowledge, no previous studies have aimed to assess social inequity in chiropractic utilisation in a general population. Therefore, the objective of this study was to evaluate social inequity in chiropractic utilisation in the general Danish population adjusted for health status as a proxy of need for chiropractic care. METHODS A population-based repeated cross-sectional study design was used based on the Danish National Health Survey in 2010 and 2017. Overall, we included 288,099 individuals aged 30 years or older in 2010 or 2017. For each individual, information on chiropractic utilisation, socioeconomic status, and health status as a proxy of need for chiropractic care was retrieved from nationwide registers using the unique personal identification number. Measures of health status included demographics, poor self-rated physical health, activity limitations, musculoskeletal pain, number of musculoskeletal conditions, and number of chronic diseases. We investigated social inequity in chiropractic utilisation (yes, no) using logistic regression adjusted for health status, stratified by sex and year. Three characteristics of socioeconomic status (educational level, employment status and income) were investigated. To further quantify the degree of social inequity in chiropractic utilisation, we estimated the concentration index of inequity for each of the three characteristics of socioeconomic status. RESULTS We found significantly higher odds of chiropractic utilisation among individuals with short or medium/long education compared with individuals with elementary education, and among employed individuals compared with individuals who were unemployed, receiving disability pension or retired. Furthermore, the odds of chiropractic utilisation increased with higher income. The concentration index indicated social inequity in chiropractic utilisation in favour of individuals with higher socioeconomic status, with income and employment status contributing more to inequity than educational level. CONCLUSION The study demonstrated social inequity in chiropractic utilisation in Denmark beyond differences in health status as a proxy of need for chiropractic care in the general population. The results suggest that new strategies are required if equal treatment for equal need is the goal.
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Affiliation(s)
- Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark.
| | - Michelle Trabjerg Pedersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Kirstine Wodschow
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark
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Assessment of Mobile Health Applications for Management of Knee and/or Hip Osteoarthritis Using the Mobile Application Rating Scale. J Clin Rheumatol 2022:00124743-990000000-00058. [PMID: 36256541 DOI: 10.1097/rhu.0000000000001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile health applications (apps) can help individuals with knee and/or hip osteoarthritis (OA) learn about, monitor, and manage their condition. These apps have not been formally evaluated. OBJECTIVE The aim of this study was to evaluate the publicly available mobile health apps for individuals with knee and/or hip OA using a systematic review. METHODS We searched the Apple App Store, Android Google Play, and Amazon Appstore using the terms "arthritis," "osteoarthritis," "hip OA," "knee OA," "hip," "knee," "rehabilitation," "rehab," and "physical therapy" in December of 2021. Applications that met the inclusion/exclusion criteria were reviewed using the Mobile Application Rating Scale (MARS; 29 items across 6 sections, each rated at 1-5). RESULTS Among 1104 identified apps, 94 met the inclusion/exclusion criteria for MARS appraisal. Fourteen apps met the predetermined score thresholds for final summary. Of the 14 apps appraised, the total overall mean app score on the MARS ranged from 3.12 to 4.20 (mean, 3.51 ± 0.37). Although app features varied, common features were symptom tracking, exercise recommendations, education, goal setting, and improving well-being. Many apps allowed for sharing with health care providers and included some measures to protect privacy. Jointfully Osteoarthritis was the top-rated app in both the Apple App Store and Android Google Play. CONCLUSIONS The majority of the apps we identified for knee and/or hip OA did not meet predetermined score thresholds for final summary. Many failed to provide comprehensive education and deliver management plans and lacked scientific testing. Future research should focus on apps that fit the needs of health care providers and patients including quality information, structured exercise programs tailored to individual needs, secure communication methods, and health information protection.
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Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202203000-00011. [PMID: 35262511 PMCID: PMC8913136 DOI: 10.5435/jaaosglobal-d-21-00173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022]
Abstract
Rapid recovery protocols (RRPs) for total joint arthroplasty (TJA) can reduce hospital length of stay (LOS) and improve patient care in select cohorts; however, there is limited literature regarding their utility in marginalized patient populations. This report aimed to evaluate the outcomes of an institutional RRP for TJA at a safety net hospital.
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Gruner MP, Hogaboom N, Hasley I, Hoffman J, Gonzalez-Carta K, Cheville AL, Li Z, Sellon JL. Prospective, Single-blind, Randomized Controlled Trial to Evaluate the Effectiveness of a Digital Exercise Therapy Application Compared With Conventional Physical Therapy for the Treatment of Nonoperative Knee Conditions. Arch Rehabil Res Clin Transl 2022; 3:100151. [PMID: 34977534 PMCID: PMC8683841 DOI: 10.1016/j.arrct.2021.100151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness and adherence of a home exercise therapy program using a digital exercise therapy application (DETA) compared with conventional physical therapy (PT). Design Parallel group, randomized controlled trial. Setting Two clinics in a tertiary care academic center. Participants Participants (N=60) were enrolled within 1 week after a provider visit for knee pain. Inclusion criteria: age 18-75 years, knee pain diagnosis, and clinician-prescribed PT. Interventions Participants were randomized to complete either an 8-week intervention of conventional PT (enrolled n=29; complete n=26) or the DETA (enrolled n=31; completed n=24). Main Outcome Measures Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores implemented via computer adaptive tests; number of exercise sessions completed per week (adherence). Results Compared with the PT group, the DETA group reported significant decreases in PROMIS-PI scores (−6.1±6.7 vs −1.5±6.6, P<.05, d=0.78) and increases in PROMIS-PF scores (6.0±6.6 vs −0.8±5.8, P<.01, d=0.89) after 8 weeks. No group differences in adherence were observed (P>.05). Conclusions Use of this DETA resulted in greater pain and functional improvements compared with PT, with no differences in adherence. It is possible this application may be a viable alternative to conventional PT in certain cases. A larger sample from various geographic locations is needed to improve generalizability and for subgroup analysis. Further investigation is warranted to determine the factors responsible for the differences observed between the groups.
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Affiliation(s)
- Marc P. Gruner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
- Corresponding author Marc P. Gruner, DO, MBA, 6608 Rivertrail Ct, Bethesda, MD 20817.
| | - Nathan Hogaboom
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ
| | - Ike Hasley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jared Hoffman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Karina Gonzalez-Carta
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jacob L. Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
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Tye EY, Taylor AJ, Kay RD, Bryman JA, Andrawis JP, Runner RP. An Orthopedic Surgeon's Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System. Arthroplast Today 2021; 12:76-81. [PMID: 34805467 PMCID: PMC8585792 DOI: 10.1016/j.artd.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 12/01/2022] Open
Abstract
Background Selective dental clearance before total joint arthroplasty (TJA) has been proposed; however, effective strategies of carrying out this practice are lacking. This study aims to determine the positive predictive value (PPV) of a novel oral examination performed by an orthopedic surgeon to better direct limited resources for marginalized patients in a safety net hospital system. Methods A retrospective review was conducted on 105 consecutive patients who had an oral examination performed by a single surgeon before elective TJA. Patients who screened negative proceeded to surgery without further formal dental clearance. Patients who screened positive underwent formal examination/intervention by a dentist before surgery. The rate of correct referral that resulted in patients undergoing an oral surgical intervention was determined. Complications during a minimum 90-day postoperative follow-up period were collected and compared. Results Thirty patients (28.6%) screened positive while 75 patients (71.4%) screened negative and proceeded to surgery without referral. The PPV of the screening test was high, with 73.3% of patients receiving a major surgical oral intervention before TJA. Patients sent for formal referral required 89.1 more days to receive their surgery than those that screened negative (54.9 days ± 4.24 vs 144.0 days ± 82.4, P < .001). Conclusion An orthopedic surgeon’s oral examination demonstrates a high PPV to identify high-risk patients in need of an oral surgical intervention before TJA. This provides a unique solution regarding over-referral for preoperative dental clearance and avoids delays for marginalized patients considering elective TJA in a safety net hospital system.
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Affiliation(s)
- Erik Y Tye
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Adam J Taylor
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert D Kay
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Jason A Bryman
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - John P Andrawis
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert P Runner
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA
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Taylor AJ, Kay RD, Tye EY, Bryman JA, Longjohn D, Najibi S, Runner RP. Implementation of an enhanced recovery protocol at a safety net hospital : a silver lining to COVID-19? Bone Jt Open 2021; 2:871-878. [PMID: 34669504 PMCID: PMC8558442 DOI: 10.1302/2633-1462.210.bjo-2021-0072.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS This study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events. METHODS A retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits. RESULTS The mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively. CONCLUSION Through use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a 'silver lining' to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era. Cite this article: Bone Jt Open 2021;2(10):871-878.
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Affiliation(s)
- Adam J. Taylor
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Robert D. Kay
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Erik Y. Tye
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Jason A. Bryman
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Donald Longjohn
- Harbor-UCLA Medical Center, Torrance, California, USA
- Department of Orthopaedic Surgery, Keck Hospital of USC, Los Angeles, California, USA
| | - Soheil Najibi
- Harbor-UCLA Medical Center, Torrance, California, USA
| | - Robert P. Runner
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
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7
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Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
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Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
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8
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Kurabayashi T, Ideno Y, Nagai K, Maruoka N, Takamatsu K, Yasui T, Hayashi K. Validity of Self-Reported Diagnosis of Osteoporosis in Japan Nurses' Health Study. Clin Epidemiol 2021; 13:237-244. [PMID: 33790653 PMCID: PMC7997557 DOI: 10.2147/clep.s304939] [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: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Although the validity of self-reported osteoporosis is often questioned, validation studies are lacking. This study was performed to investigate how well self-reported diagnoses of osteoporosis agreed with validated clinical information in young and middle-aged women in the Japan Nurses’ Health Study (JNHS), a nationwide prospective cohort study of nursing professionals. Patients and Methods Data were reviewed for 15,717 subjects from the combined cohorts of the JNHS and a preceding pilot study (Gunma Nurses’ Health Study). The subjects’ mean age at the baseline (BL) survey was 41.6 ± 8.3 years, and the mean follow-up period was 11.5 ± 4.4 years. Participating nurses were mailed a follow-up questionnaire every 2 years. Respondents who self-reported a positive osteoporosis diagnosis during the study period were sent an additional confirmation questionnaire to corroborate the details. Results The number (proportion) of women with osteoporosis was 884 (5.6%) [primary osteoporosis, 812 (5.2%); secondary osteoporosis, 72 (0.5%)]. The cumulative incidence of osteoporosis at the age of 40, 50, 60, 70, and 80 years was estimated to be 0.1% (95% confidence interval, 0.1–0.2), 1.1% (0.9–1.3), 7.7% (7.0–8.4), 23.6% (21.6–25.7), and 54.2% (40.2–68.1), respectively. For BL and regular follow-up + expert review versus BL and regular follow-up + confirmation questionnaire + expert review, the positive predictive value (PPV) was 61.3% versus 85.6% and the negative predictive value (NPV) was 98.9% versus 98.2%, respectively. Conclusion Self-reporting was associated with a high NPV for the incidence of osteoporosis. Although the PPV was slightly lower, additional corroborations by confirmation questionnaire might improve the PPV.
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Affiliation(s)
- Takumi Kurabayashi
- Department of Obstetrics and Gynecology, Niigata City General Hospital, Niigata, Japan
| | - Yuki Ideno
- Gunma University Center for Mathematics and Data Science, Maebashi, Gunma, Japan
| | - Kazue Nagai
- Department of International/Community Health Laboratory Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
| | - Naho Maruoka
- Department of International/Community Health Laboratory Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
| | - Kiyoshi Takamatsu
- Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Kunihiko Hayashi
- Department of International/Community Health Laboratory Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
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Successful Implementation of an Accelerated Recovery and Outpatient Total Joint Arthroplasty Program at a County Hospital. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e110. [PMID: 31773082 PMCID: PMC6860134 DOI: 10.5435/jaaosglobal-d-19-00110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Outpatient and accelerated recovery total joint arthroplasty (TJA) programs have become standard for private and academic practices. County hospitals traditionally serve patients with limited access to TJA and psychosocial factors which create challenges for accelerated recovery. The effectiveness of such programs at a county hospital has not been reported. Methods In 2017, our county hospital implemented an accelerated recovery protocol for all TJA patients. This protocol consisted of standardized, preoperative medical and psychosocial optimization, perioperative spinal anesthesia, tranexamic acid and local infiltration analgesia use, postoperative emphasis on non-narcotic analgesia, and early mobilization. LOS, complications, disposition, and cost were compared between patients treated before and after protocol implementation. Results In 15 months, 108 primary TJA patients were treated. Compared with the previous 108 TJA patients, LOS dropped from 3.4 to 1.6 days (P < 0.001), more patients discharged home (92% versus 72%, P < 0.001), average hospitalization and procedure-specific costs decreased 24.7% and 22.1%, respectively, and were significantly fewer complications (7% versus 21%, P = 0.007). Conclusions Implementation of an accelerated recovery TJA program at a County Hospital is novel. This implementation requires careful patient selection and a coordinated multidisciplinary approach and is a safe and cost-effective method of delivering high-quality care to an underserved cohort.
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Abstract
Sports medicine is a wide field of knowledge with a focus on the physical and psychological aspects of individuals; unfortunately, it is not well-known among occupational therapy practitioners. If at all, it is focused on exercise therapy for physical injuries and pain. We agree there are many types of physical pain and injuries among workers in different occupations, but not all that pain is related to physical overuse. Recently, new recommendations were presented by the American College of Sports Medicine highlighting particularly the psychological aspects of occupational emotional fitness. However, there is very little research about the concurrent effects of cost-effective packages of therapy for occupational emotional and physical fitness. Accordingly, this commentary reviews the occupational physical and emotional fitness aspects of sports medicine. In addition, this work makes suggestions to examine packages and protocols of physical and emotional fitness, with therapeutic targets for occupational cultures in different societies for employees and employers.
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Affiliation(s)
- Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +982188630227; E-mail:
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11
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Allen KD, Arbeeva L, Callahan LF, Golightly YM, Goode AP, Heiderscheit BC, Huffman KM, Severson HH, Schwartz TA. Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:383-396. [PMID: 29307722 PMCID: PMC6021028 DOI: 10.1016/j.joca.2017.12.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the effectiveness of physical therapy (PT, evidence-based approach) and internet-based exercise training (IBET), each vs a wait list (WL) control, among individuals with knee osteoarthritis (OA). DESIGN Randomized controlled trial of 350 participants with symptomatic knee OA, allocated to standard PT, IBET and WL control in a 2:2:1 ratio, respectively. The PT group received up to eight individual visits within 4 months. The IBET program provided tailored exercises, video demonstrations, and guidance on progression. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, range 0 [no problems]-96 [extreme problems]), assessed at baseline, 4 months (primary time point) and 12 months. General linear mixed effects modeling compared changes in WOMAC among study groups, with superiority hypotheses testing differences between each intervention group and WL and non-inferiority hypotheses comparing IBET with PT. RESULTS At 4-months, improvements in WOMAC score did not differ significantly for either the IBET or PT group compared with WL (IBET: -2.70, 95% Confidence Interval (CI) = -6.24, 0.85, P = 0.14; PT: -3.36, 95% (CI) = -6.84, 0.12, P = 0.06). Similarly, at 12-months mean differences compared to WL were not statistically significant for either group (IBET: -2.63, 95% CI = -6.37, 1.11, P = 0.17; PT: -1.59, 95% CI = -5.26, 2.08, P = 0.39). IBET was non-inferior to PT at both time points. CONCLUSIONS Improvements in WOMAC score following IBET and PT did not differ significantly from the WL group. Additional research is needed to examine strategies for maximizing benefits of exercise-based interventions for patients with knee OA. TRIAL REGISTRATION NCT02312713.
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Affiliation(s)
- K D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
| | - L Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA.
| | - L F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA.
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - A P Goode
- Duke Clinical Research Institute, Durham, NC, USA; Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, USA.
| | - B C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
| | - K M Huffman
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA.
| | | | - T A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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12
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Melo L, Schrieber L, Eyles J, Deveza LA, Meneses SRF, Hunter DJ. Comparison of physical examination performance of medical students trained by musculoskeletal versus non-musculoskeletal specialists. Int J Rheum Dis 2017; 20:451-459. [PMID: 28464548 DOI: 10.1111/1756-185x.13080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare the musculoskeletal (MSK) physical examination skills, knowledge acquisition and performance of first-year medical students trained by MSK specialist tutors to students trained by non-MSK specialist tutors, after a 6-week MSK physical examination tutorial program. METHODS Twenty-first year medical students took part in the study. They were recruited into two groups, according to their exposure to either an MSK specialist or a non-MSK specialist tutor during their 6-week MSK training block. Knowledge acquisition was measured via a pre- and post-training objective structured clinical examination (OSCE). We assessed students' self-belief and confidence levels regarding their newly acquired skills via a questionnaire. Independent t tests were used to examine mean group differences of OSCE scores and perceived level of confidence. RESULTS Both groups demonstrated a significant improvement (3.9 and 3.8 points, respectively, on an eight-point scale for shoulder assessment, P < 0.01, 3.3 and 3.5, respectively, on a five-point scale for spine assessment, P < 0.01) in OSCE scores compared to baseline after completing the 6-week MSK physical examination tutorial program. There was no between-group difference in the OSCE scores from pre- to post-training (P = 0.92 for shoulder, P = 0.66 for spine) or for perceived level of confidence in performing a basic MSK examination after training (P = 0.91). CONCLUSION Students exposed to MSK specialist tutors did not demonstrate increased skill levels or knowledge in the area of MSK physical examination compared to those receiving the same training under the supervision of non-MSK specialist tutors. Both student groups demonstrated improvement.
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Affiliation(s)
- Luciano Melo
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Leslie Schrieber
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jillian Eyles
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah R F Meneses
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Woode E, Ameyaw EO, Boakye-Gyasi E, Abotsi WKM, Oppong Kyekyeku J, Adosraku R, Biney RP. Effects of an ethanol extract and the diterpene, xylopic acid, of Xylopia aethiopica fruits in murine models of musculoskeletal pain. PHARMACEUTICAL BIOLOGY 2016; 54:2978-2986. [PMID: 27430751 DOI: 10.1080/13880209.2016.1199040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/19/2016] [Accepted: 06/04/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Fruits of Xylopia aethiopica (Dunal) A. Rich. (Annonaceae) are used traditionally to manage arthritis, headache and other pain disorders. OBJECTIVE The analgesic properties of the X. aethiopica ethanol fruit extract (XAE) and xylopic acid (XA) were evaluated in musculoskeletal pain models. MATERIALS AND METHODS Acute muscle pain was induced in gastrocnemius muscle of Sprague-Dawley rats with 3% carrageenan (i.m.). Rats received XAE (30-300 mg/kg), XA (10-100 mg/kg) or morphine (1-10 mg/kg) after 12 h. Effects of XAE and XA on muscle pain were assessed by measuring post-treatment grip strength of the rats. Chronic muscle pain was similarly induced, but drug treatment was on the eighth day and effects of XAE and XA assessed with Randall-Selitto test for hyperlagesia. Acute-skeletal pain was induced in knee joints of rats with 3% carrageenan-kaolin mixture and effects determined 12-h later. Similar induction protocol was used for chronic knee pain with treatment and measurement as done for chronic muscle pain. RESULTS XAE and XA significantly and dose-dependently ameliorated both acute muscle (ED50 mg/kg: XAE = 22.9; XA = 6.2) and skeletal hyperalgesia (XAE = 39.9; XA = 17.7) induced by 3% carrageenan. Similarly, chronic skeletal hyperalgesia was reduced by XAE and XA treatment similar to morphine (ED50: XAE = 13.0; XA = 4.6). This reduction was also seen in chronic muscle hyperalgesia (ED50: XAE = 79.1; XA = 42.7). XAE and XA significantly reduced the spread of hyperalgesia to contralateral limbs in both models of chronic hyperalgesia. CONCLUSION These findings establish analgesic properties of the ethanol fruit extract of X. aethiopica and xylopic acid in musculoskeletal pain.
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Affiliation(s)
- Eric Woode
- a Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
| | - Elvis Ofori Ameyaw
- b Department of Biomedical and Forensic Sciences, School of Biological Science , University of Cape Coast , Cape Coast , Ghana
| | - Eric Boakye-Gyasi
- a Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
| | - Wonder Kofi Mensah Abotsi
- a Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
| | - James Oppong Kyekyeku
- c Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
| | - Reimmel Adosraku
- c Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
| | - Robert Peter Biney
- a Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences , Kwame Nkrumah University of Science & Technology , Kumasi , Ghana
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Jacobs RJ, Collias BA, Rana AM, Wallace EM, Kane MN, Boesler DR. Identification of musculoskeletal disorders in medically underserved regions of South America and Vietnam. J Osteopath Med 2016; 115:12-22. [PMID: 25550488 DOI: 10.7556/jaoa.2015.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Musculoskeletal disorders have been implicated as the leading cause of disability throughout the world, representing a high percentage of the disease burden in many nations. Anecdotal evidence suggests that musculoskeletal pain has become increasingly pervasive, especially among rural populations of developing countries. OBJECTIVE To characterize specific musculoskeletal disorders in medically underserved regions where these issues have not yet been thoroughly examined. METHODS The sample comprised adult residents receiving care during brief medical outreach trips to South America (Peru, Ecuador, and Argentina) and Vietnam from December 2010 to March 2013. Patients completed an anonymous questionnaire on musculoskeletal pain, self-reported health status, and health care-seeking behavior. Demographic information was also obtained. RESULTS In Vietnam, 295 patients aged 20 to 88 years (mean [SD], 59 [14.7] years) completed the survey, 204 (69%) of whom were women. In South America, 552 patients aged 18 to 86 years (mean [SD], 44 [17.24] years) completed the survey, 398 (72.1%) of whom were women. Among the Vietnamese patients, acute pain was most frequently felt in the knees (132 [44.7%]), which were also the most frequent site of chronic pain (122 [41.4%]). Among the South American patients, acute pain was felt most frequently in the lower back (225 [47%]), and the upper back (253 [46.6%]) was the most frequent site of chronic pain. Associations were found between sex and chronic pain, with women reporting more chronic pain than men in the shoulder (17 [53%] vs 15 [47%], respectively), upper back (85 [79%] vs 22 [21%]), hand/wrist (153 [85%] vs 52 [15%]), and knee (40 [80%] vs 7 [20%]). Men reported more acute knee pain than women (73 [48%] vs 148 [38%], respectively). For patients in both samples, acute pain was associated with chronic pain in the same location for all body parts (P<.01). CONCLUSION This study characterized specific musculoskeletal disorders in selected poor and underserved regions in Vietnam and South America. Owing to reported regional differences, the authors recommend that global treatment protocols be developed with a population-specific approach after conducting a needs assessment for musculoskeletal disorders.
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Affiliation(s)
- Robin J Jacobs
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
| | - Belinda A Collias
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
| | - Arif M Rana
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
| | - Elaine M Wallace
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
| | - Michael N Kane
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
| | - David R Boesler
- From the Department of Psychiatry and Behavioral Medicine and Biomedical Informatics Program at Nova Southeastern University College of Osteopathic Medicine (NSU-COM) in Fort Lauderdale, Florida (Dr Jacobs, Rana, Wallace, and Boesler); the University of Tennessee Health Science Center in Memphis (Dr Collias); and Florida Atlantic University in Boca Raton (Dr Kane). Dr Jacobs holds a master's degree in biomedical informatics and Dr Rana holds a master's degree in medical education
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Moe RH, Grotle M, Kjeken I, Olsen IC, Mowinckel P, Haavardsholm EA, Hagen KB, Kvien TK, Uhlig T. Effectiveness of an Integrated Multidisciplinary Osteoarthritis Outpatient Program versus Outpatient Clinic as Usual: A Randomized Controlled Trial. J Rheumatol 2015; 43:411-8. [DOI: 10.3899/jrheum.150157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 12/24/2022]
Abstract
Objective.Osteoarthritis (OA) is one of the leading causes of pain and disability. Given the constraint in the provision of care, there is a need to develop and assess effectiveness of new treatment models. The objective was to compare satisfaction with and effectiveness of a new integrated multidisciplinary outpatient program with usual care in an outpatient clinic for patients with OA.Methods.Patients with clinical OA referred to a rheumatology outpatient clinic were randomized to a 3.5-h multidisciplinary group-based educational program followed by individual consultations, or to usual care. The primary outcome was satisfaction with the health service evaluated on a numerical rating scale (0 = extremely unsatisfied, 10 = extremely satisfied) after 4 months. Secondary outcomes included health-related quality of life measures.Results.Of 391 patients, 86.4% (n = 338) were women, and mean age was 61.2 (SD 8.0) years. At 4 months, patients who received integrated multidisciplinary care were significantly more satisfied with the health service compared with controls, with a mean difference of −1.05 (95% CI −1.68 to −0.43, p < 0.001). Among secondary outcomes, only self-efficacy with other symptoms scale (10–100) improved significantly in the multidisciplinary group compared with controls at 4 months (3.59, 95% CI 0.69–6.5, p = 0.02). At 12 months, the Australian/Canadian Hand Osteoarthritis Index pain (0–10) and fatigue scores (0–10) were slightly worse in the multidisciplinary group with differences of 0.38 (95% CI 0.06–0.71, p = 0.02) and 0.55 (95% CI 0.02–1.07, p = 0.04), respectively.Conclusion.Patients receiving an integrated multidisciplinary care model were more satisfied with healthcare than those receiving usual care, whereas there were no clinically relevant improvements in health outcomes.
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Williams QI, Gunn AH, Beaulieu JE, Benas BC, Buley B, Callahan LF, Cantrell J, Genova AP, Golightly YM, Goode AP, Gridley CI, Gross MT, Heiderscheit BC, Hill CH, Huffman KM, Kline A, Schwartz TA, Allen KD. Physical therapy vs. internet-based exercise training (PATH-IN) for patients with knee osteoarthritis: study protocol of a randomized controlled trial. BMC Musculoskelet Disord 2015; 16:264. [PMID: 26416025 PMCID: PMC4587879 DOI: 10.1186/s12891-015-0725-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022] Open
Abstract
Background Physical activity improves pain and function among individuals with knee osteoarthritis (OA), but most people with this condition are inactive. Physical therapists play a key role in helping people with knee OA to increase appropriate physical activity. However, health care access issues, financial constraints, and other factors impede some patients from receiving physical therapy (PT) for knee OA. A need exists to develop and evaluate other methods to provide physical activity instruction and support to people with knee OA. This study is examining the effectiveness of an internet-based exercise training (IBET) program designed for knee OA, designed by physical therapists and other clinicians. Methods/Design This is a randomized controlled trial of 350 participants with symptomatic knee OA, allocated to three groups: IBET, standard PT, and a wait list (WL) control group (in a 2:2:1 ratio, respectively). The study was funded by the Patient Centered Outcomes Research Institute, which conducted a peer review of the proposal. The IBET program provides patients with a tailored exercise program (based on functional level, symptoms, and current activity), video demonstrations of exercises, and guidance for appropriate exercise progression. The PT group receives up to 8 individual visits with a physical therapist, mirroring standard practice for knee OA and with an emphasis on a home exercise program. Outcomes are assessed at baseline, 4 months (primary time point) and 12 months (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include objective physical function, satisfaction with physical function, physical activity, depressive symptoms and global assessment of change. Linear mixed models will be used to compare both the IBET and standard PT groups to the WL control group, examine whether IBET is non-inferior to PT (a treatment that has an established evidence base for knee OA), and explore whether participant characteristics are associated with differential effects of IBET and/or standard PT. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill. Discussion The IBET program could be disseminated widely at relatively low cost and could be an important resource for helping patients with knee OA to adopt and maintain appropriate physical activity. This trial will provide an important evaluation of the effectiveness of this IBET program for knee OA. Trial registration NCT02312713
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Affiliation(s)
- Quinn I Williams
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB# 7005, Chapel Hill, NC, 27599, USA.
| | - Alexander H Gunn
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB# 7005, Chapel Hill, NC, 27599, USA.
| | | | - Bernadette C Benas
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB# 7005, Chapel Hill, NC, 27599, USA.
| | - Bruce Buley
- Comprehensive Physical Therapy Center, Chapel Hill, NC, USA.
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB# 7005, Chapel Hill, NC, 27599, USA.
| | - John Cantrell
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Andrew P Genova
- Comprehensive Physical Therapy Center, Chapel Hill, NC, USA.
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Adam P Goode
- Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, Durham, NC, USA.
| | | | - Michael T Gross
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
| | - Carla H Hill
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kim M Huffman
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA. .,Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA.
| | - Aaron Kline
- Advanced Physical Therapy of Smithfield, Smithfield, NC, USA.
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC, 27599, USA. .,Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB# 7005, Chapel Hill, NC, 27599, USA. .,Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
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Conaghan PG, Kloppenburg M, Schett G, Bijlsma JWJ. Osteoarthritis research priorities: a report from a EULAR ad hoc expert committee. Ann Rheum Dis 2014; 73:1442-5. [DOI: 10.1136/annrheumdis-2013-204660] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pluskiewicz W, Adamczyk P, Czekajło A, Grzeszczak W, Drozdzowska B. Influence of education, marital status, occupation, and the place of living on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in women in the RAC-OST-POL Study. J Bone Miner Metab 2014; 32:89-95. [PMID: 23690162 DOI: 10.1007/s00774-013-0471-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
The RAC-OST-POL population-based, epidemiological study provided data concerning the influence of education, marital status, occupation, and the place of living (residence) on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in 625 women older than 55 years, all of them recruited from the District of Raciborz in Poland. Their mean age was 66.4 ± 7.8 years. All the women completed a specially designed questionnaire. The skeletal status was assessed by femoral neck (FN) and total hip (TH) densitometry, using a Lunar DPX system (USA). In univariate analyses, taking into consideration the age differences, bone mineralization was dependent on marital status (Z score for FN and TH was significantly higher in widows than in divorcees; p < 0.05), place of residence (better results in rural areas; p < 0.05), and occupation (better in standing than sitting jobs; p < 0.05 for FN Z score and p < 0.01 for TH Z score). The multivariate model allowed us to verify that only place of living and type of occupation had a significant influence on densitometry results. In direct comparison, fracture prevalence seemed to be borderline significantly more common in widows (33.5%) and least common among divorcees (11.8%) (χ(2) = 6.9, df = 3, p = 0.07), but reanalysis performed after age adjustment excluded a true impact of marital status on fracture occurrence. Other factors did not affect fracture occurrence. Some factors influenced the use of medications for osteoporosis: higher level of education was associated with a more frequent use of vitamin D (χ(2) = 8.49, df = 3, p < 0.05) and of hormone replacement therapy (HRT) (χ(2) = 35.7, df = 3, p < 0.00001). HRT was most commonly used by unmarried women (30%) and least commonly by divorcees (11.8%) (χ(2) = 11.7, df = 3, p = 0.01). Vitamin D was more often used among women from the urban area of Raciborz than by those from surrounding rural areas (χ(2) = 9.2, df = 1, p < 0.01). The frequency of use of the three aforementioned medications was associated with the character of occupation. Women with sedentary jobs demonstrated the highest frequency of intake for vitamin D (χ(2) = 9.92, df = 3, p < 0.05) and HRT (χ(2) = 19.48, df = 3, p < 0.001) as well as for other antiresorptive medications (χ(2) = 8.18, df = 3, p < 0.05). We concluded that the results of the epidemiological study demonstrate that both skeletal status and use of antiosteoporotic medications were partially modified by analyzed social factors, whereas fracture prevalence was generally independent from those factors. These data suggest that education, marital status, place of living, and type of occupation may have impacts on implementation of osteoporosis-preventing health programs.
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Affiliation(s)
- Wojciech Pluskiewicz
- Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
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Cyril S, Oldroyd JC, Renzaho A. Urbanisation, urbanicity, and health: a systematic review of the reliability and validity of urbanicity scales. BMC Public Health 2013; 13:513. [PMID: 23714282 PMCID: PMC3671972 DOI: 10.1186/1471-2458-13-513] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 05/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Despite a plethora of studies examining the effect of increased urbanisation on health, no single study has systematically examined the measurement properties of scales used to measure urbanicity. It is critical to distinguish findings from studies that use surrogate measures of urbanicity (e.g. population density) from those that use measures rigorously tested for reliability and validity. The purpose of this study was to assess the measurement reliability and validity of the available urbanicity scales and identify areas where more research is needed to facilitate the development of a standardised measure of urbanicity. Methods Databases searched were MEDLINE with Full Text, CINAHL with Full Text, and PsycINFO (EBSCOhost) as well as Embase (Ovid) covering the period from January 1970 to April 2012. Studies included in this systematic review were those that focused on the development of an urbanicity scale with clearly defined items or the adoption of an existing scale, included at least one outcome measure related to health, published in peer-reviewed journals, the full text was available in English and tested for validity and reliability. Results Eleven studies met our inclusion criteria which were conducted in Sri Lanka, Austria, China, Nigeria, India and Philippines. They ranged in size from 3327 to 33,404 participants. The number of scale items ranged from 7 to 12 items in 5 studies. One study measured urban area socioeconomic disadvantage instead of urbanicity. The emerging evidence is that increased urbanisation is associated with deleterious health outcomes. It is possible that increased urbanisation is also associated with access and utilisation of health services. However, urbanicity measures differed across studies, and the reliability and validity properties of the used scales were not well established. Conclusion There is an urgent need for studies to standardise measures of urbanicity. Longitudinal cohort studies to confirm the relationship between increased urbanisation and health outcomes are urgently needed.
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Affiliation(s)
- Sheila Cyril
- Global Health and Society Unit, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
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Peeters GMEE, Tett SE, Dobson AJ, Mishra GD. Validity of self-reported osteoporosis in mid-age and older women. Osteoporos Int 2013; 24:917-27. [PMID: 22673826 DOI: 10.1007/s00198-012-2033-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED The validity of self-reported osteoporosis is often questioned, but validation studies are lacking. We validated self-reported prevalence and incidence of osteoporosis against self-reported and administrative data on medications. The concurrent validity was moderate to good for self-reported prevalent osteoporosis, but only poor to moderate for self-reported incident osteoporosis in mid-age and older women, respectively. Construct validity was acceptable for self-reported prevalent but not for incident osteoporosis. INTRODUCTION The validity of self-reported osteoporosis is often questioned, but validation studies are lacking. The aim was to examine the validity of self-reported prevalence and incidence of osteoporosis against self-reported and administrative data on medications. METHODS Data were from mid-age (56-61 years in 2007) and older (79-84 years in 2005) participants in the Australian Longitudinal Study on Women's Health. Self-reported diagnosis was compared with medication information from (1) self-report (n(mid) = 10,509 and n(old) = 7,072), and (2) pharmaceutical prescription reimbursement claims (n(mid) = 6,632 and n(old) = 4,668). Concurrent validity of self-report was examined by calculating agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Construct validity was tested by examining associations of self-reported diagnosis with osteoporosis-related characteristics (fracture, weight, bodily pain, back pain, and physical functioning). RESULTS Agreement, sensitivity and PPV of self-reported prevalent diagnosis were higher when compared with medication claims (mid-age women: kappa = 0.51, 95% confidence interval [CI] = 0.46-0.56; older women: kappa = 0.65, 95% CI = 0.63-0.68) than with self-reported medication (mid-age women: kappa = 0.41, 95% CI = 0.37-0.45; older women: kappa = 0.57, 95% CI = 0.55-0.59). Sensitivity, PPV and agreement were lower for self-reported incident diagnosis (mid-age women: kappa = 0.39, 95% CI = 0.32-0.47; older women: kappa = 0.55, 95% CI = 0.51-0.61). Statistically significant associations between self-reported diagnosis and at least four of five characteristics were found for prevalent diagnosis in both age groups and for incident diagnosis in older women. CONCLUSIONS The concurrent validity was moderate to good for self-reported prevalent osteoporosis, but only poor to moderate for self-reported incident osteoporosis in mid-age and older women, respectively. Construct validity was acceptable for self-reported prevalent but not for incident osteoporosis.
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Affiliation(s)
- G M E E Peeters
- School of Population Health, The University of Queensland, Public Health Building, Herston Road, Brisbane, Queensland 4006, Australia.
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Sadoghi P, Müller PE, Valderrabano V, Lidder S, Leithner A, Vavken P. Musculoskeletal clinical and cost-effectiveness outcome study group. Orthopedics 2013; 36:174. [PMID: 23464933 DOI: 10.3928/01477447-20130222-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Patrick Sadoghi
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
| | - Peter E. Müller
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
| | - Victor Valderrabano
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
| | - Surjit Lidder
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
| | - Andreas Leithner
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
| | - Patrick Vavken
- Graz, Austria (PS, AL); Munich, Germany (PEM); Basel, Switzerland (VV, PV); London, United Kingdom (SL); Boston, Massachusetts (PV)
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