1
|
Segal NA, Nilges JM, Oo WM. Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics. Osteoarthritis Cartilage 2024; 32:1045-1053. [PMID: 38588890 DOI: 10.1016/j.joca.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics. METHODS PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 were reviewed for appropriateness. RESULTS Globally, women account for 60% of people with osteoarthritis, with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, and amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions. CONCLUSIONS The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.
Collapse
Affiliation(s)
- Neil A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | | | - Win Min Oo
- The University of Sydney, Sydney, Australia; University of Medicine, Mandalay, Mandalay, Myanmar.
| |
Collapse
|
2
|
Adu Y, Hurley J, Ring D. Are There Racial and Ethnic Variations in Patient Attitudes Toward Hip and Knee Arthroplasty for Osteoarthritis? A Systematic Review. Clin Orthop Relat Res 2024; 482:1417-1424. [PMID: 38393955 PMCID: PMC11272247 DOI: 10.1097/corr.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND It is not clear why people who identify as Black or Hispanic are less likely to undergo discretionary musculoskeletal surgery such as arthroplasty for osteoarthritis of the hip or knee. Inequities and mistrust are important factors to consider. The role of socioeconomic factors and variation in values, attitudes, and beliefs regarding discretionary procedures are less well understood. A systematic review of the evidence regarding mindsets toward knee and hip arthroplasty among Black and Hispanic people could inform attempts to limit disparities in care. QUESTIONS/PURPOSES In a systematic review of qualitative and quantitative evidence, we asked: (1) What factors are associated with racial and ethnic variations in attitudes toward discretionary hip and knee arthroplasty for osteoarthritis? (2) Do studies that investigate racial and ethnic variations in mindsets toward discretionary orthopaedic care control for potential confounding by socioeconomic factors? METHODS A systematic search of PubMed, Cochrane, and Embase (last searched August 2023) for studies that addressed racial and ethnic variations in mindsets toward discretionary musculoskeletal care use was conducted. We excluded studies that were not published in English, lacked full-text availability, and those that documented patient approaches without comparing them to the willingness to undergo a discretionary procedure. Twenty-one studies were included-14 quantitative and seven qualitative-including 8472 patients. The Mixed Methods Appraisal Tool was used for quality assessment of included studies. The studies included demonstrated low risk of bias: five quantitative studies lacked detail regarding nonresponse bias and one qualitative study lacked details regarding the racial and ethnic composition of its cohort. To answer our first research question, we categorized themes associated with racial differences in mindsets toward discretionary care and recorded the presence of associations in quantitative studies. To answer our second question, we identified whether quantitative studies address potential confounding with socioeconomic factors. There were no randomized trials, so no meta-analysis was performed. RESULTS In general, self-identified Black and Hispanic patients had a lower preference for hip and knee arthroplasty than self-identified White patients. Black patients were more likely to regard osteoarthritis as a natural and irremediable part of aging and prefer home remedies. Both Black and Hispanic patients valued support from religion and were relatively cost-conscious. Black and Hispanic patients had lower perception of benefit, were less familiar with the procedure, had higher levels of fear regarding surgery and recovery, and had more-limited trust in care. Generally, Black and Hispanic social networks tended to address these concerns, whereas White social networks were more likely to discuss the benefits of surgery. Thirteen of 14 quantitative studies considered and accounted for potential confounding socioeconomic variables in their analyses. CONCLUSION The observation that lower preference for discretionary arthroplasty among Black and Hispanic patients is independent from socioeconomic factors and is related to accommodation of aging, preference for agency (home remedies), greater consideration of costs, recovery concerns, and potential harms directs orthopaedic surgeons to find ways to balance equitable access to specialty care and discretionary surgery while avoiding undermining effective accommodation strategies. It is important not to assume that lower use of discretionary surgery represents poorer care or is a surrogate marker for discrimination. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
MESH Headings
- Humans
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Hip/psychology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Hip/ethnology
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Knee/surgery
- Osteoarthritis, Knee/ethnology
- Osteoarthritis, Knee/psychology
- Healthcare Disparities/ethnology
- Hispanic or Latino/psychology
- Black or African American/psychology
- Health Knowledge, Attitudes, Practice/ethnology
- Socioeconomic Factors
- Attitude to Health/ethnology
- Ethnicity/psychology
Collapse
Affiliation(s)
- Yaw Adu
- School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Jack Hurley
- School of Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - David Ring
- Department of Orthopaedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
3
|
Ruan Q, Wang C, Zhang Y, Sun J. Ruscogenin attenuates cartilage destruction in osteoarthritis through suppressing chondrocyte ferroptosis via Nrf2/SLC7A11/GPX4 signaling pathway. Chem Biol Interact 2024; 388:110835. [PMID: 38122922 DOI: 10.1016/j.cbi.2023.110835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
Osteoarthritis (OA) is a common joint degenerative disease, and chondrocyte injury is the main pathological and physiological change. Ruscogenin (Rus), a bioactive compound isolated from Radix Ophiopogon japonicus, exhibits various pharmacological effects. The aim of this research was to test the role and mechanism of Rus on OA both in vivo and in vitro. Destabilized medial meniscus (DMM)-induced OA model was established in vivo and IL-1β-stimulated mouse chondrocytes was used to explore the role of Rus on OA in vitro. In vivo, Rus exhibited protective effects against DMM-induced OA model. Rus could inhibit MMP1 and MMP3 expression in OA mice. In vitro, IL-1β-induced inflammation and degradation of extracellular matrix were inhibited by Rus, as confirmed by the inhibition of PGE2, NO, MMP1, and MMP3 by Rus. Also, IL-1β-induced ferroptosis was suppressed by Rus, as confirmed by the inhibition of MDA, iron, and ROS, as well as the upregulation of GSH, GPX4, Ferritin, Nrf2, and SLC7A11 expression induced by Rus. Furthermore, the suppression of Rus on IL-1β-induced inflammation, MMPs production, and ferroptosis were reversed when Nrf2 was knockdown. In conclusion, Rus attenuated OA progression through inhibiting chondrocyte ferroptosis via Nrf2/SLC7A11/GPX4 signaling pathway.
Collapse
Affiliation(s)
- Qing Ruan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Cuijie Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Erdao District, 126 Sendai Street, Changchun, Jilin Province, 130033, China
| | - Yunfeng Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Jiayang Sun
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China.
| |
Collapse
|
4
|
Hawker GA, Bohm E, Dunbar MJ, Faris P, Jones CA, Noseworthy T, Ravi B, Woodhouse LJ, Marshall DA. Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome. RMD Open 2023; 9:rmdopen-2022-002808. [PMID: 37068914 PMCID: PMC10111922 DOI: 10.1136/rmdopen-2022-002808] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients' preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome. METHODS In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes-yes/no) and expectations (outcomes deemed 'very important'). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios. RESULTS Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66-0.74). The predicted probability of a good outcome ranged from 44.4% (33.9-55.5) to 92.4% (88.4-95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations. CONCLUSIONS Although external validation is required, our findings suggest that incorporation of patients' TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.
Collapse
Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Eric Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Dunbar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Faris
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Tom Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Bheeshma Ravi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Department of Public Health and Community Medicine, Tufts University, Phoenix, Arizona, USA
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
5
|
Jacobs H, Seeber GH, Lazovic D, Maus U, Hoffmann F. Disease burden of and expectations from surgery in patients prior to total knee arthroplasty: Results of the prospective FInGK study. Knee 2023; 41:257-265. [PMID: 36773371 DOI: 10.1016/j.knee.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/30/2022] [Accepted: 01/26/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Disease burden in patients prior to total knee arthroplasty (TKA) varies widely between studies and countries. We aimed to characterize individuals undergoing TKA and examine their expectations from the surgery, focusing on variations in disease burden. METHODS Consecutive patients undergoing primary TKA in a German university hospital were recruited. A questionnaire including information on disease burden, preoperative expectations from surgery, health care utilization, demography, and socioeconomics was collected one day prior to surgery and linked to data from medical records. Patients were categorized into disease burden quartiles using the Western Ontario and McMaster Universities Osteoarthritis Index' (WOMAC) total score. Subsequently, study population's characteristics and expectations from surgery were analyzed stratified by disease burden. RESULTS A total of 196 patients were included (41 % male; mean age: 68.2 years). The median WOMAC was 52.0 (IQR: 41.0-58.0). Patients in Q1 were more often males (Q1: 63 % vs Q4: 29 %) and had a shorter duration of complaints with the impaired knee. They were also less restricted in social participation, reported less often signs of depression, and were less often treated with physiotherapy (Q1: 27 % vs Q4: 54 %). Furthermore, expectations from surgery were highest in patients with a low disease burden. CONCLUSION We found large variations in disease burden with a considerable number of patients undergoing TKA whose functional capacity is still maintained and for which guideline-recommended conservative treatment options are not fully exhausted. Further research on this subgroup as well as establishing an international consensus on specific thresholds for TKA indication are needed.
Collapse
Affiliation(s)
- Hannes Jacobs
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| | - Gesine H Seeber
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Uwe Maus
- Department of Orthopaedics & Trauma Surgery, University Hospital Düsseldorf, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
6
|
Upfill-Brown AM, Paisner ND, Donnelly PC, De A, Sassoon AA. Lower Rates of Ceramic Femoral Head Use in Non-White Patients in the United States, a National Registry Study. J Arthroplasty 2022; 37:S919-S924.e2. [PMID: 35307527 PMCID: PMC9386729 DOI: 10.1016/j.arth.2022.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of our study was to investigate the association of race and ethnicity with the use of the newest technology and postoperative outcomes in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons (AAOS) American Joint Replacement Registry (AJRR). METHODS Adult THA procedures were queried from the AJRR from 2012 to 2020. A mixed-effects multivariate regression model was used to evaluate the association of race and ethnicity with the use of the newest technology (ceramic femoral head, dual-mobility implant, and robotic assist) at 30-day, and 90-day readmission. A proportional subdistribution hazard model was used to model a risk of revision THA. RESULTS There were 85,188 THAs with complete data for an analysis of outcomes and 103,218 for an analysis of ceramic head usage. The median length of follow-up was 37.9 months (interquartile range [IQR] 21.6 to 56.3 months). In multivariate models, compared to White non-Hispanic patients, Black (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.69-0.92, P < .001), Hispanic (OR 0.76, CI 0.59-0.99, P = .037), Asian (OR 0.74, CI 0.55-1.00, P = .045), and Native American (OR 0.52, CI 0.30-0.87, P = .004) patients all had significantly lower rates of ceramic head use in THA. Compared to White non-Hispanic patients, Asian (hazard ratio [HR] 0.39, CI 0.18-0.86, P = .008) and Hispanic (HR 0.43, CI 0.19-0.98, P = .043) patients had significantly lower rates of revision. No differences in 30-day or 90-day readmission rates were seen. CONCLUSION Black, Hispanic, Native American, and Asian patients had lower rates of ceramic head use in THA when compared to White patients. These differences did not translate into worse clinical outcomes on a short-term follow-up. In fact, Asian patients had lower revision rates compared to non-Hispanic White patients. Additional study is necessary to evaluate the long-term consequence of lower ceramic head use in non-White patients in the United States.
Collapse
Affiliation(s)
| | - Noah D. Paisner
- Pacific Northwest University School of Health Sciences, Yakima, WA
| | - Patrick C. Donnelly
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, IL
| | - Ayushmita De
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, IL
| | - Adam A. Sassoon
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA,Address correspondence to: Adam A. Sassoon, MD, MS, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th, Street, Suite 2100, Santa Monica, CA 90404
| |
Collapse
|
7
|
Wang KY, Puvanesarajah V, Xu A, Zhang B, Raad M, Hassanzadeh H, Kebaish KM. Growing Racial Disparities in the Utilization of Adult Spinal Deformity Surgery: An Analysis of Trends From 2004 to 2014. Spine (Phila Pa 1976) 2022; 47:E283-E289. [PMID: 34405826 DOI: 10.1097/brs.0000000000004180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE The purpose of this study was to assess trends in utilization rates of adult spinal deformity (ASD) surgery, as well as perioperative surgical metrics between Black and White patients undergoing operative treatment for ASD in the United States. SUMMARY OF BACKGROUND DATA Racial disparities in access to care, complications, and surgical selection have been shown to exist in the field of spine surgery. However, there is a paucity of data concerning racial disparities in the management of ASD patients. METHODS Adult patients undergoing ASD surgery from 2004 to 2014 were identified in the nationwide inpatient sample (NIS). Utilization rates, major complications rates, and length of stay (LOS) for Black patients and White patients were trended over time. Utilization rates were reported per 1,000,000 people and determined using annual census data among subpopulations stratified by race. All reported complication rates and prolonged hospital stay rates are adjusted for Elixhauser Comorbidity Index, income quartile by zip code, and insurance payer status. RESULTS From 2004 to 2014, ASD utilization for Black patients increased from 24.0 to 50.9 per 1,000,000 people, whereas ASD utilization for White patients increased from 29.9 to 73.1 per 1,000,000 people, indicating a significant increase in racial disparities in ASD utilization (P-trend < 0.001). There were no significant differences in complication rates or rates of prolonged hospital stay between Black and White patients across the time period studied (P > 0.05 for both). CONCLUSION Although Black and White patients undergoing ASD surgery do not differ significantly in terms of postoperative complications and length of hospital stay, there is a growing disparity in utilization of ASD surgery between White and Black patients from 2004 to 2014 in the United States. There is need for continued focus on identifying ways to reduce racial disparities in surgical selection and perioperative management in spine deformity surgery.Level of Evidence: 3.
Collapse
Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amy Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| |
Collapse
|
8
|
Li Z, Long H, Liu Q, Lin J. Willingness to Have Total Knee Arthroplasty in Rural Areas of Northern China. Orthop Surg 2022; 14:587-594. [PMID: 35174639 PMCID: PMC8926996 DOI: 10.1111/os.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate willingness and its potential predictors to have total knee arthroplasty (TKA) among residents in rural areas of northern China. METHODS Data were collected from two population-based studies on osteoarthritis (OA) in northern China. Residents aged ≥ 50 years in randomly selected rural communities were recruited using a cluster survey method. Participants completed a home interview (including social-demographic characteristics, clinical information, 12-Item Short Form Health Surveys [SF-12], and Visual Analog Scale [VAS] of knee pain), a physical examination, and bilateral weight-bearing posteroanterior semi-flexed view of radiographs of knees. Willingness to have TKA was queried by asking: "If you need to undergo total knee arthroplasty as judged by orthopaedic surgeons, are you willing to accept this operation?" Two trained investigators read all radiographs independently and reached an acceptable intra-reader agreement. We fitted univariate and multivariate regressions adjusting for potential confounders to examine predictors of willingness to have TKA stratified by sex. RESULTS A total of 2172 participants were included. The overall rate of willingness to have TKA was 33.8%. Men were more likely to be willing to have TKA than women with an odds ratio (OR) of 0.73 (95% confidence interval [CI]: 0.60-0.89, P = 0.002). A higher household income (OR: 2.34 for men and 1.77 for women, both P < 0.001), higher SF-12 Physical Component Summary (PCS) score (OR: 1.02 for both gender, P = 0.04 for men and P = 0.01 for women), and being aware of TKA (OR: 2.55 for men and 2.65 for women, both P < 0.001) were associated with a higher willingness to have TKA. Other predictors of higher willingness to have TKA were younger age (OR: 0.66 for 60-70 years, P = 0.01; and 0.48 for >70 years, P = 0.003, respectively) and lower level of physical activity (OR: 0.57 for moderate, p = 0.04; and 0.62 for heavy, p = 0.04, respectively) among men and a higher education (OR: 1.45 for Junior school, P = 0.04; and 1.66 for high school and above, P = 0.02, respectively) and being overweight among women (OR: 1.38, P = 0.008), respectively. No significant difference was observed between willingness to have TKA and frequent knee pain, VAS of knee pain and Kellgren and Lawrence grades in both men and women. CONCLUSIONS The willingness to have TKA among rural residents of northern China was relatively low. Younger age, women, educational level, household income, physical function, and awareness of TKA were positively associated with willingness to have TKA.
Collapse
Affiliation(s)
- Zhichang Li
- Arthritis Clinic and Research CenterPeking University People's HospitalBeijingChina
| | - Huibin Long
- Arthritis Clinic and Research CenterPeking University People's HospitalBeijingChina
- Department of Orthopedics, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Qiang Liu
- Arthritis Clinic and Research CenterPeking University People's HospitalBeijingChina
| | - Jianhao Lin
- Arthritis Clinic and Research CenterPeking University People's HospitalBeijingChina
| |
Collapse
|
9
|
LeDoux CV, Lindrooth RC, Stevens-Lapsley JE. The Impact of Total Joint Arthroplasty on Long-Term Physical Activity: A Secondary Analysis of the Health and Retirement Study. Phys Ther 2022; 102:6380794. [PMID: 34636910 DOI: 10.1093/ptj/pzab231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/16/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical inactivity is the fourth-leading cause of global mortality and is prevalent among people with lower extremity osteoarthritis. Lower extremity osteoarthritis is the most common arthritis type afflicting older adults, and total joint arthroplasty (TJA) performed to address the condition is Medicare's largest annual expense. Despite TJA intervention to address the disabling effects of osteoarthritis, physical activity (PA) level remains stable 6 months after TJA; however, the effect of TJA on long-term PA $(\ge$2 y) in a representative sample of older adults is unknown. The purpose of this study was to test the hypothesis that PA would remain stable in the long term. METHODS In this longitudinal observational study, a probability-weighted difference-in-differences analysis was conducted to observe the predictive margins of nontraumatic hip or knee TJA on levels of vigorous and moderate PA after 2 years. A combined Health and Retirement Study data set of community-dwelling adults who were >55 years old, had symptomatic osteoarthritis, and were in need of TJA between 2008 and 2018 (N = 4652) was used. RESULTS TJA was not associated with vigorous PA ($\delta$ = 2.37; SE = 5.23) or moderate PA ($\delta$ = -2.84; SE = 7.76) after 2 years. CONCLUSION TJA was not associated with increased long-term PA in older adults with osteoarthritis. IMPACT Physical therapists should not assume that there will be a natural increase in PA after functional recovery from TJA procedures. Older adults with lower extremity osteoarthritis may benefit from PA screening and promotion practices in physical therapy services. LAY SUMMARY Receiving a total joint replacement does not lead to increased physical activity levels 2 years after surgery.
Collapse
Affiliation(s)
- Cherie V LeDoux
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard C Lindrooth
- Colorado School of Public Health, Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- 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 (GRECC), Aurora, Colorado, USA
| |
Collapse
|
10
|
Disparities across Diverse Populations in the Health and Treatment of Patients with Osteoarthritis. Healthcare (Basel) 2021; 9:healthcare9111421. [PMID: 34828468 PMCID: PMC8619799 DOI: 10.3390/healthcare9111421] [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] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
The study of disparities across diverse populations regarding the health and treatment of patients with osteoarthritis (OA) is recognized as a priority for investigation and action by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the American Academy of Orthopedic Surgeons (AAOS). OA is a common condition that increases with age, but with prevalence generally similar across racial and ethnic groups. However, disparities in the treatment of OA among racial, ethnic, and socioeconomic groups are well-documented and continue to rise and persist. The reasons are complex, likely involving a combination of patient, provider, and healthcare system factors. Treatment disparities among these different populations have an impact on clinical outcomes, healthcare, and productivity, and are projected to increase significantly with the growing diversity of the United States population. The aim of this short review is to summarize studies of racial, ethnic, and socioeconomic disparities among patients with OA in the United States, with a focus on prevalence, treatment utilization, and clinical and economic outcomes.
Collapse
|
11
|
The Impact of Race and Socioeconomic Status on Total Joint Arthroplasty Care. J Arthroplasty 2021; 36:2729-2733. [PMID: 33773863 DOI: 10.1016/j.arth.2021.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial minorities and patients from lower socioeconomic backgrounds are less likely to undergo total joint arthroplasty (TJA) for degenerative joint disease (DJD). However, when these patients do present for care, little is known about the overall severity of DJD and surgical wait times. METHODS A retrospective cohort of 407 patients (131 black and 276 white) who presented to an arthroplasty clinic and went on to receive TJA was established. Severity of osteoarthritis was assessed radiographically via Kellgren-Lawrence (KL) grade. Preoperative Knee Society Score (KSS) and Harris Hip Score (HHS) were used to measure joint pain and function. Multivariate regression modeling and analysis of covariance were used to examine racial and socioeconomic differences in KL grade, KSS, HHS, and time to surgery. RESULTS Black patients presented with significantly greater KL scores than white patients (P = .046, odds ratio = 1.65, 95% confidence interval [1.01, 2.70]). In contrast, there were no statistically significant racial differences in the mean preoperative KSS (P = .61) or HHS (P = .69). Black patients were also found to wait, on average, 35% longer for TJA (P = .03, hazard ratio = 1.35, 95% confidence interval [1.04, 1.75]). Low income was associated with higher KL grade (P = .002), lower KSS (P = .07), and lower HHS (P = .001). CONCLUSION Despite presenting with more advanced osteoarthritis, black patients reported similar levels of joint dysfunction and had longer surgical wait times when compared with white patients. Lower socioeconomic status was similarly associated with more severe DJD.
Collapse
|
12
|
A D, A T, T J, O R, LE D, M E. The role of pain and walking difficulties in shaping willingness to undergo joint surgery for osteoarthritis: Data from the Swedish BOA register. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100157. [PMID: 36474994 PMCID: PMC9718157 DOI: 10.1016/j.ocarto.2021.100157] [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: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To investigate whether the association between pain intensity and willingness to undergo surgery is explained by walking difficulties, in patients with knee or hip osteoarthritis (OA). Methods This is an observational study using data from the Better management of patients with Osteoarthritis (BOA) register, which collects data from a publicly financed self-management programme for people with OA in Sweden. We included all patients with knee or hip OA who attended the baseline visit between 2008 and 2016. We conducted separate mediation analyses within a counterfactual framework to estimate the mediation effect of walking difficulties (yes/no) on willingness to undergo surgery (yes/no) for each one-point increase in pain (0-10 on a numeric rating scale), adjusted for relevant confounders. Results We included 72,131 patients (69% women, mean age 66, mean pain 5.4, 81% had walking difficulties, 27% was willing to undergo surgery). A one-point increase in pain intensity was associated with 1.53 (95% CI: 1.51; 1.55) higher odds of being willing to undergo surgery. Walking difficulties mediated 10%-25% of the effect of one-point increase in pain when pain was <8/10, while at pain ≥8/10 this percentage decreased to 3%. Conclusions More than 80% of the BOA patients have mild to moderate pain (<8/10) and walking difficulties can mediate up to a quarter of the total effect of pain on the willingness to undergo surgery in these patients. Trials to evaluate the potential to lower surgery demand by reducing walking difficulties in people with these characteristics are needed.
Collapse
Affiliation(s)
- Dell’Isola A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Turkiewicz A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jönsson T
- Department of Health Sciences, Division of Physiotherapy, Sport Sciences, Lund University, Sweden
| | - Rolfson O
- Department of Orthopedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Dahlberg LE
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Englund M
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Does racial background influence outcomes following total joint arthroplasty? J Clin Orthop Trauma 2021; 19:139-146. [PMID: 34099973 PMCID: PMC8167263 DOI: 10.1016/j.jcot.2021.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty. METHODS We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chi-square and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences. RESULTS This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgical-time significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (readmissions&revisions), and discharge-disposition did not statistically differ in both cohorts. CONCLUSION Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted. LEVEL OF EVIDENCE Prognostic Level III.
Collapse
|
14
|
Bove AM, Dong ER, Hausmann LRM, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Exploring Race Differences in Satisfaction with Rehabilitation Following Total Knee Arthroplasty: a Qualitative Study. J Gerontol A Biol Sci Med Sci 2021; 77:e48-e55. [PMID: 33978153 DOI: 10.1093/gerona/glab132] [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] [Received: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHODS We conducted a series of qualitative focus group discussions with groups of Non-Hispanic White and Non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of post-operative physical therapy received, and overall satisfaction with the post-operative rehabilitation process. RESULTS Thirty-six individuals participated in focus groups. Three major themes emerged: (1) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation", and often mentioned specific interventions they felt were most helpful in their recovery. (2) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (3) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS Individuals undergoing TKA can largely expect positive rehabilitation experiences post-operatively. However, some barriers to post-operative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.
Collapse
Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Erin R Dong
- Penn Presbyterian Medical Center; Philadelphia, PA, USA
| | - Leslie R M Hausmann
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System; Pittsburgh, PA, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University; Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| |
Collapse
|
15
|
Vina ER, Hannon MJ, Quinones C, Hausmann LRM, Ibrahim SA, Dagnino J, Kwoh CK. The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR Open Rheumatol 2021; 3:154-163. [PMID: 33570233 PMCID: PMC7966879 DOI: 10.1002/acr2.11235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA). METHODS Surveys of 334 adults with knee and/or hip OA were analyzed in this cross-sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables. RESULTS In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription-only NSAIDs, respectively. Hispanic participants, compared with non-Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05-7.47) and over-the-counter (OTC) (RRR 3.10; 95% CI 1.65-5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79-6.86) and OTC (RRR 2.80; 95% CI 1.39-5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71-3.66) and OTC (RRR 1.44; 95% CI 1.01-2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46-0.87]; OTC: RRR 0.53 [95% CI 0.37-0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use. CONCLUSION Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients' perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.
Collapse
Affiliation(s)
| | | | | | - L. R. M. Hausmann
- US Department of Veterans Affairs Pittsburgh Healthcare System and University of PittsburghPittsburghPennsylvania
| | - S. A. Ibrahim
- Weill Cornell MedicineCornell UniversityNew YorkNew York
| | | | | |
Collapse
|
16
|
Abstract
This article reviews the literature on racial and socioeconomic disparities in the management of osteoarthritis. Treatments investigated include arthritis education, dietary weight management, exercise/physical therapy, pharmacologic therapy with nonsteroidal antiinflammatory drugs and opioids, intra-articular steroid injections, and total joint replacement. The amount of evidence for each treatment modality varied, with the most evidence available for racial and socioeconomic disparities in total joint arthroplasty. Black patients, Hispanic patients, and patients with low socioeconomic status (SES) are less likely to undergo total joint replacement than white patients or patients with high SES, and generally have worse functional outcomes and more complications.
Collapse
Affiliation(s)
- Angel M Reyes
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA.
| | - Jeffrey N Katz
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
17
|
Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B, Noseworthy T, Woodhouse LJ, Peter F, Dick D, Powell J, Paul P, Marshall DA. The Relationship between Patient-Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One Year. Arthritis Care Res (Hoboken) 2021; 74:1374-1383. [PMID: 33460528 DOI: 10.1002/acr.24562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the relationship between patients' pre-operative readiness for total knee arthroplasty (TKA) and surgical outcome at one-year. METHODS This prospective cohort study recruited knee osteoarthritis (OA) patients aged 30+ years referred for TKA at two hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess WOMAC-pain, KOOS-physical function, Perceived Arthritis Coping Efficacy, General Self-Efficacy, PHQ-8, BMI, comorbidities and TKA readiness (Patient Acceptable Symptom State; willingness to undergo TKA), and one-year post-TKA to assess outcomes. A good TKA outcome was defined as improved knee symptoms (OARSI-OMERACT responder criteria) AND overall satisfaction with results. Poisson regression with robust error estimation was used to estimate relative risk of a good outcome for exposures, before and after controlling for covariates. RESULTS Of 1,272 TKA recipients assessed at one year, 1,053 with data for our outcome were included (mean age 66.9 years (SD 8.8); 58.6% female). Most (87.8%) were definitely willing to undergo TKA and had 'unacceptable' knee symptoms (79.7%). 78.1% achieved a good TKA outcome. Controlling for pre-TKA OA-related disability, arthritis coping efficacy, comorbid hip symptoms and depressed mood, definite willingness to undergo TKA and unacceptable knee symptoms were associated with greater likelihood of a good TKA outcome (adjusted RRs 1.18, 95% CI 1.04-1.35, and 1.14, 95% CI 1.02-1.27, respectively). CONCLUSION Among TKA recipients for knee OA, patients' psychological readiness and willingness for TKA were associated greater likelihood of a good outcome. Incorporation of these factors in TKA decision-making may enhance patient outcomes and appropriate use of TKA.
Collapse
Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Eric Bohm
- Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tom Noseworthy
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia
| | - Faris Peter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donald Dick
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Powell
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paulose Paul
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | |
Collapse
|
18
|
Vina ER, Quinones C. Understanding the Role and Challenges of Patient Preferences in Disparities in Rheumatologic Disease Care. Rheum Dis Clin North Am 2020; 47:83-96. [PMID: 34042056 DOI: 10.1016/j.rdc.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence suggests patient preferences, including values and perspectives, have affected clinical outcomes, such as compliance, patient well-being, and satisfaction with care. A literature review was conducted with the purpose of exploring the tools used to elicit patients' treatment preferences and their roles in clinical outcomes. This review revealed racial differences in treatment preferences among patients with rheumatic and musculoskeletal diseases. The use of decision aids is a proactive intervention with potential for reducing race disparities and improving clinical outcomes. The utilization of patient preferences and values can improve outcomes by complementing the shared decision-making approach between patients and rheumatologists.
Collapse
Affiliation(s)
- Ernest R Vina
- University of Arizona Arthritis Center, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA; Department of Medicine, Division of Rheumatology, University of Arizona, College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA.
| | - Cristian Quinones
- University of Arizona Arthritis Center, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA; Department of Medicine, Division of Rheumatology, University of Arizona, College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA
| |
Collapse
|
19
|
Total Hip Arthroplasty in Black/African American Patients: an Updated Nationwide Analysis. J Racial Ethn Health Disparities 2020; 8:698-703. [DOI: 10.1007/s40615-020-00829-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
|
20
|
Kwoh CK, Guehring H, Aydemir A, Hannon MJ, Eckstein F, Hochberg MC. Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints. Osteoarthritis Cartilage 2020; 28:782-791. [PMID: 32247871 DOI: 10.1016/j.joca.2020.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate associations between 2-year change in radiographic or quantitative magnetic resonance imaging (qMRI) structural measures, and knee replacement (KR), within a subsequent 7-year follow-up period. METHOD Participants from the Osteoarthritis Initiative were selected based on potential eligibility criteria for a disease-modifying osteoarthritis (OA) drug trial: Kellgren-Lawrence grade 2 or 3; medial minimum joint space width (mJSW) ≥2.5 mm; knee pain at worst 4-9 in the past 30 days on an 11-point scale, or 0-3 if medication was taken for joint pain; and availability of structural measures over 2 years. Mean 2-year change in structural measures was estimated and compared with two-sample independent t-tests for KR and no KR. Area under the receiver operating characteristic curve (AUC) was estimated using 2-year change in structural measures for prediction of future KR outcomes. RESULTS Among 627 participants, 107 knees underwent KR during a median follow-up of 6.7 years after the 2-year imaging period. Knees that received KR during follow-up had a greater mean loss of cartilage thickness in the total femorotibial joint and medial femorotibial compartment on qMRI, as well as decline in medial fixed joint space width on radiographs, compared with knees that did not receive KR. These imaging measures had similar, although modest discrimination for future KR (AUC 0.62, 0.60, and 0.61, respectively). CONCLUSIONS 2-year changes in qMRI femorotibial cartilage thickness and radiographic JSW measures had similar ability to discriminate future KR in participants with knee OA, suggesting that these measures are comparable biomarkers/surrogate endpoints of structural progression.
Collapse
Affiliation(s)
- C K Kwoh
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ, USA.
| | | | - A Aydemir
- EMD Serono Global Clinical Development Center, Billerica, MA, USA.
| | - M J Hannon
- University of Pittsburgh, Pittsburgh, PA, USA.
| | - F Eckstein
- Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - M C Hochberg
- University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
21
|
Bendich I, Halvorson RT, Ward D, Nevitt M. Predictors of a change in patient willingness to have Total knee arthroplasty: Insights from the osteoarthritis initiative. Knee 2020; 27:667-675. [PMID: 32563421 DOI: 10.1016/j.knee.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND While many factors have been shown to influence patient willingness to have total joint arthroplasty, factors associated with changes in patient willingness to have arthroplasty have not been studied. The objective of this research is to identify predictors of change in patient willingness to have total knee arthroplasty (TKA). METHODS Patient willingness to have TKA as well as questionnaire, clinical, and radiographic data, were obtained from the Osteoarthritis Initiative (OAI) for individuals with, or at high risk for developing knee OA. Mixed effects ordinal logistic regressions were employed to assess the relationships between 40 predictors and change in willingness to have surgery. Predictors significant in univariate models were included in a multivariable analysis. RESULTS Three thousand three hundred and ninety-four OAI patients were included in our analysis. Between baseline and follow-up, 462 (13.6%) became more willing and 533 (15.7%) became less willing to have TKA. After controlling for demographic factors in multivariable analysis, patients with higher income and expected difficulty with postoperative walking were more likely to increase their willingness to have TKA. General health, race, and knee injections within the past six months approached significance with regard to increasing willingness to have TKA over time. CONCLUSION Income and expectations of difficulty walking postoperatively were significantly associated with changes in patient willingness to have TKA independent of age, sex, health coverage, employment, marriage status, and knee pain. Understanding factors influencing patient willingness to have surgery may be instrumental in counseling and addressing the mismatch of OA disease burden to surgical utilization.
Collapse
Affiliation(s)
- Ilya Bendich
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave. MU W320, San Francisco, CA 94143, United States of America
| | - Ryan T Halvorson
- School of Medicine, University of California, San Francisco. 500 Parnassus Ave. San Francisco, CA 94143, United States of America.
| | - Derek Ward
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave. MU W320, San Francisco, CA 94143, United States of America
| | - Michael Nevitt
- Department of Epidemiology and Biostatistics, University of California, 550 16th St, San Francisco, CA 94158, United States of America
| |
Collapse
|
22
|
Tompson JD, Syed UA, Padegimas EM, Abboud JA. Shoulder Arthroplasty Utilization Based on Race - Are Black Patients Underrepresented? THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:484-492. [PMID: 31970252 PMCID: PMC6935522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization based on patient race. METHODS The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplasty utilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoing shoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-black subpopulations. RESULTS The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted 3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of 1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Females accounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001) and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type, 1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of five major insurance categories, including private, Medicare, Medicaid, workers' compensation, and personal injury, indicated no difference in insurance patterns (χ2=3.658, P=0.454). CONCLUSION The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national and institutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Black patients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-black patients. The obtained results highlighted the need for the expansion of black patients' access to care services related to major joint reconstruction.
Collapse
Affiliation(s)
- Jeffrey D Tompson
- Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Research performed at the Rothman Institute of Orthopedics, Methodist Hospital-Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Usman A Syed
- Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Research performed at the Rothman Institute of Orthopedics, Methodist Hospital-Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Eric M Padegimas
- Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Research performed at the Rothman Institute of Orthopedics, Methodist Hospital-Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph A Abboud
- Rothman Institute, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA, USA
- Research performed at the Rothman Institute of Orthopedics, Methodist Hospital-Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| |
Collapse
|
23
|
Espinosa P, Weiss RJ, Robertsson O, Kärrholm J. Sequence of 305,996 total hip and knee arthroplasties in patients undergoing operations on more than 1 joint. Acta Orthop 2019; 90:450-454. [PMID: 31282252 PMCID: PMC6746289 DOI: 10.1080/17453674.2019.1638177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patient-specific data on multiple total arthroplasties (TA) of the lower limbs due to osteoarthritis (OA) are limited. We investigated the sequence of surgical procedures and risk factors for additional surgery in such patients. Patients and methods - 305,996 patients operated with a TA of the hip and/or knee due to OA were extracted from the Swedish National Hip (SHAR) and the Swedish Knee Arthroplasty Register (SKAR). 177,834 total hip arthroplasty (THA, 56% women, mean age 69 years) and 128,162 total knee arthroplasty (TKA, 60% women, mean age 69 years) procedures constituted the index operations. The mean, median, and maximum follow-up was 8, 6, and 23 years. Multivariable Cox regression analysis was used and Kaplan-Meier survival curves were constructed. Results - Right-sided primary TA (34%) was most frequent. Subsequent surgery was most frequent after primary left-sided TKA (33%). The time interval to a second TA procedure was 3.1 (SD 3.2) years after TKA and 4.0 (SD 3.9) years after THA. After the index TA the probability of no subsequent surgery amounted to 64% (SD 0.3) for THA and 58% (SD 0.4) for TKA over 20 years. Lower age, female sex, left side, and TKA at index operation were associated with a higher probability for subsequent TA. Interpretation - Delineation of factors that influence risk and the size of the risk for subsequent TA in 1 of the 3 major remaining joints is of value for clinicians and healthcare providers in the decision-making process for future resource allocation.
Collapse
Affiliation(s)
- Peter Espinosa
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm; ,Correspondence:
| | - Rüdiger J Weiss
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm;
| | - Otto Robertsson
- Swedish Knee Arthroplasty Register, Lund; ,Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund;
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
24
|
Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag 2019; 9:317-334. [PMID: 31140916 PMCID: PMC6587104 DOI: 10.2217/pmt-2018-0030] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.
Collapse
Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alejandro Cortes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Calia A Morais
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
| |
Collapse
|
25
|
Goodman SM, Mehta B, Zhang M, Szymonifka J, Nguyen JT, Lee L, Figgie MP, Parks ML, Dey SA, Crego D, Russell LA, Mandl LA, Bass AR. Disparities in Total Hip Arthroplasty Outcomes: Census Tract Data Show Interactions Between Race and Community Deprivation. J Am Acad Orthop Surg 2018; 26:e457-e464. [PMID: 30192253 DOI: 10.5435/jaaos-d-17-00393] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Socioeconomic factors such as poverty may mediate racial disparities in health outcomes after total hip arthroplasty (THA) and confound analyses of differences between blacks and whites. METHODS Using a large institutional THA registry, we built models incorporating individual and census tract data and analyzed interactions between race and percent of population with Medicaid coverage and its association with 2-year patient-reported outcomes. RESULTS Black patients undergoing THA had worse baseline and 2-year pain and function scores compared with whites. We observed strong positive correlations between census tract Medicaid coverage and percent living below poverty (rho = 0.69; P < 0.001). Disparities in 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function were magnified in communities with high census tract Medicaid coverage. For blacks in these communities, 2-year WOMAC function scores were predicted to be -5.54 points lower (80.42 versus 85.96) compared with blacks in less deprived communities, a difference not observed among whites. CONCLUSION WOMAC pain and function 2 years after THA are similar among blacks and whites in communities with little deprivation (low percent census tract Medicaid coverage). WOMAC function at 2 years is worse among blacks in areas of higher deprivation but is not seen among whites. LEVEL OF EVIDENCE Level II - Cohort Study.
Collapse
Affiliation(s)
- Susan M Goodman
- From the Department of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medicine (Dr. Goodman, Dr. Mehta, Dr. Zhang, Dr. Russell, Dr. Bass and Dr. Mandl), Department of Orthopedic Surgery (Dr. Figgie and Dr.Parks) and Department of Medicine (Ms. Szymonifka, Mr. Nguyen, Ms. Lee, Ms. Dey and Ms. Crego), Hospital for Special Surgery, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kerman HM, Smith SR, Smith KC, Collins JE, Suter LG, Katz JN, Losina E. Disparities in Total Knee Replacement: Population Losses in Quality-Adjusted Life-Years Due to Differential Offer, Acceptance, and Complication Rates for African Americans. Arthritis Care Res (Hoboken) 2018; 70:1326-1334. [PMID: 29363280 DOI: 10.1002/acr.23484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/28/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Total knee replacement (TKR) is an effective treatment for end-stage knee osteoarthritis (OA). American racial minorities undergo fewer TKRs than whites. We estimated quality-adjusted life-years (QALYs) lost for African American knee OA patients due to differences in TKR offer, acceptance, and complication rates. METHODS We used the Osteoarthritis Policy Model, a computer simulation of knee OA, to predict QALY outcomes for African American and white knee OA patients with and without TKR. We estimated per-person QALYs gained from TKR as the difference between QALYs with current TKR use and QALYs when no TKR was performed. We estimated average, per-person QALY losses in African Americans as the difference between QALYs gained with white rates of TKR and QALYs gained with African American rates of TKR. We calculated population-level QALY losses by multiplying per-person QALY losses by the number of persons with advanced knee OA. Finally, we estimated QALYs lost specifically due to lower TKR offer and acceptance rates and higher rates of complications among African American knee OA patients. RESULTS African American men and women gain 64,100 QALYs from current TKR use. With white offer and complications rates, they would gain an additional 72,000 QALYs. Because these additional gains are unrealized, we call this a loss of 72,000 QALYs. African Americans lose 67,500 QALYs because of lower offer rates, 15,800 QALYs because of lower acceptance rates, and 2,600 QALYs because of higher complication rates. CONCLUSION African Americans lose 72,000 QALYs due to disparities in TKR offer and complication rates. Programs to decrease disparities in TKR use are urgently needed.
Collapse
Affiliation(s)
- Hannah M Kerman
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, Boston, Massachusetts
| | - Savannah R Smith
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, Boston, Massachusetts
| | - Karen C Smith
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, Boston, Massachusetts
| | - Jamie E Collins
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa G Suter
- Yale-New Haven Hospital Center for Outcomes Research and Evaluation, and Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
27
|
Allen KD, Golightly YM, White DK. Gaps in appropriate use of treatment strategies in osteoarthritis. Best Pract Res Clin Rheumatol 2018; 31:746-759. [PMID: 30509418 DOI: 10.1016/j.berh.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 10/28/2022]
Abstract
Optimal management of osteoarthritis (OA) requires a combination of therapies, with behavioral (e.g., exercise and weight management) and rehabilitative components at the core, accompanied by pharmacological treatments and, in later stages, consideration of joint replacement surgery. Although multiple sets of OA treatment guidelines have been developed, there are gaps in the implementation of these recommendations. Key areas of concern include the underuse of exercise, weight management, and other behavioral and rehabilitation strategies as well as the overuse of opioid analgesics. In this review, we describe the major categories of treatment strategies for OA, including self-management, physical activity, weight management, physical therapy and other rehabilitative therapies, pharmacotherapies, and joint replacement surgery. For each category, we discuss the current evidence base to report on appropriate use, data regarding adherence to treatment recommendations, and potential approaches to optimize use.
Collapse
Affiliation(s)
- Kelli D Allen
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina, Center for Health Services Research in Primary Care, Department of Veterans Affairs Center, Durham, NC, USA.
| | - Yvonne M Golightly
- Department of Epidemiology, Gillings School of Global Public Health/Division of Physical Therapy/Thurston Arthritis Research Center, School of Medicine/Injury Prevention Research Center, University of North Carolina, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599-7280, USA.
| | - Daniel K White
- Department of Physical Therapy University of Delaware, 540 South College Ave, 210L, Newark, DE, 19713, USA.
| |
Collapse
|
28
|
MacFarlane LA, Kim E, Cook N, Lee IM, Iversen MD, Katz JN, Costenbader KH. Racial Variation in Total Knee Replacement in a Diverse Nationwide Clinical Trial. J Clin Rheumatol 2018; 24:1-5. [PMID: 29232323 PMCID: PMC5741516 DOI: 10.1097/rhu.0000000000000613] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Racial variation in total knee replacement (TKR) utilization in the United States has been reported in administrative database studies. We investigated racial variation in TKR procedures in a diverse cohort with severe knee pain followed in an ongoing clinical trial. METHODS VITAL (VITamin D and OmegA-3 TriaL) is a nationwide, randomized controlled trial of 25,874 adults, 20% of whom are black. We identified a subgroup highly likely to have knee osteoarthritis based on severity of knee pain, physician-diagnosed knee osteoarthritis, and inability to walk 2 to 3 blocks without pain. Participants completed a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and self-reported incident TKR annually in follow-up. Using Cox regression, we analyzed the association of black versus white race with TKR, adjusting for demographic and socioeconomic characteristics, comorbidities, and WOMAC pain and function. RESULTS Among 1070 participants who met the inclusion criteria, black participants reported worse baseline WOMAC pain (45 vs. 32, P < 0.001) and worse function (45 vs. 32, P < 0.001). During a median of 3.6 years (interquartile range, 3.2, 3.8 years) of follow-up, TKRs were reported by 180 participants. Black participants were less likely to undergo TKR (11% vs. 19%). After adjustment, the hazard ratio for TKR for black versus white participants was 0.51 (95% confidence interval, 0.32-0.81). Lower use of TKR among black participants was observed across all levels of income and education. CONCLUSIONS Despite worse baseline knee pain and function, black participants had much lower adjusted risk of having TKR than white participants, demonstrating persistent racial disparity in TKR utilization.
Collapse
Affiliation(s)
- Lindsey A. MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
| | - Eunjung Kim
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Nancy Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Maura D Iversen
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Karen H. Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Dangelmajer S, Yang A, Githens M, Harris AHS, Bishop JA. Disparities in Total Hip Arthroplasty Versus Hemiarthroplasty in the Management of Geriatric Femoral Neck Fractures. Geriatr Orthop Surg Rehabil 2017; 8:155-160. [PMID: 28835872 PMCID: PMC5557198 DOI: 10.1177/2151458517720991] [Citation(s) in RCA: 6] [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: 02/20/2017] [Revised: 05/29/2017] [Accepted: 06/14/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction: Recent clinical evidence suggests that total hip arthroplasty (THA) provides improved clinical outcomes as compared to hemiarthroplasty (HA) for displaced femoral neck fractures in elderly individuals. However, THA is still utilized relatively infrequently. Few studies have evaluated the factors affecting utilization and the role socioeconomics plays in THA versus HA. Methods: In the United States, the National Inpatient Sample (NIS) database was used to identify patients treated surgically for femoral neck fracture, between 2009 and 2010. Patients were identified using International Classification of Diseases, Ninth Revision, codes for closed, transcervical femoral neck fractures and closed fractures at unspecified parts of the femoral neck. All candidate predictors of THA versus HA were entered into a multilevel mixed-effect regression model. Results: Older patient age, being Asian or Pacific Islander, and having Medicaid payer status were all associated with lower odds of receiving THA. Patients with private insurance including Health Maintenance organization (HMO) had higher odds of THA as did patients with other insurance. Odds of THA were significantly lower among patients in teaching hospitals and higher at hospitals with greater THA volume. Discussion: Ethnicity, payer status, hospital size, and institutional THA volume were all associated with the utilization of THA versus HA in the treatment of geriatric femoral neck fractures. Level of Evidence: Level III Retrospective Cohort study.
Collapse
Affiliation(s)
- Sean Dangelmajer
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Arthur Yang
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Michael Githens
- Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA
| | - Alex H S Harris
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| |
Collapse
|
30
|
Vina ER, Ran D, Ashbeck EL, Kaur M, Kwoh CK. Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters. Arthritis Care Res (Hoboken) 2017; 69:95-103. [PMID: 27636123 DOI: 10.1002/acr.23084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/12/2016] [Accepted: 09/06/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine if severity of osteoarthritis-related knee pain is associated with a willingness to undergo total knee replacement (TKR) and whether this association is confounded or modified by components of socioeconomic status and health care coverage. METHODS Cross-sectional analysis was conducted among 3,530 Osteoarthritis Initiative study participants. Logistic regression models were used to assess the effect of knee pain severity (where 0 = none, 1-3 = mild, 4-7 = moderate, and 8-10 = severe) on willingness to undergo TKR. Stratified analyses were conducted to evaluate whether socioeconomic status and health care coverage modify the effect of knee pain severity on willingness. RESULTS Participants with severe knee pain, compared to participants without pain, were less willing to undergo TKR (odds ratio [OR] 0.73, 95% confidence interval [95% CI] 0.57-0.93). This association was attenuated when adjusted for age, sex, comorbidity, depression, health insurance coverage, prescription medicine coverage, health care source, education, income, employment, race, and marital status (adjusted OR 0.92, 95% CI 0.68-1.24). The odds of willingness to undergo TKR were significantly lower in those with the highest level of pain, compared to those without pain, among participants without health insurance (adjusted OR 0.08, 95% CI 0.01-0.56), but not among those with health insurance (adjusted OR 1.03, 95% CI 0.73-1.38), when adjusted for demographic, clinical, health care access, and socioeconomic factors (P = 0.015). However, <5% of participants were without health insurance. CONCLUSION Among participants without health insurance, severe knee pain was paradoxically associated with less willingness to undergo TKR. Policies that improve access to quality health care may affect patient preferences and increase utilization of TKR surgery among vulnerable populations.
Collapse
Affiliation(s)
| | - Di Ran
- University of Arizona, Tucson
| | | | | | | |
Collapse
|
31
|
Collins JE, Deshpande BR, Katz JN, Losina E. Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2017; 68:965-73. [PMID: 26554629 DOI: 10.1002/acr.22771] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/24/2015] [Accepted: 10/20/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine race- and sex-specific rates of total knee arthroplasty (TKA) and to document independent effects of demographic factors on TKA incidence in a population with radiographically confirmed osteoarthritis (OA). METHODS We used data from the Osteoarthritis Initiative, a US-based, multicenter longitudinal study of knee OA. We selected subjects with radiographic symptomatic OA at baseline and determined TKA incidence rates (ratio of TKAs to time at risk for TKA) over 84 months of followup. We used multivariable Poisson regression to identify independent associations between demographic factors and TKA utilization. RESULTS During the study period there were 223 TKAs among 1,915 subjects for an incidence of 1.9% (95% confidence interval [95% CI] 1.7-2.2%). The overall rate was 1.9% (95% CI 1.5-2.3%) in men versus 2.0% (95% CI 1.7-2.3%) in women, and 2.2% (95% CI 1.9-2.6%) in whites versus 1.0% (95% CI 0.7-1.5%) in nonwhites. We observed a statistically significant interaction between sex and age (stratified at <65 and ≥65 years at end of followup), wherein male sex was associated with decreased risk of TKA for younger participants (relative risk [RR] 0.32) but not for older participants. Nonwhite race was associated with a decreased risk of TKA for both younger (RR 0.32) and older (RR 0.43) participants. CONCLUSION Our finding that nonwhites were less likely to undergo TKA than whites in adjusted analyses confirms racial differences observed in population-based studies and underscores the need for interventions to address lower use of TKA among nonwhites with OA.
Collapse
Affiliation(s)
- Jamie E Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Bhushan R Deshpande
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
32
|
Maher A, Leigh W, Brick M, Young S, Millar J, Walker C, Caughey M. Gender, ethnicity and smoking affect pain and function in patients with rotator cuff tears. ANZ J Surg 2017; 87:704-708. [PMID: 28702950 DOI: 10.1111/ans.13921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/11/2016] [Accepted: 12/31/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study is a collation of baseline demographic characteristics of those presenting for rotator cuff repair in New Zealand, and exploration of associations with preoperative function and pain. Data were obtained from the New Zealand Rotator Cuff Registry; a multicentre, nationwide prospective cohort of rotator cuff repairs undertaken from 1 March 2009 until 31 December 2010. METHODS A total of 1383 patients were included in the study. This required complete demographic information, preoperative Flex-SF (functional score) and pain scores. Following univariate analysis, a multivariate model was used. RESULTS The average age was 58 years (69% males and 11% smokers). New Zealand Europeans made up 90% and Maori 5%. The average preoperative Flex-SF was significantly lower (poorer function) in those over 65 years, females, smokers and Maori, in the non-dominant patients, using a multivariate model. Average preoperative pain scores were significantly worse (higher scores) in females, Maori, Polynesians, smokers, using a multivariate model. CONCLUSION This is the largest reported prospective cohort of patients presenting for rotator cuff surgery. Results can be used to understand the effect of rotator cuff tears on the different patients, for example Maori patients who are under-represented, present younger, with more pain and poorer function.
Collapse
Affiliation(s)
- Anthony Maher
- Department of Orthopaedics, Wanganui Hospital, Wanganui, New Zealand
| | - Warren Leigh
- Department of Orthopaedics, Orthosports North Harbour, Auckland, New Zealand
| | - Matt Brick
- Department of Orthopaedics, Orthosports North Harbour, Auckland, New Zealand
| | - Simon Young
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - James Millar
- Medical School, The University of Auckland, Auckland, New Zealand
| | - Cameron Walker
- Medical School, The University of Auckland, Auckland, New Zealand
| | - Michael Caughey
- Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
33
|
Smith MC, Ben-Shlomo Y, Dieppe P, Beswick AD, Adebajo AO, Wilkinson JM, Blom AW. Rates of hip and knee joint replacement amongst different ethnic groups in England: an analysis of National Joint Registry data. Osteoarthritis Cartilage 2017; 25:448-454. [PMID: 28159557 DOI: 10.1016/j.joca.2016.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England. DESIGN 373,613 hip and 428,936 knee National Joint Registry (NJR) primary replacement patients had coded ethnicity in Hospital Episode Statistics (HES). Age and gender adjusted observed/expected ratios of hip and knee replacements amongst ethnic groups were compared using indirect standardisation. Associations between ethnic group and type of procedure were explored and effects of demographic, clinical and hospital-related factors examined using multivariable logistic regression. RESULTS Adjusted standardised observed/expected ratios were substantially lower in Blacks and Asians than Whites for hip replacement (Blacks 0.33 [95% CI, 0.31-0.35], Asians 0.20 [CI, 0.19-0.21]) and knee replacement (Blacks 0.64 [CI, 0.61-0.67], Asians 0.86 % [CI, 0.84-0.88]). Blacks were more likely to receive uncemented hip replacements (Blacks 52%, Whites 37%, Asians 44%; P < 0.001). Black men and women aged <70 years were less likely to receive unicondylar or patellofemoral knee replacements than Whites (men 10% vs 15%, P = 0.001; women 6% vs 14%, P < 0.001). After adjustment for demographic, clinical and hospital-related factors, Blacks were more likely to receive uncemented hip replacement (OR 1.43 [CI, 1.11-1.84]). CONCLUSIONS In England, hip and knee replacement rates and prosthesis type given differ amongst ethnic groups. Whether these reflect differences in clinical need or differential access to treatment requires urgent investigation.
Collapse
Affiliation(s)
- M C Smith
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - P Dieppe
- University of Exeter Medical School, Exeter, UK
| | - A D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A O Adebajo
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - J M Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - A W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
| | | |
Collapse
|
34
|
Riddle DL, Golladay GJ, Hayes A, Ghomrawi HM. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24:354-361. [PMID: 27914722 PMCID: PMC5359031 DOI: 10.1016/j.knee.2016.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/12/2016] [Accepted: 11/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. METHODS A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. RESULTS Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded 'yes'). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1). CONCLUSION A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.
Collapse
Affiliation(s)
- Daniel L. Riddle
- Department of Physical Therapy, School of Allied Health Professions,Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University,Corresponding author: Department of Physical Therapy, West Hospital, Room B-100, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA. Tel.: 804-828-0234; fax: 804-828-8111. (Daniel L. Riddle)
| | - Gregory J. Golladay
- Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University
| | - Amanda Hayes
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
| | - Hassan M.K. Ghomrawi
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
| |
Collapse
|
35
|
Bass AR, McHugh K, Fields K, Goto R, Parks ML, Goodman SM. Higher Total Knee Arthroplasty Revision Rates Among United States Blacks Than Whites: A Systematic Literature Review and Meta-Analysis. J Bone Joint Surg Am 2016; 98:2103-2108. [PMID: 28002374 DOI: 10.2106/jbjs.15.00976] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reportedly 2% to 5.7% of total knee arthroplasties (TKAs) require revision within 5 years. The purpose of this study was to determine whether blacks are at higher risk of TKA revision than whites in the United States. METHODS We performed a systematic review of English-language articles published from 2000 to 2015. Study inclusion criteria were (1) performance of the study in the United States, (2) TKA as the primary procedure studied, (3) a follow-up period at least 2 years, (4) reporting of revision rates, and (5) analysis of patient race as an independent predictor of revision. We then performed a random-effects meta-analysis to calculate a pooled hazard ratio for TKA revision in blacks compared with whites. RESULTS A total of 4,286 studies were identified and screened by title; 106, by abstract; and 24, by full text. Six studies met the inclusion criteria. Only 4 of the 6 studies could undergo meta-analysis because of overlapping study populations in 3 of them. The meta-analysis represented 451,960 patients who underwent TKA, of whom 28,772 (6.4%) were black. Of the total, 31,568 patients (7.0%) underwent revision surgery. The risk of revision TKA was significantly higher among blacks than whites (pooled hazard ratio, 1.38; 95% confidence interval, 1.20 to 1.58; p < 0.001). Analysis of the 3 studies with overlapping study populations demonstrated discordant results as a result of adjustment compared with non-adjustment for insurance eligibility, a surrogate for socioeconomic status. CONCLUSIONS Blacks in the United States are at higher risk of revision TKA than whites. Socioeconomic status contributed to revision risk and is an important confounder in analyses of race. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Anne R Bass
- 1Rheumatology (A.R.B. and S.M.G.), Research (K.M.), Healthcare Research Institute (K.F.), Education (R.G.), and Orthopedics (M.L.P.), Hospital for Special Surgery, New York, NY
| | | | | | | | | | | |
Collapse
|
36
|
Teoh LSG, Eyles JP, Makovey J, Williams M, Kwoh CK, Hunter DJ. Observational study of the impact of an individualized multidisciplinary chronic care program for hip and knee osteoarthritis treatment on willingness for surgery. Int J Rheum Dis 2016; 20:1383-1392. [DOI: 10.1111/1756-185x.12950] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laurence S. G. Teoh
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Jillian P. Eyles
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Joanna Makovey
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Matthew Williams
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - C. Kent. Kwoh
- Department of Medicine; University of Arizona Arthritis Center and Division of Rheumatology; University of Arizona College of Medicine; Tucson Arizona USA
| | - David J. Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
37
|
Katz JN. Persistence of Racial and Ethnic Differences in Utilization and Adverse Outcomes of Total Joint Replacement. J Bone Joint Surg Am 2016; 98:1241-2. [PMID: 27489313 DOI: 10.2106/jbjs.16.00623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
38
|
Vina ER, Richardson D, Medvedeva E, Kent Kwoh C, Collier A, Ibrahim SA. Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial. Clin Orthop Relat Res 2016; 474:1755-64. [PMID: 27075333 PMCID: PMC4925413 DOI: 10.1007/s11999-016-4834-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/06/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA. QUESTIONS/PURPOSES We asked: (1) Does a patient-centered intervention consisting of a decision aid for knee OA and motivational interviewing improve the proportion of referrals of blacks with knee OA to orthopaedic surgery? (2) Does the intervention increase patients' willingness to undergo TKA? METHODS Adults who self-identified as black who were at least 50 years old with moderate to severe knee OA were enrolled from urban primary care clinics in a two-group randomized, controlled trial. A total of 1253 patients were screened for eligibility, and 760 were excluded for not meeting inclusion criteria, declining to participate, or other reasons. Four hundred ninety-three patients were randomized and completed the intervention; three had missing referral data at followup. The mean age of the patients was 61 years, and 51% were women. The majority had an annual household income less than USD 15,000. Participants in the treatment group were shown a decision-aid video and had a brief session with a trained counselor in motivational interviewing. Participants in the control group received an educational booklet about OA that did not mention joint replacement. The two groups had comparable demographic and socioeconomic characteristics. The primary outcome was referral to orthopaedic surgery 12 months after treatment exposure. Receipt of referral was defined as the receipt of a recommendation or prescription from a primary care provider for orthopaedic evaluation. The secondary outcome was change in patient willingness to undergo TKA based on patient self-report. RESULTS The odds of receiving a referral to orthopaedic surgery did not differ between the two study groups (36%, 90 of 253 of the control group; 32%, 76 of 240 of the treatment group; odds ratio [OR], 0.81; 95% CI, 0.56-1.18; p = 0.277). At 2 weeks followup, there was no difference between the treatment and the control groups in terms of increased willingness to consider TKA relative to baseline (34%, 67 of 200 patients in the treatment group; 33%, 68 of 208 patients in the control group; OR, 1.06; p = 0.779). At 12 months followup, the percent increase in willingness to undergo TKA still did not differ between patients in the treatment and control groups (29%, 49 of 174 in the treatment group; 27%, 51 of 191 in the control group; OR, 1.10; p = 0.679). CONCLUSION A combination decision aid and motivational interviewing strategy was no better than an educational pamphlet in improving patients' preferences toward joint replacement surgery for knee OA. The type of intervention treatment also did not affect access to surgical evaluation. Other tools that target patient knowledge, beliefs, and attitudes regarding surgical treatments for OA may be further developed and tested in the future. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Ernest R Vina
- University of Arizona School of Medicine and University of Arizona Arthritis Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.
| | - Diane Richardson
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Elina Medvedeva
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - C Kent Kwoh
- University of Arizona School of Medicine and University of Arizona Arthritis Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA
| | - Aliya Collier
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Said A Ibrahim
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
39
|
Leopold SS. Editor's Spotlight/Take 5: Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial. Clin Orthop Relat Res 2016; 474:1749-54. [PMID: 27160745 PMCID: PMC4925419 DOI: 10.1007/s11999-016-4873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S. Leopold
- Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19013 USA
| |
Collapse
|
40
|
Barlow T, Scott P, Griffin D, Realpe A. How outcome prediction could affect patient decision making in knee replacements: a qualitative study. BMC Musculoskelet Disord 2016; 17:304. [PMID: 27444429 PMCID: PMC4957427 DOI: 10.1186/s12891-016-1165-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022] Open
Abstract
Background There is approximately a 17 % dissatisfaction rate with knee replacements. Calls for tools that can pre-operatively identify patients at risk of being dissatisfied have been widespread. However, it is not known how to present such information to patients, how it would affect their decision making process, and at what part of the pathway such a tool should be used. Methods Using focus groups involving 12 participants and in-depth interviews with 10 participants, we examined how individual predictions of outcome could affect patients’ decision making by providing fictitious predictions to patients at different stages of treatment. A thematic analysis was used to analyse the data. Results Our results demonstrate several interesting findings. Firstly, patients who have received information from friends and family are unwilling to adjust their expectation of outcome down (i.e. to a worse outcome), but highly willing to adjust it up (to a better outcome). This is an example of the optimism bias, and suggests that the effect on expectation of a poor outcome prediction would be blunted. Secondly, patients generally wanted a “bottom line” outcome, rather than lots of detail. Thirdly, patients who were earlier in their treatment for osteoarthritis were more likely to find the information useful, and it was more likely to affect their decision, than patients later in their treatment pathway. Conclusion This research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a “bottom line” prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1165-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Timothy Barlow
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Patricia Scott
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Damian Griffin
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Alba Realpe
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
| |
Collapse
|
41
|
Goodman SM, Parks ML, McHugh K, Fields K, Smethurst R, Figgie MP, Bass AR. Disparities in Outcomes for African Americans and Whites Undergoing Total Knee Arthroplasty: A Systematic Literature Review. J Rheumatol 2016; 43:765-70. [PMID: 26834217 DOI: 10.3899/jrheum.150950] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE African Americans in the United States undergo total knee arthroplasty (TKA) less often than whites, in part because of lower expectations among African Americans for successful surgery. Whether this lower expectation is justified is unknown. Our objective is to compare health-related quality of life (HRQOL) and satisfaction after TKA between African Americans and whites. METHODS A systematic review of English language articles using Medline, the Cochrane register, Embase (April 21, 2015), and a hand search of unlisted disparities journals was performed. Search terms included total knee replacement, quality of life, outcomes, and satisfaction. High-quality cohort studies that examined HRQOL in African Americans and white adults 6 months or more after TKA were included. RESULTS Of the 4781 studies screened by title, and 346 by abstract, 7 studies included race in their analysis. Results included 5570 TKA patients, 4077 whites (89%), and 482 (11%) blacks. Because studies used different outcome measures and were inconsistent in their adjustment for confounders, we could not perform a quantitative synthesis of results. In 5 studies, US blacks had worse pain, in 5 worse function, and in 1 less satisfaction 6 months to 2 years after TKA. CONCLUSION US blacks may derive less benefit from TKA than whites as measured by HRQOL, pain, function, and satisfaction. Many studies assessing predictors of patient-related TKA outcomes fail to analyze race as a variable, which limited our study. More studies assessing the effect of race and socioeconomic factors on TKA outcome are needed.
Collapse
Affiliation(s)
- Susan M Goodman
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery.
| | - Michael L Parks
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| | - Kelly McHugh
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| | - Kara Fields
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| | - Rie Smethurst
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| | - Mark P Figgie
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| | - Anne R Bass
- From the Division of Rheumatology, Weill Cornell Medical School, and departments of Medicine and Orthopedics at the Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Department of Medicine, Weill Cornell Medical College, Division of Rheumatology, Hospital for Special Surgery; M.L. Parks, MD, Associate Professor of Clinical Orthopedic Surgery, Weill Cornell College of Medicine, Adult Reconstructive and Joint Replacement Service, Hospital for Special Surgery; K. McHugh, BA, Research Coordinator, Hospital for Special Surgery; K. Fields, MA, Statistical Analyst, Hospital for Special Surgery; R. Smethurst, MSLIS, Medical Librarian, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; A.R. Bass, MD, Associate Professor of Clinical Medicine, Weill Cornell Medical College, Rheumatology Fellowship Program Director, Hospital for Special Surgery
| |
Collapse
|
42
|
Foley B, Cleveland RJ, Renner JB, Jordan JM, Nelson AE. Racial differences in associations between baseline patterns of radiographic osteoarthritis and multiple definitions of progression of hip osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Res Ther 2015; 17:366. [PMID: 26680278 PMCID: PMC4704544 DOI: 10.1186/s13075-015-0806-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 01/03/2023] Open
Abstract
Background To identify baseline radiographic features that predict hip osteoarthritis (HOA) progression, and to explore differences in these associations by race. Methods Radiographs from the community-based Johnston County OA Project were scored using Kellgren-Lawrence (KL) grade and for presence and location of joint space narrowing (JSN), osteophytes, and subchondral changes. Associations between these features and HOA progression (increase of at least 1 KL grade, interval hip replacement, range of motion [ROM, a reduction of ≥10° in internal rotation], or disability [increase of ≥0.2 in Health Assessment Questionnaire scores], or Any of these) were assessed using logistic regression, adjusting for age, gender, race, hip injury, BMI, education, smoking and follow-up time, accounting for multiple comparisons. Race interactions were assessed and analyses stratified as indicated. Results The sample (n = 1,422) included 40 % men and 26 % African American (AA) participants, with mean age 61 years and BMI 29 kg/m2. The baseline frequency of radiographic hip OA (RHOA) between Caucasians and AAs was similar (23 %), although some radiographic features differed. AAs were more likely to have progression defined by ROM or disability or Any progression; Caucasians were more likely to have RHOA progression. JSN, subchondral sclerosis, and medial osteophytes were associated with increased RHOA progression overall; JSN was associated with disability progression only in AAs, while lateral osteophytes were associated with ROM progression only in Caucasians. Conclusions AAs and Caucasians exhibited differences in the radiographic presentation and progression patterns of HOA, with AAs reporting progressive pain and disability, while Caucasians had more RHOA progression.
Collapse
Affiliation(s)
- Bridget Foley
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA. .,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Orthopaedics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
| |
Collapse
|
43
|
Kwoh CK, Vina ER, Cloonan YK, Hannon MJ, Boudreau RM, Ibrahim SA. Determinants of patient preferences for total knee replacement: African-Americans and whites. Arthritis Res Ther 2015; 17:348. [PMID: 26635132 PMCID: PMC4669671 DOI: 10.1186/s13075-015-0864-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 11/17/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Patient preferences contribute to marked racial disparities in the utilization of total knee replacement (TKR). The objectives of this study were to identify the determinants of knee osteoarthritis (OA) patients’ preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR. Methods Five hundred fourteen White (WH) and 285 African-American (AA) patients with chronic knee pain and radiographic evidence of OA participated in the study. Participants were recruited from the community, an academic medical center, and a Veterans Affairs hospital. Structured interviews were conducted to collect socio-demographics, disease severity, socio-cultural determinants, and treatment preferences. Logistic regression was performed, stratified by race, to identify determinants of preferences. Clinical and socio-cultural factors were entered simultaneously into the models. Stepwise selection identified factors for inclusion in the final models (p < 0.20). Results Compared to WHs, AAs were less willing to undergo TKR (80 % vs. 62 %, respectively). Better expectations regarding TKR surgery outcomes determined willingness to undergo surgery in both AAs (odds ratio (OR) 2.08, 95 % confidence interval (CI) 0.91-4.79 for 4th vs. 1st quartile) and WHs (OR 5.11, 95 % CI 2.31-11.30 for 4th vs. 1st quartile). Among AAs, better understanding of the procedure (OR 1.80, 95 % CI 0.97-3.35), perceiving a short hospital course (OR 0.81, 95 % CI 0.58-1.13), and believing in less post-surgical pain (OR 0.73, 95 % CI 0.39-1.35) and walking difficulties (OR 0.66, 95 % CI 0.37-1.16) also determined willingness. Among WHs, having surgical discussion with a physician (OR 1.96, 95 % CI 1.05-3.68), not ever receiving surgical referral (OR 0.56, 95 % CI 0.32-0.99), and higher trust in the healthcare system (OR 1.58, 95 % CI 0.75-3.31 for 4th vs. 1st quartile) additionally determined willingness. Among the variables considered, only knowledge-related matters pertaining to TKR attenuated the racial difference in knee OA patients’ treatment preference. Conclusions Expectations of surgical outcomes influence preference for TKR in all patients, but clinical and socio-cultural factors exist that shape marked racial differences in preferences for TKR. Interventions to reduce or eliminate racial disparities in the utilization of TKR should consider and target these factors. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0864-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Kent Kwoh
- University of Arizona School of Medicine and University of Arizona Arthritis Center, 1501 N. Campbell Ave., PO Box 245093, Tucson, Arizona, 85724, USA.
| | - Ernest R Vina
- University of Arizona School of Medicine and University of Arizona Arthritis Center, 1501 N. Campbell Ave., PO Box 245093, Tucson, Arizona, 85724, USA.
| | - Yona K Cloonan
- University of Pittsburgh School of Public Health, 130 De Soto St., 127 Parran Hall, Pittsburgh, Pennsylvania, 15261, USA.
| | - Michael J Hannon
- University of Pittsburgh School of Medicine, 130 North Bellefield Ave., 4th Floor, Pittsburgh, Pennsylvania, 15213, USA.
| | - Robert M Boudreau
- University of Pittsburgh School of Public Health, 130 De Soto St., 127 Parran Hall, Pittsburgh, Pennsylvania, 15261, USA.
| | - Said A Ibrahim
- University of Pennsylvania Perelman School of Medicine and Philadelphia VA Medical Center, 3900 Woodland Ave., Philadelphia, Pennsylvania, 19104, USA.
| |
Collapse
|
44
|
Lin MY, Kressin NR. Race/ethnicity and Americans' experiences with treatment decision making. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30025-2. [PMID: 26254315 DOI: 10.1016/j.pec.2015.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Despite widespread documentation of racial/ethnic disparities in medical care, population-wide variation in Americans' experiences with care are not well understood. We examined whether race/ethnicity is associated with information received from physicians regarding treatment recommendations. METHODS We conducted a secondary analysis of cross-sectional survey data from a nationally representative sample (N=1238). We assessed patients' personal experiences of receiving information about the rationale for treatment recommendations from their physicians. RESULTS Overall, respondents of minority race/ethnicity received less information from their doctors about the rationale for treatment recommendations. After adjustment for possible confounders, doctors talked less often with patients of 'other' race/ethnicity about reasons for treatment recommendations. Both Blacks' and Hispanics' doctors less often cited their own experiences, or scientific research as a reason for treatment recommendations. CONCLUSION Americans' experiences with information communicated by physicians regarding treatment rationale varies significantly on some dimensions by race/ethnicity, suggesting that differences in key elements of shared decision making are evident in the care of racial/ethnic minorities. PRACTICE IMPLICATIONS Physicians should evaluate the extent to which their communication with patients varies by patient race/ethnicity, and make efforts to ensure that they share equally with all patients regarding the rationale for treatment recommendations.
Collapse
Affiliation(s)
- Meng-Yun Lin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, USA; Health Policy and Management Department, Boston University School of Public Health, Boston, USA.
| | - Nancy R Kressin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, USA; VA BostonHealthcare System, Boston, USA.
| |
Collapse
|
45
|
|
46
|
McAlindon TE, Driban JB, Henrotin Y, Hunter DJ, Jiang GL, Skou ST, Wang S, Schnitzer T. OARSI Clinical Trials Recommendations: Design, conduct, and reporting of clinical trials for knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:747-60. [PMID: 25952346 DOI: 10.1016/j.joca.2015.03.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials that target symptom or structure modification among individuals with knee OA. These updated recommendations incorporate novel technologies (e.g., magnetic resonance imaging (MRI)) and strategies to address the heterogeneity of knee OA.
Collapse
Affiliation(s)
- T E McAlindon
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111, USA
| | - J B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111, USA.
| | - Y Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, University of Liège, CHU Sart-Tilman, 4000 Liège, Belgium; Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - G-L Jiang
- Sanofi Biosurgery, Development Franchise of Immunology & Inflammation, 55 Cambridge Pkwy, Cambridge, MA 02142, USA
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5000 Odense, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - S Wang
- Global Pharmaceutical R&D, Abbvie, 1 North Waukegan Rd, North Chicago, IL 60064, USA
| | - T Schnitzer
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| |
Collapse
|
47
|
Singh JA, Ramachandran R. Racial disparities in total ankle arthroplasty utilization and outcomes. Arthritis Res Ther 2015; 17:70. [PMID: 25889569 PMCID: PMC4392624 DOI: 10.1186/s13075-015-0589-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 02/25/2015] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The objective of this study was to examine the racial disparities in total ankle arthroplasty (TAA) utilization and outcomes. METHODS We used the National Inpatient Sample (NIS) to study the time-trends. Race was categorized as White and Black. Utilization rates were calculated for the U.S. general population per 100,000. Hospital length of stay, discharge disposition and mortality after TAA were assessed. We used the Cochran Armitage trend test to assess time-trends from 1998 to 2011 and chi-square test to compare TAA utilization. We used analysis of variance or chi-squared test to compare the characteristics of Whites and Blacks undergoing TAA and logistic regression to compare mortality, length of stay and discharge to home versus medical facility. RESULTS The mean ages for Whites undergoing TAA were 62 years and for Blacks was 52 years. Significant racial disparities were noted in TAA utilization rates (/100,000) in 1998, 0.14 in Whites vs. 0.07 in Blacks (P<0.0001; 2-fold) and in 2011, 1.17 in Whites vs. 0.33 in Blacks (P<0.0001; 4-fold). Racial disparities in TAA utilization increased significantly from 1998 to 2011 (P<0.0001). There was a trend towards statistical significance for the difference in the length of hospital stay in Blacks vs. Whites (52.9% vs. 44.3% with length of hospital stay higher than the median; P=0.08). Differences in the proportion discharged to an inpatient medical facility after TAA, 16.6% Blacks vs. 13.4% Whites, were not significant (P=0.36). CONCLUSIONS This study demonstrated significant racial disparities with lower TAA utilization and suboptimal outcomes in Blacks compared to Whites. Further studies are needed to understand the mediators of these disparities and to assess whether these mediators can be targeted to reduce racial disparities in TAA.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
- Department of Medicine at the School of Medicine and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Rekha Ramachandran
- Department of Medicine at the School of Medicine and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
| |
Collapse
|