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Wilfong JM, Badley EM, Perruccio AV. Old Before Their Time? The Impact of Osteoarthritis on Younger Adults. Arthritis Care Res (Hoboken) 2024. [PMID: 38751094 DOI: 10.1002/acr.25374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults. METHODS Descriptive analysis of the Survey on Living with Chronic Diseases in Canada - Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749). RESULTS In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group. CONCLUSION OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.
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Affiliation(s)
- Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
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Cihan E, Şahbaz Pirinççi C, Leblebicier MA. Effects of osteoarthritis grades on pain, function and quality of life. J Back Musculoskelet Rehabil 2024; 37:793-799. [PMID: 38217581 DOI: 10.3233/bmr-230293] [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] [Indexed: 01/15/2024]
Abstract
BACKGROUND Osteoarthritis (OA) is a pathology that frequently affects the geriatric population. OBJECTIVE To investigate the extent to which pain, functionality, and quality of life change over the progression of OA grades. METHOD The study included 161 patients with bilateral OA, whose disease stages ranged from 1 to 4 according to the Kellgren-Lawrence radiographic classification system. Pain was assessed using the Visual Analog Scale (VAS), functionality using the two-minute walk test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and quality of life using the Nottingham Health Profile (NHP). RESULTS There were significant differences between the groups in terms of age, weight, and body mass index. The VAS, two-minute walk test, and WOMAC scores also significantly differed between the groups (p< 0.05). There was a significant difference between the groups in all domains of the NHP, except for energy (p< 0.05). The two-minute walk test score was negatively correlated with all the remaining evaluation parameters (p< 0.05). No correlation was found between the energy domain of the NHP and body mass index, the VAS score, the two-minute walk test distance, or the total WOMAC score (p> 0.05). CONCLUSION After grade 1, the functional impacts of OA on patients increased by an average of four times. Pain was one of the most basic symptoms, the severity of which started to increase in grade 2. With the added effect of diminishing walking capacity over time, the reduction in the quality of life of the patients accelerated as the OA grade progressed.
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Affiliation(s)
- Emine Cihan
- Physiotherapy Program, Department of Therapy and Rehabilitation, Vocational School of Health Sciences, Selcuk University, Konya, Turkey
| | - Cansu Şahbaz Pirinççi
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Merve Akdeniz Leblebicier
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
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Turner JR, Hill NL, Bhargava S, Madrigal C, Almeida DM, Mogle J. Age Discrepancies Across Two Decades: Desiring to be Younger Is Associated with Daily Negative Affect Over Three Waves of Assessment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:901-910. [PMID: 35614369 PMCID: PMC10824247 DOI: 10.1007/s11121-022-01386-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Negative perceptions of aging and older adulthood, including the idealization of youth, are common in the United States. Past work has found that holding negative perceptions of aging is closely associated with poor mental and physical health consequences, yet few studies have examined how these perceptions impact day-to-day experiences. The current study had two objectives: (1) investigate whether age discrepancy (specifically desiring to be younger than one's chronological age) was related to daily negative affect and (2) examine whether this relationship changed as participants aged over time. We utilized the Midlife in the United States (MIDUS) diary study, a longitudinal measurement burst study with three waves of 8-day daily diaries indexing approximately 20 years. Participants (N = 2398; Mage [baseline] = 46.85, SD = 12.24; 54.7% women; 92.4% White) reported their desired age as well as daily negative affect at each wave. Using multilevel modeling, we examined whether age discrepancy predicted daily negative affect across 3 waves of observation. Results supported a significant relationship between age discrepancy and daily negative affect. However, no interactions among age discrepancy and baseline age or time across study were found. This suggests that the relationship between age discrepancy and daily negative affect was consistent across waves and participants over a 20-year period and provides evidence for the pernicious effect of deidentifying with one's real age on daily life. Daily experiences can act as potential risk or protective factors and shape developmental trajectories. Reducing ageism through societal interventions or increasing personal acceptance of aging through targeted interventions are two potential pathways of promoting health and well-being across the lifespan.
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Affiliation(s)
- Jennifer R Turner
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA, 16802, USA.
| | - Nikki L Hill
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Sakshi Bhargava
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Caroline Madrigal
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - David M Almeida
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Jacqueline Mogle
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA, 16802, USA
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Magnussen HJ, Kjeken I, Pinxsterhuis I, Sjøvold TA, Hennig T, Thorsen E, Feiring M. Participation in healthcare consultations: A qualitative study from the perspectives of persons diagnosed with hand osteoarthritis. Health Expect 2023; 26:1276-1286. [PMID: 36916677 PMCID: PMC10154812 DOI: 10.1111/hex.13744] [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: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Scarce health resources and differing views between persons with hand osteoarthritis (OA) and health professionals concerning care preferences contribute to sustaining a gap between actual needs and existing clinical guidelines for hand OA. The aim of this study is to explore the experiences of persons diagnosed with hand OA in their encounters with health services and how those experiences influence negotiations and decision-making in hand OA care. METHODS Data from 21 qualitative interviews with persons diagnosed with hand OA were collected, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Three main themes were developed: symptoms are perceived as ordinary ageing in everyday life, consultations are shaped by trust in healthcare and the responsibilities of prioritisation and self-care govern interactions. CONCLUSION Ideas of ageing, professional knowledge and self-management dominate hand OA health encounters and contribute to shaping illness perceptions, preferences and opportunities to negotiate decisions in consultations. PATIENT OR PUBLIC CONTRIBUTION Two patient research partners with hand OA are members of the study project group. One of them is also a co-author of this manuscript.
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Affiliation(s)
- Hege Johanne Magnussen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Norwegian National Advisory Unit on Rehabilitation in Rheumatology, REMEDY, Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Irma Pinxsterhuis
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Eva Thorsen
- Lillehammer Rheumatism Hospital, Lillehammer, Norway
| | - Marte Feiring
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Norwegian National Advisory Unit on Rehabilitation in Rheumatology, REMEDY, Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
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A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100355. [PMID: 37020788 PMCID: PMC10068262 DOI: 10.1016/j.ocarto.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.
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6
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Uritani D, Koda H, Yasuura Y, Kusumoto A. Factors associated with subjective knee joint stiffness in people with knee osteoarthritis: A systematic review. Int J Rheum Dis 2023; 26:425-436. [PMID: 36572505 DOI: 10.1111/1756-185x.14536] [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: 09/19/2022] [Revised: 11/15/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Subjective knee stiffness is a common symptom in patients with knee osteoarthritis treated conservatively. However, the influencing factors or effects of knee joint stiffness are unknown. The aim of this study was to explore the factors associated with subjective knee stiffness in patients with knee osteoarthritis. METHODS The MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PEDro databases were searched in November 2021. Prospective or retrospective cohort studies were included. The methodological quality of the selected articles was assessed using the Scottish Intercollegiate Guidelines Network checklist. RESULTS Twenty out of 1943 screened articles were included in this systematic review. Eighteen and two studies were rated as having acceptable and low quality, respectively. All the included studies measured subjective knee stiffness using the Western Ontario and McMaster Universities Osteoarthritis Index. The main findings were that worse preoperative subjective knee stiffness was associated with worse pain, subjective knee stiffness, and patient satisfaction at 1 year after total knee arthroplasty. In addition, worse subjective knee stiffness was associated with future degenerative changes in the knee joint, such as joint space narrowing and osteophyte growth progression. CONCLUSION Subjective knee stiffness may be associated with the prognosis after total knee arthroplasty and degenerative changes in the knee joint. Early detection and treatment of knee stiffness could lead to a good prognosis after total knee arthroplasty and prevent the progression of degenerative changes in the knee joint.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | - Hitoshi Koda
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yuuka Yasuura
- Department of Rehabilitation, Shimada Hospital, Osaka, Japan
| | - Aya Kusumoto
- Department of Rehabilitation, Saiseikai Nara Hospital, Nara, Japan
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Sriwatananukulkit O, Desclaux S, Tawonsawatruk T, Srikuea R, Himakhun W, Likitnukul S, Hemstapat R. Effectiveness of losartan on infrapatellar fat pad/synovial fibrosis and pain behavior in the monoiodoacetate-induced rat model of osteoarthritis pain. Biomed Pharmacother 2023; 158:114121. [PMID: 36516695 DOI: 10.1016/j.biopha.2022.114121] [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: 09/28/2022] [Revised: 11/29/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Infrapatellar fat pad (IFP)/ synovial fibrosis is closely associated with the clinical symptoms of joint pain and stiffness, which contribute to locomotor restriction in osteoarthritis (OA) patients. Hence, this study was designed to gain insight on whether losartan, a selective angiotensin II type 1 receptor (AT1R) antagonist, has therapeutic benefit to reverse IFP/synovial fibrosis and secondarily to attenuate pain behavior. In male Wistar rats with monoiodoacetic acid (MIA)-induced IFP/synovial fibrosis, a possible role for increased AT1R expression in the pathogenesis of IFP/synovial fibrosis was assessed over an 8-week period. Pain behavior comprised static weight bearing and von Frey paw withdrawal thresholds (PWTs), which were assessed once or twice weekly, respectively. Groups of MIA-rats received oral losartan (30-mg/kg; n = 8 or 100-mg/kg; n = 9) or vehicle (n = 9) for 28-days according to a prevention protocol. Animals were euthanized on day 28 and various tissues (IFP/synovium, cartilage and lumbar dorsal root ganglia (DRGs)) were collected for histological, immunohistochemical and western blot analyses. Administration of once-daily losartan for 28-days dose-dependently attenuated the development of static weight bearing. This was accompanied by reduced IFP/synovial fibrosis and suppression of TGF-β1 expression. Chronic treatment of MIA-rats with losartan had an anti-fibrotic effect and it attenuated pain behavior in this animal model.
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Affiliation(s)
- Orada Sriwatananukulkit
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
| | - Scarlett Desclaux
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
| | | | - Ratchakrit Srikuea
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
| | - Wanwisa Himakhun
- Department of Pathology and Forensic Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand.
| | - Sutharinee Likitnukul
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
| | - Ruedee Hemstapat
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
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Lee SH, Kao CC, Liang HW, Wu HT. Validity of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in individuals with symptomatic Kellgren and Lawrence grade 0-2 knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:1040. [PMID: 36451167 PMCID: PMC9714223 DOI: 10.1186/s12891-022-06012-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Performance-based physical tests have been widely used as objective assessments for individuals with knee osteoarthritis (KOA), and the core set of tests recommended by the Osteoarthritis Research Society International (OARSI) aims to provide reliable, valid, feasible and standardized measures for clinical application. However, few studies have documented their validity in roentgenographically mild KOA. Our goal was to test the validity of five performance-based tests in symptomatic KOA patients with X-ray findings of Kellgren and Lawrence (K-L) grade 0-2. METHODS We recruited a convenience sample of thirty KOA patients from outpatient clinics and 30 age- and sex-matched asymptomatic controls from the community. They performed five OARSI-recommended physical tests and the KOA group answered the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. The tests included the 9-step stair-climbing test (9 s-SCT), timed up and go (TUG) test, 30-second chair-stand test (30sCST), 40-m fast walking-test (40MFPW) and 6-minute walking test (6MWT). The discriminant validity of these physical tests were assessed by comparisons between the KOA and control groups, receiver operating curve and multivariate logistic regression analysis. The convergent/divergent validity was assessed by correlation between the physical tests results and the three subscale scores of the WOMAC in the KOA group. RESULTS The KOA group had significantly worse performance than the control group. The percentage of difference was the largest in the 9 s-SCT (57.2%) and TUG tests (38.4%). Meanwhile, Cohen's d was above 1.2 for the TUG test and 6MWT (1.2 ~ 2.0), and between 0.8 and 1.2 for the other tests. The areas under the curve to discriminate the two groups were mostly excellent to outstanding, except for the 30sCST. Convergent validity was documented with a moderate correlation between the 9 s-SCT and the physical function (WOMAC-PF) subscale scores (Spearman's ρ = 0.60). CONCLUSIONS The OARSI recommended core set was generally highly discriminative between people with K-L grade 0-2 KOA and their controls, but convergent/divergent validity was observed only in the 9 s-SCT. Further studies are required to evaluate the responsiveness of these tests and understand the discordance of physical performance and self-reported measures.
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Affiliation(s)
- Si-Huei Lee
- grid.278247.c0000 0004 0604 5314Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Chi-Chun Kao
- grid.278247.c0000 0004 0604 5314Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China ,grid.260539.b0000 0001 2059 7017Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Huey-Wen Liang
- grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, No 7, Chong-Shan South Road, Taipei, 100 Taiwan, Republic of China ,grid.412094.a0000 0004 0572 7815Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Shin-Chu branch, Shin-Chu, Taiwan, Republic of China
| | - Hung-Ta Wu
- grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China ,grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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Robbins SM, Teoli A. Clinician's Commentary on Hoteit et al. 1. Physiother Can 2022; 74:276-277. [PMID: 37325216 PMCID: PMC10262830 DOI: 10.3138/ptc-2020-0093-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Shawn M Robbins
- Associate Professor Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada;
| | - Anthony Teoli
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada;
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Poole JL. Beyond the hand and upper extremity: The role of hand therapists in care of people with rheumatic diseases. J Hand Ther 2022; 35:339-345. [PMID: 35985938 DOI: 10.1016/j.jht.2022.07.008] [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: 03/25/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Invited Clinical Commentary BACKGROUND: Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists. PURPOSE OF STUDY This paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments. METHODS The impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed. RESULTS The role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented. CONCLUSION Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments.
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Affiliation(s)
- Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA.
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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12
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Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences. PLoS One 2022; 17:e0262422. [PMID: 35025935 PMCID: PMC8758099 DOI: 10.1371/journal.pone.0262422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. METHODS Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. RESULTS Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. CONCLUSION The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.
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Bell T, Franz CE, Kremen WS. Persistence of pain and cognitive impairment in older adults. J Am Geriatr Soc 2022; 70:449-458. [PMID: 34741304 PMCID: PMC8821128 DOI: 10.1111/jgs.17542] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND No studies have examined the longitudinal association between the persistence of pain and its relationship to cognitive problems in older adults. The objective of this study was to examine how the persistent of pain associates with cognitive performance, cognitive impairment, and subjective memory decline. METHODS Across 10 biennial waves, 8515 adults ages 65 and over were assessed from the Health and Retirement Study (Mage = 74.17, SD = 6.87, 59.2% female). At each wave, individuals were asked to report on pain presence, and if present, rate its intensity and interference with daily activities such as housework or chores. Using running frequencies or averages, we calculated the persistence of pain using these three pain measures. Cognition was assessed using cognitive performance and different cognitive impairment cutoffs. Incident subjective memory decline was additionally measured as new self-reported memory change in the last 2 years. General estimating equations examined concurrent associations between persistence of pain and cognitive variables, adjusting for demographics, depressive symptoms, and medical comorbidities. RESULTS Persistence of pain presence was associated with an increased risk of cognitive impairment. Only persistence of pain interference, not pain intensity, was significantly associated with poorer cognitive performance or being classified as cognitively impaired. For every 2 years, persistence of pain interference was associated with 21% increased odds of cognitive impairment. Only one of three pain variables was related to incident subjective memory decline. CONCLUSIONS Persistence of pain is associated with poorer cognitive performance in community-dwelling older adults, especially when involving ongoing interference in chores and work. Facilitating pain management might be important for helping to maintain later-life cognition and reduce dementia risk.
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Affiliation(s)
- Tyler Bell
- University of California San Diego, Department of Psychiatry, San Diego, CA
| | - Carol E. Franz
- University of California San Diego, Department of Psychiatry, San Diego, CA
| | - William S. Kremen
- University of California San Diego, Department of Psychiatry, San Diego, CA
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McLachlan AJ, Carroll PR, Hunter DJ, Wakefield TAN, Stosic R. Osteoarthritis management: Does the pharmacist play a role in bridging the gap between what patients actually know and what they ought to know? Insights from a national online survey. Health Expect 2022; 25:936-946. [PMID: 34997667 PMCID: PMC9122430 DOI: 10.1111/hex.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Guidelines encourage engagement in self-care activities for osteoarthritis (OA), but there are gaps in consumers' knowledge about suitable choices for self-care. Community pharmacists are in an ideal position to contribute to OA management through screening and supporting evidence-based pain management choices. Prior research established an association between health literacy and advice-seeking and appropriateness of analgesics choices (both lower in participants with limited health literacy) amongst people living with OA. This article explores the implications of these data for pharmacists in OA management. METHODS A national online survey was conducted amongst 628 adults aged 45-74 years, currently residing in Australia, with self-reported symptoms of OA. All data were collected using a customized online questionnaire, which was completed only once. 'Self-reported symptoms of OA' was based on six validated screening questions to identify people with OA without a formal clinical diagnosis. RESULTS Respondents matched the typical profile of people diagnosed with OA; more than half were female (56%), knees (59%) and hips (31%) were the primary affected joints and 74% were either overweight or obese. Self-identification of OA was limited (41%). Overall, 38% self-managed their pain, and limited health literacy was associated with less advice-seeking. Efficacy and ease of use were the main reasons cited for prompting use across all classes of nonprescription analgesic, with less than 20% reporting recommendation from a pharmacist. Participants were managing their pain with an average of 1.74 (95% confidence interval: 1.60-1.88) analgesics, but 73% reported inadequate pain relief and 54% had disrupted sleep. CONCLUSION Our findings highlight three key themes: lack of self-identification of OA, suboptimal pain relief and limited use of the community pharmacist as a source of management advice. Equipping community pharmacists with tools to identify OA could bridge this gap. More research is needed to determine if it will improve consumers' ability to appropriately manage OA pain. PATIENT OR PUBLIC CONTRIBUTION Consumers living with OA contributed to the study outcomes, reviewed the survey questionnaire for face validity and advised on plain language terminology.
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Affiliation(s)
- Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter R Carroll
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Clinical Pharmacology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital, The University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Rodney Stosic
- Bayer Australia Pty., Ltd., Pymble, New South Wales, Australia
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15
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Uritani D, Ikeda A, Shironoki T, Matsubata K, Mutsura Y, Fujii T, Ikeda K. Perceptions, beliefs, and needs of Japanese people with knee osteoarthritis during conservative care: a qualitative study. BMC Musculoskelet Disord 2021; 22:754. [PMID: 34479525 PMCID: PMC8417949 DOI: 10.1186/s12891-021-04641-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients' perceptions and beliefs of disease could be influenced by their lifestyle and culture. Although it is important to understand their perceptions and beliefs toward disease to prevent and manage osteoarthritis (OA) through conservative care, this topic has not been investigated in Japanese people with knee OA. Therefore, this qualitative study aims to clarify how Japanese patients with knee OA experience and perceive their symptoms and disabilities, and how they face them during conservative care. METHODS Participants were recruited by purposive sampling. Face-to-face, semi-structured interviews were conducted with nine patients (2 men and 7 women; mean age, 74.3 ± 5.5 years) with knee OA until data saturation was reached. Interview data comprised participants' accounts of particular personal experiences of living with knee OA, including their perceptions and attitudes toward knee OA-related symptoms and disabilities. Two physiotherapists (one with extensive experience conducting qualitative studies) and four physiotherapy students conducted the interviews. Recorded interview data were transcribed verbatim in Japanese. Data analysis, including developing a coding scheme, was conducted based on a grounded theory approach. RESULTS Two core categories were extracted from the data: 'Negative experiences' and 'Coping with difficulties'. 'Negative experiences' included three main categories: 'Self-analysis on the cause of knee OA', 'Difficulties in daily life due to knee symptoms', and 'Psychological barrier'. 'Coping with difficulties' included three main categories: 'How to deal with knee pain and difficulty in moving', 'Information considered useful to cope with knee OA' and 'Importance of connecting with others'. Japanese patients with knee OA desired evidence-based information and to connect with other people in the same situation to solve problems related to their condition. CONCLUSIONS To address patients' concerns, medical professionals should conduct careful interviews and obtain information regarding patients' past experiences, and understand their experiences related to knee OA. Symptoms and difficulties experienced by patients with knee OA should be managed by evidence-based information integrating their perceptions and beliefs toward knee OA.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan.
| | - Akane Ikeda
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Toru Shironoki
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Kentaro Matsubata
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Yuto Mutsura
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Tadashi Fujii
- Department of Orthopaedic surgery, Kashiba Asahigaoka Hospital, 839, Kaminaka, Kashiba city, Nara, 6390265, Japan
| | - Koji Ikeda
- Department of Rehabilitation, Faculty of Health Science, Naragakuen University, 3-15-1, Nakatomigaoka, Nara city, Nara, 6318524, Japan
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16
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Pinsker EB, Sale JEM, Gignac MAM, Daniels TR, Beaton DE. “I Don’t Have to Think About Watching the Ground”: A Qualitative Study Exploring the Concept of Vigilance as an Important Outcome for Ankle Reconstruction. Arthritis Care Res (Hoboken) 2020; 72:1367-1373. [DOI: 10.1002/acr.24039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Ellie B. Pinsker
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | - Joanna E. M. Sale
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | | | | | - Dorcas E. Beaton
- Institute of Work & Health and University of Toronto Toronto Ontario Canada
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17
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Keogh A, Sett N, Donnelly S, Mullan R, Gheta D, Maher-Donnelly M, Illiano V, Calvo F, Dorn JF, Mac Namee B, Caulfield B. A Thorough Examination of Morning Activity Patterns in Adults with Arthritis and Healthy Controls Using Actigraphy Data. Digit Biomark 2020; 4:78-88. [PMID: 33173843 DOI: 10.1159/000509724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background Wearable sensors allow researchers to remotely capture digital health data, including physical activity, which may identify digital biomarkers to differentiate healthy and clinical cohorts. To date, research has focused on high-level data (e.g., overall step counts) which may limit our insights to whether people move differently, rather than how they move differently. Objective This study therefore aimed to use actigraphy data to thoroughly examine activity patterns during the first hours following waking in arthritis patients (n = 45) and healthy controls (n = 30). Methods Participants wore an Actigraph GT9X Link for 28 days. Activity counts were analysed and compared over varying epochs, ranging from 15 min to 4 h, starting with waking in the morning. The sum, and a measure of rate of change of cumulative activity in the period immediately after waking (area under the curve [AUC]) for each time period, was calculated for each participant, each day, and individual and group means were calculated. Two-tailed independent t tests determined differences between the groups. Results No differences were seen for summed activity counts across any time period studied. However, differences were noted in the AUC analysis for the discrete measures of relative activity. Specifically, within the first 15, 30, 45, and 60 min following waking, the AUC for activity counts was significantly higher in arthritis patients compared to controls, particularly at the 30 min period (t = -4.24, p = 0.0002). Thus, while both cohorts moved the same amount, the way in which they moved was different. Conclusion This study is the first to show that a detailed analysis of actigraphy variables could identify activity pattern changes associated with arthritis, where the high-level daily summaries did not. Results suggest discrete variables derived from raw data may be useful to help identify clinical cohorts and should be explored further to determine if they may be effective clinical biomarkers.
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Affiliation(s)
- Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Niladri Sett
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Computer Science, University College Dublin, Dublin, Ireland
| | | | - Ronan Mullan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Diana Gheta
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | | | | | | | | | - Brian Mac Namee
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Computer Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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18
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Discordance between self-reported and performance-based function among knee osteoarthritis surgical patients: Variations by sex and obesity. PLoS One 2020; 15:e0236865. [PMID: 32730319 PMCID: PMC7392249 DOI: 10.1371/journal.pone.0236865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background There is currently no standardized method for measuring functional status in knee osteoarthritis (OA) patients, despite that it is one of the top priorities when determining eligibility for total knee arthroplasty (TKA). The purpose of the current investigation was to identify factors associated with discordance between individual self-report and performance-based measures of function for obese and non-obese men and women with knee OA. Methods In a cohort of 727 knee OA patients scheduled for TKA, physical function prior to surgery was assessed with the self-reported physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-pf), and the performance-based Timed Up and Go (TUG). Data on sociodemographic characteristics, health status, knee pain intensity, symptomatic joint site count, and pain catastrophizing were collected via questionnaire. The primary outcome was the difference in rescaled score between a participant’s self-report and performance-based measures of function. Multivariable linear regression stratified by sex and obesity status was used to identify factors associated with discordance. Results The mean age of participants was 65.5 years and 55% were women. With younger age, self-reported scores indicated increasingly worse function compared to performance-based scores, regardless of sex or obesity status. Among non-obese individuals, greater knee pain intensity was associated with a participant’s self-report score indicating increasingly worse function compared to their performance-based score. For obese women, pain catastrophizing, and number of symptomatic joints were also associated with discordance as was reporting fewer comorbidities. Conclusions Physical function may be differentially represented by self-reported and performance-based measures depending on a variety of patient factors. Our findings add to the evidence which suggests both measures should be used when assessing functional status prior to TKA.
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19
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Bowden JL, Lamberts R, Hunter DJ, Melo LR, Mills K. Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study. BMJ Open 2020; 10:e035030. [PMID: 32690504 PMCID: PMC7371145 DOI: 10.1136/bmjopen-2019-035030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Musculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation. DESIGN Anonymous online observational survey. SETTING Australia. PARTICIPANTS A convenience sample of 831 community-based individuals (18+ years). OUTCOME MEASURES Descriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information. RESULTS Of the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information. CONCLUSION Intelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.
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Affiliation(s)
- Jocelyn L Bowden
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rod Lamberts
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Luciano Ricardo Melo
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Sax Institute, Haymarket, New South Wales, Australia
| | - Kathryn Mills
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
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20
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Al-Khlaifat L, Okasheh R, Muhaidat J, Hawamdeh ZM, Qutishat D, Al-yahya E, Al-ajlouni JM, Mohammad MT. Knowledge of Knee Osteoarthritis and Its Impact on Health in the Middle East: Are They Different to Countries in the Developed World? A Qualitative Study. Rehabil Res Pract 2020; 2020:9829825. [PMID: 32455026 PMCID: PMC7229553 DOI: 10.1155/2020/9829825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Knowledge of knee osteoarthritis (OA) and its management options affects adherence to treatment, symptoms, and function. Many sociocultural differences exist between Jordan, as a representative of the Middle East, and the developed world which might influence the knowledge of the pathology and its impact on health. Objectives. To explore the knowledge of the pathology and the experience of people diagnosed with knee OA living in Jordan. Methods. Qualitative study design using a triangulation method of both focus groups and in-depth semistructured interviews. Fourteen participants were included (13 females and one male). One focus group and seven in-depth semistructured interviews were conducted. Discussions were audiotaped and transcribed. Framework analysis was used, and data were mapped to the International Classification of Functioning, Disability and Health framework. Results. The themes are as follows: (1) body functions and structures included two subthemes: physical changes and psychological impact; (2) activity limitation and participation restriction included three subthemes: factors influencing the activities, cultural and social perspectives to activity limitation, and participation restriction; (3) personal factors included three subthemes: knowledge and personal interpretation of disease process, knowledge of management options to relief symptoms, and influence of personal factors on activity and participation; and (4) environmental factors included three subthemes: service delivery process, ineffective communication across the care pathway, and facilitators and barriers. Conclusions. Knowledge of the disease was lacking as a consequence of inappropriate service delivery and culture. Activity limitations and participation restrictions are similar in Jordan to other cultures in addition to limitations in religious, employment, and transportation activities. The results demonstrate that the effect of knee OA varies among different cultures and highlight the role of healthcare professionals worldwide in understanding the impact of culture on health. They also increase the awareness of healthcare professionals, specifically in Jordan, on the limitations in delivered services and the importance of education.
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Affiliation(s)
- Lara Al-Khlaifat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Rasha Okasheh
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Jennifer Muhaidat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Ziad M. Hawamdeh
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dania Qutishat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Emad Al-yahya
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | | | - Maha T. Mohammad
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
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21
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McGruer N, Baldwin JN, Ruakere BT, Larmer PJ. Māori lived experience of osteoarthritis: a qualitative study guided by Kaupapa Māori principles. J Prim Health Care 2020; 11:128-137. [PMID: 32171355 DOI: 10.1071/hc18079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Osteoarthritis adversely affects people's quality of life; however, the effects of osteoarthritis on Māori in New Zealand remain unknown. AIM To explore the Māori lived experience of osteoarthritis. METHODS A qualitative study guided by Kaupapa Māori principles. Māori adults (≥30 years) with clinical knee or hip osteoarthritis took part in semi-structured interviews that were recorded and transcribed. Thematic analysis and a model of Māori health (Te Whare Tapa Whā, outlining four dimensions of wellbeing (taha tinana- physical; taha hinengaro- mental; taha wairua- spiritual; and taha whānau- family)) were used to analyse data. RESULTS Seven Māori females aged 44-71 years participated. Physical manifestations of osteoarthritis, namely pain and limited daily activities, affected mental, spiritual and family wellbeing. Participants experienced whakamā (shame) and frustration. Cultural duties such as attending the marae were impeded, affecting spiritual wellbeing and cultural identity. Participants described drawing on the strength of their ancestors to cope with their impairments. Western medicine was commonly used, although side-effects were prominent and few participants had received information about the condition from health professionals. Both positive and negative experiences of health-care and treatments were reported. DISCUSSION Osteoarthritis inflicts a substantial burden on the physical, mental, spiritual and family wellbeing of Māori women. Primary care practitioners must consider spiritual and family wellbeing when providing care for Māori with osteoarthritis. Culturally sensitive education for patients and their whānau is needed.
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Affiliation(s)
- Nikita McGruer
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Jennifer N Baldwin
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Brian T Ruakere
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Peter J Larmer
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; and Corresponding author.
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22
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Bühler M, Chapple CM, Stebbings S, Pōtiki-Bryant K, David Baxter G. Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study. Arthritis Care Res (Hoboken) 2019; 73:336-346. [PMID: 31841264 DOI: 10.1002/acr.24124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE First carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets. METHODS In this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face-to-face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact Model was employed to help with interpretation of the results. RESULTS Five interrelated levels of health impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and an altered sense of self. Constant pain and pain at night were key symptoms that were associated with impact at the other levels. CONCLUSION Constant pain, pain at night, functional capacity, medication burden, emotional impact, and sense of self are important outcomes and treatment targets in people with CMC1 joint OA.
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Affiliation(s)
| | | | - Simon Stebbings
- University of Otago and Dunedin Hospital Dunedin, Dunedin, Otago, New Zealand
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23
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Afolabi HA, Zakaria ZB, Hashim MNM, Vinayak CR, Ahmed Shokri AB. Body Mass Index and predisposition of patients to knee osteoarthritis. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.obmed.2019.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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24
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Lape EC, Hudak P, Davis AM, Katz JN. Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework. ACR Open Rheumatol 2019; 1:90-96. [PMID: 31777785 PMCID: PMC6857960 DOI: 10.1002/acr2.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital Boston Massachusetts
| | - Pamela Hudak
- Alternative Dispute Resolution Practice, Inc. Toronto Canada
| | - Aileen M Davis
- Krembil Research Institute University Health Network and University of Toronto Toronto Canada
| | - Jeffrey N Katz
- Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts
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25
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Pel-Littel RE, Hofman CS, Yu L, Metzelthin SF, Leeuwis FH, Blom JW, Buurman BM, Minkman MM. Recommendations of older adults on how to use the PROM 'TOPICS-MDS' in healthcare conversations: A Delphi study. PLoS One 2019; 14:e0225344. [PMID: 31747443 PMCID: PMC6867646 DOI: 10.1371/journal.pone.0225344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/01/2019] [Indexed: 01/19/2023] Open
Abstract
In shared decision making, the exploration of preferred personal health outcomes is important. Patient-reported outcome measures (PROMs) provide input for discussions between patients and healthcare professionals. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) PROM is a multidimensional questionnaire on the physical and mental health and wellbeing of older adults. This study investigates how the TOPICS-MDS could be used in individual healthcare conversations. We explored views of older adults regarding 1) whether the health domains they want to discuss are included in the TOPICS-MDS and 2) the comprehensibility of the TOPICS-MDS for healthcare conversations with older adults. A three-round Delphi study was conducted. A total of 57 older adults participated in the study, the mean (SD) age was 71.5 (8.5) years, and 78.9% of the participants were female. The participants were divided into four panels based on educational level and cultural background. We used online questionnaires and focus groups. Consensus was pre-defined to be the point when ≥75% of the participants agreed that a domain was important or very important (scored on a 5-point Likert scale). The inter-expert agreement was computed for Round 1 and 3 with Kendall's W. Round 2 was a focus-group. Qualitative data were analyzed by content analysis. Older adults considered 'functional limitations', 'emotional wellbeing', 'social functioning' and 'quality of life' to be important domains of the TOPICS-MDS to discuss in healthcare conversations. The participants added 'coping with stress', 'dealing with health conditions and the effects on life' as extra domains for healthcare conversations. Challenges regarding the comprehensibility of the TOPICS-MDS included difficult words and lengthy or sensitive questions. Questions that included multiple topics were difficult to understand. The TOPICS-MDS covers the domains of life that older adults value as important to discuss with healthcare professionals, and two additional domains were identified. For older adults with a low level of education or a culturally diverse background, the TOPICS-MDS needs to be adjusted for comprehensibility.
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Affiliation(s)
- Ruth E. Pel-Littel
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail: (RPL); (CH)
| | - Cynthia S. Hofman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- * E-mail: (RPL); (CH)
| | - Liesje Yu
- Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Franca H. Leeuwis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - B. M. Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M. Minkman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- University of Tilburg, TIAS school for Business and Society, Tilburg, the Netherlands
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Pålsson A, Kostogiannis I, Lindvall H, Ageberg E. Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:432. [PMID: 31521142 PMCID: PMC6745069 DOI: 10.1186/s12891-019-2794-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain. METHODS Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis. RESULTS Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (- 4; 4)), BMI (- 1.75 (- 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201). CONCLUSIONS Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.
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Affiliation(s)
- Anders Pålsson
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.
| | - Ioannis Kostogiannis
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Lindvall
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden.,Department of Imaging and Functional Medicine, Skåne University Hospital Malmö, Malmö, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden
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Theis KA, Brady TJ, Helmick CG, Murphy LB, Barbour KE. Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life. ACR Open Rheumatol 2019; 1:412-423. [PMID: 31777821 PMCID: PMC6857987 DOI: 10.1002/acr2.11050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.
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Affiliation(s)
- K. A. Theis
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - T. J. Brady
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - C. G. Helmick
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - L. B. Murphy
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - K. E. Barbour
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
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Chua JR, Jamal S, Riad M, Castrejon I, Malfait AM, Block JA, Pincus T. Disease Burden in Osteoarthritis Is Similar to That of Rheumatoid Arthritis at Initial Rheumatology Visit and Significantly Greater Six Months Later. Arthritis Rheumatol 2019; 71:1276-1284. [PMID: 30891933 DOI: 10.1002/art.40869] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyze disease burden in osteoarthritis (OA) according to Multidimensional Health Assessment Questionnaire (MDHAQ)/Routine Assessment of Patient Index Data 3 (RAPID3) scores at the initial visit and the 6-month follow-up visit, compared with rheumatoid arthritis (RA) as a benchmark for high disease burden. METHODS All patients with all diagnoses at the Rush University Medical Center Division of Rheumatology complete a paper MDHAQ at all visits, saved as a PDF in the electronic health record. MDHAQ 0-10 scores for physical function, pain, and patient global assessment (compiled into RAPID3 0-30 scores) and additional scales at the initial and 6-month follow-up visits, for new OA and RA patients seen from 2011 to 2017, were compared. OA and RA patients were classified as self-referred or physician-referred, and RA patients were classified as disease-modifying antirheumatic drug (DMARD)-naive or having prior-DMARD treatment. Patient groups were compared using t-tests and analysis of variance, adjusted for age, disease duration, body mass index (BMI), education, and ethnicity. RESULTS Compared with RA patients, OA patients had higher age, BMI, and disease duration. At initial visit, the mean RAPID3 did not differ significantly in OA versus DMARD-naive RA patients, whether self- or physician-referred (range 14.8-16.4 [P = 0.38]), or in all OA patients versus DMARD-naive RA patients versus prior-DMARD RA patients (15.0, 15.7, and 15.8, respectively [P = 0.49]). After 6 months, RAPID3 was improved to 13.3, 10.3, and 10.8, respectively, which represented substantially greater improvement in RA patients than OA patients (P < 0.001). Similar results were seen for most self-reported measures and in adjusted analyses. CONCLUSION MDHAQ/RAPID3 scores are similar in OA and RA patients at the initial visit, but higher in OA patients than in RA patients 6 months later, reflecting superior RA treatments. The same MDHAQ/RAPID3 allows comparisons of disease burdens in different diseases.
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Affiliation(s)
| | | | - Mariam Riad
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
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Hackney AJ, Klinedinst NJ, Resnick B, Johantgen M. Association of Systemic Inflammation and Fatigue in Osteoarthritis: 2007-2010 National Health and Nutrition Examination Survey. Biol Res Nurs 2019; 21:532-543. [PMID: 31238698 DOI: 10.1177/1099800419859091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Mechanistic insight into osteoarthritis fatigue is needed as clinical management of this condition is nonspecific. Systemic inflammation is associated with fatigue in other chronic diseases. The purpose of this study was to explore the relationship between systemic inflammation and fatigue in osteoarthritis, while controlling for covariates. METHOD This secondary analysis with a cross-sectional, multiyear retrospective design used data from the 2007-2010 National Health and Nutrition Examination Survey. Adults with self-reported osteoarthritis who participated in an examination at a mobile center and had no comorbidities associated with fatigue or systemic inflammation were included (n = 296). Complex sample analysis, independent samples t tests, and χ2 tests of independence were used to explore differences between nonfatigued and fatigued adults with osteoarthritis. Adjusted hierarchical logistic regression models were used to calculate odds of fatigue as a function of two systemic inflammatory markers, C-reactive protein (CRP), and white blood cell (WBC) count. RESULTS Fatigued adults with osteoarthritis had significantly higher CRP levels and WBC counts compared to nonfatigued adults with osteoarthritis. In adjusted logistic regression models, increased CRP was associated with higher odds of fatigue when controlling for age, days affected by pain, depressive symptoms, sleep quantity, and body mass index (Odds ratio [OR] = 3.38, 95% CI [1.18, 9.69]). WBC count was not associated with higher odds of fatigue when controlling for these variables (OR = 1.10, 95% CI [0.92, 1.32]). CONCLUSION Systemic inflammation may have a relationship with fatigue in osteoarthritis. Future work is necessary to replicate these findings in more robust studies.
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Affiliation(s)
- Alisha J Hackney
- 1 Robert Wood Johnson Future of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - N Jennifer Klinedinst
- 2 Department of Organizational Systems & Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Barbara Resnick
- 3 University of Maryland School of Nursing, Baltimore, MD, USA
| | - Meg Johantgen
- 4 Department of Organizational Systems & Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
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Abstract
Chronic pain is extremely prevalent in older adults and is associated with significant morbidity, including limited mobility, social isolation, and depressed mood. Pain is defined by a biopsychosocial model highlighting the importance of a multidisciplinary approach to treatment, including multimodal medications, selected interventions, physical therapy and rehabilitation, and psychological treatments. In this narrative review, the authors highlight the use of these approaches in older adults with specific attention paid to considerations unique to aging, including alterations in drug metabolism, avoidance of polypharmacy, and physiologic changes predisposing to painful conditions.
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Edgerton K, Hall J, Bland MK, Marshall B, Hulla R, Gatchel RJ. A physical therapist’s role in pain management: A biopsychosocial perspective. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Jarod Hall
- Greater Therapy Centers Lewisville Texas
| | - Michelle K. Bland
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Blaine Marshall
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Ryan Hulla
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Robert J. Gatchel
- Department of Psychology University of Texas at Arlington Arlington Texas
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Gravås EMH, Tveter AT, Nossum R, Eide REM, Klokkeide Å, Matre KH, Olsen M, Andreassen Ø, Østerås N, Haugen IK, Kjeken I. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study. BMC Musculoskelet Disord 2019; 20:180. [PMID: 31039774 PMCID: PMC6492412 DOI: 10.1186/s12891-019-2567-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment. Surgery should be considered only when other treatment has proven insufficient in relieving pain. The purpose of this study was to investigate prior treatment and characteristics of patients referred to specialist health care surgical consultation due to CMCJ OA. The study includes exploring differences in pain and function between referred and non-referred hand, between men and women, and between patients with and without OA affection of other finger joints than CMCJ. Methods Patients in this cross-sectional study reported prior non-pharmacological treatment for CMCJ OA. Patient demographics, disease and functional variables were assessed based on hand radiographs, patient-reported and observer-based outcome measures. Differences in pain and function between referred and non-referred hand, men and women, and between patients with and without additional affection of finger joints other than CMCJ, were analysed using Paired-samples T-tests, Wilcoxon Signed Rank, or Chi-Square tests. Results One hundred and eighty patients were included. The mean age was 63 years and 79% were women. Only 21% reported having received non-pharmacological treatment before referral to surgical consultation. The results show a statistically significant worse function for referred hands, women and involvement of additional interphalangeal joints. Most patients reported no pain or mild pain in their referred hand. Conclusions The results of this study show a non-pharmacological treatment gap in OA care. Most patients report no pain or mild pain, and that they had not received non-pharmacological treatment prior to being referred to CMCJ OA surgical consultation. The results furthermore show that CMCJ OA negatively affects all aspects of function. Strategies need to be developed to improve OA care, including educating general practitioners in evidence-based treatment recommendations and in the assessment of hand pain, and encourage the routine referral of patients with symptomatic hand OA to occupational therapy before considering surgery.
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Affiliation(s)
- Else Marit Holen Gravås
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway. .,Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N- 0130, Oslo, Norway.
| | - Anne Therese Tveter
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N- 0130, Oslo, Norway
| | - Randi Nossum
- Department of Rheumatology, St. Olavs Hospital, PO Box 3250, Sluppen, N-7006, Trondheim, Norway
| | - Ruth Else Mehl Eide
- Department of Rheumatology, Haukeland University Hospital, PO Box 1400, N-5504, Bergen, Norway
| | - Åse Klokkeide
- Haugesund Rheumatism Hospital, PO Box 2175, N-5504, Haugesund, Norway
| | - Karin Hoegh Matre
- Department of Rheumatology, Haukeland University Hospital, PO Box 1400, N-5504, Bergen, Norway
| | - Monika Olsen
- Haugesund Rheumatism Hospital, PO Box 2175, N-5504, Haugesund, Norway
| | - Øyvor Andreassen
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Nina Østerås
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Ida Kristin Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Ingvild Kjeken
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.,Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N- 0130, Oslo, Norway
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Tollefsrud I, Mengshoel AM. A fragile normality - illness experiences of working-age individuals with osteoarthritis in knees or hips. Disabil Rehabil 2019; 42:2593-2599. [PMID: 30829074 DOI: 10.1080/09638288.2019.1573930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Examine how individuals manage to live a life with osteoarthritis in the knee or hip.Methods: Focus group interviews were held with ten female and two male patients aged 45-65 years, who had participated in a vocational rehabilitation programme one to five years' earlier. The interviews were analysed using thematic analysis.Results: Participants' experiences are described in three themes: (1) Having "a changed and unreliable body" refers to a persistent presence of symptoms and an occasional, unpredictable flare up of symptoms involving sudden loss of movement control; (2) patients living with "(un) manageable life situations" downscale their daily activities to maintain a normal life; however, their flare-ups are unmanageable and cause significant life disruption; and (3) patients "strive to maintain an independent self" by doing their best to continue living as before without receiving any help. For the patients, continuing to participate in working life signifies an independent life that is on equal terms with others.Conclusions: The participants of this study adjusted and managed their daily activities to continue to live a normal life in accord with cultural norms. However, unpredictable flare ups and loss of control made their otherwise normal life somewhat fragile.Implications for rehabilitation•Osteoarthritis is a common disease which is often considered relatively stable, controllable and manageable.•This sample study highlights the participants uncertainty related to unpredictable variability in symptoms.•Appropriate management strategies for bad days need to be developed especially for those struggling at work.
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Affiliation(s)
| | - Anne Marit Mengshoel
- Department of Health Sciences, Medical Faculty, Institute of Health and Society, University of Oslo, Oslo, Norway
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Hackney AJ, Klinedinst NJ, Resnick B, Renn C, Fiskum G. A review and synthesis of correlates of fatigue in osteoarthritis. Int J Orthop Trauma Nurs 2019; 33:4-10. [PMID: 30808556 DOI: 10.1016/j.ijotn.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 12/29/2022]
Abstract
Fatigue affects nearly half of all adults with osteoarthritis. Affected individuals report difficulty with daily functioning, requiring more time and rest during activities, feeling easily exhausted, and having to give up on social and volunteer activities known to improve quality of life. Because its etiology is poorly understood, clinical practice guidelines are unable to address management of fatigue in osteoarthritis. Elucidating a mechanism of osteoarthritis fatigue is a high priority, but few studies have identified key factors associated with fatigue in osteoarthritis. Thus, the purpose of this narrative literature review is to present the current evidence of known and potential correlates of fatigue in osteoarthritis, and synthesize our findings into a conceptual framework. The overarching goal of this work is to provide insight into areas of needed research and guide future work toward mechanistic insight of osteoarthritis fatigue. This knowledge could lead to novel nursing interventions for prevention, management, and treatment of fatigue among adults with osteoarthritis.
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Affiliation(s)
- Alisha J Hackney
- Robert Wood Johnson Future of Nursing Scholar, University of Maryland School of Nursing 655 W. Lombard St., Office 402G, Baltimore, MD, 21201, USA.
| | - N Jennifer Klinedinst
- Organizational Systems & Adult Health, University of Maryland School of Nursing, USA.
| | - Barbara Resnick
- Sonya Ziporkin Gershowitz Chair in Gerontology, University of Maryland School of Nursing, USA.
| | - Cynthia Renn
- Pain & Translational Symptom Science, University of Maryland School of Nursing, USA.
| | - Gary Fiskum
- Department of Anesthesiology, University of Maryland School of Medicine, USA.
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Kendzerska T, King LK, Lipscombe L, Croxford R, Stanaitis I, Hawker GA. The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study. Diabetologia 2018; 61:2290-2299. [PMID: 30091045 DOI: 10.1007/s00125-018-4703-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/28/2018] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS This study examined the relationship between hip/knee osteoarthritis and incident diabetes. We hypothesised that hip/knee osteoarthritis would be independently related to an increased risk of incident diabetes and that this relationship would be due, at least in part, to walking difficulty. We also hypothesised a stronger relationship with incident diabetes for knee than hip osteoarthritis because of the higher prevalence in the former of obesity/the metabolic syndrome. METHODS A population cohort aged ≥55 years recruited from 1996 to 1998 was followed through provincial health administrative data to 2014. Participants with baseline diabetes were excluded. Hip/knee osteoarthritis was defined as swelling, pain or stiffness in any joint lasting 6 weeks in the past 3 months and indication on a joint homunculus that a hip/knee was 'troublesome'. Walking limitation was defined as self-reported difficulty standing or walking in the last 3 months (yes/no). Using Cox regressions, we examined the relationship of baseline hip/knee osteoarthritis with incident diabetes as defined from health administrative data, controlling for age, sex, BMI, income, prior hypertension, cardiovascular disease and primary care exposure. We tested whether the observed effect was mediated through walking limitation. RESULTS In total, 16,362 participants were included: median age 68 years and 61% female. Of these, 1637 (10%) individuals met the criteria for hip osteoarthritis, 2431 (15%) for knee osteoarthritis and 3908 (24%) for walking limitation. Over a median follow-up of 13.5 years (interquartile range 7.3-17.8), 3539 individuals (22%) developed diabetes. Controlling for confounders, a significant relationship was observed between number of hip/knee joints with osteoarthritis and incident diabetes: HR for two vs no osteoarthritic hips 1.25 (95% CI 1.08, 1.44); HR for two vs no osteoarthritic knees 1.16 (95% CI 1.04, 1.29). From 37% to 46% of this relationship was explained by baseline walking limitation. CONCLUSIONS/INTERPRETATION In a large population cohort aged ≥55 years who were free of diabetes at baseline, and controlling for confounders, the presence and burden of hip/knee osteoarthritis was a significant independent predictor of incident diabetes. This association was partially explained by walking limitation. Increased attention to osteoarthritis and osteoarthritis-related functional limitations has the potential to reduce diabetes risk.
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Affiliation(s)
- Tetyana Kendzerska
- Division of Respirology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada.
| | - Lauren K King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Agaliotis M, Mackey MG, Jan S, Fransen M. Perceptions of working with chronic knee pain: A qualitative study. Work 2018; 61:379-390. [PMID: 30373994 DOI: 10.3233/wor-182817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND People with chronic knee pain may opt to continue to work without seeking specific ergonomic adaptations or disclose the existence or severity of their pain to work colleagues or supervisors due to the pressures of maintaining employment. To gain a deep personal perspective on how people with chronic knee pain cope while working [7, 8, 17, 18], qualitative research methods are a useful way of in encouraging meaningful discussion amongst workers with chronic knee pain of potential work-related strategies to minimize their work-related disability. OBJECTIVE To conduct an in-depth exploration of the impact of chronic knee pain on the working life of selected individuals. The specific aim was to identify barriers and enablers for promoting sustainable work within the work environment following the methodological principles from grounded theory. METHOD Eleven workers with chronic knee pain participated in one of three focus groups (age range 51-77 years). All focus group sessions were audiotaped and transcribed verbatim. Two researchers independently identified themes around the common challenges for continuing employment among older people with chronic knee pain. RESULTS The main themes expressed in these focus groups were: 1) the effect of knee pain on work productivity, 2) strategies to improve work productivity, and 3) future suggestions about sustainable work for older people with chronic knee pain. New insights gained from the focus groups included the extent of physical limitations due to chronic knee pain, lack of ergonomic policies within the workplace, types of work transitions utilized to accommodate knee pain, complexity of disclosure, social support at work, and the unpredictability of future arthritis progression. CONCLUSION This research suggests that in providing the appropriate work environment to enable individuals with knee pain to continue to be productive members of society, workplace strategies are needed to minimize the stigma and encourage communication about chronic knee pain, as well investment in appropriate ergonomic support equipment.
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Affiliation(s)
- Maria Agaliotis
- The University of New South Wales (UNSW), Faculty of Medicine, School of Public Health & Community Medicine, Sydney, NSW, Australia
| | - Martin G Mackey
- The University of Sydney, Physiotherapy, Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Marlene Fransen
- The University of Sydney, Physiotherapy, Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, NSW, Australia
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Castrejon I, Shakoor N, Chua JR, Block JA. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 2018; 38:2137-2145. [PMID: 30293155 DOI: 10.1007/s00296-018-4166-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Abstract
The study compares patient-physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ - 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient-physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12-1.78) and RA (OR 1.47 95% CI 1.04-2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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Dziedzic KS, Allen KD. Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care. Rheumatology (Oxford) 2018; 57:iv88-iv98. [PMID: 29684219 PMCID: PMC5905599 DOI: 10.1093/rheumatology/key062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Indexed: 12/20/2022] Open
Abstract
A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health management, complex interventions and outcomes. It sets this in the context of competing health priorities and multimorbidity, access to high quality conservative care, non-pharmacological therapies, resource limitations and models of care. The overuse of some therapies and neglect of others are discussed, as well as the potential for self-management. The roles of patient and public involvement and the healthcare team are highlighted in enhancing best care for OA and providing solutions for closing the evidence-to-practice gap. Implementation of models of care offer one solution to the challenges and progress of such implementation is described. Areas for further research are highlighted.
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Affiliation(s)
- Krysia S Dziedzic
- Institute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Veterans Affairs Health Care System, Center for Health Services Research in Primary Care, Durham, NC, USA
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Rao Y, Xu X, Liu D, Reis C, Newman IM, Qin L, Sharma M, Shen J, Zhao Y. Health-Related Quality of Life in Patients with Arthritis: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040768. [PMID: 29659544 PMCID: PMC5923810 DOI: 10.3390/ijerph15040768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 12/28/2022]
Abstract
Background: Arthritis is a common disease in China, but few studies have been conducted to explore the associated health-related quality of life (HRQoL) and its influencing factors in Chongqing, China. This study aimed to explore the association of arthritis and HRQoL and probe factors affecting HRQoL among arthritis patients. Methods: A cross-sectional survey was conducted in Chongqing, China. A total of 1224 adults were included in the analysis. Medical Outcomes Study Short Form 36 Health Survey (SF-36) was used to measure HRQoL. Multiple linear regression models (stepwise) and covariance analysis models were used to examine the association of arthritis with HRQoL and analyze factors associated with HRQoL among arthritis patients. Results: Participants with arthritis had poorer HRQoL than those without. Among arthritis patients, the female was associated with a poorer state of physical functioning (p < 0.05); unemployed patients had a poorer state of role-physical than employed patients (p < 0.05); low average monthly income was associated with a poorer state of physical functioning (p < 0.01); childhood non-breastfeeding history was associated with a poorer state of social functioning (p < 0.01); average or dissatisfied attitude to current living conditions was associated with a poorer state of vitality and mental health (p < 0.05 for all); moreover, poor or general appetite was associated with a poorer state of role-physical, general health, social functioning, bodily pain, and role-emotional (p < 0.01 for all). Conclusions: Arthritis patients have worse HRQoL than those without in the Chinese population. Female, low socioeconomic status, childhood non-breastfeeding history, average or dissatisfied attitude to current living conditions and poor or general appetite were associated with poorer state of HRQoL among Chinese arthritis patients.
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Affiliation(s)
- Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- The Fourth Student Office of the School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
| | - Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Cesar Reis
- Department of Preventive Medicine, Loma Linda University Medical Center, 24785 Stewart Street, Suite 204, Loma Linda, CA 92354, USA.
| | - Ian M Newman
- Department of Educational Psychology, University of Nebraska-Lincoln, P.O. Box 880345, Lincoln, NE 68588-0345, USA.
| | - Liqiang Qin
- School of Public Health, Soochow University, Suzhou 215000, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
- School of Health Sciences, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MS 55401, USA.
| | - Jun Shen
- The Fourth Student Office of the School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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Chou L, Ellis L, Papandony M, Seneviwickrama KLMD, Cicuttini FM, Sullivan K, Teichtahl AJ, Wang Y, Briggs AM, Wluka AE. Patients' perceived needs of osteoarthritis health information: A systematic scoping review. PLoS One 2018; 13:e0195489. [PMID: 29659609 PMCID: PMC5901923 DOI: 10.1371/journal.pone.0195489] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Optimal management of osteoarthritis requires active patient participation. Understanding patients' perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients' perceived health information needs for OA. METHODS A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoarthritis health information were categorized. RESULTS 30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention. CONCLUSIONS Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa Ellis
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle Papandony
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - K. L. Maheeka D. Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Andrew J. Teichtahl
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Move: muscle, bone & joint health, Melbourne, Victoria, Australia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, Duda JL. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open 2017; 7:e017042. [PMID: 29282257 PMCID: PMC5770915 DOI: 10.1136/bmjopen-2017-017042] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes. OBJECTIVES The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance. METHODS Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme-Qualitative checklist and Lincoln and Guba's criteria were used for quality appraisal. Thematic synthesis was applied. FINDINGS Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a 'keep going' attitude, adjusting and prioritising PA, having healthcare professionals' and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored. CONCLUSION Our findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required. TRIAL REGISTRATION NUMBER CRD42016030024.
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Affiliation(s)
- Archontissa M Kanavaki
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Nursing, Institute of Clinical Sciences, Medical School, University of Birmingham, Birmingham, UK
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Asma Alrushud
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rainer Klocke
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Abhishek Abhishek
- Academic Rheumatology Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
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Louw A, Zimney K, Johnson EA, Kraemer C, Fesler J, Burcham T. De-educate to re-educate: aging and low back pain. Aging Clin Exp Res 2017; 29:1261-1269. [PMID: 28275956 DOI: 10.1007/s40520-017-0731-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients' beliefs about their condition have been shown to play a significant role in their pain experience and response to treatment, especially when a patient sees their tissue health as vulnerable or aged. Educational can alter these beliefs. Prior to new information, patients often have to be de-educated regarding common misbeliefs to undergo re-education. AIMS To determine if a brief de-education session regarding aging and low back pain (LBP) can shift pain ratings, fear-avoidance beliefs, beliefs regarding aging and LBP, and limited active trunk flexion. METHODS Fifty adults ranging from 50 to 93 years of age (SD = 10.73) with a 15.1 years of LBP were education on the poor correlation between aging and LBP. Prior to and immediately after the education pain ratings for LBP and leg pain (numeric pain rating scale-NPRS), fear-avoidance (fear avoidance beliefs questionnaire-FABQ), beliefs regarding aging and LBP (Likert scale) and active trunk flexion were measured. RESULTS Significant changes were found in positive shifts with LBP (p = 0.002), leg pain (p = 0.042), FABQ-physical activity subscale (p = 0.004) and active trunk forward flexion (p < 0.001). DISCUSSION The results show that education aimed at altering beliefs regarding LBP and aging result in a positive shift in pain, fear avoidance related to physical activity and active trunk flexion. CONCLUSION Prior to providing patients with new healthcare information, de-educating them regarding poor beliefs may be helpful in shifting them towards new, healthier paradigms associated with their condition.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, PO Box 232, Story City, IA, 50248, USA.
| | - Kory Zimney
- Department of Physical Therapy, School of Health Sciences, University of South Dakota, 414 E Clark Street, Vermillion, SD, 57069, USA
| | - Eldon A Johnson
- RehabAuthority, 3170 43rd St S, Suite 101, Fargo, ND, 58104, USA
| | - Chris Kraemer
- RehabAuthority, 3170 43rd St S, Suite 101, Fargo, ND, 58104, USA
| | - Justin Fesler
- Advanced PT, 19416 Highridge Way, Trabuco Canyon, CA, 92679, USA
| | - Tyler Burcham
- Rehabilitation Director and Clinic Administrator, RehabAuthority Physical Therapy, 1100 19th Avenue, North Suite K, Fargo, ND, 58102, USA
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Kendzerska T, Jüni P, King LK, Croxford R, Stanaitis I, Hawker GA. The longitudinal relationship between hand, hip and knee osteoarthritis and cardiovascular events: a population-based cohort study. Osteoarthritis Cartilage 2017; 25:1771-1780. [PMID: 28801210 DOI: 10.1016/j.joca.2017.07.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/20/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this population-based cohort study, we examined the association between the presence of symptomatic osteoarthritis (OA) and risk for cardiovascular (CV) events. METHOD A cohort aged ≥55 years recruited from 1996 to 98 was followed through provincial health administrative data to 2014. Demographics, joint complaints and functional limitations were collected. Hip, knee and hand OA were defined using a validated definition. Using Cox-regressions, the relationship between OA and a composite CV outcome (myocardial infarction (MI), stroke, angina, heart failure, revascularization) was assessed controlling for age, body mass index (BMI), sex, pre-existing metabolic factors, comorbidities, income status, primary care exposure and functional limitations. RESULTS 18,490 participants were included: median age was 68 years, 60.3% were female; 24.4% met criteria for OA (10.0% hip, 15.3% knee, 16.0% hand), 16.3% self-reported limitation in grip and 25.4% in walking. Over a median 13.4 years, 31.9% experienced a CV event. Controlling for all but walking limitation, a dose-response relationship was observed between number of joints affected by knee/hip OA and CV risk (HR 2 hips/knees vs none: 1.13, 95% CI 1.03-1.23; 3+ hips/knees: 1.22, 95% CI 1.09-1.36). This relationship became non-significant additionally controlling for difficulty walking. Self-reported difficulty walking was associated with a 30% increased hazard for CV events. The effect of hand OA was not significant. CONCLUSION In a large population cohort, a greater burden of hip/knee OA was associated with higher CV risk; the relationship was explained by OA-related difficulty walking. Increased attention to management of OA with a view to improving mobility has potential to reduce CV events.
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Affiliation(s)
- T Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences/Sunnybrook Research Institute, Toronto, ON, Canada
| | - P Jüni
- Applied Health Research Centre, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - L K King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences/Sunnybrook Research Institute, Toronto, ON, Canada
| | - I Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - G A Hawker
- Institute for Clinical Evaluative Sciences/Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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Fatigue in Arthritis: A Multidimensional Phenomenon with Impact on Quality of Life. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 987:243-256. [DOI: 10.1007/978-3-319-57379-3_22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Functioning Without Cartilage: Older People With Radiographic Knee Osteoarthritis Who Self-Report No Functional Limitations Do Score Lower on a Performance Battery. J Aging Phys Act 2017; 25:570-575. [PMID: 28181834 DOI: 10.1123/japa.2016-0112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The majority of the older population shows signs of radiographic knee osteoarthritis. However, many remain without functional complaints for a long period. This study aims to find early functional changes associated with stages of radiographic knee osteoarthritis. A group of older people without self-reported complaints was divided in two groups: knee osteoarthritis (K&L = 2-4, N = 29) and control (K&L = 0-1, N = 31). Muscle function was assessed with voluntary and electrically-stimulated isometric knee contractions, including a fatigue test. Physical functioning was assessed with a 6-min walk test (6MWT), a stair climb test (SCT), and a short performance battery. There were no differences in muscle function parameters, 6MWT, and SCT between groups. A clinically relevant lower score on the performance battery was found in participants with knee osteoarthritis. In conclusion, even when older people indicate to have no functional limitations, a decline in functional outcome can be measured with a physical performance battery.
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Chen AT, Kaplan SJ, Carriere R. A constant conversation: tuning into and harmonizing the needs and priorities of the body and mind. Int J Qual Stud Health Well-being 2017; 12:1350550. [PMID: 28762295 PMCID: PMC5613916 DOI: 10.1080/17482631.2017.1350550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Individuals rely upon many types of information to manage an illness, including information provided by their own bodies. This study investigated how people tune into and manage the flow of information from their bodies to manage their health. Method: We developed a platform for participants to share and collaboratively reflect on how they engaged in this dialogic process, in which participants contributed to a discussion on topics relating to body listening and body awareness. Though the study was open to anyone interested in or wanting to contribute to knowledge on “body listening,” the social media recruitment focused on chronic conditions requiring self-care and having overlapping symptomatology, with chronic pain as the primary characteristic. A qualitative analysis method based on grounded theory was used to analyse the data. Results: Six main themes emerged: learning the language, recognizing and heeding limits, experiencing emotional fatigue and despair, regulating the channel, moving from conflict to communication, and settling into an uneasy acceptance. Conclusion: The monitoring and filtering of information from one’s body, and the appeasement of conflicting demands and voices, is difficult work. Knowledge of this process can be used in patient education and in the development of tools to support body listening.
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Affiliation(s)
- Annie T Chen
- a Department of Biomedical Informatics and Medical Education , University of Washington School of Medicine , Seattle , WA , USA
| | - Samantha J Kaplan
- b School of Information and Library Science , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Rachel Carriere
- c Content Management , EBSCO Information Services , Ipswich , MA , USA
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El-Haddad C, Castrejon I, Gibson KA, Yazici Y, Bergman MJ, Pincus T. MDHAQ/RAPID3 scores in patients with osteoarthritis are similar to or higher than in patients with rheumatoid arthritis: a cross-sectional study from current routine rheumatology care at four sites. RMD Open 2017; 3:e000391. [PMID: 29225915 PMCID: PMC5708309 DOI: 10.1136/rmdopen-2016-000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To compare patients with a primary diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (RA) for scores on a patient self-report MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data 3), and for physician global assessment (DOCGL). Methods All patients with all diagnoses complete an MDHAQ/RAPID3 at all routine rheumatology visits in the waiting area before seeing a rheumatologist at four sites, one in Australia and three in the USA. The two-page MDHAQ includes 0–10 scores for physical function (in 10 activities), pain and patient global assessment [on 0–10 visual analogue scales (VAS)], compiled into a 0–30 RAPID3, as well as fatigue and self-report painful joint count scales. Rheumatologists estimate a 0–10 DOCGL VAS. Demographic, MDHAQ/RAPID3 and DOCGL data from a random visit were compared in patients with RA versus patients with OA using multivariate analysis of variance, adjusted for age, disease duration and formal education level. Results Median RAPID3 was higher in OA versus RA at all four sites (11.7–16.8 vs 6.2–11.8) (p<0.001 at three sites). Median DOCGL in OA versus RA was 5 vs 4, 4 vs 3.7, 2.2 vs 2.5 and 2 vs 1. Patterns were similar for individual RAPID3 items, fatigue and painful joint scales, and in stratified analyses of patients aged 55–70. Conclusion Patient MDHAQ/RAPID3 and physician DOCGL indicate similar or higher disease burden in OA versus RA. Routine MDHAQ/RAPID3 allows direct comparisons of the two diseases. The findings suggest possible revision of current clinical and public policy views concerning OA.
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Affiliation(s)
- Carlos El-Haddad
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia
| | - Isabel Castrejon
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia.,Ingham Research Institute, Liverpool, Australia.,Rheumatology, University of New South Wales, Sydney, NSW, Australia
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA
| | - Martin J Bergman
- Department of Arthritis and Rheumatology, Taylor Hospital, Ridley Park, Pennsylvania, USA
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Kjeken I, Eide REM, Klokkeide Å, Matre KH, Olsen M, Mowinckel P, Andreassen Ø, Darre S, Nossum R. Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:473. [PMID: 27842579 PMCID: PMC5109819 DOI: 10.1186/s12891-016-1321-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/01/2016] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA? METHODS/DESIGN All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years. DISCUSSION The findings will improve the evidence-based management of HOA. TRIAL REGISTRATION IDENTIFIER NCT01794754 . First registrated February 15th 2013.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | | | | | - Karin Hoegh Matre
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Monika Olsen
- Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Petter Mowinckel
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Øyvor Andreassen
- Patient research panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Darre
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Nossum
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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