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Velescu DR, Marc MS, Traila D, Pescaru CC, Hogea P, Suppini N, Crisan AF, Wellmann N, Oancea C. A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:261. [PMID: 38399548 PMCID: PMC10889932 DOI: 10.3390/medicina60020261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.
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Affiliation(s)
- Diana Raluca Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Traila
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Patricia Hogea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Noemi Suppini
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Plinsinga ML, Vuvan V, Maclachlan L, Klyne D, Graven-Nielsen T, Vicenzino B, Hodges P, Bjarke Vaegter H. Pain-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain. Pain 2023; 164:1593-1599. [PMID: 36728470 DOI: 10.1097/j.pain.0000000000002864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between -0.15 and 0.11, P ≥ 0.08; total: β between -0.27 and -0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Viana Vuvan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Liam Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- The Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Rosado SE. Osteoarthritis affects us too: an expert panel survey of factors important for younger adult wellbeing. SOCIAL WORK IN HEALTH CARE 2023; 62:73-92. [PMID: 36987586 DOI: 10.1080/00981389.2023.2191654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Research on quality of life (QOL) factors important for younger adults (ages 18-45 years old) with osteoarthritis (OA) is limited. This study utilizes an online survey method to conduct an expert panel review of QOL domains for this population. Health provider and young adult perspectives of living with OA were captured and compared. Results indicate that providers are underestimating the impact OA is having on a variety of QOL factors for younger adults. Overall, these results reveal critical QOL domains to consider during assessment and when considering intervention strategies aimed at improving the lives of younger adults with this chronic disease. Implications for social work are also discussed.
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Jacobs H, Seeber GH, Lazovic D, Maus U, Hoffmann F. Disease burden of and expectations from surgery in patients prior to total knee arthroplasty: Results of the prospective FInGK study. Knee 2023; 41:257-265. [PMID: 36773371 DOI: 10.1016/j.knee.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/30/2022] [Accepted: 01/26/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Disease burden in patients prior to total knee arthroplasty (TKA) varies widely between studies and countries. We aimed to characterize individuals undergoing TKA and examine their expectations from the surgery, focusing on variations in disease burden. METHODS Consecutive patients undergoing primary TKA in a German university hospital were recruited. A questionnaire including information on disease burden, preoperative expectations from surgery, health care utilization, demography, and socioeconomics was collected one day prior to surgery and linked to data from medical records. Patients were categorized into disease burden quartiles using the Western Ontario and McMaster Universities Osteoarthritis Index' (WOMAC) total score. Subsequently, study population's characteristics and expectations from surgery were analyzed stratified by disease burden. RESULTS A total of 196 patients were included (41 % male; mean age: 68.2 years). The median WOMAC was 52.0 (IQR: 41.0-58.0). Patients in Q1 were more often males (Q1: 63 % vs Q4: 29 %) and had a shorter duration of complaints with the impaired knee. They were also less restricted in social participation, reported less often signs of depression, and were less often treated with physiotherapy (Q1: 27 % vs Q4: 54 %). Furthermore, expectations from surgery were highest in patients with a low disease burden. CONCLUSION We found large variations in disease burden with a considerable number of patients undergoing TKA whose functional capacity is still maintained and for which guideline-recommended conservative treatment options are not fully exhausted. Further research on this subgroup as well as establishing an international consensus on specific thresholds for TKA indication are needed.
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Affiliation(s)
- Hannes Jacobs
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| | - Gesine H Seeber
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Uwe Maus
- Department of Orthopaedics & Trauma Surgery, University Hospital Düsseldorf, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Wojcieszek A, Kurowska A, Majda A, Liszka H, Gądek A. The Impact of Chronic Pain, Stiffness and Difficulties in Performing Daily Activities on the Quality of Life of Older Patients with Knee Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16815. [PMID: 36554695 PMCID: PMC9779661 DOI: 10.3390/ijerph192416815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons' general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life-BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p < 0.001), overall quality of life (p < 0.001) and in the following domains: physical (p < 0.001), mental (p < 0.001) and environmental (p < 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.
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Affiliation(s)
- Agata Wojcieszek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 30-126 Krakow, Poland
| | - Anna Kurowska
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 30-126 Krakow, Poland
| | - Anna Majda
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 30-126 Krakow, Poland
| | - Henryk Liszka
- Trauma and Orthopaedics Clinical Department, University Hospital, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Gądek
- Trauma and Orthopaedics Clinical Department, University Hospital, Jagiellonian University Medical College, 30-688 Krakow, Poland
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Martire LM, Zhaoyang R, Marini CM, Nah S. Dyadic Links Between Health Changes and Well-Being: The Role of Non-Spousal Confidants. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2022; 39:2617-2638. [PMID: 37033718 PMCID: PMC10079281 DOI: 10.1177/02654075221086509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Although the marital relationship is often the primary source of emotional support in adulthood, sole reliance on the spouse to discuss health-related issues may be harmful to the well-being of both partners. The first aim of this study was to examine whether declines in health during later life would be associated with poorer psychological well-being in self and partner. We further investigated whether declining health would have a stronger impact on own and partner psychological well-being in the absence of non-spousal health confidants. Longitudinal actor-partner interdependence models (APIMs) were used to test both hypotheses with dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Contrary to prediction, increased anxiety following spousal declines in gait speed and cognitive function occurred for those whose spouse did (rather than did not) have additional health confidants. A much fuller understanding is needed in regard to whether close relationships provide resources or present unwanted complications to dyadic coping, and the processes by which effects occur.
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Affiliation(s)
- Lynn M Martire
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University
| | | | | | - Suyoung Nah
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University
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7
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Zhao Q, Kong Y, Wan L. Editorial: Pain and Depression. Front Psychol 2022; 13:865071. [PMID: 35432053 PMCID: PMC9005772 DOI: 10.3389/fpsyg.2022.865071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Qing Zhao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yazhuo Kong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wan
- Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Health, Psychological and Demographic Predictors of Depression in People with Fibromyalgia and Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063413. [PMID: 35329109 PMCID: PMC8950397 DOI: 10.3390/ijerph19063413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.
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Wang ST, Ni GX. Depression in Osteoarthritis: Current Understanding. Neuropsychiatr Dis Treat 2022; 18:375-389. [PMID: 35237034 PMCID: PMC8883119 DOI: 10.2147/ndt.s346183] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
Depression, one of the most common comorbidities with osteoarthritis (OA), affects patient prognosis and quality of life. It also increases the overall burden of disease. This subgroup of patients has not been effectively managed in clinical settings. The study aimed to direct physicians' attention to the co-occurrence of depression and OA. Therefore, this review summarizes the relevant literature published over the past 10 years. The focus is on the prevalence of and risk factors for depression in OA, the effects of depression on OA development and treatment response, comorbidity mechanisms, screening, and non-pharmacological treatment. The research on the etiology of depression has been driven largely by epidemiological studies. Recent studies have shown that high levels of pain, poor levels of function, high numbers of OA sites, and slow gait might be associated with depression. However, the pathophysiology of OA and depression comorbidities remains unclear. In addition to immune inflammation and structural changes in the brain, which have been documented in brain imaging studies, psychosocial factors may also play a role. The evidence indicates that depression can be treated with early intervention; however, adjustments may need to be made for individuals with comorbid depression in OA. It is recommended that health care providers pay more attention to depressive symptoms in patients with OA. Clinicians should develop and implement an individualized and comprehensive treatment plan for patients based on a mental health assessment and in teams with other professionals to optimize treatment outcomes.
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Affiliation(s)
- Shen-Tao Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
- Correspondence: Guo-Xin Ni, Tel +86-10-62989780, Fax +86-10-62989670, Email
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10
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Cochrane SK, Calfee RP, Stonner MM, Dale AM. The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions. J Hand Ther 2022; 35:24-31. [PMID: 33250395 PMCID: PMC8985319 DOI: 10.1016/j.jht.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. PURPOSE OF THE STUDY This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. STUDY DESIGN This is a retrospective cohort study of patients from one orthopedic center. METHODS Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. RESULTS Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). CONCLUSIONS Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
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Affiliation(s)
- Shannon K. Cochrane
- Washington University School of Medicine in St. Louis, Program in Occupational Therapy, St. Louis, MO, USA
| | - Ryan P. Calfee
- Washington University School of Medicine in Saint Louis, Orthopedic Surgery, Saint Louis, MO, USA
| | - Macyn M. Stonner
- Washington University School of Medicine in St. Louis, Milliken Hand Rehabilitation Center, Center for Advanced Medicine, St. Louis, MO, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA,Corresponding author. Department of Medicine, Washington University School of Medicine in St. Louis, 4523 Clayton Ave., CB 8005, Saint Louis, MO 63110, USA. Tel.: 314-454-8470; fax: 314-454-5113. (A.M. Dale)
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Kec D, Rajdova A, Raputova J, Adamova B, Srotova I, Nekvapilova EK, Michalcakova RN, Horakova M, Belobradkova J, Olsovsky J, Weber P, Hajas G, Kaiserova M, Mazanec R, Potockova V, Ehler E, Forgac M, Birklein F, Üçeyler N, Sommer C, Bednarik J, Vlckova E. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. Eur J Pain 2021; 26:370-389. [PMID: 34592017 PMCID: PMC9293147 DOI: 10.1002/ejp.1865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022]
Abstract
Background Despite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited. Methods This observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State‐Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain‐free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes‐, neuropathy‐ and pain‐related), the socio‐economic and the cognitive factors (catastrophizing). Results The study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety. Conclusions In addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals. Significance In large cohorts of well‐defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.
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Affiliation(s)
- David Kec
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Aneta Rajdova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Raputova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Iva Srotova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | | | - Magda Horakova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Belobradkova
- Diabetology Centre, Department of Internal Medicine and Gastroenterology, University Hospital Brno, Brno, Czech Republic
| | - Jindrich Olsovsky
- Diabetology Centre, St. Anne University Hospital, Brno, Czech Republic
| | - Pavel Weber
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic
| | - Gabriel Hajas
- Department of Neurology, University Hospital Nitra, Nitra, Slovakia
| | - Michaela Kaiserova
- Department of Neurology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radim Mazanec
- Department of Neurology, Motol University Hospital, Prague, Czech Republic
| | - Veronika Potockova
- Department of Neurology, Motol University Hospital, Prague, Czech Republic
| | - Edvard Ehler
- Department of Neurology, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Martin Forgac
- General University Hospital in Prague, Prague, Czech Republic
| | - Frank Birklein
- Department of Neurology, University Medical Center, Mainz, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Germany
| | - Josef Bednarik
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Eva Vlckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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12
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Jacobs CA, Mace RA, Greenberg J, Popok PJ, Reichman M, Lattermann C, Burris JL, Macklin EA, Vranceanu AM. Development of a mind body program for obese knee osteoarthritis patients with comorbid depression. Contemp Clin Trials Commun 2021; 21:100720. [PMID: 33553798 PMCID: PMC7859301 DOI: 10.1016/j.conctc.2021.100720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/29/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Mind-body interventions to lessen depressive symptoms and increase physical activity offer the ability to target biological, mechanical and psychological mechanisms of OA progression. Our long-term goals are to evaluate the mechanisms by which the Relaxation Response Resiliency Program (3RP) delivered via secure telehealth, and adapted for patients with depression, obesity and knee OA (GetActive-OA) promotes increases in physical activity and improved knee health. We hypothesize that the synergistic interaction between mindfulness, adaptive thinking, positive psychology and healthy living skills of the GetActive-OA will slow the progression of symptomatic knee OA by reducing pro-inflammatory cytokine expression and promoting optimal mechanical loading of the cartilage. Here we present the protocol for a mixed methods study that will adapt the 3RP for the needs of knee OA patients with depression and obesity with a focus on increasing physical activity (GetActive-OA), and iteratively maximize the feasibility, credibility and acceptability of the programs and research procedures.
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Affiliation(s)
- Cale A. Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 740 S. Limestone, Suite K401, Lexington, 40536-0284, KY, USA
| | - Ryan A. Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
| | - Paula J. Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, 02467, MA, USA
| | - Jessica L. Burris
- Department of Psychology, University of Kentucky, 207K Kastle Hall, Lexington, 40506, KY, USA
| | - Eric A. Macklin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA
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13
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Zheng S, Tu L, Cicuttini F, Zhu Z, Han W, Antony B, Wluka AE, Winzenberg T, Aitken D, Blizzard L, Jones G, Ding C. Depression in patients with knee osteoarthritis: risk factors and associations with joint symptoms. BMC Musculoskelet Disord 2021; 22:40. [PMID: 33413273 PMCID: PMC7791830 DOI: 10.1186/s12891-020-03875-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods Three hundred ninety-seven participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results The presence and incidence of depression was 25.4 and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. Trial registration ClinicalTrials.gov identifier: NCT01176344. Anzctr.org.au identifier: ACTRN12610000495022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03875-1.
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Affiliation(s)
- Shuang Zheng
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Liudan Tu
- Department of Rheumatology, The Third Affiliated Hospital of SUN YAT-SEN University, Guangzhou, China
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia
| | - Changhai Ding
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. .,Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. .,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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14
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Hafkamp FJ, de Vries J, Gosens T, den Oudsten BL. The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty 2021; 36:78-87. [PMID: 32893058 DOI: 10.1016/j.arth.2020.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms. METHODS Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics. RESULTS The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms. CONCLUSION The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.
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Affiliation(s)
- Frederique J Hafkamp
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
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15
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Jetha A, Theis KA, Boring MA, Murphy LB, Guglielmo D. Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study. Arthritis Care Res (Hoboken) 2021; 73:65-77. [PMID: 32702187 PMCID: PMC10481427 DOI: 10.1002/acr.24381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the relationship between depressive symptoms, arthritis, and employment, and to determine whether this relationship differs across young, middle-age, and older working-age adults with arthritis. METHODS Data from the US National Health Interview Survey from 2013-2017 were analyzed. Analyses were restricted to adults with doctor-diagnosed arthritis of working age (ages 18-64 years) with complete data on depressive symptoms (n = 11,380). Covariates were sociodemographic information, health, and health system utilization variables. Employment prevalence was compared by self-reported depressive symptoms. We estimated percentages, as well as univariable and multivariable logistic regression models, to examine the relationship between depression and employment among young adults (ages 18-34 years), middle-age adults (ages 35-54 years), and older adults (ages 55-64 years). RESULTS Among all working-age US adults with arthritis, the prevalence of depressive symptoms was 13%. Those reporting depressive symptoms had a higher prevalence of fair/worse health (60%) and arthritis-attributable activity limitations (70%) compared to those not reporting depression (23% and 39%, respectively). Respondents with depressive symptoms reported significantly lower employment prevalence (30%) when compared to those not reporting depressive symptoms (66%) and lower multivariable-adjusted association with employment (prevalence ratio 0.88 [95% confidence interval (95% CI) 0.83-0.93]). Middle-age adults reporting depression were significantly less likely to be employed compared to their counterparts without depression (prevalence ratio 0.83 [95% CI 0.77-0.90]); similar but borderline statistically significant relationships were observed for both young adults (prevalence ratio 0.86 [95% CI 0.74-0.99]) and older adults (prevalence ratio 0.94 [95% CI 0.86-1.03]). CONCLUSION For adults with arthritis, depressive symptoms are associated with not participating in employment. Strategies to reduce arthritis-related work disability may be more effective if they simultaneously address mental health.
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Affiliation(s)
- Arif Jetha
- Institute for Work and Health, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Dana Guglielmo
- Centers for Disease Control and Prevention, Atlanta, Georgia, and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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16
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Flowers PPE, Schwartz TA, Arbeeva L, Golightly YM, Pathak A, Cooke J, Gupta JJ, Callahan LF, Goode AP, Corsi M, Huffman KM, Allen KD. Racial Differences in Performance-Based Function and Potential Explanatory Factors Among Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:1196-1204. [PMID: 31254451 PMCID: PMC6935430 DOI: 10.1002/acr.24018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/25/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In individuals with knee osteoarthritis (OA), self-reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance-based physical function as well as potential underlying factors contributing to these racial differences. METHODS Participants with knee OA from a randomized controlled trial completed the 2-minute step test (2MST), timed-up-and-go (TUG), and 30-second chair stand (30s-CST) at baseline. Race differences in performance-based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables. RESULTS In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m2 ), African Americans (versus whites) had greater unadjusted odds of poorer function (30s-CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65-4.72], 2MST OR 2.37 [95% CI 1.40-4.03], and TUG OR 3.71 [95% CI 2.16-6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates. CONCLUSION African American adults with knee OA had poorer unadjusted performance-based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function.
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Affiliation(s)
| | | | | | | | - Ami Pathak
- Comprehensive Physical Therapy Center, Chapel Hill, North Carolina
| | | | | | | | | | - Michela Corsi
- Northeastern Ohio Medical University, Rootstown, Ohio
| | | | - Kelli D Allen
- University of North Carolina at Chapel Hill and Durham VA Medical Center, Durham, North Carolina
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17
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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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18
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Rivera NV, Parmelee PA, Smith DM. The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee. Aging Ment Health 2020; 24:8-14. [PMID: 30380912 DOI: 10.1080/13607863.2018.1506744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (β = 0.49, p < .001) and momentary, especially positive (β = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (β = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.
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Affiliation(s)
- Nicole V Rivera
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Dylan M Smith
- Program in Public Health and Department of Family, Preventive, and Population Medicine, Stony Brook University, Stony Brook, NY, USA
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19
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Jacobs CA, Vranceanu AM, Thompson KL, Lattermann C. Rapid Progression of Knee Pain and Osteoarthritis Biomarkers Greatest for Patients with Combined Obesity and Depression: Data from the Osteoarthritis Initiative. Cartilage 2020; 11:38-46. [PMID: 29855190 PMCID: PMC6921961 DOI: 10.1177/1947603518777577] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the progression of biochemical biomarkers of osteoarthritis (OA), knee pain, and function between nonobese patients (NON), obese patients without depression (OBESE), and obese patients with comorbid depression (O + D). DESIGN Utilizing the FNIH OA Biomarkers Consortium dataset, we categorized knee OA patients into NON, OBESE, and O + D groups based on body mass index and Center for Epidemiological Studies-Depression (CES-D) scores. Subjective symptoms (Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QOL), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores, and the Short Form-12 (SF-12) Physical Component Score [PCS]) and objective measures of cartilage degradation and bone remodeling (urinary CTXII and CTXIα) were compared among groups at baseline and 2-year follow-up. RESULTS Of the 600 patients, 282 (47%) were NON, 285 (47.5%) OBESE, and 33 (5.5%) O + D. The O + D group had significantly worse pain and function both at baseline and 2-year follow-up (P < 0.001 for all comparisons) as evidenced by self-reported measures on KOOS QOL, WOMAC Pain, WOMAC Physical Function, and SF-12 PCS. The O + D group also demonstrated significant increases in CTXII (P = 0.01) and CTXIα (P = 0.005), whereas the NON and OBESE groups did not. CONCLUSIONS The combination of inferior knee pain, physical function, and significantly greater increases in biomarkers of cartilage degradation and bony remodelling suggest a more rapid progression for obese OA patients with comorbid depression. The link between systemic disease, inflammatory burden, and progressive cartilage degradation is in line with increasing concerns about a degenerative synovial environment in early osteoarthritic knees that progress to treatment failure with biologic restoration procedures.
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Affiliation(s)
- Cale A. Jacobs
- Department of Orthopedic Surgery and
Sports Medicine, University of Kentucky, Lexington, KY, USA,Cale A. Jacobs, Department of Orthopedic
Surgery and Sports Medicine, University of Kentucky, 740 S Limestone, Room K426,
Lexington, KY 40536-0284, USA.
| | - Ana-Maria Vranceanu
- Department of Psychology, Harvard
Medical School and Integrated Brain Health Clinical and Research Program,
Massachusetts General Hospital, Boston, MA, USA
| | | | - Christian Lattermann
- Department of Orthopaedic Surgery,
Harvard Medical School and Brigham and Women’s Hospital, Chestnut Hill, MA,
USA
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20
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Marshall DA, Liu X, Barnabe C, Yee K, Faris PD, Barber C, Mosher D, Noseworthy T, Werle J, Lix L. Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada. BMJ Open 2019; 9:e033334. [PMID: 31753902 PMCID: PMC6887009 DOI: 10.1136/bmjopen-2019-033334] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data. DESIGN Retrospective cohort analysis. SETTING All residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry. PARTICIPANTS 497 362 people with OA as defined by 'having at least one OA-related hospitalization, or at least two OA-related physician visits or two ambulatory care visits within two years'. PRIMARY OUTCOME MEASURES We selected eight comorbidities based on literature review, clinical consultation and the availability of validated case definitions to estimate their frequencies at the time of diagnosis of OA. Sex-stratified age-standardised prevalence rates per 1000 population of eight clinically relevant comorbidities were calculated using direct standardisation with 95% CIs. We applied χ2 tests of independence with a Bonferroni correction to compare the percentage of comorbid conditions in each age group. RESULTS 54.6% (n=2 71 794) of people meeting the OA case definition had at least one of the eight selected comorbidities. Females had a significantly higher rate of comorbidities compared with males (standardised rates ratio=1.26, 95% CI 1.25 to 1.28). Depression, chronic obstructive pulmonary disease (COPD) and hypertension were the most prevalent in both females and males after age-standardisation, with 40% of all cases having any combination of these comorbidities. We observed a significant difference in the percentage of comorbidities among age groups, illustrated by the youngest age group (<45 years) having the highest percentage of cases with depression (24.6%), compared with a frequency of 16.1% in those >65 years. CONCLUSIONS Our findings highlight the high frequency of comorbidity in people with OA, with depression having the highest age-standardised prevalence rate. Comorbidities differentially affect females, and vary by age. These factors should inform healthcare programme and delivery.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Xiaoxiao Liu
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen Yee
- Research Facilitation, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter D Faris
- Research Facilitation, Alberta Health Services, Calgary, Alberta, Canada
| | - Claire Barber
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Dianne Mosher
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Thomas Noseworthy
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jason Werle
- Department of Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Carney S, Parker C, Schoo A, Isaac V, Kapakoulakis T. Exploring the relationship between body mass index, mental health and outcomes of a regional physiotherapy-led post-arthroplasty review clinic. Aust J Rural Health 2019; 28:180-183. [PMID: 31709661 DOI: 10.1111/ajr.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/23/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine whether 12-month hip and knee outcomes of a regional arthroplasty clinic were comparable to results from metropolitan-based clinics, and to explore a possible relationship between body mass index and depression to identify groups at risk of not achieving optimal outcomes. DESIGN A prospective observational study. SETTING A regional physiotherapy-led post-arthroplasty review clinic. PARTICIPANTS Patients after hip or knee replacement. INTERVENTIONS Patients underwent either total hip or total knee joint arthroplasty. MAIN OUTCOME MEASURES SF-12 Health Survey, Oxford Hip/Knee Scale, 10-minute walk test, knee range of motion, body mass index and the Hospital Anxiety and Depression Scale. RESULTS Physical outcomes were comparable to those reported by metropolitan-based clinics. People with a high body mass index showed most improvement in the severity of depression compared to those with a lower body mass index. CONCLUSION It is important to consider the long-term effects of obesity on arthroplasty outcomes.
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Affiliation(s)
| | | | - Adrian Schoo
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Rajapakshe S, Sutherland JM, Wing K, Crump T, Liu G, Penner M, Younger A, Veljkovic A, Redfern K. Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis. Foot Ankle Int 2019; 40:1129-1139. [PMID: 31215232 DOI: 10.1177/1071100719856888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little research investigating which aspects of health-related quality of life change following ankle arthrodesis and total ankle replacement surgery. The objective of this study was to report on statistically and clinically relevant changes in multiple dimensions of health-related quality of life among patients undergoing ankle replacement or fusion surgery. METHODS This study was based on a prospective sample of ankle arthrodesis and total ankle replacement patients. Participants complete the Ankle Osteoarthritis Scale, EuroQoL's EQ-5D-3L, the Patient Health Questionnaire-9, and the pain intensity, interference with enjoyment of life, and general activity pain instrument. Instruments were completed preoperatively and postoperatively. Multivariate regression models were used to measure the change in health-related quality of life outcomes, adjusting for demographic, clinical, and health service utilization. RESULTS Participants achieved statistically significant improvements in health-related quality of life in each domain of measurement. The majority of participants reported clinically significant improvement in pain. Mild depressive symptoms were common, and clinically significant improvement in depression symptoms occurred in 22% of patients. Gains in health were more pronounced among participants reporting the worst preoperative health in all domains quality of life measured. CONCLUSIONS Pain showed a clinically important improvement among 64% of participants whereas 22% reported a clinically meaningful improvement in their depression symptoms postoperatively. Clinically significant gains in health-related quality of life were not experienced by all participants in all dimensions. Further research is warranted to better understand the failure of some patients to improve in dimensions of health studied. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Shanika Rajapakshe
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Redfern
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
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Al Balawi MM, Faraj F, Al Anazi BD, Al Balawi DM. Prevalence of Depression and Its Associated Risk Factors among Young Adult Patients Attending the Primary Health Centers in Tabuk, Saudi Arabia. Open Access Maced J Med Sci 2019; 7:2908-2916. [PMID: 31844457 PMCID: PMC6901847 DOI: 10.3889/oamjms.2019.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The number of young depressive patients approaching the primary health care centres in Saudi Arabia for supportive care and treatment has enormously increased, but more cases of depression are not being diagnosed properly at the primary health care level. AIM To assess the prevalence and associated factors of depression among young adult patients attending the primary health centres in Tabuk, Kingdom of Saudi Arabia. METHODS A cross-sectional study was done in selected primary health care centres in Tabuk city from March 2018 to June 2018. Patient Health Questionnaire- PHQ-2 and PHQ-9 and a modified questionnaire were used to collect the necessary information and data were analysed by using SPSS (Version 25.0, SPSS Inc. Chicago, IL, USA). RESULTS The study included 384 patients aged between 20 and 40 years. Most of them (76.6%) were females. The prevalence of depression was 74%; mild among 37.8%, moderate among 20.8% whereas moderately severe to severe among 15.4% of them. Multivariate logistic regression analysis revealed that married patients were at lower risk for depression (Adjusted odds ratio "AOR" was 0.36, 95% confidence interval "CI" was 0.20-0.93), p < 0.001. Patients who reported a lack of social support were more likely to be depressed than those with social support (AOR = 2.05, 95% CI = 1.03-4.07), p = 0.041. Patients who reported disturbed marriage were at almost four-folded risk of depression compared to those without disturbed marriage (AOR = 3.50, 95% CI = 1.23-9.98), p = 0.019. Patients with financial problems were at almost double risk for developing depression compared to those without financial problems (AOR = 2.37, 95% CI = 1.16-4.85), p = 0.019. Those with stressful experience were significantly more likely to have depression compared to those without stressful experience (AOR = 4.75, 95% CI = 2.58-8.71), p < 0.001. Opposed to patients without a family history of depression, those with such history were at higher significant risk for depression (AOR = 2.75, 95% CI = 1.23-6.14), p = 0.014. Also, patients who reported sleep disorders were at nearly double folds of having depression compared to those without such disorders (AOR = 2.24, 95% CI = 1.16-4.30), p = 0.016. CONCLUSION Depression among young adult patients (20-40 years) attending primary healthcare centres in Tabuk is very high. However, it is mostly mild to moderate in its severity. Suicidal thoughts were reported by one-tenth of the participants. Some predictors for depression among them were identified.
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Affiliation(s)
- Maram Mohsen Al Balawi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
| | - Fatma Faraj
- Department of Family Medicine, Consultant Family Medicine, Saudi and Arab Board certified, King Salman Military Hospital, Tabuk, Saudi Arabia
| | - Bashayer D Al Anazi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
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Tossing and turning with degenerative arthropathy: an assessment of poor sleep quality in knee osteoarthritis. Reumatologia 2019; 57:207-213. [PMID: 31548747 PMCID: PMC6753597 DOI: 10.5114/reum.2019.87615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives To determine the frequency and predictors of sleep abnormalities among patients with knee osteoarthritis (OA) in Nigeria. Material and methods A multi-centre, hospital-based, cross-sectional study, involving 250 knee OA patients. Consenting patients 18 years and above, who satisfied the American College of Rheumatology (ACR) criteria for knee OA were recruited from five Nigerian tertiary centres over 3 months. An interviewer-administered questionnaire was used to collect demographic and relevant clinical information. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality with scores ≥ 5 indicating poor sleep. Other variables assessed were pain, depression, functional class and family functioning. Data were summarized using appropriate measures of central tendency and dispersion. Multiple logistic regression analysis was done to identify predictors of poor sleep. Analysis was done using SPSS version 21.0 with p < 0.05 considered significant. Study approval was obtained from the ethical committees of each of the study sites. Results Participants included 209 females (83.6%) with mean age 59.9 ±10.6 years. One hundred and forty-one participants (56.4%) had PSQI scores ≥ 5 (poor sleep). This was significantly associated with depression (p < 0.001), level of education (p = 0.001), higher pain scores (p < 0.001), body mass index (p = 0.040), medial knee OA (p = 0.032) and patello-femoral OA (p = 0.002). Higher level of education, worse depression scores and higher WOMAC pain scores were the best predictors of poor sleep quality. Conclusion Sleep quality was poor in over half of our knee OA patients and best predicted by depression, pain and level of education. Regular sleep quality assessment for knee OA patients is recommended.
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Tsuji T, Nakata K, Vietri J, Jaffe DH. The added burden of depression in patients with osteoarthritis in Japan. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:411-421. [PMID: 31354321 PMCID: PMC6590842 DOI: 10.2147/ceor.s189610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/26/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives: In Japan, osteoarthritis (OA) is a leading source of pain and disability; depressive disorders may limit patients’ ability to cope with OA. This study examined the incremental effect of depression on the relationship between OA and health-related outcomes. Methods: Data from the 2014 Japan National Health and Wellness Survey (N=30,000) were collected on demographics, OA characteristics, and health characteristics of patients with OA. Depression symptoms were measured, and outcomes included health-related quality of life (HRQoL), work productivity and activity impairment, and health care resource utilization. Generalized linear regression models controlling for confounders were used to predict health-related outcomes. Results: Of 565 respondents with OA, 63 (11%) had symptoms of moderate or severe depression. In adjusted models, HRQoL remained lower among respondents with than without depression (p<0.001). Higher levels of presenteeism (mean±SE: 50%±9% vs 23%±2%) and activity impairment (mean±SE: 57%±7% vs 30%±1%) were observed for patients with than without depression (p<0.001); however, there were no differences for absenteeism (p=0.534). Patients with depression (vs no depression) reported more health care provider visits, emergency room visits, and hospitalizations (for all, p<0.001). Conclusion: Depression heightens the health-related burden of OA. Greater attention to depression among patients with OA is warranted.
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Affiliation(s)
- Toshinaga Tsuji
- Medical Affairs Department, Shionogi & Co., Ltd, Osaka, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Osaka University, Suita, Japan
| | - Jeffrey Vietri
- Health Outcomes Practice, Health Division, Kantar, 4 Ariel Sharon Street, Horsham, PA, USA
| | - Dena H Jaffe
- Health Outcomes Practice, Health Division, Kantar, Tel Aviv, Israel
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Power JD, Kudesia P, Nadeem A, Perruccio AV, Sundararajan K, Mahomed NN, Rampersaud YR, Gandhi R. Patterns of Depressive Symptoms Before and After Surgery for Osteoarthritis: A Descriptive Study. ACR Open Rheumatol 2019; 1:203-212. [PMID: 31777796 PMCID: PMC6857983 DOI: 10.1002/acr2.1031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To examine patterns of depressive symptoms before and over the year following osteoarthritis (OA) surgery, stratified by joint and postsurgical outcome. Methods Participants were hip (n = 287), knee (n = 360), and lumbar spine (n = 100) OA patients scheduled for joint replacement or decompression surgery with or without fusion. One pre‐ and 4 postsurgery questionnaires were completed. Depressive symptoms were quantified using the Hospital Anxiety and Depression Scale (HADS). One‐year outcomes were based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores for hip and knee patients and Oswestry Disability Index (ODI) scores for spine patients and were categorized as “worse” (top score tertile) vs. “better” outcomes (first, second tertiles). Plots over time were generated by joint and outcome: 1) mean pain/disability and depression scores and 2) percentage of patients meeting HADS cut‐off for depression “caseness,” reporting depression diagnosis and treatment. Results There were notable decreases in depression scores for patients with better outcomes. For those with worse outcomes, decreases were smaller for hip patients and were not significant for knee and spine patients. Among those with poorer outcomes, 25% of spine and knee patients were depression “cases” pre‐ and postsurgery; an additional 16% of spine and 10% of knee patients developed new “caseness” postsurgery. The proportion of these patients deemed depression cases by score was much higher than the proportion reporting diagnosis/treatment. Conclusion Although depressive symptoms decrease overall in OA patients postsurgery, degrees of change vary by joint and surgical outcome. Greater attention to mental health postsurgery is warranted and may lead to improved surgical outcomes, particularly among knee and spine patients.
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Affiliation(s)
- J Denise Power
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Prtha Kudesia
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Alina Nadeem
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Anthony V Perruccio
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Kala Sundararajan
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Nizar N Mahomed
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Y Raja Rampersaud
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Rajiv Gandhi
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
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Akintayo RO, Yerima A, Olaosebikan HB, Uhunmwangho C, Akpabio AA. How much gloom is in groans? Depression and its determinants in Nigerian patients with knee osteoarthritis: a multi-center cross-sectional study. Clin Rheumatol 2019; 38:1971-1978. [DOI: 10.1007/s10067-019-04497-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
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Brooks JM, Titus AJ, Polenick CA, Orzechowski NM, Reid MC, MacKenzie TA, Bartels SJ, Batsis JA. Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey. Int J Geriatr Psychiatry 2018; 33:1671-1679. [PMID: 30229563 PMCID: PMC6422526 DOI: 10.1002/gps.4971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. METHODS Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted. RESULTS Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis. CONCLUSIONS Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,University of North Texas, Denton, TX, USA
| | - Alexander J. Titus
- Program in Quantitative Biomedical Sciences, Dartmouth College, Lebanon, NH, USA,Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Nicole M. Orzechowski
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Todd A. MacKenzie
- Biomedical Data Science, Dartmouth College, Lebanon, NH, USA,Department of Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
| | - John A. Batsis
- Department of Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA,Centers for Health and Aging, Lebanon, NH, USA
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Zheng S, Tu L, Cicuttini F, Han W, Zhu Z, Antony B, Wluka A, Winzenberg T, Meng T, Aitken D, Blizzard L, Jones G, Ding C. Effect of Vitamin D Supplementation on Depressive Symptoms in Patients With Knee Osteoarthritis. J Am Med Dir Assoc 2018; 20:1634-1640.e1. [PMID: 30401608 DOI: 10.1016/j.jamda.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the effect of vitamin D supplementation and maintaining sufficient serum vitamin D on depressive symptoms in patients with knee osteoarthritis (OA) and vitamin D deficiency. DESIGN A prespecified secondary analysis of a multicentre, randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive oral vitamin D3 (50,000 IU, n = 209) or placebo (n = 204) monthly for 24 months. In addition, participants who completed the trial were classified into 2 groups according to their serum 25(OH)D levels at month 3 and 24 as follows: not consistently sufficient (serum 25(OH)D ≤ 50 nmol/L at month 3 and/or 24), and consistently sufficient (serum 25(OH)D > 50 nmol/L at both month 3 and 24). Multilevel mixed-effect models were used to compare differences of change in PHQ-9 scores between groups. SETTING AND PARTICIPANTS This clinical trial was conducted in participants with symptomatic knee OA and vitamin D deficiency from June 2010 to December 2013 in Tasmania and Victoria, Australia. MEASURES The primary outcome was the depressive symptoms change over 24 months, which was measured using the Patient Health Questionnaire (PHQ-9, 0-27). RESULTS Of 599 participants who were screened for eligibility, 413 participants were enrolled (mean age: 63.2 years; 50.3% female) and 340 participants (intervention n = 181, placebo n = 159, 82.3% retention rate) completed the study. The baseline prevalence of depression (PHQ-9 score ≥5) was 25.4%. Depressive symptoms improved more in the vitamin D supplementation group compared to the placebo group [β: -0.66, 95% confidence interval (CI): -1.22 to -0.11, P for difference = .02] and in the participants who maintained vitamin D sufficiency compared to those who did not (β: -0.73, 95% CI: -1.41 to -0.05, P for difference = .04) over 24 months. CONCLUSIONS/IMPLICATIONS These findings suggest that vitamin D supplementation and maintaining adequate vitamin D levels over 24 months may be beneficial for depressive symptoms in patients with knee OA.
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Affiliation(s)
- Shuang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Liudan Tu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anita Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Tao Meng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Senanayake S, Gunawardena N, Palihawadana P, Suraweera C, Karunarathna R, Kumara P. Depression and psychological distress in patients with chronic renal failure: Prevalence and associated factors in a rural district in Sri Lanka. J Psychosom Res 2018; 112:25-31. [PMID: 30097132 DOI: 10.1016/j.jpsychores.2018.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic Kidney Disease (CKD) is known to adversely affect mental health. The study was aimed at estimating the prevalence of depression and psychological distress and the associated factors among CKD patients living in Anuradhapura, a rural district in Sri Lanka. METHOD A community-based, cross-sectional study included a representative sample of 1174 CKD patients, drawn proportionately from all registered patients in all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained paramedical staff visited the households and administered the locally validated Centre for Epidemiologic Studies Depression Scale and General Health Questionnaire-12 to screen for depression and psychological distress. Information related to associated factors was obtained through an interviewer-administered questionnaire. RESULTS A total of 1118 CKD patients participated, with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years. 62.7% of participants were males. The majority of participants was in CKD stage 4 (58.3%). The screening revealed that 75.0% (95% CI 72.5-77.5) of participants were psychologically distressed while 65.2% (95%CI 62.4-68.0) were found to be depressed. Multiple logistic regression analysis revealed advanced age, unemployment and poor health related quality of life contributed significantly to both depression and psychological distress. CONCLUSION Depression and psychological distress were significant in this community. Policymakers should consider the likely high prevalence of psychological distress and depression among CKD patients as well as the need for specific mental health services to confirm diagnosis and initiate effective management. Identified associated factors should be used to identify targeted preventative interventions.
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Affiliation(s)
| | | | | | | | - R Karunarathna
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
| | - Priyantha Kumara
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
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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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Soto S, Arredondo EM, Villodas MT, Elder JP, Quintanar E, Madanat H. Depression and Chronic Health Conditions Among Latinos: The Role of Social Networks. J Immigr Minor Health 2018; 18:1292-1300. [PMID: 26976003 DOI: 10.1007/s10903-016-0378-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine the "buffering hypothesis" of social network characteristics in the association between chronic conditions and depression among Latinos. Cross-sectional self-report data from the San Diego Prevention Research Center's community survey of Latinos were used (n = 393). Separate multiple logistic regression models tested the role of chronic conditions and social network characteristics in the likelihood of moderate-to-severe depressive symptoms. Having a greater proportion of the network comprised of friends increased the likelihood of depression among those with high cholesterol. Having a greater proportion of women in the social network was directly related to the increased likelihood of depression, regardless of the presence of chronic health conditions. Findings suggest that network characteristics may play a role in the link between chronic conditions and depression among Latinos. Future research should explore strategies targeting the social networks of Latinos to improve health outcomes.
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Affiliation(s)
- Sandra Soto
- San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego State University/University of California, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123-4311, USA.
- Institute for Behavioral and Community Health, San Diego, CA, USA.
| | - Elva M Arredondo
- Institute for Behavioral and Community Health, San Diego, CA, USA
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Miguel T Villodas
- Department of Psychology, College of Arts and Sciences, Florida International University, Miami, FL, USA
| | - John P Elder
- Institute for Behavioral and Community Health, San Diego, CA, USA
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Elena Quintanar
- County of San Diego, Health and Human Services Agency, South Region, San Diego, CA, USA
| | - Hala Madanat
- Institute for Behavioral and Community Health, San Diego, CA, USA
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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Abstract
Persistent pain in older adults is difficult to assess and therefore address consistently. The experience of pain is individual, and therefore a comprehensive way to assess pain is required. Roy’s adaptation model offers a systematic way of evaluating pain in the older adult. In this column, the author shares some statistics about persistent pain and a case study using Roy’s model as a system for assessment.
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Affiliation(s)
- Nina M Flanagan
- Assistant Professor, Decker School of Nursing, Binghamton University, Vestal, NY, USA
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Carotti M, Salaffi F, Di Carlo M, Giovagnoni A. Relationship between magnetic resonance imaging findings, radiological grading, psychological distress and pain in patients with symptomatic knee osteoarthritis. Radiol Med 2017; 122:934-943. [DOI: 10.1007/s11547-017-0799-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/04/2017] [Indexed: 01/20/2023]
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Lowry V, Ouellet P, Vendittoli PA, Carlesso LC, Wideman TH, Desmeules F. Determinants of pain, disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty. Disabil Rehabil 2017; 40:2734-2744. [PMID: 28728444 DOI: 10.1080/09638288.2017.1355412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance. MATERIAL AND METHODS Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations. RESULTS Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p < 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p < 0.05) and explained 41%-59% of the variances of the different physical tests results. CONCLUSIONS Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.
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Affiliation(s)
- Véronique Lowry
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada
| | - Philippe Ouellet
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Pascal-André Vendittoli
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,c Department of Surgery, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Lisa C Carlesso
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - Timothy H Wideman
- d School of Physical and Occupational Therapy , McGill University , Montreal , Canada
| | - François Desmeules
- a Orthopaedic Unit, Maisonneuve-Rosemont Hospital Research Center , University of Montreal Affiliated Research Center , Montreal , Canada.,b School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Canada
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Mallen CD, Nicholl BI, Lewis M, Bartlam B, Green D, Jowett S, Kigozi J, Belcher J, Clarkson K, Lingard Z, Pope C, Chew-Graham CA, Croft P, Hay EM, Peat G. The effects of implementing a point-of-care electronic template to prompt routine anxiety and depression screening in patients consulting for osteoarthritis (the Primary Care Osteoarthritis Trial): A cluster randomised trial in primary care. PLoS Med 2017; 14:e1002273. [PMID: 28399129 PMCID: PMC5388468 DOI: 10.1371/journal.pmed.1002273] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. METHODS AND FINDINGS We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire-2 for depression, a two-item Generalized Anxiety Disorder-2 questionnaire for anxiety, and a question about current pain intensity [0-10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health. During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]). CONCLUSIONS In this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group. TRIAL REGISTRATION ISRCTN registry ISRCTN40721988.
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Affiliation(s)
- Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
- * E-mail:
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Daniel Green
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - John Belcher
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Kris Clarkson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Zoe Lingard
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Christopher Pope
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn A. Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
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Trick L, Watkins E, Windeatt S, Dickens C. The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: A systematic review. J Psychosom Res 2016; 91:89-101. [PMID: 27894469 DOI: 10.1016/j.jpsychores.2016.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions. METHOD Four electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized. RESULTS Thirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r=0.23 to r=0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes. CONCLUSION Strongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes.
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Affiliation(s)
- Leanne Trick
- University of Exeter Medical School, College House, St Lukes Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom.
| | - Edward Watkins
- University of Exeter Medical School, College House, St Lukes Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
| | - Stacey Windeatt
- University of Exeter Medical School, College House, St Lukes Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
| | - Chris Dickens
- University of Exeter Medical School, College House, St Lukes Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
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Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol 2016; 8:103-113. [PMID: 27843376 PMCID: PMC5098683 DOI: 10.2147/oarrr.s93516] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Anxiety and depression are common psychological comorbidities that impact the quality of life (QoL) of patients. In this systematic review, we 1) determined the impact of anxiety and depression on outcomes in patients with osteoarthritis (OA) and 2) summarized unique challenges these comorbidities present to current OA management. Patients and methods A systematic literature search was performed using the OVID Medline and EMBASE databases until April 2016. Full-text research articles published in English from the year 2000 onward with a sample size of >100 were included in this review. Eligible research articles were reviewed and the following data were extracted: study author(s), year of publication, study design, and key findings. Results A total of 38 studies were included in the present review. The present study found that both anxiety and/or depression were highly prevalent among patients with OA. Patients with OA diagnosed with these comorbidities experienced more pain, had frequent hospital visits, took more medication, and reported less optimal outcomes. Management strategies in the form of self-care, telephone support, audio/video education programs, and new pharmacotherapies were reported with favorable results. Conclusion Anxiety and depression adversely impact the QoL of patients with OA. Physicians/caregivers are highly recommended to consider these comorbidities in patients with OA. Ultimately, a holistic individualized management approach is necessary to improve patient outcomes.
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Affiliation(s)
- Anirudh Sharma
- Division of Genetics and Development, Krembil Research Institute
| | - Prtha Kudesia
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Qian Shi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
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Greene ME, Rolfson O, Gordon M, Annerbrink K, Malchau H, Garellick G. Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery? Acta Orthop 2016; 87:444-51. [PMID: 27482877 PMCID: PMC5016901 DOI: 10.1080/17453674.2016.1216181] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patients with anxiety and/or depression tend to report less pain reduction and less satisfaction with surgical treatment. We hypothesized that the use of antidepressants would be correlated to patient-reported outcomes (PROs) 1 year after total hip replacement (THR), where increased dosage or discontinuation would be associated with worse outcomes. Patients and methods - THR cases with pre- and postoperative patient-reported outcome measures (PROMs) were selected from the Swedish Hip Arthroplasty Register (n = 9,092; women: n = 5,106). The PROMs were EQ-5D, visual analog scale (VAS) for pain, Charnley class, and VAS for satisfaction after surgery. These cases were merged with a national database of prescription purchases to determine the prevalence of antidepressant purchases. Regression analyses were performed where PROs were dependent variables and sex, age, Charnley class, preoperative pain, preoperative health-related quality of life (HRQoL), patient-reported anxiety/depression, and antidepressant use were independent variables. Results - Antidepressants were used by 10% of the cases (n = 943). Patients using antidepressants had poorer HRQoL and higher levels of pain before and after surgery and they experienced less satisfaction. Preoperative antidepressant use was independently associated with PROs 1 year after THR regardless of patient-reported anxiety/depression. Interpretation - Antidepressant usage before surgery was associated with reduced PROs after THR. Cases at risk of poorer outcomes may be identified through review of the patient's medical record. Clinicians are encouraged to screen for antidepressant use preoperatively, because their use may be associated with PROs after THR.
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Affiliation(s)
- Meridith E Greene
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg;,Correspondence:
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Max Gordon
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;,Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm
| | - Kristina Annerbrink
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
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The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain. Support Care Cancer 2016; 24:4167-75. [DOI: 10.1007/s00520-016-3243-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
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Kettaneh AA, Umeasiegbu VI. Specialized housing adaptation in multiple sclerosis: Relationships to demographic variables. JOURNAL OF VOCATIONAL REHABILITATION 2016. [DOI: 10.3233/jvr-150790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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das Nair R, Anderson P, Clarke S, Leighton P, Lincoln NB, Mhizha-Murira JR, Scammell BE, Walsh DA. Home-administered pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): study protocol for a randomised controlled trial. Trials 2016; 17:54. [PMID: 26818407 PMCID: PMC4730777 DOI: 10.1186/s13063-016-1165-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/11/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Knee replacement surgery reduces pain for many people with osteoarthritis (OA). However, surgical outcomes are partly dependent on patients' moods, and those with depression or anxiety have worse outcomes. Approximately one-third of people with OA have mood problems. Cognitive behavioural therapy (CBT), a psychological therapy, is recommended by the National Institute for Health and Care Excellence for improving mood. However, evidence for the effectiveness of CBT before knee surgery in improving pain, mood, and quality of life following this surgery for people with knee OA is lacking. METHODS/DESIGN This is a multi-centre, mixed-methods feasibility randomised controlled trial to compare treatment as usual (TAU) plus a brief CBT-based intervention with a TAU-only control, for people with knee OA. We will recruit 50 patients with knee OA, listed for knee replacement surgery, with high levels of distress (assessed using a mood questionnaire), and who consent to take part. Participants will be randomly allocated to receive TAU plus intervention or TAU. Up to 10 sessions of CBT will be offered on an individual basis by a psychologist. The assessments and interventions will be completed before surgery. Repeat assessments at 4 and 6 months after randomisation will be sent and received by post. Two patient-partners will conduct feedback interviews with some participants to assess what aspects of the intervention were helpful or unhelpful, the acceptability of randomisation, the experience of being in a control group, and the appropriateness of the measures used. Interviews will be audio-recorded, transcribed, and analysed using the framework approach. We will examine the feasibility and acceptability of patient-partners conducting the interviews by also interviewing the patient-partners. DISCUSSION Findings from this study will be used to design a definitive study that will examine the clinical and cost-effectiveness of the CBT intervention in improving patient outcomes following knee surgery. TRIAL REGISTRATION Current Controlled Trials ISRCTN80222865; Date: 19 June 2014.
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Affiliation(s)
- Roshan das Nair
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Department of Clinical Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Simon Clarke
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK. .,Physical Health Clinical Psychology Services, Nottinghamshire Healthcare NHS Trust, Pain Management Suite, Clinic 9, King's Mill Hospital, Mansfield, NG17 4JL, UK.
| | - Paul Leighton
- School of Medicine, University of Nottingham, Room 2104, C Floor South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Nadina B Lincoln
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
| | - Jacqueline R Mhizha-Murira
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Brigitte E Scammell
- Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
| | - David A Walsh
- Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK. .,Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
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Agarwal P, Sambamoorthi U. Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach. J Gen Intern Med 2015; 30:1803-11. [PMID: 25990191 PMCID: PMC4636556 DOI: 10.1007/s11606-015-3393-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/20/2015] [Accepted: 04/27/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. DESIGN Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. KEY RESULTS Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. CONCLUSIONS Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.
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Affiliation(s)
- Parul Agarwal
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center (North), Morgantown, WV, USA.
| | - Usha Sambamoorthi
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center (North), Morgantown, WV, USA
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Huang SW, Wang WT, Chou LC, Liao CD, Liou TH, Lin HW. Osteoarthritis increases the risk of dementia: a nationwide cohort study in Taiwan. Sci Rep 2015; 5:10145. [PMID: 25984812 PMCID: PMC4434986 DOI: 10.1038/srep10145] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/01/2015] [Indexed: 11/09/2022] Open
Abstract
Osteoarthritis (OA) and dementia are prevalent causes of disability in geriatric patients. To date, information on the temporal correlation between these progressive diseases and the risk of dementia in patients with OA is limited. This retrospective population-based 4-year cohort study investigated the risk of dementia in patients with OA. We performed a case-control matched analysis by using the Taiwan Longitudinal Health Insurance Database 2005. Patients were selected on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes for OA between January 1, 2004 and December 31, 2007. The prevalence and the adjusted hazard ratio (HR) of dementia in patients with and without OA were estimated. The OA cohort comprised 35,149 patients and the non-OA cohort (comparison cohort) comprised 70,298 patients (1:2). The incidence of dementia was 21.7 per 10,000 person-years in the OA cohort and 14.7 per 10,000 person-years in the non-OA cohort. The HR for dementia during the follow-up period was 1.33 (95% confidence interval [CI], 1.17-1.50, P < 0.001) for patients with OA. The adjusted HR for dementia was 1.25 (95% CI, 1.10-1.43, P < 0.001) for patients with OA. The results of this study indicated that OA is an independent risk factor for dementia.
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Affiliation(s)
- Shih-Wei Huang
- 1] Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan [2] Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taiwan [3] Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Te Wang
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
| | - Lin-Chung Chou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- 1] Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan [2] Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- 1] Department of Mathematics, Soochow University, Taipei, Taiwan [2] Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Prospective study of depression among dialysis patients in Saudi Arabia. Int Urol Nephrol 2015; 47:1001-10. [DOI: 10.1007/s11255-015-0977-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/06/2015] [Indexed: 11/26/2022]
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de Luca K, Parkinson L, Pollard H, Byles J, Blyth F. How is the experience of pain measured in older, community-dwelling people with osteoarthritis? A systematic review of the literature. Rheumatol Int 2015; 35:1461-72. [PMID: 25869349 DOI: 10.1007/s00296-015-3268-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/04/2015] [Indexed: 12/11/2022]
Abstract
The objective of the study was to perform a systematic review to identify and appraise outcome measures and measures of pain that are used to assess the experience of pain by older people with osteoarthritis, and to assess whether these measures are effective at capturing the multidimensional nature of the experience of this pain. A systematic review of five electronic databases from January 1996 to March 2013 was done. Inclusion criteria were cohort/observational and cross-sectional studies; specific diagnosis of OA; employed outcome measures of pain and/or health and/or quality of life which included questions about pain; and considered older adults. Articles were reviewed for methodological quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. A total of 14 publications met the inclusion criteria, and 11 discrete studies were included in the review. The studies used 21 different outcome measures, utilizing 13 measures of pain. Sensory, affective and cognitive dimensions of pain were captured by the measures, albeit studies predominantly measured intensity or severity alone. Measures of pain used in epidemiological studies do not adequately capture the multidimensional nature of the experience of pain in osteoarthritis. There is a fraught complexity in the multidimensionality of the experience of pain in osteoarthritis, and studies exploring osteoarthritis pain in older people should attempt to capture this multidimensionality by employing multiple valid and reliable outcome measures that capture specific dimensions of the pain experience.
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Affiliation(s)
- Katie de Luca
- Research Centre for Gender Health and Ageing, University of Newcastle, 18 Palm Court South West Rocks, Callaghan, NSW, 2431, Australia,
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Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial. J Nerv Ment Dis 2015; 203:243-51. [PMID: 25816046 DOI: 10.1097/nmd.0000000000000273] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.
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Rodic D, Meyer AH, Meinlschmidt G. The Association between Depressive Symptoms and Physical Diseases in Switzerland: A Cross-Sectional General Population Study. Front Public Health 2015; 3:47. [PMID: 25853116 PMCID: PMC4370044 DOI: 10.3389/fpubh.2015.00047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the association between depressive symptoms and physical diseases in Switzerland, as respective findings might inform about future estimates of mental and physical health care costs. METHODS A population-based study, using data from the Swiss Health Survey collected by computer-assisted telephone interviews and additional written questionnaires during the year 2007 (n = 18,760) in Switzerland. The multistage stratified random sample included subjects aged 15 years and older, living in a private Swiss household with a telephone connection. Complete data were available for 14,348 subjects (51% of all subjects reached by telephone). Logistic regression analyses were used to estimate the associations between depressive symptoms and any physical disease, or a specific physical disease out of 13 non-communicable physical diseases assessed with a self-report checklist on common physical diseases. Analyses were adjusted for sex, age, education, occupation, and household income. RESULTS In the adjusted models, depressive symptoms were associated with arthrosis and arthritis [Odds Ratio (OR) = 1.79, 95% confidence interval (CI) = 1.28-2.50] and any physical disease (OR = 1.67, 95% CI = 1.33-2.10) after controlling for multiple testing. CONCLUSION Our findings contribute to a better understanding of the comorbidity of depressive symptoms and arthrosis and arthritis in Switzerland and might have implications for more precise future estimates of mental and physical health care costs.
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Affiliation(s)
- Donja Rodic
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
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Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis. ARTHRITIS 2015; 2015:327161. [PMID: 25861476 PMCID: PMC4377445 DOI: 10.1155/2015/327161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/25/2015] [Indexed: 02/06/2023]
Abstract
The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement.
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