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Scott JET, Mazzucchelli TG, Luszcz MA, Walker R, Windsor TD. Self-Compassion, Stressor Exposure, and Negative Affect: A Daily Diary Study of Older Adults. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae101. [PMID: 38822622 DOI: 10.1093/geronb/gbae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES Self-compassion has been identified as a psychological resource for aging well. To date, self-compassion among older adults has typically been conceptualized as a trait variable. This study examined whether day-to-day (state) variability in self-compassion was associated with negative affective reactivity to daily stressors. METHODS Daily diary assessment methods were used to examine the potential moderating role of between- and within-person self-compassion on the relationship between daily stressors and negative affect. A community-based sample of 107 older adults aged 65+ completed questionnaires once daily over 14 days. RESULTS Multilevel modeling revealed that 37% of the variance in self-compassion occurred within persons. Daily self-compassion moderated the relationship between daily stressor exposure and daily negative affect. On days with greater stressor exposure than usual, older adults showed less negative affective reactivity on days when self-compassion was higher, compared with days when self-compassion was lower. No moderating effects were observed for between-person (trait) self-compassion. DISCUSSION These findings suggest that self-compassion in older adults should be conceptualized as both state and trait variables and that state self-compassion may be protective in the stress-reactivity pathway. Future research should investigate whether brief self-compassion interventions might help older adults to avoid or downregulate negative emotions in response to stressors.
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Affiliation(s)
- Julia E T Scott
- College of Education, Psychology and Social Work, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | | | - Mary A Luszcz
- College of Education, Psychology and Social Work, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Tim D Windsor
- College of Education, Psychology and Social Work, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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2
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Wong JJ, Hogg-Johnson S, De Groote W, Ćwirlej-Sozańska A, Garin O, Ferrer M, Acuña ÀP, Côté P. Minimal important difference of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in persons with chronic low back pain. Chiropr Man Therap 2023; 31:49. [PMID: 38053118 PMCID: PMC10696846 DOI: 10.1186/s12998-023-00521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The World Health Organization Disability Assessment Schedule 2.0 12-item survey (WHODAS-12) is a questionnaire developed by the WHO to measure functioning across health conditions, cultures, and settings. WHODAS-12 consists of a subset of the 36 items of WHODAS-2.0 36-item questionnaire. Little is known about the minimal important difference (MID) of WHODAS-12 in persons with chronic low back pain (LBP), which would be useful to determine whether rehabilitation improves functioning to an extent that is meaningful for people experiencing the condition. Our objective was to estimate an anchor-based MID for WHODAS-12 questionnaire in persons with chronic LBP. METHODS We analyzed data from two cohort studies (identified in our previous systematic review) conducted in Europe that measured functioning using the WHODAS-36 in adults with chronic LBP. Eligible participants were adults with chronic LBP with scores on another measure as an anchor to indicate participants with small but important changes in functioning over time [Short-form-36 Physical Functioning (SF36-PF) or Oswestry Disability Index (ODI)] at baseline and follow-up (study 1: 3-months post-treatment; study 2: 1-month post-discharge from hospital). WHODAS-12 scores were constructed as sums of the 12 items (scored 0-4), with possible scores ranging from 0 to 48. We calculated the mean WHODAS-12 score in participants who achieved a small but meaningful improvement on SF36-PF or ODI at follow-up. A meaningful improvement was an MID of 4-16 on ODI or 5-16 on SF36-PF. RESULTS Of 70 eligible participants in study 1 (mean age = 54.1 years, SD = 14.7; 69% female), 18 achieved a small meaningful improvement based on SF-36 PF. Corresponding mean WHODAS-12 change score was - 3.22/48 (95% CI -4.79 to -1.64). Of 89 eligible participants in study 2 (mean age = 65.5 years, SD = 11.5; 61% female), 50 achieved a small meaningful improvement based on ODI. Corresponding mean WHODAS-12 change score was - 5.99/48 (95% CI - 7.20 to -4.79). CONCLUSIONS Using an anchor-based approach, the MID of WHODAS-12 is estimated at -3.22 (95% CI -4.79 to -1.64) or -5.99 (95% CI - 7.20 to -4.79) in adults with chronic LBP. These MID values inform the utility of WHODAS-12 in measuring functioning to determine whether rehabilitation or other health services achieve a minimal difference that is meaningful to patients with chronic LBP.
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Affiliation(s)
- Jessica J Wong
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada.
- Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Wouter De Groote
- Rehabilitation Programme, Department of Noncommunicable Diseases, Sensory Functions, Disability, and Rehabilitation Unit, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana Street 16C, Rzeszow, 35-959, Poland
- Laboratory of Geronto-prophylaxis, Center for Innovative Research in Medical and Natural Sciences, Rzeszow of University, Warzywna Street 1A, Rzeszow, 35-310, Poland
| | - Olatz Garin
- Health Services Research Unit, IMIM-Hospital del Mar, C/ del Dr. Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Montse Ferrer
- Health Services Research Unit, IMIM-Hospital del Mar, C/ del Dr. Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Universitat Autònoma de Barcelona, Ronda de la Univ, Barcelona, 21, 08007, Spain
| | - Àngels Pont Acuña
- Health Services Research Unit, IMIM-Hospital del Mar, C/ del Dr. Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
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3
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Joshy G, Khalatbari-Soltani S, Soga K, Butow P, Laidsaar-Powell R, Koczwara B, Rankin NM, Brown S, Weber M, Mazariego C, Grogan P, Stubbs J, Thottunkal S, Canfell K, Blyth FM, Banks E. Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer. BMC Cancer 2023; 23:774. [PMID: 37700229 PMCID: PMC10498633 DOI: 10.1186/s12885-023-11214-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/21/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Pain is a common, debilitating, and feared symptom, including among cancer survivors. However, large-scale population-based evidence on pain and its impact in cancer survivors is limited. We quantified the prevalence of pain in community-dwelling people with and without cancer, and its relation to physical functioning, psychological distress, and quality of life (QoL). METHODS Questionnaire data from participants in the 45 and Up Study (Wave 2, n = 122,398, 2012-2015, mean age = 60.8 years), an Australian population-based cohort study, were linked to cancer registration data to ascertain prior cancer diagnoses. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for bodily pain and pain sufficient to interfere with daily activities (high-impact pain) in people with versus without cancer, for 13 cancer types, overall and according to clinical, personal, and health characteristics. The relation of high-impact pain to physical and mental health outcomes was quantified in people with and without cancer. RESULTS Overall, 34.9% (5,436/15,570) of cancer survivors and 31.3% (32,471/103,604) of participants without cancer reported bodily pain (PR = 1.07 [95% CI = 1.05-1.10]), and 15.9% (2,468/15,550) versus 13.1% (13,573/103,623), respectively, reported high-impact pain (PR = 1.13 [1.09-1.18]). Pain was greater with more recent cancer diagnosis, more advanced disease, and recent cancer treatment. High-impact pain varied by cancer type; compared to cancer-free participants, PRs were: 2.23 (1.71-2.90) for multiple myeloma; 1.87 (1.53-2.29) for lung cancer; 1.06 (0.98-1.16) for breast cancer; 1.05 (0.94-1.17) for colorectal cancer; 1.04 (0.96-1.13) for prostate cancer; and 1.02 (0.92-1.12) for melanoma. Regardless of cancer diagnosis, high-impact pain was strongly related to impaired physical functioning, psychological distress, and reduced QoL. CONCLUSIONS Pain is common, interfering with daily life in around one-in-eight older community-dwelling participants. Pain was elevated overall in cancer survivors, particularly for certain cancer types, around diagnosis and treatment, and with advanced disease. However, pain was comparable to population levels for many common cancers, including breast, prostate and colorectal cancer, and melanoma.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia.
| | | | - Kay Soga
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Nicole M Rankin
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Brown
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia
| | - Marianne Weber
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Carolyn Mazariego
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
| | - Paul Grogan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - John Stubbs
- Independent Cancer Consumer Advisor, Sydney, NSW, Australia
| | - Stefan Thottunkal
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Fiona M Blyth
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia
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4
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Tennant A, Küçükdeveci AA. Application of the Rasch measurement model in rehabilitation research and practice: early developments, current practice, and future challenges. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1208670. [PMID: 37529206 PMCID: PMC10387545 DOI: 10.3389/fresc.2023.1208670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
The application of the Rasch measurement model in rehabilitation is now well established. Both its dichotomous and polytomous forms provide for transforming ordinal scales into interval-level measures, consistent with the requirements of fundamental measurement. The growth of applying the model in rehabilitation spans 30 years, during which both the protocol has steadily developed and several software packages have emerged that provide for analysis, together with the "R" language that has an increasing set of codes for applying the model. This article reviews that development and highlights current practice requirements, including those for providing the relevant information for the methods, and what is expected of the analysis. In addition, this provides a worked example and looks at the remaining issues and current developments of its application.
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Affiliation(s)
- Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Ayse A. Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Welberry HJ, Chau T, Heffernan M, San Jose JC, Jorm LR, Singh MF, Sachdev PS, Anstey KJ, Lautenschlager NT, Valenzuela M, McNeil J, Brodaty H. Factors Associated with Participation in a Multidomain Web-Based Dementia Prevention Trial: Evidence from Maintain Your Brain (MYB). J Alzheimers Dis 2023; 92:959-974. [PMID: 36806506 DOI: 10.3233/jad-220990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The Maintain Your Brain (MYB) trial aims to prevent cognitive decline and dementia through multidomain, web-based risk-reduction. To facilitate translation, it is important to understand drivers of participation. OBJECTIVE To describe characteristics associated with participation in MYB. METHODS This was an observational ancillary study of MYB, a randomized controlled trial nested within the 45 and Up Study in New South Wales, Australia. We linked 45 and Up Study survey and MYB participation data. The study cohort comprised 45 and Up Study participants, aged 55-77 years at 1 January 2018, who were invited to participate in MYB. 45 and Up Study participant characteristics and subsequent MYB consent and participation were examined. RESULTS Of 98,836 invited, 13,882 (14%) consented to participate and 6,190 participated (6%). Adjusting for age and sex, a wide range of factors were related to participation. Higher educational attainment had the strongest relationship with increased MYB participation (university versus school non-completion; AdjOR = 5.15; 95% CI:4.70-5.64) and lower self-rated quality of life with reduced participation (Poor versus Excellent: AdjOR = 0.19; 95% CI:0.11-0.32). A family history of Alzheimer's disease was related to increased participation but most other dementia risk factors such as diabetes, obesity, stroke, high blood pressure, and current smoking were associated with reduced participation. CONCLUSION Higher socio-economic status, particularly educational attainment, is strongly associated with engagement in online dementia prevention research. Increasing population awareness of dementia risk factors, and better understanding the participation barriers in at-risk groups, is necessary to ensure online interventions are optimally designed to promote maximum participation.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Juan Carlo San Jose
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Fiaratone Singh
- School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Valenzuela
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
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6
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Yap S, He E, Egger S, Goldsbury DE, Lew JB, Ngo PJ, Worthington J, Rillstone H, Zalcberg JR, Cuff J, Ward RL, Canfell K, Feletto E, Steinberg J. Colon and rectal cancer treatment patterns and their associations with clinical, sociodemographic and lifestyle characteristics: analysis of the Australian 45 and Up Study cohort. BMC Cancer 2023; 23:60. [PMID: 36650482 PMCID: PMC9845101 DOI: 10.1186/s12885-023-10528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Colorectal cancer is the third most diagnosed cancer globally and the second leading cause of cancer death. We examined colon and rectal cancer treatment patterns in Australia. METHODS From cancer registry records, we identified 1,236 and 542 people with incident colon and rectal cancer, respectively, diagnosed during 2006-2013 in the 45 and Up Study cohort (267,357 participants). Cancer treatment and deaths were determined via linkage to routinely collected data, including hospital and medical services records. For colon cancer, we examined treatment categories of "surgery only", "surgery plus chemotherapy", "other treatment" (i.e. other combinations of surgery/chemotherapy/radiotherapy), "no record of cancer-related treatment, died"; and, for rectal cancer, "surgery only", "surgery plus chemotherapy and/or radiotherapy", "other treatment", and "no record of cancer-related treatment, died". We analysed survival, time to first treatment, and characteristics associated with treatment receipt using competing risks regression. RESULTS 86.4% and 86.5% of people with colon and rectal cancer, respectively, had a record of receiving any treatment ≤2 years post-diagnosis. Of those treated, 93.2% and 90.8% started treatment ≤2 months post-diagnosis, respectively. Characteristics significantly associated with treatment receipt were similar for colon and rectal cancer, with strongest associations for spread of disease and age at diagnosis (p<0.003). For colon cancer, the rate of "no record of cancer-related treatment, died" was higher for people with distant spread of disease (versus localised, subdistribution hazard ratio (SHR)=13.6, 95% confidence interval (CI):5.5-33.9), age ≥75 years (versus age 45-74, SHR=3.6, 95%CI:1.8-7.1), and visiting an emergency department ≤1 month pre-diagnosis (SHR=2.9, 95%CI:1.6-5.2). For rectal cancer, the rate of "surgery plus chemotherapy and/or radiotherapy" was higher for people with regional spread of disease (versus localised, SHR=5.2, 95%CI:3.6-7.7) and lower for people with poorer physical functioning (SHR=0.5, 95%CI:0.3-0.8) or no private health insurance (SHR=0.7, 95%CI:0.5-0.9). CONCLUSION Before the COVID-19 pandemic, most people with colon or rectal cancer received treatment ≤2 months post-diagnosis, however, treatment patterns varied by spread of disease and age. This work can be used to inform future healthcare requirements, to estimate the impact of cancer control interventions to improve prevention and early diagnosis, and serve as a benchmark to assess treatment delays/disruptions during the pandemic. Future work should examine associations with clinical factors (e.g. performance status at diagnosis) and interdependencies between characteristics such as age, comorbidities, and emergency department visits.
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Affiliation(s)
- Sarsha Yap
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Emily He
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Sam Egger
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - David E Goldsbury
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Jie-Bin Lew
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Preston J Ngo
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Joachim Worthington
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Hannah Rillstone
- grid.420082.c0000 0001 2166 6280Cancer Policy and Advocacy, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales Australia
| | - John R Zalcberg
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia ,grid.267362.40000 0004 0432 5259Department of Medical Oncology, Alfred Health, Melbourne, Victoria Australia
| | - Jeff Cuff
- grid.1005.40000 0004 4902 0432Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales Australia ,Research Advocate, The Daffodil Centre, Sydney, New South Wales Australia
| | - Robyn L Ward
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales Australia
| | - Karen Canfell
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Eleonora Feletto
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Julia Steinberg
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
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7
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Ramaskandhan J, Kakwani R, Kometa S, Hewart P, Rawlings D, Chockalingam N, Siddique M. Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement. J Foot Ankle Surg 2023:S1067-2516(22)00370-2. [PMID: 36710141 DOI: 10.1053/j.jfas.2022.12.005] [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: 12/04/2020] [Revised: 06/09/2021] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.
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Affiliation(s)
- Jayasree Ramaskandhan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
| | - Rajesh Kakwani
- Department of Orthopaedics, Northumbria Healthcare NHS Trust, North Shields, UK
| | - Simon Kometa
- Newcastle University IT (NUIT) Service, Newcastle upon Tyne, UK
| | - Penny Hewart
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - David Rawlings
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Malik Siddique
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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8
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Heimburg K, Cronberg T, Tornberg ÅB, Ullén S, Friberg H, Nielsen N, Hassager C, Horn J, Kjærgaard J, Kuiper M, Rylander C, Wise MP, Lilja G. Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Resusc Plus 2022; 11:100275. [PMID: 36164471 PMCID: PMC9508620 DOI: 10.1016/j.resplu.2022.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Limitations in physical function are common in cardiac arrest survivors. Age and gender are associated with limitations in physical function. Cognitive impairment is a predictive variable for physical limitations. Anxiety and depression symptoms are associated with physical limitations. Physical function should be addressed at follow-up after cardiac arrest.
Title Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Background Out-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. Aims To describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. Methods A cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results 287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. Conclusion Self-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registration ClinicalTrials.gov Identifier: NCT01946932.
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Briggs R, McDonough A, Ellis G, Bennett K, O'Neill D, Robinson D. Comprehensive Geriatric Assessment for community-dwelling, high-risk, frail, older people. Cochrane Database Syst Rev 2022; 5:CD012705. [PMID: 35521829 PMCID: PMC9074104 DOI: 10.1002/14651858.cd012705.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary diagnostic process focused on determining an older person's medical, psychological and functional capability in order to develop a co-ordinated and integrated care plan. CGA is not limited simply to assessment, but also directs a holistic management plan for older people, which leads to tangible interventions. While there is established evidence that CGA reduces the likelihood of death and disability in acutely unwell older people, the effectiveness of CGA for community-dwelling, frail, older people at risk of poor health outcomes is less clear. OBJECTIVES To determine the effectiveness of CGA for community-dwelling, frail, older adults at risk of poor health outcomes in terms of mortality, nursing home admission, hospital admission, emergency department visits, serious adverse events, functional status, quality of life and resource use, when compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, three trials registers (WHO ICTRP, ClinicalTrials.gov and McMaster Aging Portal) and grey literature up to April 2020; we also checked reference lists and contacted study authors. SELECTION CRITERIA We included randomised trials that compared CGA for community-dwelling, frail, older people at risk of poor healthcare outcomes to usual care in the community. Older people were defined as 'at risk' either by being frail or having another risk factor associated with poor health outcomes. Frailty was defined as a vulnerability to sudden health state changes triggered by relatively minor stressor events, placing the individual at risk of poor health outcomes, and was measured using objective screening tools. Primary outcomes of interest were death, nursing home admission, unplanned hospital admission, emergency department visits and serious adverse events. CGA was delivered by a team with specific gerontological training/expertise in the participant's home (domiciliary Comprehensive Geriatric Assessment (dCGA)) or other sites such as a general practice or community clinic (community Comprehensive Geriatric Assessment (cCGA)). DATA COLLECTION AND ANALYSIS Two review authors independently extracted study characteristics (methods, participants, intervention, outcomes, notes) using standardised data collection forms adapted from the Cochrane Effective Practice and Organisation of Care (EPOC) data collection form. Two review authors independently assessed the risk of bias for each included study and used the GRADE approach to assess the certainty of evidence for outcomes of interest. MAIN RESULTS We included 21 studies involving 7893 participants across 10 countries and four continents. Regarding selection bias, 12/21 studies used random sequence generation, while 9/21 used allocation concealment. In terms of performance bias, none of the studies were able to blind participants and personnel due to the nature of the intervention, while 14/21 had a blinded outcome assessment. Eighteen studies were at low risk of attrition bias, and risk of reporting bias was low in 7/21 studies. Fourteen studies were at low risk of bias in terms of differences of baseline characteristics. Three studies were at low risk of bias across all domains (accepting that it was not possible to blind participants and personnel to the intervention). CGA probably leads to little or no difference in mortality during a median follow-up of 12 months (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.76 to 1.02; 18 studies, 7151 participants (adjusted for clustering); moderate-certainty evidence). CGA results in little or no difference in nursing home admissions during a median follow-up of 12 months (RR 0.93, 95% CI 0.76 to 1.14; 13 studies, 4206 participants (adjusted for clustering); high-certainty evidence). CGA may decrease the risk of unplanned hospital admissions during a median follow-up of 14 months (RR 0.83, 95% CI 0.70 to 0.99; 6 studies, 1716 participants (adjusted for clustering); low-certainty evidence). The effect of CGA on emergency department visits is uncertain and evidence was very low certainty (RR 0.65, 95% CI 0.26 to 1.59; 3 studies, 873 participants (adjusted for clustering)). Only two studies (1380 participants; adjusted for clustering) reported serious adverse events (falls) with no impact on the risk; however, evidence was very low certainty (RR 0.82, 95% CI 0.58 to 1.17). AUTHORS' CONCLUSIONS CGA had no impact on death or nursing home admission. There is low-certainty evidence that community-dwelling, frail, older people who undergo CGA may have a reduced risk of unplanned hospital admission. Further studies examining the effect of CGA on emergency department visits and change in function and quality of life using standardised assessments are required.
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Affiliation(s)
- Robert Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Anna McDonough
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Graham Ellis
- Medicine for the Elderly, Monklands Hospital, Airdrie, UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - David Robinson
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Marin GH, Giangreco L, Marin L, Bruzzoni-Giovanelli H, Marin G, Vetere P. [Implementation of a support system for isolated elderly people to limit the consequences of the Covid-19 epidemic in Buenos Aires]. SOINS. GERONTOLOGIE 2022; 27:30-38. [PMID: 35393033 DOI: 10.1016/j.sger.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Covid-19 pandemic with its associated quarantine and isolation has had a dramatic impact on the elderly. In order to mitigate this, the National University of La Plata and the Agence Universitaire de la Francophonie set up a health surveillance and early warning project for the elderly in Buenos Aires, Argentina. This interventional study, has included 1,964 people. A general health and quality of life questionnaire was completed by all participants at the beginning of the isolation, and another time a year later.
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Affiliation(s)
- Gustavo H Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine.
| | - Lucia Giangreco
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Lupe Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Heriberto Bruzzoni-Giovanelli
- Centre d'investigations cliniques-1427, Institut national de la santé et de la recherche médicale, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, universite de Paris, 1 avenue Claude-Vellefaux, 75010 Paris, France
| | - Gina Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Pablo Vetere
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
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Hsu B, Korda RJ, Lindley RI, Douglas KA, Naganathan V, Jorm LR. Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure. BMC Geriatr 2021; 21:538. [PMID: 34635068 PMCID: PMC8504055 DOI: 10.1186/s12877-021-02519-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services. METHODS The study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006-14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF. RESULTS Two thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18-1.35), 1.53 (95%CI:1.44-1.64) and 1.39 (95%CI:1.32-1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12-1.41), 2.65 (95%CI:2.42-2.91) and 1.50 (95%CI:1.37-1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31-5.32), 3.26 (95%CI:2.91-3.65) and 4.94 (95%CI:4.47-5.46)). CONCLUSIONS Older people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.
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Affiliation(s)
- Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kirsty A Douglas
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Repatriation Hospital and University of Sydney, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Akinyemiju T, Deveaux A, Wilson L, Gupta A, Joshi A, Bevel M, Omeogu C, Ohamadike O, Huang B, Pisu M, Liang M, McFatrich M, Daniell E, Fish LJ, Ward K, Schymura M, Berchuck A, Potosky AL. Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): methodology for a population-based study of black, Hispanic and white patients with ovarian cancer. BMJ Open 2021; 11:e052808. [PMID: 34607872 PMCID: PMC8491419 DOI: 10.1136/bmjopen-2021-052808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Less than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions-Availability, Affordability, Accessibility, Accommodation and Acceptability-among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities. METHODS AND ANALYSIS We will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions. ETHICS AND DISSEMINATION Result dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina, USA
| | - April Deveaux
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Malcolm Bevel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Onyinye Ohamadike
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bin Huang
- Department of Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington, Kentucky, USA
| | - Maria Pisu
- Division of Preventive Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Margaret Liang
- Division of Preventive Medicine, The University of Alabama, Birmingham, Alabama, USA
- Division of Hematology and Supportive Care, University of Alabama, Birmingham, Alabama, USA
| | - Molly McFatrich
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erin Daniell
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura Jane Fish
- Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina, USA
| | - Kevin Ward
- Georgia Cancer Registry, Emory University, Atlanta, Georgia, USA
| | - Maria Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, New York, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arnold L Potosky
- Georgetown University Medical Center, Washington, District of Columbia, USA
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13
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Sibert NT, Pfaff H, Breidenbach C, Wesselmann S, Kowalski C. Different Approaches for Case-Mix Adjustment of Patient-Reported Outcomes to Compare Healthcare Providers-Methodological Results of a Systematic Review. Cancers (Basel) 2021; 13:cancers13163964. [PMID: 34439117 PMCID: PMC8392243 DOI: 10.3390/cancers13163964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Patient-reported outcomes need to be reported with case-mix adjustment in order to allow fair comparison between healthcare providers. This systematic review identified different approaches to case-mix adjustment, with wide variation between the various approaches. Abstract Patient-reported outcomes (PROs) are increasingly being used to compare the quality of outcomes between different healthcare providers (medical practices, hospitals, rehabilitation facilities). However, such comparisons can only be fair if differences in the case-mix between different types of provider are taken into account. This can be achieved with adequate statistical case-mix adjustment (CMA). To date, there is a lack of overview studies on current CMA methods for PROs. The aim of this study was to investigate which approaches are currently used to report and examine PROs for case-mix-adjusted comparison between providers. A systematic MEDLINE literature search was conducted (February 2021). The results were examined by two reviewers. Articles were included if they compared (a) different healthcare providers using (b) case-mix-adjusted (c) patient-reported outcomes (all AND conditions). From 640 hits obtained, 11 articles were included in the analysis. A wide variety of patient characteristics were used as adjustors, and baseline PRO scores and basic sociodemographic and clinical information were included in all models. Overall, the adjustment models used vary considerably. This evaluation is an initial attempt to systematically investigate different CMA approaches for PROs. As a standardized approach has not yet been established, we suggest creating a consensus-based methodological guideline for case-mix adjustment of PROs.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
- Correspondence:
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany;
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
| | - Christoph Kowalski
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
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Rachele JN, Wang J, Wijnands JS, Zhao H, Bentley R, Stevenson M. Using machine learning to examine associations between the built environment and physical function: A feasibility study. Health Place 2021; 70:102601. [PMID: 34157507 DOI: 10.1016/j.healthplace.2021.102601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/16/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022]
Abstract
Linking geospatial neighbourhood design characteristics to health and behavioural data from population-representative cohorts is limited by data availability and difficulty collecting information on environmental characteristics (e.g. greenery, building setbacks, dwelling structure). As an alternative, this study examined the feasibility of Generative Adversarial Networks (GANs) - machine learning - to measure neighbourhood design using 'street view' and aerial imagery to explore the relationship between the built environment and physical function. This study included 3102 adults aged 45 years and older clustered in 200 neighbourhoods in 2016 from the How Areas in Brisbane Influence Health and Activity (HABITAT) project in Brisbane, Australia. Exposure data were Google Street View and Google Maps images from within the 200 neighbourhoods, and outcome data were self-reported physical function using the PF-10 (a subset of the SF-36). Physical function scores were aggregated to the neighbourhood level, and the highest and lowest 20 neighbourhoods respectively were used in analysis. We found that the aerial imagery retrieved was unable to be used to adequately train the model, meaning that aerial imagery failed to produce meaningful results. Of the street view images, n = 56,330 images were downloaded and used to train the GAN model. Model outputs included augmented street view images between neighbourhoods classed as having high function and low function residents. The GAN model detected differences in neighbourhood design characteristics between neighbourhoods classed as high and low physical function at the aggregate level. Specifically, differences were identified in urban greenery (including tree heights) and dwelling structure (e.g. building height). This study provides important lessons for future work in this field, especially related to the uniqueness, diversity and amount of imagery required for successful applications of deep learning methods.
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Affiliation(s)
- Jerome N Rachele
- College of Health and Biomedicine and Institute for Health and Sport, Victoria University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Jingcheng Wang
- Melbourne School of Design, University of Melbourne, Australia.
| | | | - Haifeng Zhao
- Melbourne School of Design, University of Melbourne, Australia.
| | - Rebecca Bentley
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Mark Stevenson
- Melbourne School of Design, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
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15
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Bin Sayeed MS, Joshy G, Paige E, Banks E, Korda R. Cardiovascular disease subtypes, physical disability and workforce participation: A cross-sectional study of 163,562 middle-aged Australians. PLoS One 2021; 16:e0249738. [PMID: 33831054 PMCID: PMC8031377 DOI: 10.1371/journal.pone.0249738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Workforce participation is reduced among people with cardiovascular disease (CVD). However, detailed quantitative evidence on this is limited. We examined the relationship of CVD to workforce participation in older working-age people, by CVD subtype, within population subgroups and considering the role of physical disability. Methods Questionnaire data (2006–2009) for participants aged 45–64 years (n = 163,562) from the population-based 45 and Up Study (n = 267,153) were linked to hospitalisation data through the Centre for Health Record Linkage. Prior CVD was from self-report or hospitalisation. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for non-participation in the workforce in people with versus without CVD, adjusting for sociodemographic factors. Results There were 19,161 participants with CVD and 144,401 without. Compared to people without CVD, workforce non-participation was greater for those with CVD (40.0% vs 23.5%, PR = 1.36, 95%CI = 1.33–1.39). The outcome varied by CVD subtype: myocardial infarction (PR = 1.46, 95%CI = 1.36–1.55); cerebrovascular disease (PR = 1.92, 95%CI = 1.80–2.06); heart failure (PR = 1.83, 95%CI = 1.68–1.98) and peripheral vascular disease (PR = 1.76, 95%CI = 1.65–1.88). Workforce non-participation in those with CVD versus those without was at least 21% higher in all population subgroups examined, with PRs ranging from 1.75 (95%CI = 1.65–1.85) in people aged 50–55 years to 1.21 (95%CI = 1.19–1.24) among those aged 60–64. Compared to people with neither CVD nor physical functioning limitations, those with physical functional limitations were around three times as likely to be out of the workforce regardless of CVD diagnosis; participants with CVD but without physical functional limitations were 13% more likely to be out of the workforce (PR = 1.13, 95%CI = 1.07–1.20). Conclusions While many people with CVD participate in the workforce, participation is substantially lower, especially for people with cerebrovascular disease, than for people without CVD, highlighting priority areas for research and support, particularly for people experiencing physical functioning limitations.
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Affiliation(s)
- Muhammad Shahdaat Bin Sayeed
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
- * E-mail:
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Welsh J, Banks E, Joshy G, Butterworth P, Strazdins L, Korda RJ. Does psychological distress directly increase risk of incident cardiovascular disease? Evidence from a prospective cohort study using a longer-term measure of distress. BMJ Open 2021; 11:e039628. [PMID: 33593764 PMCID: PMC7888372 DOI: 10.1136/bmjopen-2020-039628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study. DESIGN We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations. RESULTS Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26). CONCLUSION Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.
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Affiliation(s)
- Jennifer Welsh
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Sax Institute, Sydney, New South Wales, Australia
| | - Grace Joshy
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter Butterworth
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyndall Strazdins
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary J Korda
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Joshy G, Thandrayen J, Koczwara B, Butow P, Laidsaar-Powell R, Rankin N, Canfell K, Stubbs J, Grogan P, Bailey L, Yazidjoglou A, Banks E. Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer. BMC Med 2020; 18:372. [PMID: 33256726 PMCID: PMC7708114 DOI: 10.1186/s12916-020-01830-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. METHODS Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes-severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)-in participants with versus without cancer, for 13 cancer types. RESULTS Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25-1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02-1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24-1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56-3.77; distress 1.53, 1.20-1.96; poor/fair QoL 2.40, 1.87-3.07), lung cancer (disability 2.81, 2.50-3.15; distress 1.67, 1.46-1.92; poor/fair QoL 2.53, 2.21-2.91) and non-Hodgkin's lymphoma (disability 1.56, 1.37-1.78; distress 1.20, 1.05-1.36; poor/fair QoL 1.66, 1.44-1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16-1.32; distress 0.95, 0.90-1.01; poor/fair QoL 1.15, 1.05-1.25), prostate cancer (disability 1.11, 1.04-1.19; distress 1.09, 1.02-1.15; poor/fair QoL 1.15, 1.08-1.23) and melanoma (disability 1.02, 0.94-1.10; distress 0.96, 0.89-1.03; poor/fair QoL 0.92, 0.83-1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. CONCLUSIONS Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Nicole Rankin
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | - Paul Grogan
- Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia
| | - Louise Bailey
- Primary Care Collaborative Cancer Clinical Trials Group Community Advisory Group, Melbourne, VIC, Australia.,Psycho-oncology Cooperative Research Group Community Advisory Group, Camperdown, NSW, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.,Sax Institute, Haymarket, NSW, Australia
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Lane CY, Givens DL, Thoma LM. General Functional Status: Common Outcome Measures for Adults With Rheumatic Disease. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:431-451. [PMID: 33091251 DOI: 10.1002/acr.24196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/24/2020] [Indexed: 12/30/2022]
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Keller S, Dy S, Wilson R, Dukhanin V, Snyder C, Wu A. Selecting Patient-Reported Outcome Measures to Contribute to Primary Care Performance Measurement: a Mixed Methods Approach. J Gen Intern Med 2020; 35:2687-2697. [PMID: 32495096 PMCID: PMC7459066 DOI: 10.1007/s11606-020-05811-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/17/2020] [Indexed: 01/11/2023]
Abstract
New models of primary care include patient-reported outcome measures (PROMs) to promote patient-centered care. PROMs provide information on patient functional status and well-being, can be used to enhance care quality, and are proposed for use in assessing performance. Our objective was to identify a short list of candidate PROMs for use in primary care practice and to serve as a basis for performance measures (PMs). We used qualitative and quantitative methods to identify relevant patient-reported outcome (PRO) domains for use in performance measurement (PRO-PM) and their associated PROMs. We collected data from key informant groups: patients (n = 13; one-on-one and group interviews; concept saturation analysis), clinical thought leaders (n = 9; group discussions; thematic analysis), primary care practices representatives (n = 37; six focus groups; thematic analysis), and primary care payer representatives (n = 10; 12-question survey; frequencies of responses). We merged the key informant group information with findings from environmental literature scans. We conducted a targeted evidence review of measurement properties for candidate PROMs. We used a scoping review and key informant groups to identify PROM evaluation criteria, which were linked to the National Quality Forum measure evaluation criteria. We developed a de novo schema to score candidate PROMs against our criteria. We identified four PRO domains and 10 candidate PROMs: 3 for depressive symptoms, 2 for physical function, 3 for self-efficacy, 2 for ability to participate. Five PROMs met ≥ 70% of the evidence criteria for three PRO domains: PHQ-9 or PROMIS Depression (depression), PF-10 or PROMIS-PF (physical functioning), and PROMIS Self-Efficacy for Managing Treatments and Medications (self-efficacy). The PROMIS Ability to Participate in Social Roles and Activities met 68% of our criteria and might be considered for inclusion. Existing evidence and key informant data identified 5 candidate PROMs to use in primary care. These instruments can be used to develop PRO-PMs.
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Affiliation(s)
- San Keller
- American Institutes for Research in the Behavioral and Social Sciences, Chapel Hill, NC, USA.
| | - Sydney Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Renee Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vadim Dukhanin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Albert Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
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20
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Vyas CM, Ogata S, Reynolds CF, Mischoulon D, Chang G, Cook NR, Manson JE, Crous-Bou M, De Vivo I, Okereke OI. Lifestyle and behavioral factors and mitochondrial DNA copy number in a diverse cohort of mid-life and older adults. PLoS One 2020; 15:e0237235. [PMID: 32785256 PMCID: PMC7423118 DOI: 10.1371/journal.pone.0237235] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
Mitochondrial DNA copy number (mtDNAcn) is a putative biomarker of oxidative stress and biological aging. Modifiable factors, including physical activity (PA), avoidance of heavy alcohol use and smoking, and maintaining good mental health, may reduce oxidative stress and promote healthy aging. Yet, limited data exist regarding how these factors are associated with mtDNAcn or whether age, sex or race/ethnicity moderate associations. In this cross-sectional study, we selected 391 adults (183 non-Hispanic White, 110 Black and 98 Hispanic; mean = 67 years) from the VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention) ancillary to the VITAL trial. We estimated associations between lifestyle and behavioral factors (PA, alcohol consumption, cigarette smoking and depression) and log-transformed mtDNAcn using multivariable linear regression models. MtDNAcn was not correlated with chronological age; women had ~17% higher mtDNAcn compared to men. There were no significant associations between PA measures (frequency, amount or intensity) or alcohol consumption with mtDNAcn. Cigarette smoking (per 5 pack-years) was significantly associated with mtDNAcn (percent difference = -2.9% (95% confidence interval (CI) = -5.4%, -0.4%)); a large contrast was observed among heavy vs. non-smokers (≥30 vs. 0 pack-years): percent difference = -28.5% (95% CI = -44.2%, -8.3%). The estimate of mtDNAcn was suggestively different for past vs. no depression history (percent difference = -15.1% 95% CI = -30.8%, 4.1%), but this difference was not statistically significant. The association between smoking and log-mtDNAcn varied by sex and race/ethnicity; it was stronger in men and Black participants. While chance findings cannot be excluded, results from this study support associations of smoking, but not chronological age, with mtDNAcn and suggest nuanced considerations of mtDNAcn as indicative of varying oxidative stress states vs. biological aging itself.
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Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Soshiro Ogata
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts, United States of America
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marta Crous-Bou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Ramaskandhan J, Rashid A, Kometa S, Siddique MS. Comparison of 5-Year Patient-Reported Outcomes (PROMs) of Total Ankle Replacement (TAR) to Total Knee Replacement (TKR) and Total Hip Replacement (THR). Foot Ankle Int 2020; 41:767-774. [PMID: 32370645 DOI: 10.1177/1071100720918880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle replacement (TAR) is becoming a more common alternative to ankle arthrodesis for the improvement of pain and function in end-stage arthritis of the ankle. The effects of end-stage arthritis of the ankle are similar to those of end-stage hip arthritis. There is a paucity of literature on patient-reported outcome measures (PROMs) following TARs in comparison with total hip replacement (THR) or total knee replacement (TKR). We aimed to study the 1-, 3-, and 5-year outcomes of TAR in comparison with TKR and THR. METHODS PROMs data from patients who underwent a primary THR, TKR, or TAR performed between March 2008 and 2013 over a 5-year period were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient-reported outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-item Short-Form (SF-36) scores, and patient satisfaction scores at follow-up) were compared preoperatively and at the 1-, 3-, and 5-year follow-ups. RESULTS There were data available on 2672 THR, 3520 TKR, and 193 TAR patients preoperatively. Preoperatively, TAR patients reported statistically significantly higher function scores when compared with THR and TKR patients (40 vs 33; P = .001 [P < .05] and 40 vs 36; P = .001 [P < .05]). For SF-36 scores, there was no statistically significant difference between groups for the general health and role emotional components (P = .171 and .064, respectively [P > .05]); TAR patients reported similar scores to TKR patients for physical domains at the 3- and 5-year follow-ups (P > .05), and TAR patients also reported similar scores to both THR and TKR patients for the mental domains (P > .05). At 5 years postoperatively, TAR patients reported lower scores than THR and TKR patients for function and stiffness. For SF-36 scores, TAR patients reported similar outcomes to THR and TKR patients for mental health components (P > .05), similar scores to TKR patients for 3 of 4 physical domains (P < .05), but lower satisfaction rates for activities of daily living (ADL) and recreation when compared with THR (P < .05). CONCLUSION TAR patients had similar outcomes to THR and TKR patients for disease-specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL, and recreation. Further research is warranted including clinical outcomes along with PROMs with a long-term follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | - Anjum Rashid
- Carlisle and District Primary Care Trust, United Kingdom
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22
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Cohee A, Storey S, Winger JG, Cella D, Stump T, Monahan PO, Champion VL. A cohort study of quality of life in partners of young breast cancer survivors compared to partners of healthy controls. J Patient Rep Outcomes 2020; 4:19. [PMID: 32144626 PMCID: PMC7060298 DOI: 10.1186/s41687-020-0184-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Partners of young breast cancer survivors (BCS) are at increased risk for deficits in quality of life (QoL). To intervene effectively, it is important to understand how the breast cancer experience impacts partners. The purpose of this study was to compare QoL between partners of young BCS and partners of healthy acquaintance controls. METHODS Partners of young BCS (3-8 years post treatment and ≤ 45 years old at diagnosis) and partners of age-matched healthy acquaintance controls completed questionnaires on overall, physical (physical function, sexual difficulty), social (personal resources, sexual enjoyment, marital satisfaction, partner social support, social constraints, parenting satisfaction), psychological (depressive symptoms), and spiritual (behaviors, beliefs, and activities) QoL. Analyses included descriptive statistics and one-way ANOVA to compare partner groups on all study variables. RESULTS Although partners of young BCS (n = 227) reported fewer social constraints (p < .001), they reported lower overall QoL (p < .001), fewer personal resources (p < .001), more sexual difficulty (p = .019), less sexual enjoyment (p = .002), less marital satisfaction (p = .019), more depressive symptoms (p = .024), and fewer spiritual behaviors (p < .001), beliefs (p = .001) and activities (p = .003) compared to partners of healthy acquaintance controls (n = 170). Additional analysis showed that perceptions that the relationship changed for the better since cancer, social constraints, partner social support, and depression predicted marital satisfaction among partners of young BCS. CONCLUSIONS Partners of young BCS are at risk for poorer overall, physical, social, psychological, and spiritual QoL compared to partners of healthy women. Interventions targeting QoL domains may enable partners to effectively support their partner and improve their QoL.
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Affiliation(s)
- Andrea Cohee
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Susan Storey
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Timothy Stump
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Victoria L Champion
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
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Bisaso KS, Bisaso KR, Mukonzo JK, Ette EI. Maximizing Knowledge Extraction From Patient-Reported Outcome Data Using Exposure-Outcome Item Response Modeling Approach: Understanding Efavirenz-Induced Central Nervous System Toxicity. J Clin Pharmacol 2020; 60:711-721. [PMID: 32096561 DOI: 10.1002/jcph.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/02/2019] [Indexed: 11/09/2022]
Abstract
This investigation was undertaken to maximally extract hidden knowledge from an efavirenz-based trial data set using an item response theory-based approach to exposure-outcome analysis. The aim was to understand the influence of efavirenz exposure on the underlying neuropsychiatric impairment in HIV/AIDS patients. Data from 196 individuals with 4136 neuropsychiatric impairment symptom observations at baseline and 2 and 12 weeks of 600-mg efavirenz-based therapy was analyzed. The 7 symptoms were categorized as sleep disorders (3), hallucinations (3), and cognitive impairment (1). A longitudinal item response theory model incorporating 3 latent variables based on the symptom categories and a linear disease progression model with a symptomatic drug effect was developed in NONMEM 7.4.1. The model adequately characterized the observed symptoms and revealed the hidden knowledge on the informativeness of symptoms in characterizing the underlying neuropsychiatric impairment. Informativeness, which was affected by underlying impairment severity and efavirenz therapy duration, varied among symptoms. Sleep disorders were the most efavirenz-sensitive symptom category. Vivid dreams and auditory hallucinations were most informative in their respective symptom categories. Mini-Mental State Examination score cutoff levels used to classify the severity of cognitive impairment did not distinctively correspond with neuropsychiatric impairment severity. Efavirenz treatment effect on the severity of neuropsychiatric impairment was not more than 15%. Simulation of individual symptoms at the 400-mg dose only reduced the prevalence of sleep disorder symptoms. Use of the exposure-item response theory modeling approach maximally extracted hidden knowledge about efavirenz-induced neuropsychiatric impairment and appropriately characterized the impact of dose reduction on specific neuropsychiatric impairment symptoms.
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Affiliation(s)
| | - Kuteesa R Bisaso
- Breakthrough Analytics Limited, Kampala, Uganda.,Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jackson K Mukonzo
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ene I Ette
- Anoixis Corporation, Natick, Massachusetts, USA
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24
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A new assessment scale for post-dialysis fatigue in hemodialysis patients. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-019-0252-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kaat AJ, Buckenmaier CT, Cook KF, Rothrock NE, Schalet BD, Gershon RC, Vrahas MS. The expansion and validation of a new upper extremity item bank for the Patient-Reported Outcomes Measurement Information System® (PROMIS). J Patient Rep Outcomes 2019; 3:69. [PMID: 31773413 PMCID: PMC6879697 DOI: 10.1186/s41687-019-0158-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background The Patient-Reported Outcomes Measurement Information System® (PROMIS) includes a Physical Function (PF) item bank and an Upper Extremity (UE) item bank, which is composed of a subset of items from the PF bank. The UE item bank has few items and known ceiling effects. Therefore, this study aimed to expand the item bank to assess a wider range of functioning. With the additional content, other psychometric properties—improved content validity, item bank depth, range of measurement, and score reliability—were also evaluated. We convened an expert panel to review potential items, and then conducted psychometric analyses on both extant and newly-collected data. Results Expert focus groups reviewed the PF item bank for items that were “sufficiently” related to upper extremity functioning for inclusion in the expanded UE item bank. The candidate item bank was quantitatively evaluated in a new sample of 600 people. The final items were calibrated in an aggregated dataset (n = 11,635) from two existing datasets, and the newly collected sample. The original UE item bank included 15 items. After expert review and quantitative evaluation, 31 items were added. The combined 46 items were calibrated using item response theory (IRT). Then computer adaptive tests (CATs) were simulated based off of the psychometric results. These indicated that the new UE item bank has an extended measurement range compared to the original version. Conclusions The expanded PROMIS UE item bank assesses a wider range of upper extremity functioning compared to the initial UE item bank. However, ceiling effects remain a concern for unimpaired groups. The new UE item bank is recommended for individuals with known or suspected upper extremity limitations.
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Affiliation(s)
- Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA.
| | - Chester Trip Buckenmaier
- Uniformed Services University, Defense & Veterans Center for Integrative Pain Management, 11300 Rockville Pike #709, Rockville, MD, 20852, USA
| | - Karon F Cook
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Mark S Vrahas
- Department of Orthopaedics, Cedars-Sinai Medical Center, Mark Goodson Building, 444 S. San Vicente Blvd., #603, Los Angeles, CA, 90048, USA
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Welsh J, Korda RJ, Joshy G, Greaves K, Banks E. Variation in coronary angiography and revascularisation procedures in relation to psychological distress among patients admitted to hospital with myocardial infarction or angina. J Psychosom Res 2019; 125:109794. [PMID: 31445320 DOI: 10.1016/j.jpsychores.2019.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/24/2019] [Accepted: 08/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cardiac patients with psychological distress have a poorer prognosis than patients without distress; which may in part reflect differences in treatment. We quantified variation in coronary angiography and revascularisation procedures according to psychological distress among patients admitted with incident acute myocardial infarction (AMI) or angina. METHODS Questionnaire data (collected 2006-09) from 45 and Up Study participants were linked to hospitalisation and mortality data, to 30 June 2016. Among patients free from ischaemic heart disease at baseline and subsequently hospitalised with AMI or angina, Cox regression was used to model the association between distress (Kessler-10 scores: low [10-<12], mild [12-<16], moderate [16-<22] and high [22-50]) - assessed on the questionnaire - and coronary angiography and revascularisation procedures (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) within 30 days of admission, adjusting for personal characteristics, including physical functioning. RESULTS Proportions receiving angiography and PCI/CABG were 71.4% and 51.7% following AMI (n = 3749), and 61.3% and 31.3% for angina patients (n = 3772), respectively. Following AMI, age-sex-adjusted rates of PCI/CABG were lower with higher levels of distress (test for trend: p = .037), as were rates of angiography and PCI/CABG (p < .01) following admission with angina. After additional adjustment for personal characteristics, associations between distress and procedure rates attenuated substantively and were no longer significant, except that PCI/CABG rates remained lower among angina patients with high versus low distress (HR = 0.76, 95%CI: 0.59-0.99). CONCLUSION Distress-related variation in coronary procedures largely reflects differences in personal characteristics. Whether lower revascularisation rates among angina patients with high compared to low distress are clinically appropriate or represent under-treatment remains unclear.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Kim Greaves
- Sunshine Coast University Hospital, Australia; Griffith University, Australia.
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia; The Sax Institute, Australia.
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Abstract
BACKGROUND Partners of breast cancer survivors experience the effects of a spouse's cancer years after treatment. Partners of younger survivors (YPs) may experience greater problems than partners of older survivors (OPs), just as younger survivors experience greater problems than their older counterparts. OBJECTIVES The aims of this study were to (1) compare quality of life (QoL) in YPs and OPs and (2) determine contributing factors to each group's QoL. METHODS Cross-sectional data were collected from YPs (n = 227) and OPs (n = 281) through self-report. Multivariate analysis of variance was used to determine differences between YPs and OPs on QoL while controlling for covariates. Multiple regression analyses were conducted to determine what contributes to each group's QoL. RESULTS Partners of younger survivors reported better physical function (effect size [ES], -0.57), lower marital satisfaction (ES, 0.39), and lower overall QoL (ES, 0.43) than OPs. Predictors of QoL also differed between partner groups. For YPs, overall QoL was predicted by greater physical functioning, fewer depressive symptoms, higher marital satisfaction, higher parenting satisfaction, and more personal resources (R = 0.47, F5,195 = 35.05, P < .001). For OPs, overall QoL was predicted by fewer depressive symptoms, higher parenting satisfaction, higher spirituality, and greater social support from the breast cancer survivor spouse (R = 0.33, F4,244 = 29.80, P < .001). CONCLUSION Partners of older survivors reported greater QoL than YPs. Common factors contributing to QoL between YPs and OPs were fewer depressive symptoms and higher parenting satisfaction. IMPLICATIONS FOR PRACTICE Partners of breast cancer survivors may need support coping with their spouse/partner's cancer. Partners of younger survivors may require more support than OPs.
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Abstract
Patient-reported outcome measures (PROMs) are used to collect information directly from patients. They may cover several different types of outcomes ranging from symptoms, functioning, utility, satisfaction, through to quality-of-life (QoL). They generally consist of self-completed questionnaires that can be administered by means of hard copies or in a range of electronic formats. PROMs vary considerably in terms of the constructs they assess, the care with which they are developed, and their scientific quality. However, none of the PROMs available approach the quality of measurement achieved by measures/instruments used in physics. PROs are examples of latent variables. These are not directly observable, but can be inferred from, for example, responses to a questionnaire. The only measure of a latent variable that approaches the quality of measurement achieved by the physical sciences is the Lexile Framework for Reading. This framework is based on a construct theory that grew out of an analysis of several available reading measures. A specification equation was generated that was able to link the construct theory to scores obtained with the Lexile measure. A fundamental requirement of this quality of measurement is that the data collected with the model fit Rasch Measurement Theory (RMT). It is argued that PROM developers should aspire to match this level of measurement sophistication if their instruments are to provide valid insights into the impacts of disease and its treatment.
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Affiliation(s)
- Stephen P McKenna
- a Galen Research Ltd , Manchester , UK
- b School of Health Sciences, University of Manchester , Manchester , UK
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Ware JE, Richardson MM, Meyer KB, Gandek B. Improving CKD-Specific Patient-Reported Measures of Health-Related Quality of Life. J Am Soc Nephrol 2019; 30:664-677. [PMID: 30898870 DOI: 10.1681/asn.2018080814] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/30/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures that are more practical and clinically useful are needed for patients with CKD. We compared a new CKD-specific quality-of-life impact scale (CKD-QOL) with currently used measures. METHODS Patients (n=485) in different treatment groups (nondialysis stages 3-5, on dialysis, or post-transplant) completed the kidney-specific CKD-QOL and Kidney Disease Quality of Life-36 (KDQOL-36) forms and the generic SF-12 Health Survey at baseline and 3 months. New items summarizing quality of life (QOL) impact attributed to CKD across six QOL domains yielded single impact scores from a six-item static (fixed-length) form and from computerized adaptive tests (CATs) with three to six items. Validity tests compared the CKD-QOL, KDQOL-36 (Burden, Effects, and Symptoms/Problems subscales), and generic SF-12 measures across groups in four tests of clinical status and clinician assessment of change (CKD-specific tests), and number of comorbidities. ANOVA was used to test for group mean differences, variances in each measure explained by groups, and relative validity (RV) in comparison with the referent KDQOL-36 Burden subscale. RESULTS KDQOL-36 and CKD-QOL measures generally discriminated better than generic SF-12v2 measures. The pattern of variances across CKD-specific tests comparing validity favored CKD-QOL two-fold over KDQOL-36. Two RV test results confirmed CKD-QOL improvements over the referent KDQOL scale. Results for static and CAT CKD-QOL forms were similar. SF-12 Physical and KDQOL-36 Symptoms scores worsened with increasing comorbid condition counts. CONCLUSIONS Overall, compared with the KDQOL-36, the new approach to summarizing CKD-specific QOL impact performed better across multiple tests of validity. CAT surveys were more efficient than static surveys.
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Affiliation(s)
- John E Ware
- John Ware Research Group, Outcomes Measurement Department, Watertown, Massachusetts; .,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michelle M Richardson
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; and.,Dialysis Clinic, Inc., Outcomes Monitoring Program, Boston, Massachusetts
| | - Klemens B Meyer
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; and.,Dialysis Clinic, Inc., Outcomes Monitoring Program, Boston, Massachusetts
| | - Barbara Gandek
- John Ware Research Group, Outcomes Measurement Department, Watertown, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Du W, Gnjidic D, Pearson SA, Hilmer SN, McLachlan AJ, Blyth F, Viney R, Joshy G, Day C, Banks E. Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: a prospective cohort investigation among adults aged 45 years and over in Australia. BMJ Open 2019; 9:e027305. [PMID: 30772867 PMCID: PMC6398774 DOI: 10.1136/bmjopen-2018-027305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. DESIGN Prospective cohort analysis. SETTINGS, PARTICIPANTS, MEASUREMENTS Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. PRIMARY OUTCOME HMR receipt during the 5-year study period. RESULTS Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5-9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5-9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy. CONCLUSIONS HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
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Affiliation(s)
- Wei Du
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, University of Sydney, North Shore, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Sydney Medical School University of Sydney, Camperdown, Camperdown, Australia
| | - Rosalie Viney
- Centre for Health Economics Research Eval., University of Technology, Sydney, New South Wales, Australia
| | - Grace Joshy
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Cathy Day
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Emily Banks
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
- The Sax Institute, Sydney, New South Wales, Australia
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Loh VH, Rachele JN, Brown WJ, Ghani F, Washington S, Turrell G. The potential for walkability to narrow neighbourhood socioeconomic inequalities in physical function: A case study of middle-aged to older adults in Brisbane, Australia. Health Place 2019; 56:99-105. [PMID: 30716668 DOI: 10.1016/j.healthplace.2019.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/17/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
Residents of disadvantaged neighbourhoods have poorer physical function than their advantaged counterparts, although the reasons for this remain largely unknown. We examined the moderating effects of walkability in the relationship between neighbourhood disadvantage and physical function using 2013 cross-sectional data from 5115 individuals aged 46-72 living in 200 neighbourhoods in Brisbane, Australia. The relationship between neighbourhood disadvantage and physical function differed by levels of walkability: positive associations as levels of walkability increased for those living in more disadvantaged neighbourhoods, and no difference for those living in more advantaged neighbourhoods. Further work is required to better understand the underlying mechanisms.
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Affiliation(s)
- Venurs Hy Loh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Jerome N Rachele
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Carlton, Australia.
| | - Wendy J Brown
- Centre for Research on Exercise, Physical Activity and Health and School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
| | - Fatima Ghani
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Simon Washington
- School of Civil Engineering, The Faculty of Engineering, Architecture and Information Technology, University of Queensland, Brisbane, Australia.
| | - Gavin Turrell
- School of Health and Social Development, Centre for Population and Health Research, Deakin University, Geelong, Australia.
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Ardoin A, Canot B. Bénéfices physiques et psychologiques de l’activité sportive adaptée dans une cohorte de malades chroniques. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Palumbo AJ, Cannuscio C, De Roos AJ, Robinson L, Mossey J, Wallace R, Garcia L, Shadyab AH, Sealy-Jefferson S, Michael Y. Women’s Occupational Patterns and Later Life Physical Functioning. J Aging Health 2019; 32:410-421. [DOI: 10.1177/0898264319826797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Timing and accumulation of work-related exposures may influence later life health. This study evaluates the association between women’s work patterns and physical functioning. Method: Work history and physical functioning information was collected at baseline for U.S. women ages 50 to 79 years in the Women’s Health Initiative Observational Study ( N = 75,507). We estimated life course workforce participation patterns using latent class analysis. Associations between work patterns and physical limitations were explored using modified Poisson regression. Results: Compared with working continuously, women who left the workforce early had 8% increased risk and women who worked intermittently had 5% reduced risk of physical limitations later in life. The negative association with intermittent workforce participation was stronger for women with substantively complex work (9% reduced risk) than for women with nonsubstantively complex work (2% reduced risk). Discussion: Life course work patterns and characteristics may contribute to physical functioning later in life among women.
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Affiliation(s)
- Aimee J. Palumbo
- Drexel University, Philadelphia, PA, USA
- Temple University, Philadelphia, PA, USA
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Côté P, Boyle E, Shearer HM, Stupar M, Jacobs C, Cassidy JD, Carette S, van der Velde G, Wong JJ, Hogg-Johnson S, Ammendolia C, Hayden JA, van Tulder M, Frank JW. Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial. BMJ Open 2019; 9:e021283. [PMID: 30679283 PMCID: PMC6347946 DOI: 10.1136/bmjopen-2017-021283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. DESIGN Pragmatic randomised clinical trial with blinded outcome assessment. SETTING Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. PARTICIPANTS 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. INTERVENTIONS Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. RESULTS The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported. CONCLUSIONS Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life. TRIAL REGISTRATION NUMBER NCT00546806.
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Affiliation(s)
- Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Heather M Shearer
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Maja Stupar
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Craig Jacobs
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - John David Cassidy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Simon Carette
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, University Health Network, Toronto, Ontario, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill Alison Hayden
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - John W Frank
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Hagan KA, Grodstein F. The Alternative Healthy Eating Index and Physical Function Impairment in Men. J Nutr Health Aging 2019; 23:459-465. [PMID: 31021363 DOI: 10.1007/s12603-019-1185-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Physical function is increasingly recognized as integral to healthy aging, in particular as a core component of mobility and independent living in older adults. Thus, it is important to identify strategies for the prevention of physical function decline. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS A total of 12,658 men from the Health Professionals Follow-Up Study were followed from 2008-2012. MEASUREMENTS We examined the association between the Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality combining 11 dietary components (vegetables, fruits, nuts and legumes, red and processed meats, sugar-sweetened beverages and fruit juices, alcohol, whole grains, omega-3 fatty acids, polyunsaturated fatty acids, trans fatty acids, sodium), and impairment in physical function, as measured by the SF-36. Multivariable logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of impairment in physical function. RESULTS In the multivariable-adjusted model, each 10-point increase in total AHEI score was associated with a 10% lower odds of impairment in physical function (OR=0.90, 95% CI: 0.86,0.95), and in the categorical analysis, men with AHEI scores in the top quintile had a 26% lower odds (OR=0.74, 95% CI:0.63,0.86) compared with men in the bottom quintile. For individual AHEI components, higher intake of vegetables (p-trend=0.01), nuts and legumes (p-trend<0.01), polyunsaturated fatty acids (p-trend<0.01) and lower intake of red and processed meats (p-trend=0.03) and sugar-sweetened beverages (p-trend=0.01) were significantly associated with lower odds of physical impairment. For specific foods, higher consumption of lettuce, broccoli, blueberries, peanuts, walnuts and other nuts were associated with lower odds of impairment. CONCLUSIONS In this large cohort of older men, better overall diet quality was significantly associated with a lower odds of impairment in physical function. Given the value of physical function to healthy aging and quality of life, this may represent a particularly compelling public health rationale for older men to improve their diet.
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Affiliation(s)
- K A Hagan
- Kaitlin A. Hagan, 181 Longwood Ave, 3rd Floor, Boston, MA 02115, Telephone: (617) 525-2096, Fax: (617) 731-1541,
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Cordier R, Brown T, Clemson L, Byles J. Evaluating the Longitudinal Item and Category Stability of the SF-36 Full and Summary Scales Using Rasch Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1013453. [PMID: 30519566 PMCID: PMC6241362 DOI: 10.1155/2018/1013453] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health-Related Quality of Life (HRQoL) and has undergone rigorous psychometric evaluation using Classic Test Theory (CTT). However, Item Response Theory-based evaluation of the SF-36 has been limited with an overwhelming focus on individual scales and cross-sectional data. PURPOSE This study aimed to examine the longitudinal item and category stability of the SF-36 using Rasch analysis. METHOD Using data from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health, responses of the SF-36 from six waves of data collection were analysed. Rasch analysis using Winsteps version 3.92.0 was performed on all 36 items of the SF-36 and items that constitute the physical health and mental health scales. RESULTS Rasch analysis revealed issues with the SF-36 not detected using classical methods. Redundancy was seen for items on the total measure and both scales across all waves of data. Person separation indexes indicate that the measure lacks sensitivity to discriminate between high and low performances in this sample. The presence of Differential Item Functioning suggests that responses to items were influenced by locality and marital status. CONCLUSION Previous evaluations of the SF-36 have relied on cross-sectional data; however, the findings of the current study demonstrate the longitudinal efficacy of the measure. Application of the Rasch Measurement Model indicated issues with internal consistency, generalisability, and sensitivity when the measure was evaluated as a whole and as both physical and mental health summary scales. Implications for future research are discussed.
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Affiliation(s)
- Reinie Cordier
- Curtin University, School of Occupational Therapy, Social Work and Speech Pathology, Bentley, Australia
| | - Ted Brown
- Monash University, Occupational Therapy Department, Melbourne, Victoria, Australia
| | - Lindy Clemson
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Julie Byles
- The University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia
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Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. J Stroke Cerebrovasc Dis 2018; 27:2306-2318. [PMID: 29880211 PMCID: PMC6087671 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.013] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Tele-rehabilitation for stroke survivors has emerged as a promising intervention for remotely supervised administration of physical, occupational, speech, and other forms of therapies aimed at improving motor, cognitive, and neuropsychiatric deficits from stroke. OBJECTIVE We aimed to provide an updated systematic review on the efficacy of tele-rehabilitation interventions for recovery from motor, higher cortical dysfunction, and poststroke depression among stroke survivors. METHODS We searched PubMed and Cochrane library from January 1, 1980 to July 15, 2017 using the following keywords: "Telerehabilitation stroke," "Mobile health rehabilitation," "Telemedicine stroke rehabilitation," and "Telerehabilitation." Our inclusion criteria were randomized controlled trials, pilot trials, or feasibility trials that included an intervention group that received any tele-rehabilitation therapy for stroke survivors compared with a control group on usual or standard of care. RESULTS This search yielded 49 abstracts. By consensus between 2 investigators, 22 publications met the criteria for inclusion and further review. Tele-rehabilitation interventions focused on motor recovery (n = 18), depression, or caregiver strain (n = 2) and higher cortical dysfunction (n = 2). Overall, tele-rehabilitation interventions were associated with significant improvements in recovery from motor deficits, higher cortical dysfunction, and depression in the intervention groups in all studies assessed, but significant differences between intervention versus control groups were reported in 8 of 22 studies in favor of tele-rehabilitation group while the remaining studies reported nonsignificant differences. CONCLUSION This updated systematic review provides evidence to suggest that tele-rehabilitation interventions have either better or equal salutary effects on motor, higher cortical, and mood disorders compared with conventional face-to-face therapy.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Ohene K Opare-Sem
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Medical University of South Carolina, Charleston, South Carolina
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Johnson-Lynn SE, Ramaskandhan J, Siddique MS. The effect of patient age and diagnosis on the 5-year outcomes of mobile-bearing total ankle replacement. Foot (Edinb) 2018; 36:1-5. [PMID: 30036683 DOI: 10.1016/j.foot.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 02/04/2023]
Abstract
Total Ankle Replacement is an established technique for the management of end-stage ankle arthritis. However, there are few studies focussing on patient-reported outcomes in the medium and long term related to age or arthritis type. We compared demographic data and patient-reported outcomes preoperatively and at five years postoperatively for patients who underwent total ankle replacement with the aim of establishing whether differences exist in outcome depending on patient age or diagnosis. The Foot and Ankle Score (FAOS) and 36-item Short-Form (SF-36) Health Survey were analysed by diagnosis (osteoarthritis, rheumatoid arthritis, post-traumatic arthritis) and age (under or over 60 years). At 5 years, the post-traumatic arthritis group had a significantly higher composite score than the osteoarthritis (p<0.0001) or rheumatoid arthritis groups (p<0.0001). Only the post-traumatic arthritis group experienced a significant increase in composite SF-36 score from baseline (p<0.0001). There was a significant improvement from pre-operatively to 5 years in all three domains of the FAOS and in total scores in both groups (over 60 p<0.0001; 60 and under p=0.0002). There was a significant improvement in composite SF-36 score from pre-operative to 5 years in the patients 60 years or younger at the time of surgery (p=0.0006), but not for the patients over 60. Three patients have been revised (4%), at a mean of 4.8 years following surgery with one patient awaiting revision.
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Affiliation(s)
- S E Johnson-Lynn
- Department of Orthopaedics, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, England, United Kingdom.
| | - J Ramaskandhan
- Department of Orthopaedics, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, England, United Kingdom
| | - M S Siddique
- Department of Orthopaedics, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, England, United Kingdom
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Abou-Al-Shaar H, Adogwa O, Mehta AI. Lumbar Spinal Stenosis: Objective Measurement Scales and Ambulatory Status. Asian Spine J 2018; 12:765-774. [PMID: 30060388 PMCID: PMC6068421 DOI: 10.31616/asj.2018.12.4.765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is one of the most common affecting the elderly population that may lead to loss of function and the inability to execute basic activities of daily living. While surgical decompression remains the standard of care, choosing an optimal management strategy is usually guided by a set of clinical, radiological, and measurement indices. However, to date, there is a major uncertainty and discrepancy regarding the methodology used. There is also inconsistent adoption of outcome measures across studies, which may result in huge limitations in predicting the efficacy and cost-effectiveness of different treatment paradigms. Herein, we review the various measurement indices used for outcome assessment among patients with LSS, and delineate the major advantages and disadvantages of each index. We call for the development of a single objective outcome measure that encompasses and addresses all issues encountered in this heterogeneous group of patients, including monitoring the patient's progression after treatment.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Neighborhood Disadvantage and Physical Function: The Contributions of Neighborhood-Level Perceptions of Safety From Crime and Walking for Recreation. J Phys Act Health 2018; 15:553-563. [DOI: 10.1123/jpah.2017-0423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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El-Jawahri A, Pidala J, Khera N, Wood WA, Arora M, Carpenter PA, Palmer J, Flowers ME, Jagasia M, Chen YB, Lee SJ. Impact of Psychological Distress on Quality of Life, Functional Status, and Survival in Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 24:2285-2292. [PMID: 30031937 DOI: 10.1016/j.bbmt.2018.07.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/11/2018] [Indexed: 01/12/2023]
Abstract
Data on psychological distress and its association with clinical outcomes in patients with chronic graft-versus-host-disease (GVHD) are lacking. We used data of patients with chronic GVHD (N = 482) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between self-reported depression or anxiety symptoms (measured by the Lee Symptom Scale) and patients' quality of life (QOL; measured by the Functional Assessment of Cancer Therapy-General [FACT-G] and the Physical Component Scale [PCS] of the 36-item Short-Form Health Survey), physical functioning (measured by the Human Activity Profile), functional status (measured by the 2-minute walk test), and overall survival (OS). Overall, 19.3% of patients (93/481) reported being moderately to extremely bothered by depression, and 22.8% (110/482) reported being moderately to extremely bothered by anxiety, with 14.1% (68/482) of those reporting being bothered by both. In multivariable models adjusted for clinical covariates, patients with self-reported depression had worse QOL (FACT-G: β = -23.09, P < .001; PCS: β = -4.94, P < .001), physical functioning (β = -8.31, P < .001), functional status (β = -37.21, P = .025), and lower OS (hazard ratio, 1.62; P = .020) compared with those with no depression symptoms. Patients who reported anxiety also had lower QOL (FACT-G: β = -19.47, P < .001; PCS: β = -3.91, P < .001), physical functioning (β = -6.69, P < .001), and functional status (β = -32.42, P = .036) but no difference in OS. Patients with chronic GVHD who report depression or anxiety symptoms have significantly compromised QOL and physical functioning. Self-reported depression is associated with lower OS. Patients with chronic GVHD and self-reported depression or anxiety represent a highly vulnerable population at risk for poor clinical outcomes and substantial morbidity from their illness.
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Affiliation(s)
- Areej El-Jawahri
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Joseph Pidala
- Department of Hematology-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nandita Khera
- Department of Bone Marrow Transplant Program, Mayo Clinic, Phoenix, Arizona
| | - William A Wood
- Department of Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Mukta Arora
- Department of Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Carpenter
- Department of Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jeanne Palmer
- Department of Hematology and Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Mary E Flowers
- Department of Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Madan Jagasia
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yi-Bin Chen
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Stephanie J Lee
- Department of Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Rampersaud YR. Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial. Arch Phys Med Rehabil 2018; 99:2408-2419.e2. [PMID: 29935152 DOI: 10.1016/j.apmr.2018.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis (LSS). DESIGN Randomized controlled trial. SETTING Academic hospital outpatient clinic. PARTICIPANTS Participants (N=104) with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum walking capacity was 328.7 m. INTERVENTIONS A 6-week structured comprehensive training program or a 6-week self-directed program. MAIN OUTCOME MEASURES Continuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (minimally clinically important difference [MCID]) in the SPWT at 6 months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score, and the Short-Form General Health Survey subscales. RESULTS A total of 48 versus 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment, respectively, received the intervention and 89% of the total study sample completed the study. At 6 months, the adjusted mean difference in walking distance from baseline was 421.0 m (95% confidence interval [95% CI], 181.4-660.6), favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID (adjusted relative risk, 1.3; 95% CI, 1.0-1.7; P=.03). Both primary treatment effects persisted at 12 months favoring the comprehensive program. At 6 months, the ODI walk score and at 12 months the ZCQ, Medical Outcomes Study 36-Item Short-Form Health Survey-physical function and -bodily pain scores showed greater improvements favoring the comprehensive program. CONCLUSIONS A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS.
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Affiliation(s)
- Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology and UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Danielle Southerst
- Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Brian Budgell
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Claire Bombardier
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Department of Orthopedics, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Hagan KA, Harrington LB, Kim J, Zeleznik O, Rimm EB, Grodstein F, Kabrhel C. Reduction in physical function in women after venous thromboembolism. J Thromb Haemost 2018; 16:S1538-7836(22)02216-4. [PMID: 29883039 PMCID: PMC6286689 DOI: 10.1111/jth.14196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Indexed: 11/30/2022]
Abstract
Essentials The association of venous thromboembolism (VTE) with subsequent physical function remains unclear. We prospectively evaluated this relationship among women from the Nurses' Health Studies. We found a decline in physical function over four years in women with incident VTE. This decline was somewhat greater among women specifically reporting a pulmonary embolism. SUMMARY Background Physical function is integral to healthy aging; however, limited research has examined the association of venous thromboembolism(VTE) with subsequent physical function. Objectives To prospectively evaluate the relationship between VTE and decline in physical function among 80 836 women from the Nurses' Health Study(NHS), ages 46-72 in 1992, and 84 304 women from the Nurses' Health Study II(NHS II), ages 29-48 in 1993. Methods Physical function was measured by the Medical Outcomes Short Form-36 physical function scale, administered every 4 years. We compared change in physical function for women with vs. without an incident VTE in each 4-year follow-up period using multivariable linear regression. Results We observed a decline in physical function over 4 years when comparing women with vs. those without incident VTE in both older (NHS) and younger (NHS II) women (multivariable-adjusted mean difference NHS, -6.5 points [95% CI -7.4, -5.6] per 4 years; NHS II, -3.8 [95% CI -5.6, -2.0]). This difference appeared greater among women specifically reporting a pulmonary embolism (NHS, -7.4 [95% CI -8.7, -6.1]; NHS II, -4.8 [95% CI -6.8, -2.8]), and was equivalent to 6.2 years of aging. Whereas longer-term slopes of physical function decline following a VTE were not different from the slopes of decline in women without a VTE, the absolute level of physical function of women with VTE was worse at the end of follow-up compared to women without VTE. Conclusions In this prospective cohort, incident VTE was strongly associated with an acute decline in physical function. These results suggest it may be clinically important to consider approaches to ameliorating functional deficits shortly after VTE diagnosis.
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Affiliation(s)
- Kaitlin A Hagan
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Laura B Harrington
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jihye Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oana Zeleznik
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Clinically Relevant Outcome Measures Following Limb Osseointegration; Systematic Review of the Literature. J Orthop Trauma 2018; 32:e64-e75. [PMID: 29373379 DOI: 10.1097/bot.0000000000001031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The current standard of care for an amputee is a socket-based prostheses. An osseointegrated implant (OI) is an alternative for prosthetic attachment. Osseointegration addresses reported problems related to wearing a socket interface, such as skin issues, discomfort, diminished function, quality of life, prosthetic use, and abandonment. The purpose of this report is to systematically review current literature regarding OI to identify and categorize the reported clinically relevant outcome measures, rate the quality of available evidence, and synthesize the findings. DATA SOURCES A multidisciplinary team used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methods. Search methodology was based on identifying clinically relevant articles. Three databases were searched: PubMed, CINAHL, and Web of Science. STUDY SELECTION Clinical studies with aggregated data reporting at least 1 clinically relevant outcome measure were included. DATA EXTRACTION The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criterion was used for critical appraisal and recommendations. CONCLUSIONS This review identified 21 clinically relevant observational studies. Outcome measures were categorized into the following 9 categories: vibratory stimulation, complications, biomechanics, economics, patient-reported outcome measures, electromyography, x-ray, physical functional performance, and energy consumption. This systematic review consisted of Level III and IV observational studies. Homogeneous outcome measures with strong psychometric properties across prospective studies do not exist to date. Higher-level, prospective, randomized, long-term, clinically relevant trials are needed to prove efficacy of OI compared with socket prosthetic attachment. Osseointegration was at least equivalent to sockets in most studies. In some cases, it was superior. Osseointegration represents a promising alternative to socket prosthetic attachments for extremity amputees. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Armstrong NM, Gitlin LN, Parisi JM, Carlson MC, Rebok GW, Gross AL. E pluribus unum: Harmonization of physical functioning across intervention studies of middle-aged and older adults. PLoS One 2017; 12:e0181746. [PMID: 28753644 PMCID: PMC5533461 DOI: 10.1371/journal.pone.0181746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
Abstract
Common scales for physical functioning are not directly comparable without harmonization techniques, complicating attempts to pool data across studies. Our aim was to provide a standardized metric for physical functioning in adults based on basic and instrumental activities of daily living scaled to NIH PROMIS norms. We provide an item bank to compare the difficulty of various physical functioning activities. We used item response theory methods to place 232 basic and instrumental activities of daily living questions, administered across eight intervention studies of middle-aged and older adults (N = 2,556), on a common metric. We compared the scale’s precision to an average z-score of items and evaluated criterion validity based on objective measures of physical functioning and Fried’s frailty criteria. Model-estimated item thresholds were widely distributed across the range of physical functioning. From test information plots, the lowest precision in each dataset was 0.80. Using power calculations, the sample size needed to detect 25% physical functional decline with 80% power based on the physical functioning factor was less than half of what would be needed using an average z-score. The physical functioning factor correlated in expected directions with objective measurements from the Timed Up and Go task, tandem balance, gait speed, chair stands, grip strength, and frailty status. Item-level harmonization enables direct comparison of physical functioning measures across existing and potentially future studies and across levels of function using a nationally representative metric. We identified key thresholds of physical functioning items in an item bank to facilitate clinical and epidemiologic decision-making.
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Affiliation(s)
- Nicole M Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
| | - Laura N Gitlin
- Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.,Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Jeanine M Parisi
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michelle C Carlson
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George W Rebok
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
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46
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Palumbo AJ, De Roos AJ, Cannuscio C, Robinson L, Mossey J, Weitlauf J, Garcia L, Wallace R, Michael Y. Work Characteristics Associated with Physical Functioning in Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040424. [PMID: 28420131 PMCID: PMC5409625 DOI: 10.3390/ijerph14040424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
Women make up almost half of the labor force with older women becoming a growing segment of the population. Work characteristics influence physical functioning and women are at particular risk for physical limitations. However, little research has explored the effects of work characteristics on women’s physical functioning. U.S. women between the ages of 50 and 79 were enrolled in the Women’s Health Initiative Observational Study between 1993 and 1998. Women provided job titles and years worked at their three longest-held jobs (n = 79,147). Jobs were linked to characteristics in the Occupational Information Network. Three categories of job characteristics related to substantive complexity, physical demand, and social collaboration emerged. The association between job characteristics and physical limitations in later life, measured using a SF-36 Physical Functioning score <25th percentile, was examined using modified Poisson regression. After controlling for confounding variables, high physical demand was positively associated with physical limitations (RR = 1.09 CI: 1.06–1.12) and substantively complex work was negatively associated (RR = 0.94, CI: 0.91–0.96). Jobs requiring complex problem solving, active learning, and critical thinking were associated with better physical functioning. Employers should explore opportunities to reduce strain from physically demanding jobs and incorporate substantively complex tasks into women’s work to improve long-term health.
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Affiliation(s)
- Aimee J Palumbo
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Drexel University, Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Carolyn Cannuscio
- Section on Public Health, Perelman School of Medicine, University of Pennsylvania PA 19104, USA.
| | - Lucy Robinson
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Jana Mossey
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Julie Weitlauf
- Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, CA 95616, USA.
| | - Robert Wallace
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA.
| | - Yvonne Michael
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA 19104, USA.
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Agogo D, Hajjat F, Milne GR, Schewe CD, Perrott B. An empirical examination of subjective age in older adults. Health Mark Q 2017; 34:62-79. [PMID: 28350277 DOI: 10.1080/07359683.2016.1275237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
It has been observed that subjective age (SA) often trails chronological age, especially in older adults. In a previously published article, we argued that differences in individual's SA is a function of their level of activity on biological, mental, and social dimensions. This article empirically tests this proposition using a newly created Subjective Aging Index (SAI). The SAI is related to SA above the effect of age with differences existing across age groups and sex. The findings contribute to the literature on successful aging strategies with important implications for health care practitioners, marketers, and individuals heading towards older adult years.
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Affiliation(s)
- David Agogo
- a Department of Management Science, Isenberg School of Management , University of Massachusetts , Amherst , Massachusetts , USA
| | - Fatima Hajjat
- b Department of Marketing, Isenberg School of Management , University of Massachusetts , Amherst , Massachusetts , USA
| | - George R Milne
- b Department of Marketing, Isenberg School of Management , University of Massachusetts , Amherst , Massachusetts , USA
| | - Charles D Schewe
- b Department of Marketing, Isenberg School of Management , University of Massachusetts , Amherst , Massachusetts , USA
| | - Bruce Perrott
- c Department of Marketing , University of Technology , Sydney , Australia
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Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Penson DF. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA 2017; 317:1126-1140. [PMID: 28324093 PMCID: PMC5782813 DOI: 10.1001/jama.2017.1704] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Understanding the adverse effects of contemporary approaches to localized prostate cancer treatment could inform shared decision making. Objective To compare functional outcomes and adverse effects associated with radical prostatectomy, external beam radiation therapy (EBRT), and active surveillance. Design, Setting, and Participants Prospective, population-based, cohort study involving 2550 men (≤80 years) diagnosed in 2011-2012 with clinical stage cT1-2, localized prostate cancer, with prostate-specific antigen levels less than 50 ng/mL, and enrolled within 6 months of diagnosis. Exposures Treatment with radical prostatectomy, EBRT, or active surveillance was ascertained within 1 year of diagnosis. Main Outcomes and Measures Patient-reported function on the 26-item Expanded Prostate Cancer Index Composite (EPIC) 36 months after enrollment. Higher domain scores (range, 0-100) indicate better function. Minimum clinically important difference was defined as 10 to 12 points for sexual function, 6 for urinary incontinence, 5 for urinary irritative symptoms, 5 for bowel function, and 4 for hormonal function. Results The cohort included 2550 men (mean age, 63.8 years; 74% white, 55% had intermediate- or high-risk disease), of whom 1523 (59.7%) underwent radical prostatectomy, 598 (23.5%) EBRT, and 429 (16.8%) active surveillance. Men in the EBRT group were older (mean age, 68.1 years vs 61.5 years, P < .001) and had worse baseline sexual function (mean score, 52.3 vs 65.2, P < .001) than men in the radical prostatectomy group. At 3 years, the adjusted mean sexual domain score for radical prostatectomy decreased more than for EBRT (mean difference, -11.9 points; 95% CI, -15.1 to -8.7). The decline in sexual domain scores between EBRT and active surveillance was not clinically significant (-4.3 points; 95% CI, -9.2 to 0.7). Radical prostatectomy was associated with worse urinary incontinence than EBRT (-18.0 points; 95% CI, -20.5 to -15.4) and active surveillance (-12.7 points; 95% CI, -16.0 to -9.3) but was associated with better urinary irritative symptoms than active surveillance (5.2 points; 95% CI, 3.2 to 7.2). No clinically significant differences for bowel or hormone function were noted beyond 12 months. No differences in health-related quality of life or disease-specific survival (3 deaths) were noted (99.7%-100%). Conclusions and Relevance In this cohort of men with localized prostate cancer, radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after 3 years and was associated with fewer urinary irritative symptoms than active surveillance; however, no meaningful differences existed in either bowel or hormonal function beyond 12 months or in in other domains of health-related quality-of-life measures. These findings may facilitate counseling regarding the comparative harms of contemporary treatments for prostate cancer.
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Affiliation(s)
- Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Alvarez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark D. Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Dan McCollum
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Matthew R. Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California, Irvine, Irvine, California
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Sherrie H. Kaplan
- Health Policy Research Institute, University of California, Irvine, Irvine, California
| | - Lisa E. Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette M. Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Veterans Administration Health System, Nashville, TN
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Nguyen USDT, Ayers DC, Li W, Harrold LR, Franklin PD. Preoperative Pain and Function: Profiles of Patients Selected for Total Knee Arthroplasty. J Arthroplasty 2016; 31:2402-2407.e2. [PMID: 27259392 PMCID: PMC5069189 DOI: 10.1016/j.arth.2016.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an effective treatment to relieve pain and restore function in patients with advanced knee osteoarthritis. TKA utilization is growing rapidly, and the appropriateness of current TKA use is of great interest. We examined patient-reported preoperative pain and function profiles to understand symptom severity at the time of TKA decision. METHODS Data were from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement. We included patients undergoing primary, unilateral TKAs between 2011 and 2014 for osteoarthritis and had data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Short-Form 36-item Physical Component Summary (PCS) score. We compared patient profiles across groupings by symptoms: (1) little pain and high function (KOOS ≥70, PCS ≥40); (2) little pain but poor function (KOOS ≥70, PCS <40); (3) high pain but high function (KOOS <70, PCS ≥40); and (4) high pain and poor function (KOOS <70, PCS <40). RESULTS Of 6936 patients, 77% had high pain and poor function (group 4), 19% had high pain "or" poor function (groups 2-3), and 5% had little pain and high function before TKA (group 1). In group 1, 86% were constantly aware of their knee problem, 48% reported pain daily yet 5% experienced severe or extreme pain on stairs, and 1% pain in bed. Over half had a lot of limitations in vigorous activities. Compared with group 4, group 1 were older, less obese, more educated, and included more men and people reporting being healthy, less disabled, and happy (P < .05 for all). CONCLUSION Most patients undergoing TKAs had significant pain and/or poor function. Our results provide critical information given the current debate of potentially inappropriate TKA utilization in the United States.
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Affiliation(s)
- Uyen-Sa D T Nguyen
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Wenjun Li
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leslie R Harrold
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Patricia D Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts
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Wu TY, Yu WH, Huang CY, Hou WH, Hsieh CL. Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:332-339. [PMID: 26614307 DOI: 10.1007/s10926-015-9617-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose The purpose of this study was to apply Rasch analysis to examine the unidimensionality and reliability of the General Self-Efficacy Scale (GSE) in workers with traumatic limb injuries. Furthermore, if the items of the GSE fitted the Rasch model's assumptions, we transformed the raw sum ordinal scores of the GSE into Rasch interval scores. Methods A total of 1076 participants completed the GSE at 1 month post injury. Rasch analysis was used to examine the unidimensionality and person reliability of the GSE. The unidimensionality of the GSE was verified by determining whether the items fit the Rasch model's assumptions: (1) item fit indices: infit and outfit mean square (MNSQ) ranged from 0.6 to 1.4; and (2) the eigenvalue of the first factor extracted from principal component analysis (PCA) for residuals was <2. Person reliability was calculated. Results The unidimensionality of the 10-item GSE was supported in terms of good item fit statistics (infit and outfit MNSQ ranging from 0.92 to 1.32) and acceptable eigenvalues (1.6) of the first factor of the PCA, with person reliability = 0.89. Consequently, the raw sum scores of the GSE were transformed into Rasch scores. Conclusions The results indicated that the items of GSE are unidimensional and have acceptable person reliability in workers with traumatic limb injuries. Additionally, the raw sum scores of the GSE can be transformed into Rasch interval scores for prospective users to quantify workers' levels of self-efficacy and to conduct further statistical analyses.
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Affiliation(s)
- Tzu-Yi Wu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wan-Hui Yu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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