1
|
Silva CFO, Obara K, Paixão L, Santos EH, Santos AIZ, Cardoso JR. Use of posturography in patients with ankylosing spondylitis: A systematic review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1953. [PMID: 38841593 PMCID: PMC11151370 DOI: 10.4102/sajp.v80i1.1953] [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: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 06/07/2024] Open
Abstract
Background Ankylosing spondylitis (AS) is characterised as a chronic inflammatory disease of the axial skeleton. The force platform is an option for performing the postural assessment of these individuals. Objectives To review and evaluate the behaviour of the centre of pressure (CoP) variables during the postural control examination in patients with AS compared to a control group. Method A systematic review, registered in PROSPERO, that followed the PRISMA Statement. A search was carried out in the following databases: Medline, Web of Science, Embase, Scopus, and Scielo, from 1945 to 2023. Studies were selected that aimed to understand the use of the force platform for the assessment of postural control. The risk of bias assessment was performed using the AXIS tool. Results Five studies were included, with a total of 247 participants. The assessment of risk of bias presented high scores in the AXIS tool. Patients with a diagnosis of AS presented increased thoracic kyphosis in most of the studies, as well as large displacements in the anteroposterior (AP) and mediolateral (ML) directions, and altered total mean velocity (TMV) and frequency, indicating worse postural stability. Regarding the functional status, the most used questionnaires were the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Disease Activity Index (BASDAI). Conclusion Patients with ankylosing spondylitis present postural instability, verified by means of higher values of centre of posture variables. Clinical implications Individuals with ankylosing spondylitis presented postural instability and balance deficit. Therefore, exercises for balance training and postural control are essential in the clinical management of these patients.
Collapse
Affiliation(s)
- Caroline F O Silva
- Department of Physical Therapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Luana Paixão
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Eduarda H Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Amanda I Z Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Jefferson R Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| |
Collapse
|
2
|
Hofstetter L, Mikhail J, Lalji R, Kurmann A, Rabold L, Côté P, Tricco AC, Pagé I, Hincapié CA. Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review. J Clin Epidemiol 2024; 165:111217. [PMID: 37952699 DOI: 10.1016/j.jclinepi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Effective measurement and monitoring of health status in patients with spine-related musculoskeletal (MSK) disorders are essential for providing appropriate care and improving outcomes. Minimal clinical datasets are standardized sets of key data elements and patient-centered outcomes that can be measured and recorded during routine clinical care. Our scoping review aimed to identify and map current evidence on minimal clinical datasets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. STUDY DESIGN AND SETTING We followed the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations and Theses Global, and medRxiv preprint repository were searched from database inception to August 1, 2021. Two reviewers independently screened titles and abstracts, full-text articles, and charted the evidence. Findings were synthesized and summarized descriptively. RESULTS After screening 5,583 citations and 301 full-text articles, 104 studies about 32 individual minimal clinical datasets were included. Most minimal clinical datasets were developed for patient populations with spine-involving inflammatory arthritis, nonspecific or degenerative spinal pain, and MSK disorders in general. The minimal clinical datasets varied substantially in terms of the author-reported time-to-complete (1-48 minutes) and the number of items (5-100 items). Fifty percent of the datasets involved healthcare professionals in their development process, and only 28% involved patients. Health domain items were most frequently linked to the components of activities and participation (43.9%) and body functions (28.6%), according to the International Classification of Functioning, Disability, and Health. There is no standardized definition of minimal clinical datasets to measure and monitor health status of patients with spine-related MSK disorders in routine clinical practice. Common core elements identified were practicality, feasibility in a busy routine practice, time efficiency, and the capability to be used across different healthcare settings. CONCLUSION Due to the absence of a standard definition for minimal clinical datasets for patients with spine-related MSK disorders, there is a lack of consistency in the selection of key data elements and patient-centered outcomes that should be included. More research on the implementation and feasibility of minimal clinical datasets in routine care settings is warranted and needed. It is essential to involve all relevant partners in the development process of minimal clinical datasets to ensure successful implementation and adoption in routine primary care.
Collapse
Affiliation(s)
- Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Astrid Kurmann
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Lorene Rabold
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrea C Tricco
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) - Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
3
|
El Miedany Y, El Gaafary M, Toth M, Palmer D, Ali A, Bahlas S, Mahran S, Hassan W, Abu-Zaid MH, Saber S, Elwakil W. Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure. Semin Arthritis Rheum 2023; 63:152285. [PMID: 37944298 DOI: 10.1016/j.semarthrit.2023.152285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA. OBJECTIVES To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA). METHODS The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. RESULTS A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy. CONCLUSIONS The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.
Collapse
Affiliation(s)
- Y El Miedany
- Professor Canterbury Christ Church University, England; H. Senior Clinical Lecturer, King's College London, England.
| | - M El Gaafary
- Professor Community and Public Health, Ain Shams University, Cairo, Egypt
| | - M Toth
- H. Senior Clinical Lecturer, King's College London, England; Darent Valley Hospital, Kent, England
| | - D Palmer
- North Middlesex University Hospital, London, England
| | - Ayman Ali
- Darent Valley Hospital, Kent, England
| | - S Bahlas
- Professor of Internal Medicine/Rheumatology, College of Medicine, King Abdulaziz University, Saudi Arabia
| | - S Mahran
- Professor Rheumatology, Physical Medicine and Rehabilitation, Assiut University, Egypt
| | - W Hassan
- Professor Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - M H Abu-Zaid
- Assistant Professor Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | - S Saber
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - W Elwakil
- Lectuer Rheumatology and Rehabilitation, Alexandria University, Alexanrdia, Egypt
| |
Collapse
|
4
|
Lim GRS, Ng CH, Kwan YH, Fong W. Prevalence and risk factors for falls in patients with spondyloarthritis: A systematic review. Int J Rheum Dis 2021; 24:623-632. [PMID: 33704897 DOI: 10.1111/1756-185x.14092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no published reviews that study falls in patients with SpA. Therefore, we aim to systematically review the literature and identify the prevalence and risk factors of falls in patients with SpA. METHODS We conducted a systematic review using 5 electronic databases: PubMed, EMBASE, Scopus, Web of Science and Google Scholar using controlled vocabulary terms (eg MeSH terms) in the search strategy for the concepts: falls, fall risk, SpA and its subtypes. RESULTS We identified 7279 articles, of which 3 studies with a total of 441 patients were included. Prevalence of falls ranged from 13% to 25%. We identified 16 main factors across 5 categories. Under socio-demographic factors, functional limitation, decreased quality of life, advanced age and job loss were associated with an increased risk of falls. Poor balance and mobility and fear of falling were associated with increased risk of falls. Active disease and symptoms of SpA were medical factors that were associated with increased risk of falls. Medication factors including polypharmacy, myorelaxants and antidepressants were not associated with increased fall risk. CONCLUSION We identified potentially modifiable risk factors associated with increased risk of falls in patients with SpA, including functional limitation, poor balance and mobility, fear of falling and active disease. Clinicians should recognize these factors and address them in the holistic management of patients with SpA, thereby reducing falls and their complications.
Collapse
Affiliation(s)
- Grace Rui Si Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Caitlin Hsuen Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Sciences and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
| |
Collapse
|
6
|
Palmer D, El Miedany Y. Tackling comorbidity associated with rheumatic diseases in standard practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:380-387. [PMID: 28410044 DOI: 10.12968/bjon.2017.26.7.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In spite of the dramatic improvement of the long-term prognosis of inflammatory arthritic conditions, patients living with arthritis remain more likely to have a shorter lifespan in contrast to the age-matched population without arthritis. This high incidence of morbidity-mortality has been attributed to an increased prevalence of comorbidities, particularly cardiovascular disease, infections, and the development of malignant space-occupying lesions. In spite of the published guidelines highlighting the importance of comorbidity assessment and management, implementing these recommendations in standard clinical practice remains a challenge for the treating rheumatologists and rheumatology nurse specialists. This article will review the challenge of comorbidity in inflammatory arthritic conditions and its dynamic nature, the impact on patient management, as well as recent trends in the screening and assessment of comorbidity risk in standard clinical practice.
Collapse
Affiliation(s)
- Deborah Palmer
- Advanced Nurse Practitioner, North Middlesex University Hospital, London
| | | |
Collapse
|
7
|
Fam MD, Zeineddine HA, Nassir RM, Bhatt P, Kamel MH. Patient-reported outcome following nonsurgical management of type II odontoid process fractures in adults. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:64-69. [PMID: 28250639 PMCID: PMC5324363 DOI: 10.4103/0974-8237.199871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Transverse (type II) odontoid process fracture is among the most commonly encountered cervical spine fractures. Nonsurgical management through external immobilization is occasionally preferred to surgical management but is criticized for its higher rates of failure and lower patient satisfaction. Our aim is to analyze patient-reported outcomes in patients who underwent nonsurgical treatment for type II odontoid fractures. Methods: We identified patients >18-year-old who underwent external immobilization as a treatment for isolated type II odontoid fracture between 2007 and 2012. We collected demographic parameters, clinical presentation, mode of injury, imaging studies and modality and duration of treatment (soft collar, halo-vest, or both). Patients were contacted by telephone to participate in a 15-min survey addressing their recovery including their subjective rate of return to preinjury level of functioning. Results: Fifteen patients met the inclusion/exclusion criteria and participated in our survey. Patients were followed up for an average of 19 months after injury. Overall mean age was 61 years. Injury followed a mechanical fall or a road traffic accident in 11 and 4 cases, respectively. External immobilization was achieved by halo vest only in nine patients, soft collar only in two patients (13%), and through a sequential combination in the remaining 4 (27%). This was deployed for a mean of 7.8 months. Radiological studies at the last follow-up showed bony healing (27%), fibrous nonunion (60%), and persistent instability (13%). Patients reported gradual recovery of function throughout the 1st year after injury with levels above 70% of preinjury functioning achieved by 13% of patients at 6 months, 33% at 9 months, and 47% at 12 months. Overall satisfaction with nonsurgical management was 68%. Conclusion: In selected patients with type II odontoid fractures, external immobilization represents a good option with acceptable course of recovery.
Collapse
Affiliation(s)
- Maged D Fam
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa, USA
| | - Hussein A Zeineddine
- Department of Surgery, Section of Neurosurgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | | | - Pragnesh Bhatt
- Department of Neurosurgery, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, Scotland, UK
| | - Mahmoud H Kamel
- Department of Neurosurgery, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, Scotland, UK
| |
Collapse
|
8
|
El Miedany Y, El Gaafary M, Youssef S, Ahmed I, Nasr A. Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage. Clin Rheumatol 2014; 34:307-13. [PMID: 24794490 DOI: 10.1007/s10067-014-2630-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/06/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
This study aims to identify the clinical predictors of arthritis in patients with psoriasis and to evaluate the use of musculoskeletal ultrasonography (US) as a predictor for inflammatory structural progression in psoriatic patients. Measures of association (odds ratio (OR)) were tested, in a prospective, cohort 1-year follow-up study, between structural deterioration and the presence of baseline inflammation, or its persistence. One hundred twenty-six psoriatic patients were prospectively evaluated both clinically and by US at 0, 6, and 12 months for synovitis/ joint damage, enthesitis, and onychopathy. X-ray was performed at 0 and 12 months. One hundred twelve sex and age-matched pasoriatic patients without histories of musculoskeletal symptoms were included as control group. Structural deterioration was observed in 47% of the 5,292 evaluated joints. Clinical variables associated with arthritis risk: BMI > 25 (OR = 1.7), body surface area (OR = 1.13), family history (OR = 5.72) and nail involvement (OR = 2.25). BMI > 30 was significantly correlated (P < 0.01) with shorter time for the onset of arthritis. Baseline synovial score/PD score ≥ 2 was associated with increased risk of structural progression: OR = 1.98 versus 2.61 versus 2.66 (P < 0.001) for the clinical versus US-gray scale (GS) versus US-power Doppler (PD) evaluation, respectively. An increased probability for structural progression in the presence of enthesitis was observed (OR = 2.79 and 3.50) for both US-GS and US-PD, whereas OR was 2.46 for clinical examination. Onychopathy was associated with structural joint damage (OR = 2.30). In multivariate logistic regression analysis, persistent of synovitis/enthesitis at 6 months of therapy was predictive of subsequent structural progression. Family history of psoriatic arthritis, large BMI (>25), high percentage of psoriatic body surface area, and nail involvement were significantly associated with early onset psoriatic arthritis. Baseline GS score of ≥2, PD score of ≥2, presence of enthesitis, enhanced vascularity at enthesitis, higher GUESS score, and onychopathy, all at base line as well as persistent synovitis and enthesitis at 6 months are predictors of progressive early psoriatic arthritis. Regular ultrasonographic monitoring of these patients is mandatory to assess the progression of their arthritis status.
Collapse
|
9
|
Abstract
Early diagnosis and initiation of therapy has become a primary objective in clinical rheumatology. As psoriatic arthritis causes deformities and joint damage leading to impaired quality of life and function as well as increased mortality risk, there was an urgent call for action aiming at inducing remission of the active inflammatory process. Until the year 2000 there were no treatments that led to a reduction in progression of joint damage. However, with the advent of anti-tumour necrosis factor agents, it is now possible to arrest the progression of damage in these patients. Therefore, the concept of window of opportunity, that is early assessment and management in specialist clinics, has been extended to psoriatic arthritis with successful outcomes among psoriatic arthritis patients similar to those with rheumatoid arthritis. Although all this sounds plausible, early psoriatic arthritis assessment remains limited to research as setting up this type of service in standard clinical practice faces several challenges that would need tackling. The objective of this article is to provide an overview of these challenges and suggest a paradigm for use in standard clinical practice to identify early psoriatic arthritis patients.
Collapse
Affiliation(s)
- Deborah Palmer
- Clinical Nurse Specialist at Rheumatology Department, North Middlesex University Hospital, London
| | | |
Collapse
|