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Tran E, Rosenfeld S, Ngan E, Kan JH. Clinical impact of diagnostic image-guided injections for musculoskeletal pain work-up in adolescent and adult patients at a children's hospital: initial results. Skeletal Radiol 2024; 53:1573-1582. [PMID: 38430274 DOI: 10.1007/s00256-024-04635-1] [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: 01/30/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To assess the clinical impact of diagnostic musculoskeletal (MSK) injections on treatment decision-making in adolescent and adult patients at a children's hospital. MATERIALS AND METHODS Retrospective study in patients who underwent diagnostic MSK injections by fluoroscopy or ultrasound (US) between 8/2020 and 3/2023 at a children's hospital. Patients received ropivacaine and triamcinolone acetonide at pain site, reporting quantitative FACES pain score prior to, immediately following, and 2-3 days following injection. Impact on patient care was subsequently assessed. RESULTS A total of 109 diagnostic fluoroscopic or US MSK injection referrals (mean: 17.6 years old) were included, most commonly hip (76.2%), ankle (9.2%), and iliopsoas tendon sheath (8.3%). Pain improvement occurred in 89.0% immediately and 67.9% 2-3 days after MSK injection, with net 84.4% exhibiting improvement based on pain scores and clinical exams. When there was pain improvement at the site of injection, there was a statistically higher incidence of operative intervention or additional therapeutic injections compared with the cohort that did not have symptom improvement (88% versus 35.3%, P < 0.0001). For the 15.6% (N = 17) of referrals that did not have pain improvement, 17.6% (n = 3) ultimately had an operative intervention at a separate site from the diagnostic injection, as an alternative etiology for the pain was found. CONCLUSION Image-guided MSK injections play an important role in the management of musculoskeletal disorders. 84.4% of referrals experienced symptom relief, improving confidence for treatment decision-making. Importantly, 15.6% of patients were found to have an alternative etiology for symptoms, altering management altogether.
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Affiliation(s)
- Evelyn Tran
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Scott Rosenfeld
- Department of Orthopaedic Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Esther Ngan
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - J Herman Kan
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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van Middelkoop M, Schiphof D, Hattle M, Simkins J, Bennell KL, Hinman RS, Allen KD, Knoop J, van Baar ME, Bossen D, Wallis J, Hurley M, Holden MA, Bierma-Zeinstra SMA. People with short symptom duration of knee osteoarthritis benefit more from exercise therapy than people with longer symptom duration: An individual participant data meta-analysis from the OA trial bank. Osteoarthritis Cartilage 2024:S1063-4584(24)01313-X. [PMID: 39032625 DOI: 10.1016/j.joca.2024.07.007] [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: 04/08/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To investigate whether duration of knee symptoms influenced the magnitude of the effect of exercise therapy compared to non-exercise control interventions on pain and physical function in people with knee osteoarthritis (OA). METHOD We undertook an individual participant data (IPD) meta-analysis utilising IPD stored within the OA Trial Bank from randomised controlled trials (RCTs) comparing exercise to non-exercise control interventions among people with knee OA. IPD from RCTs were analysed to determine the treatment effect by considering both study-level and individual-level covariates in the multilevel regression model. To estimate the interaction effect (i.e., treatment x duration of symptoms (dichotomised)), on self-reported pain or physical function (standardised to 0-100 scale), a one-stage multilevel regression model was applied. RESULTS We included IPD from 1767 participants with knee OA from 10 RCTs. Significant interaction effects between the study arm and symptom duration (≤1 year vs >1 year, and ≤2 years vs>2 years) were found for short- (~3 months) (Mean Difference (MD) -3.57, 95%CI -6.76 to -0.38 and -4.12, 95% CI-6.58 to -1.66, respectively) and long-term (~12 months) pain outcomes (MD -8.33, 95%CI -12.51 to -4.15 and -8.00, 95%CI -11.21 to -4.80, respectively), and long-term function outcomes (MD -5.46, 95%CI -9.22 to -1.70 and -4.56 95%CI -7.33 to-1.80, respectively). CONCLUSIONS This IPD meta-analysis demonstrated that people with a relatively short symptom duration benefit more from therapeutic exercise than those with a longer symptom duration. Therefore, there seems to be a window of opportunity to target therapeutic exercise in knee OA.
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Affiliation(s)
- M van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - D Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Hattle
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J Simkins
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - K D Allen
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs Healthcare System, Durham, NC, USA
| | - J Knoop
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science, Musculoskeletal Health, Vrije Universiteit, Amsterdam, the Netherlands; Musculoskeletal Rehabilitation research group, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - M E van Baar
- Association of Dutch Burn Centres (ADBC), Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - D Bossen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, the Netherlands
| | - J Wallis
- School of Public Health and Preventive Medicine, Monash University, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Australia
| | - M Hurley
- Population Health Research Institute, St George's University of London, UK
| | - M A Holden
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Zinno R, van den Akker-Scheek I, Pinelli E, Bragonzoni L, Stevens M. Orthopaedic surgeons' attitude toward physical activity for people after total hip or knee replacement: Northern vs Southern European country. BMC Musculoskelet Disord 2024; 25:371. [PMID: 38730408 PMCID: PMC11088017 DOI: 10.1186/s12891-024-07488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Regular physical activity (PA) is a key factor of lifestyle behavior enhancing general health and fitness, especially in people after total hip or knee replacement (THR and TKR). Orthopaedic surgeons can play a primary role in advocating the benefits of an active lifestyle. Aim of the study was 1) to assess the attitude of orthopaedic surgeons towards PA for people after THR/TKR and 2) to compare the attitude between a Northern European (the Netherlands) and a Southern European (Italy) country and analyze which factors influence the attitude towards PA. METHODS A cross-cultural study. An (online) survey was distributed among orthopaedic surgeons in Italy and the Netherlands. Chi-square and Mann-Whitney tests were used to compare surgeons' and clinics' characteristics, and questionnaires' scores, respectively. A linear regression analysis was conducted to assess which surgeon characteristics influence attitude towards PA. RESULTS A cohort of 159 surgeons (103 Italians and 56 Dutch) was analyzed. The median score of overall orthopaedic surgeons' attitude towards PA was positive (57 out of 72). Dutch surgeons showed a more positive attitude compared to Italian surgeons (p < 0.01). Main difference was found in the "Physical activity concern" factor, where Italian surgeons showed more concern about the negative effects of PA on the survival of the prosthesis. The regression analyses showed that "Country" and "Type of clinic" were associated with the surgeons' attitude. CONCLUSIONS Overall, the orthopaedic surgeons' attitude towards PA for people with THR and TKR was positive. However, Dutch surgeons seem to be more positive compared to the Italian. The country of residence was the item that most influenced attitude. Further investigations are needed to untangle specific factors, such as cultural, socioeconomic, or contextual differences within the variable "country" that may influence orthopaedic surgeons' attitudes towards PA.
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Affiliation(s)
- Raffaele Zinno
- Department for Life Quality Studies, University of Bologna, Via Di Barbiano 1/10, 47921, Rimini, Italy
| | - Inge van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erika Pinelli
- Department for Life Quality Studies, University of Bologna, Via Di Barbiano 1/10, 47921, Rimini, Italy.
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Via Di Barbiano 1/10, 47921, Rimini, Italy
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Arslan IG, van Berkel AC, Damen J, Bindels P, de Wilde M, Bierma-Zeinstra SMA, Schiphof D. Patterns of knee osteoarthritis management in general practice: a retrospective cohort study using electronic health records. BMC PRIMARY CARE 2024; 25:2. [PMID: 38166639 PMCID: PMC10759465 DOI: 10.1186/s12875-023-02198-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study determined patterns of knee osteoarthritis (OA) management by general practitioners (GPs) using routine healthcare data from Dutch general practices from 2011 to 2019. DESIGN A retrospective cohort study was conducted using the Integrated Primary Care Information database between 2011 and 2019. Electronic health records (EHRs) of n = 750 randomly selected knee OA patients (with either codified or narrative diagnosis) were reviewed against eligibility criteria and n = 503 patients were included. Recorded information was extracted on GPs' management from six months before to three years after diagnosis and patterns of management were analysed. RESULTS An X-ray referral was the most widely recorded management modality (63.2%). The next most widely recorded management modalities were a referral to secondary care (56.1%) and medication prescription or advice (48.3%). Records of recommendation of/referral to other primary care practitioners (e.g. physiotherapists) were found in only one third of the patients. Advice to lose weight was least common (1.2%). Records of medication prescriptions or recommendation of/referral to other primary care practitioners were found more frequently in patients with an X-ray referral compared to patients without, while records of secondary care referrals were found less frequently. Records of an X-ray referral were often found in narratively diagnosed knee OA patients before GPs recorded a code for knee OA in their EHR. CONCLUSION These findings emphasize the importance of better implementing non-surgical management of knee OA in general practice and on initiatives for reducing the overuse of X-rays for diagnosing knee OA in general practice.
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Affiliation(s)
- Ilgin G Arslan
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - A C van Berkel
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Damen
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M de Wilde
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - D Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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van Zaanen Y, Siertsema T, Kievit AJ, van Geenen RCI, Pahlplatz TMJ, Hoozemans MJM, Blankevoort L, Schafroth MU, Haverkamp D, Vervest TMJS, Das DHPW, Scholtes VA, Kuijer PPFM. Only Low Patients' Expectations Are Prognostic for Dissatisfaction With Performing Work-Related Knee-Straining Activities After Total Knee Arthroplasty: A Prospective Multicenter Cohort Study. Arch Phys Med Rehabil 2023; 104:2051-2058. [PMID: 37270023 DOI: 10.1016/j.apmr.2023.05.004] [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: 12/27/2022] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate whether preoperative expectations regarding performing work-related knee-straining activities were associated with being dissatisfied 6 months after total knee arthroplasty (TKA) among working patients, and, to identify prognostic factors for being dissatisfied with performing these work-related knee-straining activities. DESIGN Multicenter prospective cohort study. SETTING Orthopedic surgery departments of 7 hospitals in the Netherlands. PARTICIPANTS A consecutive sample of 175 working patients who were on the waiting list for TKA (median age 59 years, 53% women) and intended to return to work (N=175). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Dissatisfaction with performing work-related knee-straining activities 6 months postoperative was measured using the Work Osteoarthritis or joint-Replacement Questionnaire (score range 0-100). The clinically relevant cut-off points for being satisfied and dissatisfied were ≥71 and ≤50, respectively. RESULTS Thirty-three patients (19%) were dissatisfied with performing work-related knee-straining activities 6 months after TKA. Patients who expected to be dissatisfied preoperative had a 5.1 times higher odds (95% CI 1.7-15.5) of being dissatisfied 6 months postoperatively compared with patients who expected to be satisfied preoperative. Regression analyses revealed that only patients' expectations were prognostic for being dissatisfied 6 months postoperatively rather than age, pain level, or having a knee-straining job. CONCLUSIONS Two in 10 working patients are dissatisfied with performing work-related knee-straining activities 6 months after TKA. Only preoperative patients' expectations appeared prognostic. Therefore, we should better prepare working patients with low expectations by managing their preoperative expectations and improving their performance of work-related knee-straining activities in rehabilitation.
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Affiliation(s)
- Yvonne van Zaanen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam, Netherlands.
| | - Tessa Siertsema
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Arthur J Kievit
- Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands
| | | | - Thijs M J Pahlplatz
- Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands
| | - Marco J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Leendert Blankevoort
- Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands
| | - Matthias U Schafroth
- Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands
| | | | - Ton M J S Vervest
- Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, Netherlands
| | - Dirk H P W Das
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, Netherlands
| | | | - P Paul F M Kuijer
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Bouma S, van den Akker-Scheek I, Schiphof D, van der Woude L, Diercks R, Stevens M. Implementing lifestyle-related treatment modalities in osteoarthritis care: Identification of implementation strategies using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool. Musculoskeletal Care 2023; 21:1125-1134. [PMID: 37356082 DOI: 10.1002/msc.1791] [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: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
AIMS Despite recommendations in international clinical guidelines, lifestyle-related treatment modalities (LRTMs) are currently underutilised in the conservative treatment of patients with hip and/or knee osteoarthritis. This study aimed to identify implementation strategies in order to address barriers to implementing LRTMs from the perspective of healthcare professionals (HCPs). METHODS The Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool was applied. First, previously identified influencing factors among primary and secondary HCPs were mapped onto the corresponding CFIR constructs/subconstructs by two researchers. Second, the CFIR-based barriers relevant for all HCPs were entered into the tool. Third, the CFIR-based barriers specific to one or more subgroups of HCPs served as additional input for the tool. Finally, a selection of ERIC implementation strategies was made based on the tool's output. RESULTS Fourteen implementation strategies were selected. The strategy most endorsed by the tool was 'build a coalition'. Eight of the selected strategies belonged to the ERIC cluster 'develop stakeholder interrelationships'. Other strategies were part of the clusters 'use evaluative and iterative strategies' (n = 3), 'utilise financial strategies' (n = 2), and 'engage consumers' (n = 1). CONCLUSIONS The findings emphasise the importance of an interdisciplinary approach when addressing the implementation of LRTMs in osteoarthritis care. The final selection of implementation strategies forms the basis for a tailored implementation plan. Future work should focus on further operationalising the implementation strategies and evaluating the effectiveness of the resulting implementation plan.
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Affiliation(s)
- Sjoukje Bouma
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Lucas van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron Diercks
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Bouma S, Stevens M, van der Woude L, Diercks R, van den Akker-Scheek I. Barriers and facilitators for implementing lifestyle-related treatment modalities in osteoarthritis: A cross-sectional study among primary and secondary healthcare professionals. Health Policy 2023; 136:104898. [PMID: 37657360 DOI: 10.1016/j.healthpol.2023.104898] [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: 03/24/2023] [Revised: 07/05/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE To identify barriers and facilitators as perceived by primary and secondary healthcare professionals (HCPs) when implementing lifestyle-related treatment modalities (LRTMs) in patients with hip/knee osteoarthritis (OA). METHODS A cross-sectional study. A Dutch online survey was distributed among eight different disciplines of primary and secondary HCPs. Potential barriers and facilitators were identified based on participants' responses to 32 research-derived statements on implementing LRTMs, and presented as factors with "major agreement" (≥75%), "minor agreement" (60-75%) or "no agreement" (<60%). RESULTS 213 participants completed the survey. Seven "barriers" and 20 "facilitators" were identified. There were three "major agreement barriers": organization of Dutch healthcare system, audits within organization, and lifestyle climate in Dutch society. The top three "major agreement facilitators" were: health effects on patients, safety of increasing physical activity, and personal attitude. The total number of "barriers" differed per HCP discipline, with the highest number (12) among orthopedic surgeons (or in-training) and the lowest number (4) among dieticians, physiotherapists, and lifestyle counselors. CONCLUSIONS The findings suggest that implementing LRTMs within OA care could be improved by focusing on societal rather than individual HCP factors. National preventive policies on health promotion could counteract the expected increase in healthcare demand and costs due to OA and other chronic diseases. Future research is needed to match relevant implementation strategies to all barriers identified.
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Affiliation(s)
- Sjoukje Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands.
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
| | - Lucas van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
| | - Ron Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
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Pacheco-Brousseau L, Poitras S, Charette M, Amor SB, Desmeules F, Stacey D. Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive descriptive study. J Eval Clin Pract 2023; 29:942-954. [PMID: 37410789 DOI: 10.1111/jep.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
RATIONAL The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. AIMS AND OBJECTIVES Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. METHODS Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi-structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. RESULTS Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy-in fosters programme changes. CONCLUSION Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision-making.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Quebec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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9
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Dell'Isola A, Hellberg C, Turkiewicz A, Appleyard T, Yu D, Thomas G, Peat G, Englund M. Use of non-surgical treatments on the journey to knee replacement in patients with knee osteoarthritis: a 10-year population-based case-control study. RMD Open 2023; 9:e003422. [PMID: 37739449 PMCID: PMC10533805 DOI: 10.1136/rmdopen-2023-003422] [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: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 09/24/2023] Open
Abstract
AIM To investigate temporal trends in primary care visits, physiotherapy visits, dispensed non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in knee osteoarthritis (OA) patients who have and have not undergone knee replacement. METHODS We analysed 5665 OA patients from the Skåne Healthcare Register, Sweden, who underwent knee replacement between 2015 and 2019. Controls were OA patients without knee replacement, matched 1:1 by sex, age, time and healthcare level of initial OA diagnosis, and assigned a pseudo-index date corresponding to their case's knee replacement date. Annual prevalence and prevalence ratio of primary care and physiotherapy visits, dispensed NSAIDs and opioids (all for any cause) in the 10 years before knee replacement were estimated using Poisson regression. RESULTS The annual prevalence of all-cause primary care visits, physiotherapy visits and opioid use was similar between cases and controls until 3 years before the index date when it started to increase among the cases. The year before the index date, the prevalence ratio (cases vs controls) for physiotherapy use was 1.8 (95% CI 1.7, 1.8), while for opioid use 1.6 (1.5, 1.7). NSAID use was consistently higher among cases, even 10 years before the index date when the prevalence ratio versus controls was 1.3 (1.2, 1.3), increasing to 1.8 (1.7, 1.9) in the year preceding the index date. CONCLUSIONS Management of OA patients who have and have not undergone knee replacement appears largely similar except for higher use of NSAIDs in knee replacement cases. Symptomatic treatments start to increase a few years before the surgery in knee replacement cases.
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Affiliation(s)
- Andrea Dell'Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Clara Hellberg
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Tom Appleyard
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Newcastle, UK
| | - Geraint Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Martin Englund
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
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Grenier JP, Rothmund M, Missmann M. Variation in the utilisation of physiotherapy in patients with advanced knee osteoarthritis prior to total knee arthroplasty a systematic review. Musculoskeletal Care 2023; 21:338-354. [PMID: 36539952 DOI: 10.1002/msc.1726] [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] [Received: 12/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Due to demographic changes and increasing knee osteoarthritis (KOA) prevalence, the incidence of total knee arthroplasties (TKA) is constantly rising. Clinical practice guidelines for the treatment of KOA unanimously recommend non-surgical interventions such as exercise, education, and weight reduction in overweight patients. The aim of this systematic review is to determine the proportion of patients with end-stage KOA who attended physiotherapy (PT) prior to TKA. METHODS A systematic literature search was carried out in the medical databases MEDLINE (via Pubmed), PEDro, and EBSCO in August of 2022. Studies were included regardless of their design, if they reported the proportion of patients with a diagnosis of primary KOA, who participated in PT prior to undergoing TKA. Study quality assessment was performed by two independent authors using the Joanna Briggs Institutes Checklist for studies reporting prevalence data. Results were presented by using a narrative synthesis. RESULTS Eighteen studies, comprising 579,718 patients, were identified in this systematic review. PT utilisation prior to TKA ranged from 10% to 73% for patients with advanced KOA. Only two studies showed PT utilisation rates of 60% or higher. Female gender, higher income, better socioeconomic status, higher education levels, older age were associated with PT utilisation. Data for other predicting factors was conflicting. DISCUSSION This review shows substantial variation in the utilisation of PT in patients with end-stage KOA. This is concerning, considering the uniform recommendation from clinical practice guidelines for non-surgical treatments like exercise and education in patients with KOA, which are mostly provided by physiotherapists.
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Affiliation(s)
- Jean-Pascal Grenier
- Department for Health Sciences, University for Continuing Education Krems, Krems, Austria
- Department of Physiotherapy, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Maria Rothmund
- University Clinic for Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Martin Missmann
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Austrian Workers' Compensation Board AUVA, Innsbruck, Austria
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van der Wilk S, Hoorntje A, Blankevoort L, van Geenen R, Kerkhoffs GMMJ, Kuijer PPFM. Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE. BMC Musculoskelet Disord 2023; 24:368. [PMID: 37161424 PMCID: PMC10170708 DOI: 10.1186/s12891-023-06458-y] [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: 10/14/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The number of primary knee arthroplasties (KAs) performed annually is rising, especially among active, working age patients. Consequently, revision KA is also increasingly performed. Our aim was to systematically review the extent to which patients were physically active following revision KA, and the rate and timing of return to sport and work. METHODS A search was conducted in the databases Medline and Embase until February 24th, 2023. Studies describing patients with revision total knee arthroplasty (rTKA) or revision unicondylar knee arthroplasty (rUKA), with outcomes regarding physical activity or return to sport (RTS) or work (RTW) were included. Quality of studies was assessed using the Newcastle-Ottawa scale, meta-analyses were performed using RevMan 5.4 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS Of the 4,314 articles screened, 22 studies were included describing 2,462 rTKA patients (no rUKA), 42% were male with a mean age of 67 years (range 24 - 95). No studies reported objective physical activity measurements. Twenty-two studies reported patient reported outcome measures (PROMs). The PROMs that were pooled on a scale from zero to ten were the UCLA Activity Score, the Tegner Activity Level Scale, the Lower-Extremity Activity Scale, Devane Activity Score, and physical activity related subscales of the Knee injury and Osteoarthritis Outcome Score. The retrospective studies of moderate quality showed a statistically significant postoperative improvement of 1.7 points (MD = 1.71, 95% CI 1.48 - 1.94 (p < 0.0001); 14 studies, n = 1,211). For the prospective moderate-quality studies, a statistically significant postoperative increase of 0.9 points was found (MD = 0.89, 95% CI 0.48 - 1.30 (p < 0.0001); 6 studies, n = 1,027). Regarding RTS, 12% of patients participated in so-called 'non-recommended' activities (i.e., hockey, soccer, football, gymnastics, jogging, singles tennis, and basketball) after rTKA (1 study, n = 206). The pooled RTW was 86% (2 studies, range 18-95%, n = 234). CONCLUSIONS The majority of patients self-reported an improved postoperative activity level after rTKA. Patients could maintain an active lifestyle in daily life, including sports and work. For reliable physical activity, RTS and RTW estimations, more studies are required. In terms of GRADE, the quality of evidence for the five prospective studies was rated as low. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Sten van der Wilk
- Department of Orthopaedic Surgery & Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Alexander Hoorntje
- Department of Orthopaedic Surgery & Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery & Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rutger van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery & Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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What Personal and Work-Related Characteristics of Dutch Construction Workers With Knee Osteoarthritis Are Associated With Future Work Ability? J Occup Environ Med 2023; 65:271-276. [PMID: 36240753 PMCID: PMC9988233 DOI: 10.1097/jom.0000000000002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess personal and work-related characteristics of construction workers with knee osteoarthritis (KO) associated with their ability to perform their current profession in the following 2 years. METHODS A cross-sectional study was performed among Dutch construction workers diagnosed with KO using data from the Worker Health Surveillance. Logistic regression was used to assess the characteristics associated with future work ability. RESULTS On the basis of 344 construction workers with KO, being able to perform their current profession in 2 years' time was associated with working weekly 36 to 45 hours (odds ratio [OR], 3.0 to 6.3), performing high-intensity exercises 1 to 2 times weekly (OR, 2.0 to 2.6), being younger than 56 years (OR, 0.2 to 0.3), and not performing strenuous work activities such as lifting and kneeling (OR, 0.4 to 0.5). CONCLUSIONS To keep construction workers with KO at work, intervention studies should evaluate the effects of reducing strenuous work activities and promote leisure-time exercise.
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Manansala C, Ferbers S, Johnson M, Passmore S. Factors associated with non-pharmacological, non-operative treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian Spine Outcomes Research Network (CSORN) study. Musculoskelet Sci Pract 2023; 63:102695. [PMID: 36473826 DOI: 10.1016/j.msksp.2022.102695] [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: 07/14/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment. OBJECTIVES This study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population. DESIGN Retrospective cohort design. METHODS Canadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement. RESULTS A total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61-90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0-10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4-9.2, p = .010; 3) body mass index (BMI) score 25-29.9 (OR 6.7, 95% CI 2.2-20.9, p < .001) and BMI ≥ 30 (OR 4.2, 95% CI 1.4-12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0-5.6, p = .039. CONCLUSIONS In total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.
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Affiliation(s)
- Christian Manansala
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - Spencer Ferbers
- Max Rady College of Medicine, University of Manitoba, 260 Brodie Centre - 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Michael Johnson
- Departments of Orthopedics and Neurosurgery, AD401 - 820 Sherbrook Street, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Steven Passmore
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada
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Singh JA. Making the current non-surgical treatments for knee osteoarthritis more effective: Solutions from a diverse patient group. Joint Bone Spine 2023; 90:105535. [PMID: 36706945 DOI: 10.1016/j.jbspin.2023.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine patient perceived solutions to barriers to effective non-surgical knee osteoarthritis (OA) treatments in a diverse racial/ethnic group. METHODS Nominal groups were conducted with consecutive patients with knee OA at a medical center clinic, oversampling for African Americans with knee OA. Participants discussed potential solutions and rank-ordered their concerns. RESULTS Thirteen nominal groups with 46 knee OA patients were conducted with mean age, 60.8 years (standard deviation [sd], 10.0) and knee OA duration, 8.1 years (sd, 5.4); 22% were men, and 56% were African American. The following solutions were in the top three ranked solutions in 13 NGTs: (A) more research, effective and/or safer new medications/treatments, and joint cartilage restoration (8 groups; 15% votes [43/276]); (B) early diagnosis (2 groups; 7% votes [20/276]); (C) better and more effective communication (5 groups; 10% votes [29/276]); (D) public and patient education (4 groups; 8% votes [22/276]); (E) motivation and behavioral modification (4 groups; 9% votes [26/276]); (F) team approach (1 group; 1% votes [2/276]); (G) personalized medicine (6 groups; 8% votes [24/276]); (H) cheaper and more affordable medications and treatments (3 groups; 5% votes [15/276]). CONCLUSIONS A diverse group of participants with knee OA identified several solutions to barriers to the effectiveness of current knee OA treatments. This new knowledge can inform the development and implementation of future interventions to improve the outcomes of people with knee OA.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA.
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Satisfaction with Medications Prescribed for Osteoarthritis: A Cross-Sectional Survey of Patients and Their Physicians in the United States. Pain Ther 2022; 11:191-208. [PMID: 35028917 PMCID: PMC8861239 DOI: 10.1007/s40122-021-00350-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Satisfaction with medications prescribed for osteoarthritis (OA) varies; this study aimed to determine the factors associated with satisfaction in US patients and their physicians. Methods This point-in-time study used the Adelphi OA Disease Specific Programme (physicians identified from public lists reported on nine consecutive patients diagnosed with OA [any joint]: physicians and patients completed questionnaires). Patient’s demographic, clinical, and treatment characteristics associated with patient-reported and physician-rated overall satisfaction with, and expectations of effectiveness of, medication for OA were assessed using multivariate linear regression. Results Responses from 572 patients (mean age 64.9 years, 60.5% female) currently prescribed medication for OA and 153 physicians (81 primary care, 35 rheumatologists, 37 orthopedic surgeons) were analyzed. Pain intensity was moderate or severe for 59.4% of patients. Greater patient-reported overall satisfaction with medication was significantly associated with (standardized beta, 95% confidence interval) exercise (0.12, 0.03–0.20), comorbid other musculoskeletal or painful conditions (vs none) (0.15, 0.06–0.24), and physicians’ report that the best control had been achieved (0.12, 0.03–0.20); lack of efficacy was among factors associated with worse satisfaction. Greater patient-reported expectation of effectiveness was significantly associated with exercise (0.12, 0.03–0.21) and the most troublesome joint not being a knee, hip, or their back (0.08, 0.01–0.14). Greater physician-rated overall satisfaction with medication was significantly associated with their report that the best control had been achieved (0.18, 0.11–0.26), the most troublesome joint being a knee (0.08, 0.01–0.14), comorbid other musculoskeletal or painful conditions (0.07, 0.01–0.12), obesity (0.06, 0.00–0.11), and female patients (0.06, 0.00–0.11); lack of efficacy and adverse events/tolerability issues were among factors associated with worse satisfaction. For physicians, their report that the best control had been achieved (0.19, 0.11–0.27), the most troublesome joint being a knee (0.08, 0.00–0.15), improving (vs stable) OA (0.15, 0.07–0.24), and uncertain duration of OA (0.11, 0.02–0.21) were associated with greater perception that the medication was meeting patients’ efficacy expectations. Conclusion Although efficacy was strongly associated with both patients’ and physicians’ satisfaction with medication, other factors were also important, including exercise (for patients), tolerability (for physicians), and knee OA (for physicians). Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00350-0.
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Holm J, Frumento P, Almondo G, Gémes K, Bottai M, Alexanderson K, Friberg E, Farrants K. Predicting the duration of sickness absence due to knee osteoarthritis: a prognostic model developed in a population-based cohort in Sweden. BMC Musculoskelet Disord 2021; 22:603. [PMID: 34215239 PMCID: PMC8254363 DOI: 10.1186/s12891-021-04400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background Predicting the duration of sickness absence (SA) among sickness absent patients is a task many sickness certifying physicians as well as social insurance officers struggle with. Our aim was to develop a prediction model for prognosticating the duration of SA due to knee osteoarthritis. Methods A population-based prospective study of SA spells was conducted using comprehensive microdata linked from five Swedish nationwide registers. All 12,098 new SA spells > 14 days due to knee osteoarthritis in 1/1 2010 through 30/6 2012 were included for individuals 18–64 years. The data was split into a development dataset (70 %, nspells =8468) and a validation data set (nspells =3690) for internal validation. Piecewise-constant hazards regression was performed to prognosticate the duration of SA (overall duration and duration > 90, >180, or > 365 days). Possible predictors were selected based on the log-likelihood loss when excluding them from the model. Results Of all SA spells, 53 % were > 90 days and 3 % >365 days. Factors included in the final model were age, sex, geographical region, extent of sickness absence, previous sickness absence, history of specialized outpatient healthcare and/or inpatient healthcare, employment status, and educational level. The model was well calibrated. Overall, discrimination was poor (c = 0.53, 95 % confidence interval (CI) 0.52–0.54). For predicting SA > 90 days, discrimination as measured by AUC was 0.63 (95 % CI 0.61–0.65), for > 180 days, 0.69 (95 % CI 0.65–0.71), and for SA > 365 days, AUC was 0.75 (95 % CI 0.72–0.78). Conclusion It was possible to predict patients at risk of long-term SA (> 180 days) with acceptable precision. However, the prediction of duration of SA spells due to knee osteoarthritis has room for improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04400-8.
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Affiliation(s)
- Johanna Holm
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Via F. Serafini 3, 56126, Pisa, Italy
| | - Gino Almondo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Katalin Gémes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristin Farrants
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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