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Lannon M, Duda T, Mastrolonardo A, Huang E, Martyniuk A, Farrokhyar F, Xie F, Bhandari M, Kalia SK, Sharma S. Economic Evaluations Comparing Deep Brain Stimulation to Best Medical Therapy for Movement Disorders: A Meta-Analysis. PHARMACOECONOMICS 2024; 42:41-68. [PMID: 37751075 DOI: 10.1007/s40273-023-01318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Movement disorders (Parkinson's disease, essential tremor, primary dystonia) are a debilitating group of conditions that are progressive in nature. The mainstay of treatment is best medical therapy; however, a number of surgical therapies are available, including deep brain stimulation. Economic evaluations are an important aspect of evidence to inform decision makers regarding funding allocated to these therapies. OBJECTIVE This systematic review and meta-analysis evaluated the cost effectiveness of including deep brain stimulation compared with best medical therapy for movement disorder indications in the adult population. METHODS Ovid Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Central Register of Controlled Trials were queried. Only economic evaluations reporting incremental cost-effectiveness ratios for including deep brain stimulation versus best medical therapy for movement disorders were included. Studies were reviewed in duplicate for inclusion and data abstraction. Data were harmonized using the Consumer Price Index and Purchasing Power Parity to standardize values to 2022 US dollars. For inclusion in meta-analyses, studies were required to have sufficient data available to calculate an estimate of the incremental net benefit. Meta-analyses of pooled incremental net benefit based on the time horizon were performed. The study was registered at PROSPERO (CRD42022335436). RESULTS There were 2190 studies reviewed, with 14 economic evaluations included following a title/abstract and full-text review. Only studies considering Parkinson's disease were available for the meta-analysis. Quality of the identified studies was low, with moderate transferability to the American Healthcare System, and certainty of evidence was low. However, studies with a longer time horizon (15 years to lifetime) were found to have significant positive incremental net benefit (indicating cost effectiveness) for including deep brain stimulation with a mean difference of US$40,504.81 (95% confidence interval 2422.42-78,587.19). CONCLUSIONS Deep brain stimulation was cost effective for Parkinson's disease when considered over the course of the patient's remaining life after implantation. TRIAL REGISTRATION Clinical Trial Registration: PROSPERO (CRD42022335436).
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Affiliation(s)
- Melissa Lannon
- Division of Neurosurgery, McMaster University, 237 Barton Street East, Hamilton, ON, Canada.
| | - Taylor Duda
- Division of Neurosurgery, McMaster University, 237 Barton Street East, Hamilton, ON, Canada
| | | | - Ellissa Huang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Amanda Martyniuk
- Division of Neurosurgery, McMaster University, 237 Barton Street East, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Department of Health, Evidence, Impact, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health, Evidence, Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Health, Evidence, Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, 237 Barton Street East, Hamilton, ON, Canada
- Department of Health, Evidence, Impact, McMaster University, Hamilton, ON, Canada
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Reyes-Ortiz CA, Pacheco S, Slovacek CA, Jiang M, Salinas-Fernandez IC, Ocampo-Chaparro JM. Medical falls among older adults in Latin American cities. Rev Salud Publica (Bogota) 2023; 22:527-532. [PMID: 36753221 DOI: 10.15446/rsap.v22n5.84883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/30/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors for falls requiring medical attention, referred as medical falls, in community-dwelling persons aged >60 years. Methods A cross-sectional analysis was conducted using information from the Health, Well-Being, and Aging ("SABE") Study in Latin America and the Caribbean (7 cities), as well as from the SABE Bogota study (pooled sample of 8 cities n=12,487). Falls that occurred during a past 12-month period were considered and then noted if required medical treatment because of the fall. RESULTS The weighted prevalence of medical falls across the eight surveys ranged from 6.0% to 11.3%. In weighted multivariate logistic regression analyses, potentially modifiable risk factors for medical falls include urinary incontinence (OR=1.51 95% CI 1.18-1.92), high depressive symptomatology (OR=1.53 95% CI 1.24-1.91), poor self-rated health (OR=1.35 95% CI 1.10-1.66) and activities of daily living limitations (OR=1.48 95% CI 1.16-1.87). CONCLUSIONS Based on our results, preventive measures targeting these risk factors may help to decrease the risk for medical falls among older adults in Latin America.
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Affiliation(s)
- Carlos A Reyes-Ortiz
- CR: MD. Ph. D. Associate Professor and Researcher. Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences. Florida A&M University, Tallahassee. Florida, USA.
| | - Soraira Pacheco
- SP: MD. Assistant Professor in Geriatric and Palliative Medicine. Division of Geriatric and Palliative Medicine. McGovern Medical School, Houston. Texas, USA.
| | - Cedar A Slovacek
- CS: MD. Physician. McGovern Medical School, Houston. Texas, USA.
| | - Meng Jiang
- MJ: Gerontological Nurse Practitioner. Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston. Texas, USA.
| | | | - Jose M Ocampo-Chaparro
- JO: MD. M. Sc. Associate Professor and Researcher. Department of Internal Medicine, Universidad Libre. Department of Family Medicine, Universidad del Valle. Cali, Colombia.
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Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults. J Clin Med 2023; 12:jcm12020450. [PMID: 36675379 PMCID: PMC9864613 DOI: 10.3390/jcm12020450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively.
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Grabowska W, Burton W, Kowalski MH, Vining R, Long CR, Lisi A, Hausdorff JM, Manor B, Muñoz-Vergara D, Wayne PM. A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research. BMC Musculoskelet Disord 2022; 23:844. [PMID: 36064383 PMCID: PMC9442928 DOI: 10.1186/s12891-022-05783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis. CONCLUSION Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
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Affiliation(s)
- Weronika Grabowska
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Wren Burton
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA.
| | - Matthew H Kowalski
- Osher Clinical Center for Integrative Medicine, Brigham and Women's Healthcare Center, 850 Boylston Street, Suite 422, Chestnut Hill, MA, 02445, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Anthony Lisi
- Yale University Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Dennis Muñoz-Vergara
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
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Effects of a modified Otago exercise program delivered through outpatient physical therapy to community-dwelling older adult fallers in Greece during the COVID-19 pandemic: a controlled, randomized, multicenter trial. Eur Geriatr Med 2022; 13:893-906. [PMID: 35606677 PMCID: PMC9126757 DOI: 10.1007/s41999-022-00656-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022]
Abstract
Aim To investigate the effectiveness of a video-supported OTAGO exercise program (OEP) in balance, functional ability, fear of falls and number of falls in Greek older adults with a history of falls. Findings A 6-month OEP helped older adults to improve their balance and functional ability test scores as well as reduce fear and number of falls, both after the intervention and at the 12-month follow-up. However, the adherence to the program remained unaffected. Message The OEP contributes to the well-being of older adults with a history of falls by improving all their relevant skills and scores. More long-term research under less adverse conditions is required to solidify these findings. Background The pandemic has led to the isolation and social exclusion of older adults and cut them off from any exercise activity. Thus, it is more than ever necessary to implement organized interventions to prevent falls in older people as they remain a global health problem associated with serious injuries, chronic disability, and high costs for the healthcare system. Otago exercise program (OEP) can effectively reduce the number of falls. Aim To study the effect of a 6 months modified video supported OEP in balance, functional ability, fear of falls and number of falls in Greek older people who have fallen. Method 150 fallers aged 65–80 years [Median age 70 (67–74), 88.7% women] were divided into two groups (intervention and control). Primary outcomes included changes in Short FES-I, CONFbal scale, 4-Stage Balance test, BBS, TUG test and number of falls, while the secondary outcome consists of the monthly adherence to exercise after the intervention. Analysis of variance with repeated measures was applied. Results There were statistically significant between groups differences after 6 months with the OEP group to shows improved values in TUG time score (17.8 vs 3.9%, p < 0.001, 95% CI), 4-Stage Balance Test (6.85 vs 1.09%, p < 0.05 95% CI), 30-Second Chair Stand Test 7.35 vs 2.93%, p < 0.001), BBS score (13.27 vs 3.89%, p < 0.001, 95% CI), Short FES-I (35.78 vs 13.01%, p < 0.001, 95% CI) and number of falls (69.12 vs 18.70%, p < 0.001, 95% CI). All the above differences remained statistically significant in the 12 months follow-up (p < 0.05), when differences in the CONFbal score were also observed (p < 0.001, 95% CI). No differences were found in adherence to OEP (p > 0.05). Conclusions A modified OEP decreases the number of falls, improves the balance and functional ability of older adults and reduces the fear of falling. However, it did not contribute to satisfactory adherence to exercise. Trial registration number/date of registration NCT04330053/April 1, 2020.
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Patterson BW, Jacobsohn GC, Maru AP, Venkatesh AK, Smith MA, Shah MN, Mendonça EA. RESEARCHComparing Strategies for Identifying Falls in Older Adult Emergency Department Visits Using EHR Data. J Am Geriatr Soc 2020; 68:2965-2967. [PMID: 32951200 DOI: 10.1111/jgs.16831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Health Innovation Program, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Industrial and Systems Engineering, Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Gwen Costa Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Apoorva P Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Arjun K Venkatesh
- Department of Emergency Medicine and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Eneida A Mendonça
- Department of Pediatrics and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana
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Haddad YK, Bergen G, Florence C. Estimating the Economic Burden Related to Older Adult Falls by State. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E17-E24. [PMID: 29757813 PMCID: PMC6314899 DOI: 10.1097/phh.0000000000000816] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Unintentional falls in older adults (persons 65 years of age and older) impose a significant economic burden on the health care system. Methods for calculating state-specific health care costs are limited. This study describes 2 methods to estimate state-level direct medical spending due to older adult falls and explains their differences, advantages, and limitations. DESIGN The first method, partial attributable fraction, applied a national attributable fraction to the total state health expenditure accounts in 2014 by payer type (Medicare, Medicaid, and private insurance). The second method, count applied to cost, obtained 2014 state counts of older adults treated and released from an emergency department and hospitalized because of a fall injury. The counts in each state were multiplied by the national average lifetime medical costs for a fall-related injury from the Web-based Injury Statistics Query and Reporting System. Costs are reported in 2014 US dollars. SETTING United States. PARTICIPANTS Older adults. MAIN OUTCOME MEASURE Health expenditure on older adult falls by state. RESULTS The estimate from the partial attributable fraction method was higher than the estimate from the count applied to cost method for all states compared, except Utah. Based on the partial attributable fraction method, in 2014, total personal health care spending for older adult falls ranged from $48 million in Alaska to $4.4 billion in California. Medicare spending attributable to older adult falls ranged from $22 million in Alaska to $3.0 billion in Florida. For the count applied to cost method, available for 17 states, the lifetime medical costs of 2014 fall-related injuries ranged from $68 million in Vermont to $2.8 billion in Florida. CONCLUSIONS The 2 methods offer states options for estimating the economic burden attributable to older adult fall injuries. These estimates can help states make informed decisions about how to allocate funding to reduce falls and promote healthy aging.
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Affiliation(s)
- Yara K. Haddad
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Curtis Florence
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sanghavi P, Pan S, Caudry D. Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare. Health Serv Res 2019; 55:201-210. [PMID: 31884706 PMCID: PMC7080404 DOI: 10.1111/1475-6773.13247] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). DATA SOURCES MDS assessments and Medicare claims, 2011-2015. STUDY DESIGN/METHODS We linked inpatient claims for major injury falls with MDS assessments. The proportion of claims-identified falls reported for each fall-related MDS item was calculated. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. We created a claims-based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures. PRINCIPAL FINDINGS We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long-stay (62.9 percent) than short-stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). Adjusting for facility-level race differences, reporting was lower for nonwhite people than white people; holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. The correlation between fall rates based on claims vs the MDS was 0.22. CONCLUSIONS The nursing home-reported data used for the NHC falls measure may be highly inaccurate.
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Affiliation(s)
- Prachi Sanghavi
- Department of Public Health Sciences, The University of Chicago Biological Sciences, Chicago, Illinois
| | - Shengyuan Pan
- Department of Public Health Sciences, The University of Chicago Biological Sciences, Chicago, Illinois
| | - Daryl Caudry
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Min L, Tinetti M, Langa KM, Ha J, Alexander N, Hoffman G. Measurement of Fall Injury With Health Care System Data and Assessment of Inclusiveness and Validity of Measurement Models. JAMA Netw Open 2019; 2:e199679. [PMID: 31433480 PMCID: PMC6707014 DOI: 10.1001/jamanetworkopen.2019.9679] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE National injury surveillance systems use administrative data to collect information about severe fall-related trauma and mortality. Measuring milder injuries in ambulatory clinics would improve comprehensive outcomes measurement across the care spectrum. OBJECTIVES To assess a flexible set of administrative data-only algorithms for health systems to capture a greater breadth of injuries than traditional fall injury surveillance algorithms and to quantify the algorithm inclusiveness and validity associated with expanding to milder injuries. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal diagnostic study of 13 939 older adults (≥65 years) in the nationally representative Health and Retirement Study, a survey was conducted every 2 years and was linked to hospital, emergency department, postacute skilled nursing home, and outpatient Medicare claims (2000-2012). During each 2-year observation period, participants were considered to have sustained a fall-related injury (FRI) based on a composite reference standard of having either an external cause of injury (E-code) or confirmation by the Health and Retirement Study patient interview. A framework involving 3 algorithms with International Classification of Diseases, Ninth Revision codes that extend FRI identification with administrative data beyond the use of fall-related E-codes was developed: an acute care algorithm (head and face or limb, neck, and trunk injury reported at the hospital or emergency department), a balanced algorithm (all acute care algorithm injuries plus severe nonemergency outpatient injuries), and an inclusive algorithm (almost all injuries). Data were collected from January 1, 1998, through December 31, 2012, and statistical analysis was performed from August 1, 2016, to March 1, 2019. MAIN OUTCOMES AND MEASURES Validity, measured as the proportion of potential FRI diagnoses confirmed by the reference standard, and inclusiveness, measured as the proportion of reference-standard FRIs captured by the potential FRI diagnoses. RESULTS Of 13 939 participants, 1672 (42.4%) were male, with a mean (SD) age of 77.56 (7.63) years. Among 50 310 observation periods, 9270 potential FRI diagnoses (18.4%) were identified; these were tested against 8621 reference-standard FRIs (17.1%). Compared with the commonly used method of E-coded-only FRIs (2-year incidence, 8.8% [95% CI, 8.6%-9.1%]; inclusion of 51.5% [95% CI, 50.4%-52.5%] of the reference-standard FRIs), FRI inclusion was increased with use of the study framework of algorithms. With the acute care algorithm (2-year incidence, 12.6% [95% CI, 12.4%-12.9%]), validity was prioritized (88.6% [95% CI, 87.4%-89.8%]) over inclusiveness (62.1% [95% CI, 61.1%-63.1%]). The balanced algorithm showed a 2-year incidence of 14.6% (95% CI, 14.3%-14.9%), inclusion of 65.3% (95% CI, 64.3%-66.3%), and validity of 83.2% (95% CI, 81.9%-84.6%). With the inclusive algorithm, the number of potential FRIs increased compared with the E-code-only method (2-year incidence, 17.4% [95% CI, 17.1%-17.8%]; inclusion, 68.4% [95% CI, 67.4%-69.3%]; validity, 75.2% [95% CI, 73.7%-76.6%]). CONCLUSIONS AND RELEVANCE The findings suggest that use of algorithms with International Classification of Diseases, Ninth Revision codes may increase inclusion of FRIs by health care systems compared with E-codes and that these algorithms may be used by health systems to evaluate interventions and quality improvement efforts.
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Affiliation(s)
- Lillian Min
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
- Geriatric Research Education Clinical Center, Virginia Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Mary Tinetti
- Section of Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kenneth M. Langa
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
- Geriatric Research Education Clinical Center, Virginia Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Neil Alexander
- Geriatric Research Education Clinical Center, Virginia Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
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Patterson BW, Jacobsohn GC, Shah MN, Song Y, Maru A, Venkatesh AK, Zhong M, Taylor K, Hamedani AG, Mendonça EA. Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department. BMC Med Inform Decis Mak 2019; 19:138. [PMID: 31331322 PMCID: PMC6647058 DOI: 10.1186/s12911-019-0843-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/20/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Falls among older adults are both a common reason for presentation to the emergency department, and a major source of morbidity and mortality. It is critical to identify fall patients quickly and reliably during, and immediately after, emergency department encounters in order to deliver appropriate care and referrals. Unfortunately, falls are difficult to identify without manual chart review, a time intensive process infeasible for many applications including surveillance and quality reporting. Here we describe a pragmatic NLP approach to automating fall identification. METHODS In this single center retrospective review, 500 emergency department provider notes from older adult patients (age 65 and older) were randomly selected for analysis. A simple, rules-based NLP algorithm for fall identification was developed and evaluated on a development set of 1084 notes, then compared with identification by consensus of trained abstractors blinded to NLP results. RESULTS The NLP pipeline demonstrated a recall (sensitivity) of 95.8%, specificity of 97.4%, precision of 92.0%, and F1 score of 0.939 for identifying fall events within emergency physician visit notes, as compared to gold standard manual abstraction by human coders. CONCLUSIONS Our pragmatic NLP algorithm was able to identify falls in ED notes with excellent precision and recall, comparable to that of more labor-intensive manual abstraction. This finding offers promise not just for improving research methods, but as a potential for identifying patients for targeted interventions, quality measure development and epidemiologic surveillance.
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Affiliation(s)
- Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,Health Innovation Program, University of Wisconsin-Madison, Madison, WI, 53705, USA.
| | - Gwen C Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Yiqiang Song
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Pediatrics and Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Apoorva Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Monica Zhong
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Katherine Taylor
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Azita G Hamedani
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eneida A Mendonça
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Pediatrics and Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
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Howard B, Baca R, Bilger M, Cali S, Kotarski A, Parrett K, Skibinski K. Investigating Older Adults’ Expressed Needs Regarding Falls Prevention. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2018. [DOI: 10.1080/02703181.2018.1520380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brenda Howard
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Ryan Baca
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Melissa Bilger
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Sarah Cali
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Abigail Kotarski
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Kiana Parrett
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Karena Skibinski
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
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Shah VN, Wu M, Foster N, Dhaliwal R, Al Mukaddam M. Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes. Arch Osteoporos 2018; 13:66. [PMID: 29892791 DOI: 10.1007/s11657-018-0475-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/04/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED We evaluated fall frequency and factors affecting falls among middle-aged and older adults with type 1 diabetes (T1D) from T1D Exchange Registry. Twenty-nine percent of T1D participants reported falls within the past 12 months. Severe hypoglycemia, diabetic peripheral neuropathy, and depression were associated with falls in adults with T1D. PURPOSE Fall is an important risk factor for osteoporotic fracture; we evaluated fall frequency and factors affecting falls among middle-aged and older adults with type 1 diabetes (T1D). METHODS Participants aged ≥ 55 years with T1D completed an email-based questionnaire on falls in the prior 12 months. Demographic, clinical, and fall-related information were gathered from the questionnaire; HbA1c was recorded from medical record data extraction. RESULTS Four hundred and thirty five adults with T1D completed the fall questionnaire (mean age 64 ± 7 years, 57% females, and 97% were non-Hispanic whites). The mean diabetes duration was 36 years with mean HbA1c of 7.3%. Among the 435 participants, 126 reported at least one fall in the prior 12 months (29%). The fall frequency values in adults (55-64 years) with T1D and older adults (> 65 years) were 26 and 32%, respectively (p = 0.16). There was no significant difference in frequency of fall between female and male participants (31 vs. 26%, p = 0.33). Of 126 participants who had a fall, 44% had injuries due to fall, 24% required medical attention, and 13 participants reported fracture (10%). Severe hypoglycemia (odds ratio (OR) 3.6), diabetic peripheral neuropathy (OR 2.2), and depression (OR 1.7) were associated with falls in adults with T1D. Forty-one percent of participants were fearful of falls. CONCLUSIONS This is the first study on prevalence and risk factors for falls suggesting that falls are common in T1D and severe hypoglycemia is a unique diabetes-related factor associated with threefold higher risk for falls.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Aurora, CO, 80045, USA
| | - Mengdi Wu
- Jaeb Center for Health Research, 15310 Amberly Dr, Suite 350, Tampa, FL, 33647, USA.
| | - Nicole Foster
- Jaeb Center for Health Research, 15310 Amberly Dr, Suite 350, Tampa, FL, 33647, USA
| | - Ruban Dhaliwal
- SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA
| | - Mona Al Mukaddam
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Mark JA, Loomis J. The STEADI toolkit: Incorporating a fall prevention guideline into the primary care setting. Nurse Pract 2017; 42:50-55. [PMID: 29176440 DOI: 10.1097/01.npr.0000525720.06856.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Falls are a growing problem in the older adult population, leading to debilitating and traumatic consequences. The CDC's STEADI toolkit was created to assist providers in screening and managing falls. This article introduces the toolkit and examines the process and importance of adopting it into routine clinical practice.
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Affiliation(s)
- Janice A Mark
- Janice A. Mark is adjunct faculty at the University of San Francisco, San Francisco, Calif. Jo Loomis is an assistant professor at the University of San Francisco, San Francisco, Calif
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Mundell B, Maradit Kremers H, Visscher S, Hoppe K, Kaufman K. Direct medical costs of accidental falls for adults with transfemoral amputations. Prosthet Orthot Int 2017. [PMID: 28641476 DOI: 10.1177/0309364617704804] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. OBJECTIVE We describe the direct medical costs of falls in adults with a transfemoral amputation. STUDY DESIGN This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. METHODS A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. RESULTS The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). CONCLUSION Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.
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Patterson BW, Smith MA, Repplinger MD, Pulia MS, Svenson JE, Kim MK, Shah MN. Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department. J Am Geriatr Soc 2017; 65:E135-E140. [PMID: 28636072 PMCID: PMC5603381 DOI: 10.1111/jgs.14982] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare incidence of falls in an emergency department (ED) cohort using a traditional International Classification of Diseases, Ninth Revision (ICD-9) code-based scheme and an expanded definition that included chief complaint information and to examine the clinical characteristics of visits "missed" in the ICD-9-based scheme. DESIGN Retrospective electronic record review. SETTING Academic medical center ED. PARTICIPANTS Individuals aged 65 and older seen in the ED between January 1, 2013, and September 30, 2015. MEASUREMENTS Two fall definitions were applied (individually and together) to the cohort: an ICD-9-based definition and a chief complaint definition. Admission rates and 30-day mortality (per encounter) were measured for each definition. RESULTS Twenty-three thousand eight hundred eighty older adult visits occurred during the study period. Using the most-inclusive definition (ICD-9 code or chief complaint indicating a fall), 4,363 visits (18%) were fall related. Of these visits, 3,506 (80%) met the ICD-9 definition for a fall-related visit, and 2,664 (61%) met the chief complaint definition. Of visits meeting the chief complaint definition, 857 (19.6%) were missed when applying the ICD-9 definition alone. Encounters missed using the ICD-9 definition were less likely to lead to an admission (42.9%, 95% confidence interval (CI) = 39.7-46.3%) than those identified (54.4%, 95% CI = 52.7-56.0%). CONCLUSION Identifying individuals in the ED who have fallen based on diagnosis codes underestimates the true burden of falls. Individuals missed according to the code-based definition were less likely to have been admitted than those who were captured. These findings call attention to the value of using chief complaint information to identify individuals who have fallen in the ED-for research, clinical care, or policy reasons.
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Affiliation(s)
- Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Health Innovation Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maureen A Smith
- Health Innovation Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - James E Svenson
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael K Kim
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Chen KH, Hsieh HM, Chen CM, Chiu HC, Lee IC. The Long-Term Trends of the Association Between Falls Among the Elderly in Taiwan and their Utilization of Medical Facilities. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults. Med Care 2017; 54:664-71. [PMID: 27057747 DOI: 10.1097/mlr.0000000000000531] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data. RESEARCH DESIGN Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures. SUBJECTS The analysis included 5497 community-dwelling adults ≥65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study. RESULTS The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95% confidence interval (CI), $4662-$19,680], $5648 (95% CI, $3819-$7476), and $9388 (95% CI, $5969-$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods. CONCLUSIONS FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.
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Hoffman GJ, Hays RD, Shapiro MF, Wallace SP, Ettner SL. The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. Health Serv Res 2016; 52:1794-1816. [PMID: 27581952 DOI: 10.1111/1475-6773.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries. DATA SOURCES The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries. STUDY DESIGN FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated. PRINCIPAL FINDINGS Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion). CONCLUSIONS FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Steven P Wallace
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA
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Pietzsch JB, Garner AM, Marks WJ. Cost-Effectiveness of Deep Brain Stimulation for Advanced Parkinson's Disease in the United States. Neuromodulation 2016; 19:689-697. [PMID: 27491661 DOI: 10.1111/ner.12474] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/22/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is clinically superior to medical therapy for treating advanced Parkinson's disease (PD). We studied the cost-effectiveness of DBS in conjunction with medical therapy compared to best medical therapy (BMT) alone, using the latest clinical and cost data for the U.S. healthcare system. MATERIALS AND METHODS We used a decision-analytic state-transition (Markov) model to project PD progression and associated costs for the two treatment strategies. We estimated the discounted incremental cost-effectiveness ratio (ICER) in U.S. dollars per quality-adjusted life-year (QALY) from the Medicare payer perspective, considering a ten-year horizon, and evaluated the robustness of our projections through extensive deterministic sensitivity analyses. RESULTS Over ten years, DBS treatment led to discounted total costs of $130,510 compared to $91,026 for BMT and added 1.69 QALYs more than BMT, resulting in an ICER of $23,404 per QALY. This ICER was relatively insensitive to variations in input parameters, with neurostimulator replacement, costs for DBS implantation, and costs for treatment of disease-related falls having the greatest effects. Across all investigated scenarios, including a five-year horizon, ICERs remained under $50,000 per QALY. Longer follow-up periods and younger treatment age were associated with greater cost-effectiveness. CONCLUSIONS DBS is a cost-effective treatment strategy for advanced PD in the U.S. healthcare system across a wide range of assumptions. DBS yields substantial improvements in health-related quality of life at a value profile that compares favorably to other well-accepted therapies.
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Affiliation(s)
- Jan B Pietzsch
- Wing Tech Inc., Menlo Park, CA, USA.,Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - William J Marks
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Kim SB, Zingmond DS, Keeler EB, Jennings LA, Wenger NS, Reuben DB, Ganz DA. Development of an algorithm to identify fall-related injuries and costs in Medicare data. Inj Epidemiol 2016; 3:1. [PMID: 27747538 PMCID: PMC4701758 DOI: 10.1186/s40621-015-0066-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying fall-related injuries and costs using healthcare claims data is cost-effective and easier to implement than using medical records or patient self-report to track falls. We developed a comprehensive four-step algorithm for identifying episodes of care for fall-related injuries and associated costs, using fee-for-service Medicare and Medicare Advantage health plan claims data for 2,011 patients from 5 medical groups between 2005 and 2009. METHODS First, as a preparatory step, we identified care received in acute inpatient and skilled nursing facility settings, in addition to emergency department visits. Second, based on diagnosis and procedure codes, we identified all fall-related claim records. Third, with these records, we identified six types of encounters for fall-related injuries, with different levels of injury and care. In the final step, we used these encounters to identify episodes of care for fall-related injuries. RESULTS To illustrate the algorithm, we present a representative example of a fall episode and examine descriptive statistics of injuries and costs for such episodes. Altogether, we found that the results support the use of our algorithm for identifying episodes of care for fall-related injuries. When we decomposed an episode, we found that the details present a realistic and coherent story of fall-related injuries and healthcare services. Variation of episode characteristics across medical groups supported the use of a complex algorithm approach, and descriptive statistics on the proportion, duration, and cost of episodes by healthcare services and injuries verified that our results are consistent with other studies. CONCLUSIONS This algorithm can be used to identify and analyze various types of fall-related outcomes including episodes of care, injuries, and associated costs. Furthermore, the algorithm can be applied and adopted in other fall-related studies with relative ease.
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Affiliation(s)
- Sung-Bou Kim
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - David S Zingmond
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - Emmett B Keeler
- RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Lee A Jennings
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA.,RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - David A Ganz
- RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. .,Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA. .,Geriatric Research, Education and Clinical Center, and Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (11G), Los Angeles, CA, 90073, USA.
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Falls Reduction and Exercise Training in an Assisted Living Population. J Aging Res 2015; 2015:957598. [PMID: 26345431 PMCID: PMC4541005 DOI: 10.1155/2015/957598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022] Open
Abstract
Multicomponent exercise programs are currently an efficacious fall prevention strategy among community dwelling older adults although research documents differential falls susceptibility among frail older adults. This study aimed to examine the association between the Boston FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) exercise program (the original exercise program to demonstrate that nursing home residents can increase strength) and falls incidents in an assisted living community. A descriptive cross-sectional study matched exercise charts for frequency and duration of training with number of reported fall incidents. Among 39 participants, 33% (n = 13) reported a fall incident. Adults without a fall history reported more time in aerobic (26.30 versus 20.00, P value = 0.71) and strength (1.50 versus 0.50, P value = 0.01) training sessions compared to those with a fall history. Multivariate models adjusting for covariates illustrated a significant protective association between strength training and fall incidents (OR = 0.25; 95% CI = 0.07, 0.85). In this cross-sectional study, this progressive resistance exercise training program into an assisted living population was associated with a decrease in the number of fall incidents.
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Chaudhuri S, Kneale L, Le T, Phelan E, Rosenberg D, Thompson H, Demiris G. Older Adults' Perceptions of Fall Detection Devices. J Appl Gerontol 2015; 36:915-930. [PMID: 26112030 DOI: 10.1177/0733464815591211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A third of adults over the age of 65 are estimated to fall at least once a year. Perhaps as dangerous as the fall itself is the time spent after a fall if the person is unable to move. Although there are many devices available to detect when a person has fallen, little is known about the opinions of older adults regarding these fall detection devices (FDDs). We conducted five focus groups with 27 older adults. Transcripts from sessions were coded to generate themes that captured participants' perceptions. Themes were identified that related to two topics of interest: (a) personal influences on the participants' desire to have a FDD, including perceived need, participant values, and cost, and (b) participant recommendations regarding specific features and functionalities of these devices such as automation, wearable versus non-wearable devices, and device customization. Together, these themes suggest ways in which FDDs may be improved so that they are suitable for their intended population.
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Affiliation(s)
| | | | - Thai Le
- 1 University of Washington, Seattle, WA, USA
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Greenwood-Hickman MA, Rosenberg DE, Phelan EA, Fitzpatrick AL. Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011. Prev Chronic Dis 2015; 12:E90. [PMID: 26068411 PMCID: PMC4467255 DOI: 10.5888/pcd12.140574] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care. Methods A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes. Results In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63–0.88) and intermittent (HR, 0.87; 95% CI, 0.8–0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90–0.97). Conclusion Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk.
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Affiliation(s)
- Mikael Anne Greenwood-Hickman
- University of North Carolina, Radiology, 130 Mason Farm Road, Room 3126, Chapel Hill, NC 27514. . At the time of this study, Ms Greenwood-Hickman was affiliated with the University of Washington, Seattle, Washington, and Group Health Research Institute, Seattle, Washington
| | | | - Elizabeth A Phelan
- Department of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, Washington
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Fields J, Alturkistani T, Kumar N, Kanuri A, Salem DN, Munn S, Blazey-Martin D. Prevalence and cost of imaging in inpatient falls: the rising cost of falling. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:281-6. [PMID: 26082653 PMCID: PMC4461128 DOI: 10.2147/ceor.s80104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. DESIGN Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. SETTING Four hundred and fifteen bed urban academic hospital over 3 years (2008-2010). PATIENTS All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. MEASUREMENTS AND MAIN RESULTS Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20-98). More than half of falls were men (55%) and patients considered at risk of falls (56%). Falls were evenly distributed across morning (33%), evening (34%), and night (33%) shifts. Of 530 falls, 178 (34%) patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700) from head computed tomography (CT). CONCLUSION Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward clarifying the indications for head CT after inpatient falls and validating risk models for positive and negative imaging, in order to decrease unnecessary imaging and thereby limit unnecessary cost and radiation exposure.
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Affiliation(s)
- Jessica Fields
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | | | - Neal Kumar
- Tufts University School of Medicine, Boston, MA, USA
| | - Arjun Kanuri
- Tufts University School of Medicine, Boston, MA, USA
| | - Deeb N Salem
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Samson Munn
- Department of Radiology, Tufts Medical Center, Boston, MA, USA
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Castro VM, McCoy TH, Cagan A, Rosenfield HR, Murphy SN, Churchill SE, Kohane IS, Perlis RH. Stratification of risk for hospital admissions for injury related to fall: cohort study. BMJ 2014; 349:g5863. [PMID: 25954985 PMCID: PMC4208628 DOI: 10.1136/bmj.g5863] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether the ability to stratify an individual patient's hazard for falling could facilitate development of focused interventions aimed at reducing these adverse outcomes. DESIGN Clinical and sociodemographic data from electronic health records were utilized to derive multiple logistic regression models of hospital readmissions for injuries related to falls. Drugs used at admission were summarized based on reported adverse effect frequencies in published drug labeling. SETTING Two large academic medical centers in New England, United States. PARTICIPANTS The model was developed with 25,924 individuals age ≥ 40 with an initial hospital discharge. The resulting model was then tested in an independent set of 13,032 inpatients drawn from the same hospital and 36,588 individuals discharged from a second large hospital during the same period. MAIN OUTCOME MEASURE Hospital readmissions for injury related to falls. RESULTS Among 25,924 discharged individuals, 680 (2.6%) were evaluated in the emergency department or admitted to hospital for a fall within 30 days of discharge, 1635 (6.3%) within 180 days of discharge, 2360 (9.1%) within one year, and 3465 (13.4%) within two years. Older age, female sex, white or African-American race, public insurance, greater number of drugs taken on discharge, and score for burden of adverse effects were each independently associated with hazard for fall. For drug burden, presence of a drug with a frequency of adverse effects related to fall of 10% was associated with 3.5% increase in odds of falling over the next two years (odds ratio 1.04, 95% confidence interval 1.02 to 1.05). In an independent testing set, the area under the receiver operating characteristics curve was 0.65 for a fall within two years based on cross sectional data and 0.72 with the addition of prior utilization data including age adjusted Charlson comorbidity index. Portability was promising, with area under the curve of 0.71 for the longitudinal model in a second hospital system. CONCLUSIONS It is potentially useful to stratify risk of falls based on clinical features available as artifacts of routine clinical care. A web based tool can be used to calculate and visualize risk associated with drug treatment to facilitate further investigation and application.
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Affiliation(s)
- Victor M Castro
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Thomas H McCoy
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA
| | - Andrew Cagan
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hannah R Rosenfield
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA
| | - Shawn N Murphy
- Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Susanne E Churchill
- Information Systems, Partners HealthCare System, New Research Building 255, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Isaac S Kohane
- Department of Medicine, Brigham and Women's Hospital, Suite 255, New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Roy H Perlis
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA
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Patel KV, Phelan EA, Leveille SG, Lamb SE, Missikpode C, Wallace RB, Guralnik JM, Turk DC. High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study. J Am Geriatr Soc 2014; 62:1844-52. [PMID: 25283473 PMCID: PMC4206582 DOI: 10.1111/jgs.13072] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States. DESIGN Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%). SETTING In-person assessments were conducted in the home or residential care facility of the sampled study participant. PARTICIPANTS Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries). MEASUREMENTS Participants were asked whether they had been "bothered by pain" and the location of pain, as well as questions about balance and coordination, fear of falling, and falls. RESULTS Fifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥ 2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28-3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance. CONCLUSION Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.
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Affiliation(s)
- Kushang V. Patel
- Center for Pain Research on Impact, Measurement and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle
| | - Suzanne G. Leveille
- College of Nursing and Health Sciences, University of Massachusetts, Boston
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sarah E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK
- Kadoorie Critical Care Research Centre, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Jack M. Guralnik
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Dennis C. Turk
- Center for Pain Research on Impact, Measurement and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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Fachinger U, Schöpke B. Business model for sensor-based fall recognition systems. Inform Health Soc Care 2014; 39:305-18. [DOI: 10.3109/17538157.2014.931855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ali Y, Parekh A, Baig M, Ali T, Rafiq T. Renal tubular acidosis type II associated with vitamin D deficiency presenting as chronic weakness. Ther Adv Endocrinol Metab 2014; 5:86-9. [PMID: 25343024 PMCID: PMC4206616 DOI: 10.1177/2042018814547359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic vitamin D deficiency, though common in the elderly, is often under diagnosed and when progressing to renal tubular acidosis type II (RTA 2) can cause several simultaneous electrolyte imbalances that may present with weakness and pain as chief symptoms. We present such a case that after months of evaluation and symptomatic treatment did not lead to an effective establishment of the etiology causing chronic weakness and body pain in an elderly female patient. Eventually, after a careful review of the patient's history, repeat physical examinations, laboratory data evaluation, and diagnostic testing led to the establishment of the diagnosis of proximal RTA 2 associated with vitamin D deficiency, which caused the patient to develop several remarkable secondary electrolyte imbalances such as hypokalemia, hypocalcemia, hypophosphatemia, acidemia, hyperparathyroidism, with weakness and body pain.
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Affiliation(s)
- Yaseen Ali
- Ohio University, 120 Chubb Hall, Athens, OH 45701, USA
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Rhon D, Deyle G, Gill N, Rendeiro D. Manual physical therapy and perturbation exercises in knee osteoarthritis. J Man Manip Ther 2013; 21:220-8. [PMID: 24421635 PMCID: PMC3822322 DOI: 10.1179/2042618613y.0000000039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA. Methods: This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program. Results: Mean total WOMAC score significantly improved (P = 0.001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session. Discussion: A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.
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Affiliation(s)
- Daniel Rhon
- Madigan Army Medical Center, Department of Physical Medicine, Tacoma, WA, USA
| | - Gail Deyle
- Brooke Army Medical Center, San Antonio, TX, USA
| | - Norman Gill
- Brooke Army Medical Center, San Antonio, TX, USA
| | - Daniel Rendeiro
- Occupational and Physical Therapy Service, Warrior Transition Brigade, Fort Hood, TX, USA
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