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Munk N, Daggy JK, Slaven JE, Evans E, Foote T, Laws BV, Matthias MS, Bair MJ. Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results. Contemp Clin Trials 2024; 142:107561. [PMID: 38704120 DOI: 10.1016/j.cct.2024.107561] [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: 11/12/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C0). METHODS CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint. RESULTS Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C0, CA-M participants had statistically significant reductions in pain-related disability at 3-months (-3.4, 95%CI = [-5.8, -1.0]; p = .006) and 6-months (-4.6, 95%CI = [-7.0, -2.1]; p < .001) and pain severity at 3-months (-1.3, 95%CI = [-1.9, -0.8]; p < .001) and 6-months (-1.0, 95%CI = [-1.6, -0.4]; p = .007), respectively. CONCLUSION In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C0, despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training.
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Affiliation(s)
- N Munk
- Indiana University School of Health and Human Sciences, Department of Health Sciences, Indianapolis, Indiana, USA; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Massage & Myotherapy Australia Fellow and Visiting Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - J K Daggy
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - J E Slaven
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - E Evans
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - T Foote
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - B V Laws
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - M S Matthias
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA; Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - M J Bair
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA; Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
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Cheng R, Mantena Y, Chiu YF, Kahlenberg CA, Figgie MP, Driscoll DA. To Stage or Not to Stage? Comparison of Patient-Reported Outcomes, Complications, and Discharge Disposition After Staged and Simultaneous Bilateral Posterior Total Hip Arthroplasty. J Arthroplasty 2024; 39:1752-1757. [PMID: 38216001 DOI: 10.1016/j.arth.2024.01.011] [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: 04/20/2023] [Revised: 12/23/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Patients who have bilateral hip arthritis can be treated with bilateral total hip arthroplasty (bTHA) in either a staged or simultaneous fashion. The goal of this study was to determine whether staged and simultaneous posterior bTHA patients differ in regard to (1) patient-reported outcome measures, (2) 90-day complication rates, and (3) discharge dispositions and cumulative lengths of stay. METHODS Patients who (1) underwent simultaneous bTHA or staged bTHA (within 12 months) using the posterior approach, and (2) completed preoperative and 1-year postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement surveys were included in the study. A total of 266 patients (87 simultaneous bTHA and 179 staged bTHA) were included. Chart review was performed to collect patient-level variables, postoperative complications, discharge dispositions, and lengths of stay. RESULTS Staged bTHA patients had higher Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Lower Extremity Activity Scale, and Veterans RAND 12-Item Health Survey physical component scores compared to simultaneous bTHA patients at 6 weeks after surgery (P = .019, .006, and .008, respectively), but these differences did not meet the minimal clinically important difference threshold for any questionnaire. Simultaneous bTHA was associated with higher rate of periprosthetic fractures (P = .034) and discharge to a location other than home (P < .001). CONCLUSIONS There were statistically significant, but likely not clinically meaningful differences in patient-reported outcomes for staged and simultaneous bTHA patients at 6 weeks after surgery. Surgeons should be aware of the higher periprosthetic fracture risk and greater likelihood of discharge to a rehabilitation facility associated with simultaneous bTHA. Further research should aim to understand which patients may benefit most from simultaneous bTHA.
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Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yasoda Mantena
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Mark P Figgie
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Daniel A Driscoll
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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3
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Ecker AH, Shivaji S, Plasencia M, Kauth MR, Hundt NE, Fletcher TL, Sansgiry S, Cully JA. The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy. Psychother Res 2024:1-9. [PMID: 38861659 DOI: 10.1080/10503307.2024.2349992] [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: 04/04/2023] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes. METHOD Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL. RESULTS Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator. CONCLUSION Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02466126.
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Affiliation(s)
- Anthony H Ecker
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Maribel Plasencia
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Natalie E Hundt
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Terri L Fletcher
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Shubhada Sansgiry
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Martin JR, Castaneda P, Kisana H, McKee MD, Amini MH. Preoperative Patient-Reported Outcomes Predict Postoperative Clinical Outcomes Following Rotator Cuff Repair. Arthroscopy 2024; 40:1445-1452. [PMID: 37865130 DOI: 10.1016/j.arthro.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To determine whether preoperative patient-reported outcomes (PROs) predict postoperative PROs and satisfaction following rotator cuff repair. METHODS We retrospectively identified patients who underwent a primary rotator cuff repair at a single institution. A receiver operating characteristics analysis was used to reach a preoperative American Shoulder and Elbow Surgeons (ASES) score threshold predictive of postoperative ASES and satisfaction scores. We evaluated patients above and below the receiver operating characteristics threshold by comparing their final ASES scores, ASES change (Δ) from baseline, percent maximum outcome improvement, and achievement of minimum clinically important differences, substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS). Fischer exact tests were used to analyze categorical data, and continuous data were analyzed using t-test. RESULTS A total of 348 patients who underwent rotator cuff repair were included in this study. The preoperative ASES value predictive of achieving SCB was 63 (area under the curve, 0.75; 95% confidence interval: 58-67; P < .001). Patients with preoperative ASES less than 63 were significantly more likely to achieve MCID (odds ratio [OR]: 4.7, P < .001) and SCB (OR:6.1, P < .001) and had significantly higher percent maximum outcome improvement (63% vs 41%; P = 0.003) and Δ ASES scores (36 vs 12; P < .001). However, patients with preoperative ASES scores above 63 had significantly higher final ASES scores (86 vs 79; P = .003), were more likely to achieve PASS (59% vs 48%; P = .045), and had higher satisfaction scores (7.4 vs 6.7; P = .024). CONCLUSIONS Patients with high preoperative ASES scores achieve less relative improvement; however, these patients may be more likely to achieve PASS and may have higher satisfaction scores postoperatively. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- John R Martin
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Paulo Castaneda
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Haroon Kisana
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Michael D McKee
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
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Cheng R, Debbi EM, Chalmers BP, Chiu YF, Rodriguez JA, Lee GC. Clinical Outcomes of Isolated Polyethylene Exchange Versus Full Component Revision for the Management of Instability Following Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00335-8. [PMID: 38631514 DOI: 10.1016/j.arth.2024.04.023] [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: 11/23/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Instability following total knee arthroplasty (TKA) is a common cause for revision. Isolated polyethylene exchange (IPE) can be performed to increase knee joint stability, but results have been mixed. The purpose of this study was to compare the survivorship and patient-reported outcomes of patients undergoing revision TKA for instability with IPE versus full component revision. METHODS We reviewed 280 primary TKAs undergoing revision TKA for instability. There were 181 knees that underwent revision with IPE, compared to 99 knees treated with full component revision. The mean follow-up was 32.8 months (range, 24.8 to 82.5). Patient demographics, radiographic parameters, prosthesis constraints, reoperations for instability, and patient-reported outcomes were compared. RESULTS The survivorship for instability was significantly higher at 2 years (99 versus 92%, P = .024) and 5 years (94 versus 84%, P = .024) for patients undergoing full component revision. Although there was no difference in Knee Injury and Osteoarthritis Outcome Score for Joint Replacements and Veterans RAND 12 physical component scores between the 2 groups at 6 weeks, 1 year, and 2 years after surgery, full revision patients reported greater pain relief (P = .006) and greater improvements in Veterans RAND 12 physical component scores (P = .027) at 1 year and Knee Injury and Osteoarthritis Outcome Score for Joint Replacements scores at 2 years (P = .017) compared to IPE patients. Men were associated with an increased risk for recurrent instability following IPE (hazard ratio 3.3, 95% confidence interval: [1.0 to 10.6]). CONCLUSIONS Isolated polyethylene exchange was not as reliable or durable compared to full component revision for the management of postoperative instability. These procedures should only be reserved in cases with competent collaterals and when component position, offset, and rotation are optimized.
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Affiliation(s)
- Ryan Cheng
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jose A Rodriguez
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Gwo-Chin Lee
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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6
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Cheng R, Blevins J, Debbi EM, Chiu YF, Gonzalez Della Valle A, Lee GC. Contemporary Isolated Bearing Exchange for the Management of Hip Instability Following Primary Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00255-9. [PMID: 38522800 DOI: 10.1016/j.arth.2024.03.039] [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: 11/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Isolated ball and liner exchanges (IBLEs) can be performed to increase hip joint stability, but historical results have been mixed due to a lack of head size options or dual mobility articulations. The purpose of this study was to evaluate the contemporary results of IBLEs in patients who have instability following primary total hip arthroplasty (THA). METHODS We retrospectively reviewed 65 primary THAs from 2016 to 2020 with hip instability undergoing IBLE or conversion to dual mobility articulation. There were 31 men and 34 women who had an average age of 70 years (range, 26 to 92). The mean time to revision from primary was 40.1 months (range, 1 to 120). In 52 cases, IBLE was performed using conventional bearings, while 13 hips were converted to dual mobility. Radiographic factors, including acetabular component orientation, reproduction of hip joint offset, leg lengths, and outcomes such as recurrent instability requiring subsequent revision and patient-reported outcome measure, were recorded and compared. RESULTS There were 12 (18.4%) hips that experienced subsequent instability and required another revision (17.3% ball and liner exchange versus 23.1% dual mobility articulation, P = .615). The mean time to rerevision for instability was 17.1 months. There were no significant differences in either acetabular component anteversion (P = .25) or restoration of hip joint offset (P = .87) in patients who required another revision for instability compared to those who did not, respectively. At 1 year, patients undergoing conventional bearing exchange reported higher Hip Dysfunction Osteoarthritis Outcome Score for Joint Replacements (P = .002) and Veterans Rand physical component (P = .023) scores compared to those who underwent a conversion to dual mobility articulation. Only age > 75 years at the time of surgery was associated with increased risk for dislocation (odds ratio 7.2, confidence interval 1.2 to 43.7, P = .032). CONCLUSIONS Isolated bearing exchanges for instability following THA remained at high risk for subsequent instability. Conversion to dual mobility articulations did not reduce the risk of reoperation.
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Affiliation(s)
- Ryan Cheng
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason Blevins
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | | | - Gwo-Chin Lee
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Finsterwald M, Mancino F, Waters G, Ebert J, Malik SS, Jones CW, Yates PJ, D'Alessandro P. Endoscopic Tendon Release for Iliopsoas Impingement After Total Hip Arthroplasty-Excellent Clinical Outcomes and Low Failure Rates at Short-Term Follow-Up. Arthroscopy 2024; 40:790-798. [PMID: 37544336 DOI: 10.1016/j.arthro.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To investigate the clinical effectiveness of endoscopic iliopsoas tendon release (IPR) at the lesser trochanter (LT) in patients with iliopsoas impingement (IPI) after total hip arthroplasty (THA). METHODS Between November 2017 and March 2021, a consecutive series of 36 patients were treated with endoscopic IPR for diagnosed IPI. Patients included had acetabular cup position confirmed by functional imaging (OPS, Corin, Pymble, NSW), typical clinical symptoms of IPI, and a positive response to diagnostic injection. Clinical assessment included validated patient-reported outcome measures (PROMs) along with hip flexion strength and active range of motion at different time marks up to 2-year follow-up, as well as surgical complications. RESULTS Overall, 36 consecutive patients (11 males) with a mean age of 62 ± 12 years were included. All patients had failed nonoperative management. Dynamic computed tomography assessment was available in 89% of the patients, edge loading was reported in 10%, and variable cup overhang was reported in 50%. Clinically, PROMs were significantly improved at every time mark when compared with preoperative values (P < .001), showing the biggest improvement within the first 4 weeks after surgery. At the 6-month follow-up, peak isometric hip flexion strength on the operated side was 20% lower than the contralateral side (P < .001). Failure rate of the procedure was 2.8% (1 case). Linear regression showed no association between cup overhang and clinical outcomes. CONCLUSIONS Endoscopic IPR at the LT is a safe and reproducible technique associated with significant and immediate improvement in pain, functional outcomes, and high patient satisfaction. With minimal short-term weakness, no complications, and only a single revision, even in cases with cup malposition and/or edge loading, we believe that endoscopic IPR can be considered as one of the first-line operative options in patients with symptomatic IPI, irrespective of component position. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia.
| | - Fabio Mancino
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Georgina Waters
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Jay Ebert
- Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia; HFRC Rehabilitation Clinic, Perth, Western Australia
| | | | - Christopher W Jones
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Curtin University, Perth, Western Australia, Australia
| | - Piers J Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
| | - Peter D'Alessandro
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
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Judd DL, Cheuy V, Peters A, Graber J, Hinrichs-Kinney L, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial. Phys Ther 2024; 104:pzad168. [PMID: 38102757 DOI: 10.1093/ptj/pzad168] [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: 07/11/2023] [Revised: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. METHODS A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to either the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured, and between-group differences were assessed. RESULTS There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. CONCLUSION The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. IMPACT Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Victor Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amy Peters
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lauren Hinrichs-Kinney
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- US Department of Veterans Affairs, Rocky Mountain Mental Illness, Research, Education and Clinical Center, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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Meyer-Moock S, Szczotkowski D, Schouten L, Petzke F, Milch L, Metz-Oster B, Zinndorf L, Geber C, Hoffmann G, Preißler A, Marschall U, Rottke F, Waidner A, Möller A, Isenberg T, Lindena G, Gärtner A, Kaiser U, Kohlmann T. PAIN2.0: study protocol for a multicentre randomised controlled trial to evaluate the efficacy of a 10-week outpatient interdisciplinary multimodal pain therapy to manage recurrent pain for patients with risk factors of developing chronic pain in Germany. Trials 2024; 25:145. [PMID: 38395869 PMCID: PMC10893721 DOI: 10.1186/s13063-024-07975-4] [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: 11/16/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Up to 27% of the German population suffers from recurrent or persistent pain (lasting more than three months). Therefore, prevention of chronic pain is one major object of pain management interventions. The aim of this nationwide, multicentre, randomised controlled trial is to evaluate the efficacy of a 10-week ambulatory (outpatient) interdisciplinary multimodal pain therapy (A-IMPT) for patients with recurrent pain and at risk of developing chronic pain. This project was initiated by the German Pain Society (Deutsche Schmerzgesellschaft e.V.) and the public health insurance provider BARMER. It is currently funded by the German Innovation Fund (01NVF20023). The study PAIN2.0 focuses on reducing pain intensity and pain-related disability and investigates whether this intervention can improve physical activity, psychological well-being, and health literacy. METHODS PAIN2.0 is designed as a multicentre 1:1 randomised controlled trial with two parallel groups (randomisation at the patient level, planned N = 1094, duration of study participation 12 months, implemented by 22 health care facilities nationwide). After 6 months, patients within the control group also receive the intervention. The primary outcomes are pain intensity and pain-related impairment, measured as Characteristic Pain Intensity (PI) and Disability Score (DS) (Von Korff), as well as patient-related satisfaction with the intervention. Secondary outcomes are the number of sick leave days, sickness allowance, treatment costs, psychological distress, health-related quality of life, and catastrophizing. The effects of the intervention will be analysed by a parallel-group comparison between the intervention and control groups. In addition, the long-term effects within the intervention group will be observed and a pre-post comparison of the control group before and after the intervention will be performed. DISCUSSION Recurrent or persistent pain is common in the German population and causes high costs for patients and society. The A-IMPT aims to improve pain and pain-related impairments in pain patients at risk of chronification, thereby reducing the risk of developing chronic pain with its high socioeconomic burden. This new therapy could easily be integrated into existing therapy programs if positively evaluated. TRIAL REGISTRATION The trial PAIN2.0 has been registered in the German Clinical Trials Register (DRKS) since 21/11/2022 with the ID DRKS00030773 .
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Affiliation(s)
- Sandra Meyer-Moock
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Daniel Szczotkowski
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Schouten
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Frank Petzke
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Lena Milch
- German Red Cross Pain Centre Mainz, Mainz, Germany
| | | | | | | | - Greta Hoffmann
- University Pain Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Anke Preißler
- University Pain Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | | | | | | | | | | | - Anne Gärtner
- University Pain Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ulrike Kaiser
- University Hospital Schleswig-Holstein/Lübeck, Lübeck, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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10
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Marcus-Aiyeku U, Fake P, Fetzer C, Hessels A, Kilpatrick R, Markiewicz D, McNicholas M, Mills K, Nedumalayil S, Paliwal M, Panten A, Schuld C, Ullero A. Utilization of patient-reported outcomes in joint replacement care design. Nurs Manag (Harrow) 2024; 55:42-50. [PMID: 38314996 DOI: 10.1097/nmg.0000000000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Analysis finds health disparities among the elective surgery population.
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Affiliation(s)
- Ulanda Marcus-Aiyeku
- Ulanda Marcus-Aiyeku is a nurse scientist at the Ann May Center, Hackensack Meridian Health in Edison, N.J. Pamela Fake is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Christine Fetzer is a retired occupational therapist located in N.J. Amanda Hessels is a nurse scientist at the Ann May Center, Hackensack Meridian Health in Edison, N.J. and an assistant professor of nursing at Columbia University in New York, N.Y. Rachel Kilpatrick is the clinical program manager at Riverview Medical Center in Red Bank, N.J. Dorothy Markiewicz is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Miriam McNicholas is the director of professional practice/clinical policy at Hackensack Meridian Health in Edison, N.J. Kimberly Mills is a project manager, Orthopedic-Care Transformation Services, Hackensack Meridian Health in Edison, N.J. Seera Nedumalayil is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Mani Paliwal is a senior biostatistician at the Institute for Evidence Based Care, Hackensack Meridian Health in Edison, N.J. Angie Panten is a clinical program manager at Ocean University Medical Center in Brick Township, N.J. Clare Schuld is a clinical nurse navigator for Orthopedics at Old Bridge Medical Center in Old Bridge, N.J., and Raritan Bay Medical Center in Raritan, N.J. Amarlyn Ullero is a staff RN at Hackensack University Medical Center in Hackensack, N.J
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11
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Bach RR, Rudquist RR. Gulf war illness inflammation reduction trial: A phase 2 randomized controlled trial of low-dose prednisone chronotherapy, effects on health-related quality of life. PLoS One 2023; 18:e0286817. [PMID: 37319244 PMCID: PMC10270619 DOI: 10.1371/journal.pone.0286817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/28/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Gulf War illness (GWI) is a deployment-related chronic multisymptom illness impacting the health-related quality of life (HRQOL) of many U.S. Military Veterans of the 1990-91 Gulf War. A proinflammatory blood biomarker fingerprint was discovered in our initial study of GWI. This led to the hypothesis that chronic inflammation is a component of GWI pathophysiology. OBJECTIVES The GWI inflammation hypothesis was tested in this Phase 2 randomized controlled trial (RCT) by measuring the effects of an anti-inflammatory drug and placebo on the HRQOL of Veterans with GWI. The trial is registered at ClinicalTrials.gov, Identifier: NCT02506192. RCT DESIGN AND METHODS Gulf War Veterans meeting the Kansas case definition for GWI were randomized to receive either 10 mg modified-release prednisone or matching placebo. The Veterans RAND 36-Item Health Survey was used to assess HRQOL. The primary outcome was a change from baseline in the physical component summary (PCS) score, a measure of physical functioning and symptoms. A PCS increase indicates improved physical HRQOL. RESULTS For subjects with a baseline PCS <40, there was a 15.2% increase in the mean PCS score from 32.9±6.0 at baseline to 37.9±9.0 after 8 weeks on modified-release prednisone. Paired t-test analysis determined the change was statistically significant (p = 0.004). Eight weeks after cessation of the treatment, the mean PCS score declined to 32.7±5.8. CONCLUSIONS The prednisone-associated improvement in physical HRQOL supports the GWI inflammation hypothesis. Determining the efficacy of prednisone as a treatment for GWI will require a Phase 3 RCT.
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Affiliation(s)
- Ronald R. Bach
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Rebecca R. Rudquist
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
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12
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Singh V, Lygrisse KA, Macaulay W, Slover JD, Schwarzkopf R, Long WJ. Comparative Analysis of Outcomes in Medicare-Eligible Patients with a Hospital Stay Less than Two-Midnights versus Longer Length of Stay following Total Knee Arthroplasty: Implications for Inpatient-Outpatient Designation. J Knee Surg 2022; 35:1357-1363. [PMID: 33545728 DOI: 10.1055/s-0041-1723015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Centers for Medicaid and Medicare Services (CMS) removed primary total knee arthroplasty (TKA) from the inpatient-only list in January 2018. This study aims to compare outcomes in Medicare-aged patients who underwent primary TKA and had an in-hospital stay spanning less than two-midnights to those with a length of stay greater than or equal to two-midnights. We retrospectively reviewed 4,138 patients ages ≥65 who underwent primary TKA from 2016 to 2020. Two cohorts were established based on length of stay (LOS), those with an LOS <2 midnights were labeled outpatient and those with an LOS ≥2 midnights were labeled inpatient as per CMS designation. Demographic, clinical data, knee injury and osteoarthritis outcome score for joint replacement (KOOS, JR), and veterans RAND 12 physical and mental components (VR-12 PCS & MCS) were collected. Demographic differences were assessed with Chi-square and independent sample t-tests. Clinical data and KOOS, JR and VR-12 PCS and MCS scores were compared by using multilinear regression analysis, controlling for demographic differences. There were 841 (20%) patients with a LOS < 2 midnights and 3,297 (80%) patients with a LOS ≥ 2 midnights. Patients with a LOS < 2 midnights were significantly younger (71.70 vs. 73.06; p < 0.001), more likely male (42.1 vs. 25.7%; p < 0.001), Caucasian (68.8 vs. 57.7%; p <0.001), have lower BMI (30.80 vs. 31.92; p < 0.001), Charlson Comorbidity Index (CCI; 4.62 vs. 4.96; p < 0.001), and American Society of Anesthesiologists (ASA) class II or higher (p < 0.001). These patients were more likely to be discharged home compared to patients with LOS ≥ 2 midnights (95.8 vs. 73.1%; p < 0.001). Patients who stayed ≥ 2 midnights reported lower patient-reported outcome scores at all time-periods (preoperatively, 3 months and 1 year), but these differences did not exceed the minimum clinically important difference. Mean improvement preoperatively to 1 year postoperatively in KOOS, JR (22.53 vs. 25.89; p < 0.001), and VR-12 PCS (12.16 vs. 11.49; p = 0.002) was statistically higher for patients who stayed < 2 midnights, though these differences were not clinically significant. All-cause ED visits (p = 0.167), 90-day all-cause readmissions (p = 0.069) and revision (p = 0.277) did not statistically differ between the two cohorts. TKA patients classified as outpatient had similar quality metrics and saw similar clinical improvement following TKA with respect to most patient reported outcome measures, although they were demographically different. Outpatient classification is more likely to be assigned to younger males with higher functional scores, lower BMI, CCI, and ASA class compared with inpatients. This Retrospective Cohort Study shows level III evidence.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York City, New York
| | | | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York City, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York City, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York City, New York
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York City, New York
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13
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Schweda S, Munz B, Burgstahler C, Niess AM, Roesel I, Sudeck G, Krauss I. Proof of Concept of a 6-Month Person-Oriented Exercise Intervention 'MultiPill-Exercise' among Patients at Risk of or with Multiple Chronic Diseases: Results of a One-Group Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9469. [PMID: 35954825 PMCID: PMC9368673 DOI: 10.3390/ijerph19159469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022]
Abstract
Physical exercise has been shown to be effective in the treatment of non-communicable chronic diseases. However, patients with multiple chronic diseases (multimorbidity) have received little attention in health policy. This pilot trial served as a proof of concept of a 6-months person-oriented exercise intervention for people at risk of or with diagnosed cardiovascular diseases, diabetes mellitus type 2, overweight and/or hip/knee osteoarthritis, regarding effects on health outcomes as well as adherence and safety. The intervention (‘MultiPill-Exercise’) was designed to promote physical exercise participation, considering an individual perspective by addressing personal and environmental factors. Outcomes were assessed at baseline (t0) and after three- (t3) and six-months (t6). The primary outcome was self-reported physical exercise participation in minutes/week comparing t3 and t6 vs. t0. Secondary outcomes included cardio-respiratory fitness (maximum oxygen uptake VO2peak during incremental cycling ergometry), isometric peak torque of knee extensors and flexors, health-related quality of life (Veterans Rand 12 with its subscales of perceived general health (GH), mental health (MCS), and physical health (PCS)) and blood levels. Adherence to exercise (% of attended sessions during the first 12-weeks of the intervention) and adverse events were monitored as well. Data were analyzed using a non-parametric procedure for longitudinal data, estimating rank means (MRank) and relative treatment effects (RTE) as well as linear-mixed effect models for parametric data. The primary endpoint of physical exercise participation was significantly higher at t3 and t6 compared to baseline (t3 vs. t0: MRank = 77.1, p < 0.001, RTE: 0.66; t6 vs. t0: MRank = 70.6, p < 0.001, RTE = 0.60). Improvements at both follow-up time points compared to t0 were also found for relative VO2peak (t3 vs. t0 = 2.6 mL/kg/min, p < 0.001; t6 vs. t0 = 2.0 mL/kg/min, p = 0.001), strength of knee extensors (t3 vs. t0 = 11.7 Nm, p = 0.007; t6 vs. t0= 18.1 Nm, p < 0.001) and GH (t3 vs. t0 = 16.2, p = 0.003; t6 vs. t0 = 13.4, p = 0.008). No changes were found for MCS, PCS and for blood levels. Overall exercise adherence was 77%. No serious adverse events were recorded. Results of this pilot trial represent a first proof of concept for the intervention ‘MultiPill-Exercise’ that will now be implemented and evaluated in a real-world health care setting.
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Affiliation(s)
- Simone Schweda
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
| | - Barbara Munz
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
| | - Christof Burgstahler
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
| | - Andreas Michael Niess
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
| | - Inka Roesel
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
- Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074 Tuebingen, Germany
| | - Gorden Sudeck
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
- Institute of Sports Science, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, University Hospital, Medical Clinic, 72074 Tuebingen, Germany; (B.M.); (C.B.); (A.M.N.); (I.R.); (I.K.)
- Interfaculty Research Institute for Sports and Physical Activity, 72074 Tuebingen, Germany;
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14
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Oak SR, Kobayashi E, Gagnier J, Denard PJ, Sears BW, Gobezie R, Lederman E, Werner BC, Bedi A, Miller BS. Patient Reported Outcomes and Range of Motion After Reverse Total Shoulder Arthroplasty With and Without Subscapularis Repair. JSES Int 2022; 6:923-928. [PMID: 36353412 PMCID: PMC9637760 DOI: 10.1016/j.jseint.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In performing reverse total shoulder arthroplasty (rTSA), the role of repairing the subscapularis has been debated. Our objective was to determine the effect of subscapularis repair following rTSA on postoperative shoulder ranges of motion and patient reported outcome scores (PROs). Methods A prospective registry was reviewed to establish a cohort of primary rTSA patients with a 135-degree humeral implant, with a minimum of 2 years of follow-up. Variables collected included demographics, subscapularis repair information, diagnosis, glenosphere size, and glenoid lateralization information. Outcomes collected were range of motion measurements, subscapularis strength, and multiple generic and shoulder PROs. Multivariable linear regression models were created to predict these 2-year outcomes. Results The 143-patient cohort had a mean age of 69 years with 68% of patients undergoing subscapularis repair. After adjustment in the multivariable models, whether the subscapularis was repaired did not significantly predict a 2-year forward elevation, external rotation, internal rotation, subscapularis strength, Western Ontario Osteoarthritis of the Shoulder score, VR-12 scores, Constant Score, or American Shoulder and Elbow Surgeons Shoulder Scores. Increased glenoid lateralization significantly predicted greater internal rotation, higher VR-12 physical score, and higher Constant Score. There were no dislocations in either group. Conclusions After adjusting for patient and implant factors, subscapularis repair was not associated with a 2-year postoperative range of motion, strength, or any PROs suggesting that repairing the subscapularis may not affect functional outcome. Increased glenoid lateralization through the baseplate and glenosphere independently predicted better internal rotation, VR-12 physical score, and Constant Scores indicating a benefit to lateralization during rTSA.
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Affiliation(s)
- Sameer R. Oak
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | | | - Joel Gagnier
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Asheesh Bedi
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
| | - Bruce S. Miller
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI, USA
- Corresponding author: Bruce S. Miller, MD, University of Michigan Orthopaedic Surgery Department, 24 Frank Lloyd Wright Dr Ste 1000, Lobby A, Ann Arbor, MI 48105, USA.
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15
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Bredemeier K, Larsen S, Shivakumar G, Grubbs K, McLean C, Tress C, Rosenfield D, DeRubeis R, Xu C, Foa E, Morland L, Pai A, Tsao C, Crawford J, Weitz E, Mayinja L, Feler B, Wachsman T, Lupo M, Hooper V, Cook R, Thase M. A comparison of prolonged exposure therapy, pharmacotherapy, and their combination for PTSD: What works best and for whom; study protocol for a randomized trial. Contemp Clin Trials 2022; 119:106850. [PMID: 35842108 DOI: 10.1016/j.cct.2022.106850] [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: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several efficacious psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available; however, the comparative effectiveness of these treatments represents a major gap in the literature. The proposed study will compare the effectiveness of two leading PTSD treatments - Prolonged Exposure (PE) therapy and pharmacotherapy with paroxetine or venlafaxine extended release - as well as the combination of PE and medication. METHODS In a randomized clinical trial, veterans with PTSD (N = 450) recruited across six Veterans Affairs Medical Centers will complete assessments at baseline, mid-treatment (Week 7), post-treatment (Week 14), and follow-up (Weeks 27 and 40). The primary outcome will be change in (both clinician-rated and self-reported) PTSD severity. Depression symptoms, quality of life, and functioning will also be measured and examined as secondary outcomes. Baseline demographic and clinical data will be used to develop "personalized advantage indices" (PAIs), with the goal of identifying who is most likely to benefit from which treatment. CONCLUSIONS This planned trial will yield findings to directly inform clinical practice guidelines for PTSD, by providing comparative effectiveness data to support recommendations about what can be considered the "first-line" treatment option(s) for PTSD. Further, findings from this trial have the potential to guide treatment planning for individual patients, through implementation of PAIs developed from study data, in service of "personalized medicine." TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04961190.
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Affiliation(s)
- Keith Bredemeier
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Sadie Larsen
- Milwaukee VA Medical Center, 5000 West National Avenue, Milwaukee, WI 53295-1000, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Geetha Shivakumar
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Kathleen Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Carmen McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carmella Tress
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - David Rosenfield
- Southern Methodist University, 6425 Boaz Lane, Dallas, TX 75205, USA.
| | - Rob DeRubeis
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Colin Xu
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Edna Foa
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Leslie Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Anushka Pai
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Carol Tsao
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jaclyn Crawford
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Erica Weitz
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Lindiwe Mayinja
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Bridget Feler
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Tamara Wachsman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA.
| | - Margaret Lupo
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Vaughan Hooper
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | - Riley Cook
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Michael Thase
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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16
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Grubbs KM, Abraham TH, Pyne JM, Greene CJ, Teng EJ, Fortney JC. Enhancing Problem-Solving Therapy With Smartphone Technology: A Pilot Randomized Controlled Trial. Psychiatr Serv 2022; 73:805-808. [PMID: 35139654 DOI: 10.1176/appi.ps.201900254] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Development of smartphone apps for mental health care has outpaced research on their effectiveness. This pilot study tested Moving Forward, an app designed to support problem-solving therapy (PST). METHODS Thirty-three veterans seeking mental health care in U.S. Department of Veterans Affairs primary care clinics were randomly assigned to receive six sessions of PST accompanied by either the Moving Forward app (N=17) or a workbook (N=16). Participants completed measures of anxiety, depression, stress, problem-solving style, satisfaction, and between-session practice at baseline and 6- and 12-week follow-ups. Qualitative interviews were used to elicit feedback. RESULTS Participants in both groups reported high satisfaction and reductions in depression, anxiety, and stress. Veterans who used the app reported skills practice, and qualitative data indicated that patients perceived the app as valuable, with the potential to reduce barriers to care. CONCLUSIONS This study provides preliminary evidence to support the ability of the Moving Forward app to augment brief psychotherapy in primary care clinics.
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Affiliation(s)
- Kathleen M Grubbs
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Traci H Abraham
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Jeffrey M Pyne
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Carolyn J Greene
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Ellen J Teng
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - John C Fortney
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
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Abstract
There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.
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Lim R, Du J, Calligeros K. Virtual arthroplasty clinic: a single centre experience: commentary on progress, cost savings and patient retention. ANZ J Surg 2022; 92:2242-2246. [PMID: 35727065 DOI: 10.1111/ans.17854] [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: 12/14/2020] [Revised: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. METHOD A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. RESULTS Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fifty-four arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. CONCLUSION Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.
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Affiliation(s)
- Reuben Lim
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - John Du
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Kosta Calligeros
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
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19
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Schweda S, Müller G, Munz B, Sudeck G, Martus P, Dierkes K, Krauss I. Implementation and evaluation of an individualized physical exercise promotion program in people with manifested risk factors for multimorbidity (MultiPill-Exercise): a study protocol for a pragmatic randomized controlled trial. BMC Public Health 2022; 22:1174. [PMID: 35698074 PMCID: PMC9190168 DOI: 10.1186/s12889-022-13400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/11/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is a major problem in Europe, increasing the need for prevention and rehabilitation programs. In Germany no guidelines have been developed that focus on patients with multiple chronic non-communicable diseases (NCDs). Benefits of physical activity (PA) and exercise in NCDs have been proven, but most interventions focus on single conditions. The evaluation of the effectiveness, efficiency and safety of PA programs in patients suffering from multiple NCDs and the feasibility of the implementation within the health care service remain open research questions. METHODS The multi-site randomized controlled pragmatic trial includes 320 sedentary subjects with at least two of the following NCDs, either manifested or in a pre-stage with evident risk factors: Cardio-vascular disease, Diabetes mellitus type 2, knee/ hip osteoarthritis and obesity. Participants will be recruited from general practitioners and medical specialists and randomized to standard care of a statutory health insurance or MultiPill-Exercise. Standard care includes a choice of one or a maximum of two 8- to 12-week health programs, including nutrition, exercise, relaxation or special disease management programs. MultiPill-Exercise is based on the bio-psycho-social health model, considering a person-oriented perspective in light of given individual characteristics and context factors. The 24-weeks intervention focuses on aerobic and strengthening exercises in line with the WHO PA recommendations. Psychological and pedagogical elements along with behavior change techniques are implemented to ease the initiation and maintenance of exercise participation and lifestyle change, including nutrition. Primary outcome will be short- and long-term PA measured with the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). Secondly, the effectiveness of the program on generic, disease specific, economic, and exercise behavioral parameters, as well as program adherence and safety will be evaluated. DISCUSSION Results of this trial evaluate the PA intervention program in people with multiple NCDs in a real-life scenario. It will serve as a proof of concept with the opportunity of translation into routine practice. This approach, as a multi-site RCT with its rigorous methods and standardized operating procedures for the conduction of the intervention, will allow valid conclusions for the implementation of PA interventions in people with multimorbidity. TRIAL REGISTRATION The trial was registered at www.drks.de (ID: DRKS00025033 ) on 30th September 2021.
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Affiliation(s)
- Simone Schweda
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany.
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany.
| | - Gerhard Müller
- Allgemeine Ortskrankenkasse AOK Baden-Wuerttemberg, Presselstrasse 19, 70191, Stuttgart, Germany
| | - Barbara Munz
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Gorden Sudeck
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
- Department of Sports Science Tuebingen, Faculty of Economic and Social Science, Eberhard Karls University Tuebingen, Wilhelmstrasse 124, 72074, Tuebingen, Germany
| | - Peter Martus
- Department for Clinical Epidemiology and Applied Biostatistics, Faculty of Medicine, University Hospital, Medical Clinic, Silcherstrasse 5, 72076, Tuebingen, Germany
| | - Katja Dierkes
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
- Department of Sports Science Tuebingen, Faculty of Economic and Social Science, Eberhard Karls University Tuebingen, Wilhelmstrasse 124, 72074, Tuebingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
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20
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Bonfils KA, Tennity CL, Congedo BA, Dolowich BA, Hammer LA, Haas GL. Functional outcomes from psychotherapy for people with posttraumatic stress disorder: A meta-analysis. J Anxiety Disord 2022; 89:102576. [PMID: 35580437 DOI: 10.1016/j.janxdis.2022.102576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023]
Abstract
People with posttraumatic stress disorder (PTSD) experience a wide array of symptoms, often accompanied by significant functional and quality of life impairments. Evidence-based psychotherapies are effective for alleviating symptoms in this group, but functional outcomes following psychotherapy are understudied. This study aimed to synthesize existing work on functional outcomes of psychotherapy to conduct a meta-analytic investigation examining whether people with PTSD experience significant improvements in functioning and quality of life following a course of psychotherapy. A literature search was conducted for studies reporting results of randomized clinical trials of psychotherapies for people diagnosed with PTSD that included a functional or quality of life outcome measured at pre- and post-intervention. Both between-groups and within-groups analyses were conducted using a random effects model. Fifty-six independent samples were included. Results suggest that, on average, people with PTSD experience significant, moderate improvement in functional outcomes after a course of psychotherapy. Taken together, this meta-analysis represents a substantial advance in our understanding of functional outcomes of psychotherapy for people with PTSD. Findings suggest that psychotherapy is one vehicle through which functional outcomes may be improved for this group, though notably to a lesser degree than symptom improvement.
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Affiliation(s)
- Kelsey A Bonfils
- Department of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 39406, United States; VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, United States.
| | - Cassidy L Tennity
- Department of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 39406, United States.
| | - Benjamin A Congedo
- VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, United States.
| | - Benjamin A Dolowich
- Department of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 39406, United States.
| | - Lillian A Hammer
- Department of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 39406, United States.
| | - Gretchen L Haas
- VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
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21
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Impact of preoperative opioid use on patient-reported outcomes following primary total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1283-1290. [PMID: 35608692 DOI: 10.1007/s00590-022-03297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The previous literature suggests that 25-30% of patients who undergo total knee arthroplasty (TKA) are using opioids prior to their surgery. This study aims to investigate the effect of preoperative opioid use on clinical outcomes and patient-reported outcome measures (PROMs) following TKA. METHODS We retrospectively reviewed 329 patients who underwent primary TKA from 2019 to 2020, answered the preoperative opioid survey, and had available PROMs. Patients were stratified into two groups based on whether they were taking opioids preoperatively or not: 26 patients with preoperative opioid use (8%) and 303 patients without preoperative opioid use (92%) were identified. Demographics, clinical data, and PROMs [Forgotten Joint Score (FJS-12), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), and Veterans RAND-12 Physical and Mental components (VR-12 PCS and MCS)] were collected. Demographic differences were assessed with Chi-square and independent sample t-tests. Outcomes were compared using multilinear regression analysis, controlling for demographic differences. RESULTS Preoperative opioid users had a significantly longer length-of-stay (2.74 vs. 2.10; p = 0.010), surgical time (124.65 vs. 105.69; p < 0.001), and were more likely to be African-American (38.5 vs. 14.2%; p = 0.010) compared to preoperative opioid-naive patients. Postoperative FJS-12 did not statistically differ between the two groups. While preoperative KOOS, JR scores were significantly lower for preoperative opioid users (41.10 vs. 46.63; p = 0.043), they did not significantly differ postoperatively. Preoperative VR-12 PCS did not statistically differ between the groups; however, both 3-month (33.87 vs. 38.41; p = 0.049) and 1-year (36.01 vs. 44.73; p = 0.043) scores were significantly lower for preoperative opioid users. Preoperative VR-12 MCS was significantly lower for preoperative opioid users (46.06 vs. 51.06; p = 0.049), though not statistically different postoperatively. CONCLUSION At 8%, our study population had a lower percentage of opioid users than previously reported in the literature. Preoperative opioid users had longer operative times and length of stay compared to preoperatively opioid-naive patients. While both cohorts achieved similar clinical benefits following TKA, preoperative opioid users reported lower postoperative scores with respect to VR-12 PCS scores. LEVEL III EVIDENCE Retrospective Cohort.
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22
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Lynch CP, Cha EDK, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Two-year validation and minimal clinically important difference of the Veterans RAND 12 Item Health Survey Physical Component Score in patients undergoing minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine 2022; 36:731-740. [PMID: 34798597 DOI: 10.3171/2021.6.spine21231] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Physical Component Score of the Veterans RAND 12 Item Health Survey (VR-12 PCS) has been assessed for use at short-term and intermediate-term time points for lumbar fusion populations. This study assesses the long-term validity and establishes minimal clinically important difference (MCID) values of VR-12 PCS in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS A surgical registry was retrospectively reviewed for primary, elective, single-level MIS TLIF procedures with posterior instrumentation. Patients missing preoperative and 2-year postoperative VR-12 PCS survey data were excluded. VR-12 PCS, SF-12 Health Survey Physical Component Summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), and Oswestry Disability Index (ODI) patient-reported outcome measures (PROMs) were recorded preoperatively and postoperatively. Responsiveness of the VR-12 measure was assessed in two ways. First, the mean postoperative PROM scores were compared with preoperative baseline values using a paired Student t-test. Second, MCID values were calculated using both distribution-based and anchor-based methods and used to assess improvement in VR-12 score at the 2-year time point. Discriminant validity of the VR-12 was assessed using cross-sectional and longitudinal anchors. Convergent validity of the VR-12 measure was assessed using Pearson's correlation coefficient and partial time-independent correlation. Floor and ceiling effects were assessed. RESULTS A total of 74 patients who underwent MIS TLIF were included. The VR-12 PCS demonstrated significant improvements at all time points from 12 weeks to 2 years (p < 0.001 for all). VR-12 PCSs were significantly different for patients classified using cross-sectional anchors (p < 0.001) and longitudinal anchors (p ≤ 0.005). Calculated MCID values ranged from 4.1 to 8.5, and 4.1 was selected as the optimal MCID, which 87.8% of patients achieved. Strong, significant correlations of the VR-12 PCS with SF-12 PCS and PROMIS PF were demonstrated at all time points (p < 0.001 for all). No significant floor or ceiling effects were detected. CONCLUSIONS The VR-12 PCS demonstrated excellent responsiveness, discriminant and convergent validity, and no significant floor or ceiling effects up to 2 years after MIS TLIF. Therefore, VR-12 PCS may serve as a valid measure of long-term physical function.
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Donald EE, Whitlock K, Dansereau T, Sands DJ, Small D, Stajduhar KI. A codevelopment process to advance methods for the use of patient-reported outcome measures and patient-reported experience measures with people who are homeless and experience chronic illness. Health Expect 2022; 25:2264-2274. [PMID: 35411709 PMCID: PMC9615092 DOI: 10.1111/hex.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction People who experience social disadvantage including homelessness suffer from numerous ill health effects when compared to the general public. Use of patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) enables collection of information from the point of view of the person receiving care. Involvement in research and health care decision‐making, a process that can be facilitated by the use of PROMs and PREMs, is one way to promote equity in care. Methods This article reports on a codevelopment and consultation study investigating the use of PROMs and PREMs with people who experience homelessness and chronic illness. Data were analysed according to interpretative phenomenological analysis. Results Committee members with lived experience identified three themes for the role of PROMs and PREMs in health care measurement: trust and relationship‐building; health and quality of life; and equity, alongside specific recommendations for the design and administration of PROMs and PREMs. The codevelopment process is reported to demonstrate the meaningful investment in time, infrastructure and relationship‐building required for successful partnership between researchers and people with lived experience of homelessness. Conclusion PROMs and PREMs can be meaningful measurement tools for people who experience social disadvantage, but can be alienating or reproduce inequity if they fail to capture complexity or rely on hidden assumptions of key concepts. Patient or Public Contribution This study was conducted in active partnership between researchers and people with experience of homelessness and chronic illness, including priority setting for study design, data construction, analysis and coauthorship on this article.
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Affiliation(s)
- Erin E Donald
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Schäfer A, Löffler-Idel I, Adelt E, Fielder C, Reinhardt A, Wilhelm N, Lochwitz A, Paelke V. Evaluation eines mHealth unterstützten Heimübungsprogramms für Menschen mit Kniearthrose (mhexos). PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1405-5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Kniearthrose ist einer der Hauptgründe für Behinderungen und Mobilitätseinschränkungen bei älteren Menschen, die mit Leid und hohen Krankheitskosten verbunden sind. Nicht operative Therapien wie Übungstherapie, Maßnahmen zur Steigerung der körperlichen Aktivität und zur Unterstützung des Selbstmanagements können Schmerzen verringern sowie die Funktion und gesundheitsbezogene Lebensqualität verbessern. Entsprechende Heimübungsprogramme sind ein wichtiger Baustein der Therapie, die Adhärenz ist jedoch oft nicht ausreichend. Digitale Gesundheitsanwendungen sind, insbesondere unter den Bedingungen der aktuellen COVID-19-Pandemie, eine vielversprechende Möglichkeit, um Barrieren zu überwinden.
Ziel Untersuchung der Implementierbarkeit eines mHealth-Heimübungsprogramms für Patient*innen mit Kniearthrose (mhexos) in Hinblick auf Bedienbarkeit, Erfahrungen von Nutzer*innen, Nutzungsverhalten und der Veränderung gesundheitsbezogener Endpunkte.
Methode Patient*innen mit Kniearthrose führten das mHealth Heimübungsprogramm mhexos 4 Wochen lang durch. Die Umsetzung erfolgte über ein Tablet mit insgesamt 39 Übungsvideos zur Kräftigung, Balance und Koordination, die in 3 Schwierigkeitsstufen konfiguriert werden können. Über eine App wurden Daten zur Schmerzintensität und der selbst wahrgenommenen Belastung erfasst. Es wurden leitfadengestützte Interviews durchgeführt und Fragebögen zur Erfassung der Bedienbarkeit und der Erfahrungen der Nutzer*innen sowie zu gesundheitsbezogenen Endpunkten an 2 Messzeitpunkten eingesetzt.
Ergebnisse Es wurden 10 Patient*innen und 7 Therapeut*innen eingeschlossen. Das mHealth-Heimübungsprogramm konnte in die Praxis und den Alltag der Teilnehmenden implementiert werden. Die App wurde überwiegend als bedienungsfreundlich und motivierend eingeschätzt, die Therapietreue war mit einer Übungsfrequenz von 2,7 × pro Woche (SD 0,6) hoch. In den gesundheitsbezogenen Endpunkten zeigten sich im Interventionszeitraum kleine, klinisch und statistisch nicht signifikante Veränderungen.
Schlussfolgerung: mhexos scheint geeignet, Heimübungsprogramme für Menschen mit Kniearthrose unter den Rahmenbedingungen der Routineversorgung zu unterstützen. Für eine weitergehende Beurteilung der klinischen Wirksamkeit sind kontrollierte Studien nötig.
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Affiliation(s)
- Axel Schäfer
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Ingrid Löffler-Idel
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Elisabeth Adelt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Christina Fielder
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Angelika Reinhardt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Nathalie Wilhelm
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Andreas Lochwitz
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
| | - Volker Paelke
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
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Ting CH, Scholes C, Zbrojkiewicz D, Bell C. Baseline Analysis of Patients Presenting for Surgical Review of Anterior Cruciate Ligament Rupture Reveals Heterogeneity in Patient-Reported Outcome Measures. J Knee Surg 2022; 35:159-166. [PMID: 32629513 DOI: 10.1055/s-0040-1713658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the establishment of successful surgical techniques and rehabilitation protocols for anterior cruciate ligament (ACL) reconstruction, published return to sport rates are less than satisfactory. This has led orthopaedic surgeons and researchers to develop more robust patient selection methods, and investigate prognostic patient characteristics. No previous studies have integrated baseline characteristics and responses to patient-reported outcome measures (PROMs) of patients with ACL rupture presenting for surgical review. Patients electing to undergo ACL reconstruction under the care of a single orthopaedic surgeon at a metropolitan public hospital were enrolled in a clinical quality registry. Patients completed Veterans RAND 12-item Health Survey (VR-12) Physical Component Summary and Mental Component Summary scores, Tegner activity scale, and International Knee Documentation Committee (IKDC) questionnaires at presentation. Total scores were extracted from the electronic registry, and a machine learning approach (k-means) was used to identify subgroups based on similarity of questionnaire responses. The average scores in each cluster were compared using analysis of variance (ANOVA; Kruskal-Wallis) and nominal logistic regression was performed to determine relationships between cluster membership and patient age, gender, body mass index (BMI), and injury-to-examination delay. A sample of 107 patients with primary ACL rupture were extracted, with 97 (91%) available for analysis with complete datasets. Four clusters were identified with distinct patterns of PROMs responses. These ranged from lowest (Cluster 1) to highest scores for VR-12 and IKDC (Cluster 4). In particular, Cluster 4 returned median scores within 6 points of the patient acceptable symptom state for the IKDC score for ACL reconstruction (70.1, interquartile range: 59-78). Significant (p < 0.05) differences in PROMs between clusters were observed using ANOVA, with variance explained ranging from 40 to 69%. However, cluster membership was not significantly associated with patient age, gender, BMI, or injury-to-examination delay. Patients electing to undergo ACL reconstruction do not conform to a homogenous group but represent a spectrum of knee function, general physical and mental health, and preinjury activity levels, which may not lend itself to uniform treatment and rehabilitation protocols. The factors driving these distinct responses to PROMs remain unknown but are unrelated to common demographic variables.
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Affiliation(s)
- Chee Han Ting
- Department of Orthopaedics, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | | | - David Zbrojkiewicz
- Department of Orthopaedics, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Christopher Bell
- Department of Orthopaedics, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
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Fortin M, Stewart M, Almirall J, Berbiche D, Bélanger M, Katz A, Ryan BL, Wong ST, Zwarenstein M. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. JOURNAL OF COMORBIDITY 2021; 11:26335565211039780. [PMID: 34820337 PMCID: PMC8606917 DOI: 10.1177/26335565211039780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18-80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Canada. The patient-centered intervention was based on motivational approach and self-management support. Outcomes were evaluated in a one-year pre-post study design with questionnaires that included the Health Education Questionnaire (heiQ), the Self-Efficacy for Managing Chronic Diseases, the Veteran RAND-12 Health Survey (VR-12), the EuroQoL 5-Domains questionnaire, the Kessler six item Psychological Stress Scale, and measures of smoking habit, physical activity, healthy eating and alcohol consumption. Subgroup analyses by age, number of conditions, sex, and income were also conducted. Results The heiQ domain of emotional wellbeing improved significantly. Improvement was also observed for the VR-12 and the K6. Among the health behaviours, only healthy eating was improved. Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. Conclusion One year after the intervention, participants significantly improved a variety of outcomes. Subgroup analyses suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. This suggests that future interventions should be tailored to patients' characteristics including age, sex, income and number of conditions.
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Affiliation(s)
| | | | | | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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Brady CB, Robey I, Stein TD, Huber BR, Riley J, Abdul Rauf N, Spencer KR, Walt G, Adams L, Averill JG, Walker S, McKee AC, Thomson SP, Kowall NW. The Department of Veterans Affairs Gulf War Veterans' Illnesses Biorepository: Supporting Research on Gulf War Veterans' Illnesses. Brain Sci 2021; 11:1349. [PMID: 34679413 PMCID: PMC8533803 DOI: 10.3390/brainsci11101349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS To introduce a resource supporting research on Gulf War illness (GWI) and related disorders, the Gulf War Veterans' Illnesses Biorepository (GWVIB). METHODS Gulf War era veterans (GWVs) are recruited nationally and enrolled via telephone and email/postal mail. Enrolled veterans receive annual telephone and mail follow-up to collect health data until their passing. A postmortem neuropathological examination is performed, and fixed and frozen brain and spinal cord samples are banked to support research. Investigators studying GWI and related disorders may request tissue and data from the GWVIB. RESULTS As of September 2021, 127 GWVs from 39 states were enrolled; 60 met the criteria for GWI, and 14 met the criteria for chronic multisymptom illness (CMI). Enrollees have been followed up to six years. Postmortem tissue recoveries were performed on 14 GWVs. The most commonly found neuropathologies included amyotrophic lateral sclerosis, chronic traumatic encephalopathy, and Lewy body disease. Tissue was of good quality with an average RNA integrity number of 5.8 (SD = 1.0) and ≥4.8 in all of the cases. DISCUSSION The availability of health data and high-quality CNS tissue from this well-characterized GWV cohort will support research on GWI and related disorders affecting GWVs. Enrollment is ongoing.
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Affiliation(s)
- Christopher B. Brady
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Thor D. Stein
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA 01730, USA
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Jessica Riley
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Nazifa Abdul Rauf
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Keith R. Spencer
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Gabriel Walt
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Latease Adams
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - James G. Averill
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Sean Walker
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Ann C. McKee
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stephen P. Thomson
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Neil W. Kowall
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Neurology Service, VA Boston Healthcare System, Boston, MA 02130, USA
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[Results of a pilot study on the role of therapy expectation in interdisciplinary multimodal pain therapy for chronic back pain]. Schmerz 2021; 36:172-181. [PMID: 34618234 PMCID: PMC9156493 DOI: 10.1007/s00482-021-00590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Hintergrund Chronische Rückenschmerzen sind eine schwerwiegende und global sehr häufig auftretende Erkrankung mit enormen persönlichen sowie sozioökonomischen Auswirkungen. Die interdisziplinäre multimodale Schmerztherapie (IMST) ist eines der wenigen evidenzbasierten Behandlungsverfahren für chronische Schmerzen. Obwohl bekannt ist, dass Schmerzen sowie deren Chronifizierung und Behandlung von den persönlichen Erwartungen der Patienten beeinflusst werden, gibt es wenige etablierte Interventionen oder Richtlinien für eine aktive Modulation dieses Effekts. Ziel der Arbeit Wir möchten mit dieser Arbeit die Rolle der Erwartung als Prädiktor für Schmerzen sowie schmerzbezogene Beeinträchtigung in der klinischen Praxis verdeutlichen und präsentieren hierzu beispielhaft explorative Pilotdaten einer Beobachtungskohorte unserer Klinik. Material und Methoden Die Untersuchung zeigt erste Daten einer prospektiven longitudinalen Beobachtungsstudie bestehend aus bis zu 41 Patienten mit chronischen Rückenschmerzen, die im Setting einer IMST am Essener Rückenschmerz-Zentrum behandelt wurden. Es wurden Daten zum Zeitpunkt der Aufnahme (T0) und der Entlassung (T1) sowie drei Monate nach Therapieende (T2) erhoben. Primäre Endpunkte waren die Schmerzintensität und die Schmerzbeeinträchtigung. Zusätzlich erfassten wir die Therapieerwartung zum Zeitpunkt der Aufnahme als möglichen Prädiktor. Die Bedeutung der vor der Therapie erhobenen Therapieerwartung wurde mittels linearer Regression erfasst. Ergebnisse Die IMST führte zu einer signifikanten Besserung in Bezug auf die Schmerzintensität und -beeinträchtigung. Der Effekt auf die Schmerzintensität war über den Zeitraum von drei Monaten nach Therapieende anhaltend und die Beeinträchtigung sank in diesem Zeitraum weiter signifikant. Diskussion Erwartung war ein signifikanter Prädiktor für die Abnahme der Schmerzintensität und erklärte ca. 15 % der Varianz. In der klinischen Praxis sollten daher valide Methoden etabliert werden, negative Erwartungen zu reduzieren und positive Erwartungen zu fördern.
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Alam R, Patel HD, Su ZT, Cheaib JG, Ged Y, Singla N, Allaf ME, Pierorazio PM. Self-reported quality of life as a predictor of mortality in renal cell carcinoma. Cancer 2021; 128:479-486. [PMID: 34609761 DOI: 10.1002/cncr.33956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/22/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study evaluated the utility of self-reported quality of life (QOL) metrics in predicting mortality among all-comers with renal cell carcinoma (RCC) and externally tested the findings in a registry of patients with small renal masses. METHODS The Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) captured QOL metrics composed of mental component summary (MCS) and physical component summary (PCS) scores. Regression models assessed associations of MCS and PCS with all-cause, RCC-specific, and non-RCC-specific mortality. Harrell's concordance statistic (the C-index) and the Akaike information criterion (AIC) determined predictive accuracy and parsimony, respectively. Findings were tested in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry. RESULTS In SEER-MHOS, 1494 patients had a median age of 73.4 years and a median follow-up time of 5.6 years. Each additional MCS and PCS point reduced the hazard of all-cause mortality by 1.3% (95% CI, 0.981-0.993; P < .001) and 2.3% (95% CI, 0.971-0.984; P < .001), respectively. Models with QOL metrics demonstrated higher predictive accuracy (C-index, 72.3% vs 70.1%) and parsimony (AIC, 9376.5 vs 9454.5) than models without QOL metrics. QOL metrics exerted a greater effect on non-RCC-specific mortality than RCC-specific mortality. External testing in the DISSRM registry confirmed these findings with similar results for all-cause mortality. CONCLUSIONS Models with self-reported QOL metrics predicted all-cause mortality in patients with RCC with higher accuracy and parsimony than those without QOL metrics. Physical health was a stronger predictor of mortality than mental health. The findings support the incorporation of QOL metrics into prognostic models and patient counseling for RCC.
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Affiliation(s)
- Ridwan Alam
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhuo T Su
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph G Cheaib
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yasser Ged
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nirmish Singla
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Stein DJ, Craske MG, Rothbaum BO, Chamberlain SR, Fineberg NA, Choi KW, de Jonge P, Baldwin DS, Maj M. The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry 2021; 20:336-356. [PMID: 34505377 PMCID: PMC8429350 DOI: 10.1002/wps.20919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | | | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- University of Cambridge Clinical Medical School, Cambridge, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Viola C, Toma P, Manta F, Benvenuto M. The more you know, the better you act? Institutional communication in Covid-19 crisis management. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2021; 170:120929. [PMID: 34898725 PMCID: PMC8648080 DOI: 10.1016/j.techfore.2021.120929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/10/2021] [Accepted: 05/31/2021] [Indexed: 06/14/2023]
Abstract
The plurality of communication channels and the spread of fake news are widespread phenomena in today's society. Those constituted a serious risk during the Covid-19 pandemic crisis management, increasing the confusion among the population. This research aims at assessing the effectiveness of institutional communication amid the management of the Covid-19 pandemic crisis in Italy. We first assessed the phenomenon by building a structured theoretical background stressing the concepts of risk communication, community engagement, and health literacy, highlighting the dynamic and continuously changing scenario of communication strategies, also due to the spread of social media and the mutation of conventional media outlets. We sent a questionnaire to a sample of citizens to assess the impact of three predictors, i.e., the perceived communication, the perceived knowledge, and the perceived information. Based on answers, we built an ordered logit model assigning continuous intervals as values for the dependent variables. The observed results enhanced the crucial role of the phenomenon of health literacy and the impact of asymmetric information on the effectiveness of institutional communication. Education played a fundamental role in understanding communication pillars and building an individual consciousness about health risks prevention.
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Affiliation(s)
- Carmine Viola
- Dipartimento di Scienze dell'Economia, University of Salento, Lecce, Italy
| | - Pierluigi Toma
- Dipartimento di Scienze dell'Economia, University of Salento, Lecce, Italy
| | - Francesco Manta
- Department of Management, Finance and Technology, LUM "G. Degennaro" University, Bari, Italy
| | - Marco Benvenuto
- Dipartimento di Scienze dell'Economia, University of Salento, Lecce, Italy
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Klute M, Laekeman M, Kuss K, Petzke F, Dieterich A, Leha A, Neblett R, Ehrhardt S, Ulma J, Schäfer A. Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE). BMC Musculoskelet Disord 2021; 22:708. [PMID: 34407773 PMCID: PMC8375049 DOI: 10.1186/s12891-021-04481-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Central Sensitization Inventory (CSI) is a screening tool designed to detect symptoms related to Central Sensitization (CS) and Central Sensitivity Syndromes (CSS) by measuring the degree of related phenomena. The objective of this study was to create a German, culturally-adapted version of the CSI and to test its psychometric properties. METHODS A German version of the CSI (CSI-GE) was developed, culturally-adapted, and pretested for comprehensibility. The psychometric properties of the resulting version were validated in a clinical study with chronic pain and pain-free control subjects. To assess retest reliability, the CSI-GE was administered twice to a subgroup of patients. Structural validity was tested using factor analyses. To investigate construct validity a hypotheses testing approach was used, including (1) correlations between the CSI-GE and several other well-established questionnaires as well as (2) an investigation of the CSI-GE discriminative power between different subgroups of participants believed to have different degrees of CS. RESULTS The CSI-GE showed excellent reliability, including high test-retest characteristics. Factor analyses confirmed a bi-factor dimensionality as has been determined previously. Analysing construct validity 6 out of 11 hypotheses (55%) were met. CSI-GE scores differentiated between subgroups according to expectations. Correlations between CSI-GE scores and other questionnaires suggested that none of the correlated constructs was identical, but there was overlap with other questionnaires based on symptom load. Several correlations did not fit with our current understanding of CS. CONCLUSION The CSI-GE appears to be a reliable tool for measuring CS/CSS-related symptomatology. Whether this implies that the CSI-GE measures the degree of CS within an individual subject remains unknown. The resulting score should be interpreted cautiously until further clarification of the construct.
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Affiliation(s)
- Michel Klute
- Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Marjan Laekeman
- Physiological Psychology, Otto-Friedrich- University of Bamberg, Bamberg, Germany
| | - Katrin Kuss
- Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany
| | - Frank Petzke
- Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Angela Dieterich
- Physiotherapy, Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Steffen Ehrhardt
- Faculty of Social Sciences, City University of Applied Sciences, Bremen, Germany
| | - Joachim Ulma
- Clinic for Pain Medicine Bremen, Rotes-Kreuz-Krankenhaus Bremen, Bremen, Germany
| | - Axel Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art, Hildesheim, Germany
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[Characteristic values and test statistical goodness of the Veterans RAND 12-Item Health Survey (VR-12) in patients with chronic pain : An evaluation based on the KEDOQ pain dataset]. Schmerz 2021; 36:109-120. [PMID: 34279750 PMCID: PMC8956556 DOI: 10.1007/s00482-021-00570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/01/2022]
Abstract
The Veterans RAND 12-Item Health Survey (VR-12) was added to the German Pain Questionnaire (DSF) as a self-report measure of health-related quality of life in 2016, replacing the previously used SF-12, which required a license. Both measures have 12 items and include a physical component summary (PCS) and a mental component summary (MCS). Evaluations with a larger sample on characteristic values and on the test-statistical goodness of the VR-12 in patients with chronic pain are so far missing. Data on the VR-12 and other procedures of the DSF were evaluated from 11,644 patients from 31 centers participating in KEDOQ pain. The patients filled out the DSF before starting a pain therapy treatment. Change sensitivity was determined for 565 patients for whom the VR-12 was available from a follow-up questionnaire of the DSF several months after the initial survey.The reliability (Cronbach's alpha) of the PCS was rtt = 0.78 and for the MCS rtt = 0.84. The MCS had significant relationships with the depression, anxiety and stress scales (r = -0.51 to r = -0.72), and the PCS correlated more highly with areas of pain-related impairment (r = -0.48 to r = -0.52). Patients with higher pain chronicity, those with higher pain severity, and those with evidence of high psychological distress described significantly lower health-related quality of life in PCS and MCS. The effect size (ES) of change in terms of improvement in health-related quality of life was ES = 0.33 in the MCS and ES = 0.51 in the PCS.The results are in agreement with the findings of the SF-36 and SF-12 in patient collectives with chronic pain. In summary, they show that the VR-12 is an adequate substitute for the SF-12 in the German pain questionnaire.
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Singh V, Kugelman DN, Rozell JC, Meftah M, Schwarzkopf R, Davidovitch RI. Impact of Preoperative Opioid Use on Patient Outcomes Following Primary Total Hip Arthroplasty. Orthopedics 2021; 44:77-84. [PMID: 34038695 DOI: 10.3928/01477447-20210217-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate whether preoperative opioid use had any effect on clinical outcomes and patient-reported outcome measures (PROMs) before and after primary, elective total hip arthroplasty (THA). The authors retrospectively reviewed 793 patients who underwent primary THA from November 2018 to March 2020 with available PROMs. Patients were stratified into two groups based on whether or not they were taking opioids preoperatively. Demographics, clinical data, and PROMs (Forgotten Joint Score-12 [FJS-12], Hip disability and Osteoarthritis Outcome Score for Joint Replacement [HOOS, JR], and Veterans RAND 12 [VR-12] Physical Component Score [PCS] and Mental Component Score [MCS]) were collected at various time periods. Demographic differences were assessed with chi-square and independent sample t tests. Clinical data and PROMs were compared using multilinear regressions. Seventy-five (10%) patients were preoperative opioid users and 718 (90%) were not. Preoperative opioid users had a longer stay (1.37 vs 1.07 days; P=.030), a longer surgical time (102.44 vs 90.20 minutes; P=.001), and higher all-cause postoperative emergency department visits (6.7% vs 2.1%; P=.033) compared with patients not taking opioids preoperatively. Preoperative HOOS, JR (46.63 vs 51.26; P=.009), VR-12 PCS (27.79 vs 31.53; P<.001), and VR-12 MCS (46.24 vs 49.33; P=.044) were significantly lower for preoperative opioid users, but 3-month and 1-year postoperative scores were not statistically different. At 3 months and 1 year, FJS-12 scores did not differ significantly. Mean improvement preoperatively to 1 year in HOOS, JR values exceeded the minimal clinically important difference, with preoperative opioid users experiencing a greater improvement (36.50 vs 33.11; P=.008). Preoperative opioid users had a longer stay, a longer surgical time, and higher all-cause emergency department visits compared with preoperatively opioid naïve patients. Although preoperative opioid users reported significantly lower preoperative PROMs, they did not statistically differ postoperatively, which indicates a larger delta improvement and similar benefits following THA. [Orthopedics. 2021;44(2):77-84.].
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Ho K, Novak Lauscher H, Cordeiro J, Hawkins N, Scheuermeyer F, Mitton C, Wong H, McGavin C, Ross D, Apantaku G, Karim ME, Bhullar A, Abu-Laban R, Nixon S, Smith T. Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study. JMIR Form Res 2021; 5:e24509. [PMID: 34081015 PMCID: PMC8212633 DOI: 10.2196/24509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/29/2023] Open
Abstract
Background Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384
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Affiliation(s)
- Kendall Ho
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Helen Novak Lauscher
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cordeiro
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Craig Mitton
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Colleen McGavin
- BC Support for People & Patient-Oriented Research & Trials, Vancouver, BC, Canada
| | - Dianne Ross
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Glory Apantaku
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsan Karim
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amrit Bhullar
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Suzanne Nixon
- University of British Columbia, Vancouver, BC, Canada
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Buchholz I, Feng YS, Buchholz M, Kazis LE, Kohlmann T. Translation and adaptation of the German version of the Veterans Rand-36/12 Item Health Survey. Health Qual Life Outcomes 2021; 19:137. [PMID: 33947411 PMCID: PMC8097879 DOI: 10.1186/s12955-021-01722-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The translated and culturally adapted German version of the Veterans Rand 36 Items Health Survey (VR-36), and its short form, the VR-12 counterpart, were validated in a German sample of orthopedic (n = 399) and psychosomatic (n = 292) inpatient rehabilitation patients. METHODS The instruments were analyzed regarding their acceptance, distributional properties, validity, responsiveness and ability to discriminate between groups by age, sex and clinically specific groups. Eligible study participants completed the VR-36 (n = 169) and the VR-12 (n = 177). They also completed validated patient-reported outcome measures (PROs) including the Euroqol-5 Dimensions 5 Level (EQ-5D-5L); Depression, Anxiety and Stress Scale (DASS); Hannover Functional Abilities Questionnaire (HFAQ); and CDC Healthy Days. The VR-12 and the VR-36 were compared to the reference instruments MOS Short Form-12 Items Health Survey (SF-12) version 1.0 and MOS Short Form-36 Items Health Survey (SF-36) version 1.0, using percent of completed items, distributional properties, correlation patterns, distribution measures of known groups validity, and effect size measures. RESULTS Item non-response varied between 1.8%/1.1% (SFVR-36/RESF-36) and 6.5%/8.6% (GHVR-36/GHSF-36). PCS was normally distributed (Kolmogorov-Smirnov tests: p > 0.05) with means, standard deviations and ranges very similar between SF-36 (37.5 ± 11.7 [13.8-66.1]) and VR-36 (38.5 ± 10.1 [11.7-67.8]), SF-12 (36.9 ± 10.9 [15.5-61.6]) and VR-12 (36.2 ± 11.5 [12.7-59.3]). MCS was not normally distributed with slightly differing means and ranges between the instruments (MCSVR-36: 36.2 ± 14.2 [12.9-66.6], MCSSF-36: 39.0 ± 15.6 [2.0-73.2], MCSVR-12: 37.2 ± 13.8 [8.4-70.2], MCSSF-12: 39.0 ± 12.3 [17.6-65.4]). Construct validity was established by comparing correlation patterns of the MCSVR and PCSVR with measures of physical and mental health. For both PCSVR and MCSVR there were moderate (≥ 0.3) to high (≥ 0.5) correlations with convergent (PCSVR: 0.55-0.76, MCSVR: 0.60-0.78) and small correlations (< 0.1) with divergent (PCSVR: < 0.12, MCSVR: < 0.16) self-report measures. Known-groups validity was demonstrated for both VR-12 and VR-36 (MCS and PCS) via comparisons of distribution parameters with significant higher mean PCS and MCS scores in both VR instruments found in younger patients with fewer sick days in the last year and a shorter duration of rehabilitation. CONCLUSIONS The psychometric analysis confirmed that the German VR is a valid and reliable instrument for use in orthopedic and psychosomatic rehabilitation. Yet further research is needed to evaluate its usefulness in other populations.
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Affiliation(s)
- Ines Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - You-Shan Feng
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Maresa Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany St Talbot Building, Boston, MA 02118 USA
| | - Thomas Kohlmann
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
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Ganguly AP, Lira MC, Lodi S, Forman LS, Colasanti JA, Williams EC, Liebschutz JM, del Rio C, Samet JH, Tsui JI. Race and satisfaction with pain management among patients with HIV receiving long-term opioid therapy. Drug Alcohol Depend 2021; 222:108662. [PMID: 33775447 PMCID: PMC9215531 DOI: 10.1016/j.drugalcdep.2021.108662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Management of chronic pain is an essential aspect of HIV primary care. Previous literature in the general population has elucidated racial disparities in the evaluation and treatment of pain. This study examined racial/ethnic differences in patient satisfaction and barriers to pain management among a cohort of PWH receiving LTOT. MATERIALS AND METHODS Patient-reported survey and EMR data were compared between non-white (n = 135; 81.3 %) and white (n = 31; 18.7 %) patients in a cohort of 166 PWH receiving LTOT in two clinics in Atlanta and Boston. Quantile and linear regression were used to evaluate the association between race and pain management outcomes: 1) satisfaction with pain management (0-10) and 2) patient-related barriers to pain management, including patient perceptions of pain medications, fatalism, and communication about pain. Models were adjusted for sex, age, clinical site, and baseline general health. RESULTS Non-white participants were noted to receive chronic opioids for a shorter mean duration of time than white participants (6.0 versus 11.0 years, p < 0.001) and lower mean morphine equivalent daily dose (MEDD) than white participants (28.1 versus 66.9 mg, p < 0.001). In adjusted analyses, there was no significant difference in satisfaction with pain management among non-white and white participants (p = 0.101). There was no significant difference in barriers to pain management in unadjusted (p = 0.335) nor adjusted models (p = 0.397). CONCLUSION While non-white PWH were noted to have received lower doses of chronic opioids and for shorter duration than white PWH, satisfaction with pain management was similar. Patient-related barriers to pain management were similar among non-white and white PWH.
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Affiliation(s)
- Anisha P. Ganguly
- Internal Medicine Residency, University of Washington, Seattle, Washington
| | - Marlene C. Lira
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan A. Colasanti
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Emily C. Williams
- University of Washington School of Public Health, Department of Health Services, Seattle, Washington,VA Puget Sound Health Care System, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos del Rio
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
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Gugliucci MR, Weaver SA, Lin A. Vet to Vet Maine: A Pilot Study Measuring Effectiveness of a Veteran Companion Program in Reducing Social Isolation and Loneliness. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Lassen CL, Siam L, Degenhart A, Klier TW, Bundscherer A, Lindenberg N. Short-term impact of the COVID-19 pandemic on patients with a chronic pain disorder. Medicine (Baltimore) 2021; 100:e25153. [PMID: 33725917 PMCID: PMC7969217 DOI: 10.1097/md.0000000000025153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
The current Covid-19 pandemic has already had a definite impact on the daily life of many people worldwide. It has been proposed that people with preexisting medical conditions will be harder hit by the pandemic and the subsequent measures to contain the spread of the disease. In this questionnaire-based, observational study, we aimed to assess the impact of the pandemic on patients with a chronic pain disorder, who are treated at a tertiary multidisciplinary pain center.Participants rated the impact of the pandemic on their chronic pain disorder using a self-designed questionnaire. Also, participants filled out the regular follow-up questionnaire to assess a chronic pain disorder measuring among other parameters pain intensity, symptoms of depression, anxiety, stress, and pain-related quality of life.Of 136 eligible patients who presented to our pain center between May 5th and July 17th, 112 agreed to participate in the study (82.4%). Eighty two participants (73.2%) reported a deterioration of the pain disorder using the self-designed questionnaire. The more robust parameters of the regular follow-up questionnaire showed no relevant changes compared to data collected before the pandemic. We were not able to detect any demographic and medical parameters that were clinically relevantly associated with a higher impact of the pandemic.We conclude that a chronic pain disorder is a relatively stable disease that does not change significantly due to external factors, like the Covid-19 pandemic, even if the subjective impact is perceived to be high.
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40
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Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
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Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
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Singh V, Simcox T, Aggarwal VK, Schwarzkopf R, Long WJ. Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons. Arthroplast Today 2021; 8:40-45. [PMID: 33718554 PMCID: PMC7921708 DOI: 10.1016/j.artd.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 01/22/2023] Open
Abstract
Background An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-trained surgeons and non-AR (NAR) fellowship-trained surgeons. Material and Methods We retrospectively reviewed 7415 patients who underwent primary TKA from 2016 to 2020. Two cohorts were established based on whether the operation was performed by an AR or NAR fellowship-trained surgeon. Demographic, clinical data, and patient-reported outcome measures were collected at various time-points (preoperatively, 3 months, 1 year). Demographic differences were assessed with chi-square and independent sample t-tests. Primary outcomes were compared using multilinear regressions, controlling for demographic differences. Results AR surgeons performed 5194 (70%) cases while NAR surgeons performed 2221 (30%) cases. Surgical time (minutes) significantly differed between the 2 groups (101.26 vs 111.56; P < .001). Length of stay, 90-day all-cause readmissions, revisions, and all-cause emergency department visits did not statistically differ (P = .079, P = .978, P = .094, and P = .241, respectively). AR surgeons were more likely to discharge their patients home than NAR surgeons (P = .001). NAR group reported lower KOOS, JR scores at 3 months and 1 year (preop: 45.30 vs 45.79, P = .728; 3 months: 64.73 vs 59.47, P < .001; 1 year: 71.66 vs 69.56, P = .234); however, only 3-month scores statistically differed. Veterans RAND-12 Physical and Mental components scores (VR-12 PCS and MCS) were not statistically significant at any time-point between the cohorts. Delta-improvements preoperatively to 1 year in KOOS, JR (26.36 vs 23.77; P < .001) and VR-12 PCS (11.98 vs 10.62; P < .001) scores were significantly higher for the AR cohort but did not exceed the minimal clinically important difference. Conclusion This study demonstrates significantly shorter surgical times and greater improvements in KOOS, JR and VR-12 PCS scores associated with TKAs performed by AR fellowship-trained surgeons. Level III Evidence Retrospective Cohort Study.
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Affiliation(s)
- Vivek Singh
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor Simcox
- NYU Winthrop Hospital, Department of Orthopedic Surgery, Mineola, NY, USA
| | - Vinay K Aggarwal
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - William J Long
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Cenkner DP, Asnaani A, DiChiara C, Harb GC, Lynch KG, Greene J, Scott JC. Neurocognitive Predictors of Treatment Outcomes in Cognitive Processing Therapy for Post-traumatic Stress Disorder: Study Protocol. Front Psychol 2021; 12:625669. [PMID: 33574791 PMCID: PMC7870481 DOI: 10.3389/fpsyg.2021.625669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy (CPT), are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in CPT in some individuals with PTSD. Methods and Analysis Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD (CPTPTSD) study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD (NCT# 03641924). The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: (1) examining the specificity of memory effects on treatment response; (2) exploring how baseline cognitive functioning impacts functional outcomes; and (3) examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD.
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Affiliation(s)
- David P Cenkner
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Christina DiChiara
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Gerlinde C Harb
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Kevin G Lynch
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Greene
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Hyman SA, Card EB, De Leon-Casasola O, Shotwell MS, Shi Y, Weinger MB. Prevalence of burnout and its relationship to health status and social support in more than 1000 subspecialty anesthesiologists. Reg Anesth Pain Med 2021; 46:381-387. [PMID: 33574158 DOI: 10.1136/rapm-2020-101520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Physician burnout may be at 'epidemic' proportions due to factors associated with modern healthcare practice and technology. Practice attributes vary appreciably among subspecialists. Understanding burnout incidence and its associated factors could illuminate potential causes and interventions. We evaluated burnFout, mental and physical health, and social support and coping skills in acute and chronic pain physicians and pediatric and cardiac anesthesiologists. METHODS We administered the Maslach Burnout Inventory Human Services Survey (MBI-HSS), a two-item self-identified burnout measure, the Veterans RAND 12-item Health Survey and the Social Support and Personal Coping Survey to subspecialty society members practicing acute and chronic pain management, pediatric anesthesiology and cardiac anesthesiology. Multivariable regression analysis compared the groups, and adjusted burnout prevalence was compared with an all-physician and an employed general population sample. RESULTS Among 1303 participants (response rates 21.6%-35.6% among the subspecialty groups), 43.4% met established burnout criteria (range 30.0%-62.3%). Chronic pain physicians had significantly worse scores (unadjusted) than the other three groups of subspecialty anesthesiologists, the all-physician comparator group and the general population comparator group. Mental health inversely correlated with emotional exhaustion and depersonalization in all groups. Self-identified burnout correlated with the full MBI-HSS (R=0.54; positive predictive value of 0.939 (0.917, 0.955)). Physicians' scores for personal accomplishment were higher than population norms. CONCLUSIONS This study provides data on burnout prevalence and associated demographic, health and social factors in subspecialist anesthesiologists. Chronic pain anesthesiologists had significantly greater burnout than the other groups. The self-identified burnout metric performed well and may be an attractive alternative to the full MBI-HSS.
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Affiliation(s)
- Steve A Hyman
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Borg Card
- Nursing Research, Vanderbilt Nursing, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Oscar De Leon-Casasola
- Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Matthew S Shotwell
- Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew B Weinger
- Anesthesiology, Biomedical Informatics, Medical Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Construct Validity and Responsiveness of the University of Wisconsin Running Injury and Recovery Index. J Orthop Sports Phys Ther 2020; 50:702-710. [PMID: 33115339 DOI: 10.2519/jospt.2020.9698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The University of Wisconsin Running Injury and Recovery Index (UWRI) is the first running-specific patient-reported outcome measure (PROM). The UWRI evaluates the key elements runners use to self-assess running ability during recovery. This study evaluated the construct-related validity and responsiveness of the UWRI as an evaluative PROM of running ability following running-related injury (RRI). DESIGN Prospective longitudinal study. METHODS Runners seeking care from a physical therapist for an RRI (n = 396) completed PROMs at baseline and 12 weeks later. Change in UWRI score was validated against the global rating of change (GROC), Veterans RAND 12-Item Health Survey (VR-12) change, and change in body region- specific PROMs. Responsiveness was evaluated using anchor-based and distribution-based techniques. RESULTS Change in UWRI score (mean ± SD, 7.7 ± 8.9 points) was correlated with the GROC (r = 0.67), as well as with changes in the VR-12 Physical Component Summary (PCS) (r = 0.54) and Mental Component Summary (MCS) (r = 0.31). Change in UWRI score was correlated with changes in the Foot and Ankle Ability Measure sports subscale (r = 0.75), the 12-item International Hip Outcome Tool (r = 0.75), and the Anterior Knee Pain Scale (r = 0.48), but not with the Oswestry Disability Index Version 2.0 (r = 0.05). Change in UWRI score was significantly different in runners reporting significant improvement (12.2 ± 5.9 points), slight improvement (7.1 ± 6.6 points), no change (0.0 ± 9.1 points), and worsening (-14.6 ± 7.4 points) on the GROC anchor-based responsiveness assessment. The UWRI minimal important change and minimal clinically important difference were 5 and 8 points, respectively. CONCLUSION The UWRI is a valid clinical tool for evaluating running ability following RRI; it demonstrated longitudinal validity (GROC), convergent validity (PCS and body region- specific PROMs), divergent validity (MCS), and responsiveness to changes in patient-perceived running ability. J Orthop Sports Phys Ther 2020;50(12):702-710. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9698.
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Jenkins NW, Parrish JM, Nolte MT, Hrynewycz NM, Brundage TS, Singh K. Validating the VR-12 Physical Function Instrument After Anterior Cervical Discectomy and Fusion with SF-12, PROMIS, and NDI. HSS J 2020; 16:443-451. [PMID: 33380979 PMCID: PMC7749899 DOI: 10.1007/s11420-020-09817-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Development and validation of Veterans RAND 12-item (VR-12) physical component survey (PCS) has been established among civilian and veteran populations but it has not been examined among anterior cervical discectomy and fusion (ACDF) patients. PURPOSES/QUESTIONS We sought to validate legacy patient-reported outcome measures (PROMs) with VR-12 PCS among patients undergoing ACDF procedures. METHODS A prospectively collected surgical registry was retrospectively evaluated for elective single or multi-level ACDFs performed for degenerative spinal pathologies from January 2014 to August 2019. Exclusion criteria included missing pre-operative surveys and surgery for trauma, metastasis, or infection. Demographic variables, baseline pathologies, and peri-operative variables were collected. A paired t test evaluated the change from the pre-operative score to each post-operative timepoint for VR-12 PCS, the 12-item Short-Form Survey (SF-12) PCS, Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), and Neck Disability Index (NDI). Minimal clinically important difference (MCID) achievement was calculated at each timepoint. Correlation was evaluated with a Pearson's correlation coefficient and time-independent partial correlation. RESULTS Of the 202 patients who underwent ACDF, 41.1% were female and the average age was 49.5 years. All PROMs had statistically significantly increased from baseline when compared with post-operative timepoints (12 weeks, 6 months, 1 year, and 2 years). MCID achievement rates increased through 2 years. All timepoints revealed strong VR-12 PCS correlations with SF-12 PCS, PROMIS-PF, and NDI scores. CONCLUSION VR-12 PCS was strongly correlated with the well-validated SF-12 PCS and NDI metrics as well as with the more recent PROMIS-PF. All PROMs demonstrated statistically significant improvement in patients post-operatively. VR-12 PCS is a valid measure of physical function among patients undergoing ACDF.
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Affiliation(s)
- Nathaniel W. Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - James M. Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Nadia M. Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Thomas S. Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612 USA
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Sahoo S, Derwin KA, Zajichek A, Entezari V, Imrey PB, Iannotti JP, Ricchetti ET. Associations of preoperative patient mental health status and sociodemographic and clinical characteristics with baseline pain, function, and satisfaction in patients undergoing primary shoulder arthroplasty. J Shoulder Elbow Surg 2020; 30:e212-e224. [PMID: 32860879 PMCID: PMC7907259 DOI: 10.1016/j.jse.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Shoulder pain and dysfunction are common indications for shoulder arthroplasty, yet the factors that are associated with these symptoms are not fully understood. This study aimed to investigate the associations of patient and disease-specific factors with preoperative patient-reported outcome measures (PROMs) in patients undergoing primary shoulder arthroplasty. We hypothesized that worse mental health status assessed by the Veterans RAND 12-Item Health Survey (VR-12) mental component score (MCS), glenoid bone loss, and increasing rotator cuff tear severity would be associated with lower values for the preoperative total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscores. METHODS We prospectively identified 12 patient factors and 4 disease-specific factors as possible statistical predictors of preoperative PROMs in patients undergoing primary shoulder arthroplasty at a single institution over a 3-year period. Multivariable statistical modeling and Akaike information criterion comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in the preoperative PSS and its subscores. RESULTS A total of 788 cases performed by 12 surgeons met the inclusion criteria, with a preoperative median total PSS of 31 points (pain, 10 points; function, 18 points; and satisfaction, 1 point). As hypothesized, a lower VR-12 MCS was associated with lower preoperative PSS pain, function, and total scores, but patients with intact status or small to medium rotator cuff tears had modestly lower PSS pain subscores (ie, more pain) than patients with large to massive superior-posterior rotator cuff tears. Glenoid bone loss was not associated with the preoperative PSS. Female sex and fewer years of education (for all 4 outcomes), lower VR-12 MCS and preoperative opioid use (for all outcomes but satisfaction), and rotator cuff tear severity (for pain only) were the factors most prominently associated with preoperative PROMs. CONCLUSION In addition to mental health status and rotator cuff tear status, patient sex, years of education, and preoperative opioid use were most prominently associated with preoperative PROMs in patients undergoing shoulder arthroplasty. Further studies are needed to investigate whether these factors will also predict postoperative PROMs.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA,Address for Correspondence: Eric T. Ricchetti, M.D. Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code A40, Cleveland, Ohio 44195, USA, Telephone: 216-445-6915, ,
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Spungen AM, Bauman WA, Biswas K, Jones KM, Snodgrass AJ, Goetz LL, Gorman PH, Kirshblum S, Sabharwal S, White KT, Asselin PK, Morin KG, Cirnigliaro CM, Huang GD. The design of a randomized control trial of exoskeletal-assisted walking in the home and community on quality of life in persons with chronic spinal cord injury. Contemp Clin Trials 2020; 96:106102. [PMID: 32800962 DOI: 10.1016/j.cct.2020.106102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
There are more than 300,000 estimated cases of spinal cord injury (SCI) in the United States, and approximately 27,000 of these are Veterans. Immobilization from SCI results in adverse secondary medical conditions and reduced quality of life. Veterans with SCI who have completed rehabilitation after injury and are unable to ambulate receive a wheelchair as standard of care. Powered exoskeletons are a technology that offers an alternative form of limited mobility by enabling over-ground walking through an external framework for support and computer-controlled motorized hip and knee joints. Few studies have reported the safety and efficacy for use of these devices in the home and community environments, and none evaluated their impact on patient-centered outcomes through a randomized clinical trial (RCT). Absence of reported RCTs for powered exoskeletons may be due to a range of challenges, including designing, statistically powering, and conducting such a trial within an appropriate experimental framework. An RCT for the study of exoskeletal-assisted walking in the home and community environments also requires the need to address key factors such as: avoiding selection bias, participant recruitment and retention, training, and safety concerns, particularly in the home environment. These points are described here in the context of a national, multisite Department of Veterans Affairs Cooperative Studies Program-sponsored trial. The rationale and methods for the study design were focused on providing a template for future studies that use powered exoskeletons or other strategies for walking and mobility in people with immobilization due to SCI.
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Affiliation(s)
- Ann M Spungen
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States of America.
| | - Karen M Jones
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States of America.
| | - Amanda J Snodgrass
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM 87106, United States of America; University of New Mexico, College of Pharmacy, Albuquerque, NM 87106, United States of America.
| | - Lance L Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, United States of America; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23298, United States of America.
| | - Peter H Gorman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; VA Maryland Healthcare System, Baltimore, MD 21201, United States of America.
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, United States of America; Rutgers New Jersey Medical School, Newark, NJ 07103, United States of America; Kessler Foundation, West Orange, NJ 07052, United States of America.
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, MA 02130, United States of America; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Kevin T White
- James A Haley Veterans' Hospital, Tampa, FL 33612, United States of America; University of South Florida, Tampa, FL 33612, United States of America.
| | - Pierre K Asselin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Kel G Morin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America.
| | - Christopher M Cirnigliaro
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America.
| | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC 20420, United States of America.
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Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty. Arthroplast Today 2020; 6:451-456. [PMID: 32637515 PMCID: PMC7327380 DOI: 10.1016/j.artd.2020.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/10/2020] [Accepted: 05/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background There has been increasing interest in performing primary hip and knee replacement with same-day discharge (SDD). The purpose of this study is to compare patient-reported outcome (PRO) scores, pain scores, and readmissions in patients who underwent SDD total hip arthroplasty (THA) with those in patients who underwent traditional inpatient THA. Methods A retrospective study was conducted on 963 patients who underwent primary THA at our institution between September 2016 and December 2018. Two cohorts were established based on whether the patient underwent SDD or traditional inpatient THA. An electronic physical engagement application was used to collect PRO scores (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, Veterans Rand 12-Item Health Survey Physical Component Score, and Mental Component Score) and pain scores. To control for demographic variables, a multiple regression analysis of PRO scores was conducted. Results Four hundred fifteen (43.1%) patients in this study underwent the SDD protocol. There were significant differences between both cohorts with respect to sex, age, body mass index, American Society of Anesthesiologists score, and smoking status. The bivariate analysis revealed that the SDD cohort had a significantly greater change in the Veterans Rand 12-Item Health Survey Physical Component Score and had fewer readmissions. Both cohorts had equivalent decreases in pain scores. After controlling for demographic variables in a multivariable analysis, the SDD cohort was found to have higher PRO scores at all time points, but there were no significant differences in the change in PRO scores over time between both groups. Conclusion Patients in an SDD THA care pathway experienced similar improvements in PRO scores and clinically equal reduction in pain scores.
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Dolovich L, Gaber J, Valaitis R, Ploeg J, Oliver D, Richardson J, Mangin D, Parascandalo F, Agarwal G. Exploration of volunteers as health connectors within a multicomponent primary care-based program supporting self-management of diabetes and hypertension. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:734-746. [PMID: 31777125 DOI: 10.1111/hsc.12904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. 'Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management' (Health TAPESTRY-HC-DM) integrates volunteer 'health connectors' into a community- and primary care-based program supporting client self-management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in-person training, self-efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self-efficacy, value of volunteering). A concurrent triangulation, mixed-methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self-efficacy survey, Veterans RAND 12-Item (VR-12) survey, in-person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples t tests, and effect size (Cohen's d). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In-person training received largely positive evaluations. Self-efficacy was high post-training and higher after volunteering. VR-12 sub-scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow-up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.
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Affiliation(s)
- Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Fiona Parascandalo
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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George J, Elwy AR, Charns MP, Maguire EM, Baker E, Burgess JF, Meterko M. Exploring the Association Between Organizational Culture and Large-Scale Adverse Events: Evidence from the Veterans Health Administration. Jt Comm J Qual Patient Saf 2020; 46:270-281. [PMID: 32238298 DOI: 10.1016/j.jcjq.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large-scale adverse events (LSAEs) involve unsafe clinical practices stemming from system issues that may affect multiple patients. Although literature suggests a supportive organizational culture may protect against system-related adverse events, no study has explored such a relationship within the context of LSAEs. This study aimed to identify whether staff perceptions of organizational culture were associated with LSAE incidence. METHODS The team conducted an exploratory analysis using the 2008-2010 data from the US Department of Veterans Affairs (VA) All Employee Survey (AES). LSAE incidence was the outcome variable in two facilities where similar infection control practice issues occurred, leading to LSAEs. For comparison, four facilities where LSAEs had not occurred were selected, matched on VA-assigned facility complexity and geography. The AES explanatory factors included workgroup-level (civility, employee engagement, leadership, psychological safety, resources, rewards) and hospital-level Likert-type scales for four cultural factors (group, rational, entrepreneurial, bureaucratic). Bivariate analyses and logistic regressions were performed, with individual staff as the unit of analysis from the anonymous AES data. RESULTS Responses from 209 AES participants across the six facilities in the sample indicated that the four comparison facilities had significantly higher mean scores compared to the two LSAE facilities for 9 of 10 explanatory factors. The adjusted analyses identified that employee engagement significantly predicted LSAE incidence (odds ratio = 0.58, 95% confidence interval = 0.37-0.90). CONCLUSION Staff at the two exposure facilities in this study described their organizational culture to be less supportive. Lower scores in employee engagement may be a contributing factor for LSAEs.
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