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Cabell GH, Kwon NF, Sutton KF, Lentz TA, Lewis BD, Olson S, Mather RC. Pain-Associated Psychological Distress Is of High Prevalence in Patients With Hip Pain: Characterizing Psychological Distress and Phenotypes. Arthrosc Sports Med Rehabil 2024; 6:100846. [PMID: 38260823 PMCID: PMC10801259 DOI: 10.1016/j.asmr.2023.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/11/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To identify common pain-related psychological factors among patients seeking care for athletic hip pain, as well as characterize psychological distress phenotypes and compare hip-specific quality-of-life measures across those phenotypes. Methods A total of 721 patients were recruited from hip preservation clinics. The Optimal Screening for Prediction of Referral and Outcome-Yellow Flag Assessment Tool (OSPRO-YF) was used to identify the presence or absence of 11 different pain-associated psychological distress characteristics (yellow flags), while the International Hip Outcome Tool-12 (iHOT-12) was used to assess hip-related quality of life. Latent class analysis identified patient subgroups (phenotypes) based on naturally occurring combinations of distress characteristics. An analysis of variance was used to compare demographics, number of yellow flags, and iHOT-12 scores across phenotypes. Results The median (interquartile range) number of yellow flags was 6 (3-9), with 13.5% of the sample reporting 11 yellow flags. Latent class analysis (L2 = 543.3, classification errors = 0.082) resulted in 4 phenotypes: high distress (n = 299, 41.5%), low distress (n = 172, 23.9%), low self-efficacy and acceptance (n = 74, 10.3%), and negative pain coping (n = 276, 24.4%). Significant differences in mean yellow flags existed between all phenotypes except low self-efficacy and negative pain coping. There were no differences in demographics between phenotypes. The high distress class had the lowest mean iHOT-12 score (mean [SD], 23.5 [17.6]), with significant differences found between each phenotypic class. Conclusions There was a high prevalence of pain-associated psychological distress in patients presenting to tertiary hip arthroscopy clinics with hip pain. Furthermore, hip quality-of-life outcome scores were uniformly lower in patients with higher levels of psychological distress. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Grant H Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Nicholas F Kwon
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, California, U.S.A
| | - Kent F Sutton
- Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
- Duke Clinical Research Institute, Durham, North Carolina, U.S.A
| | - Brian D Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Steven Olson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Faurot KR, Park J, Miller V, Honvoh G, Domeniciello A, Mann JD, Gaylord SA, Lynch CE, Palsson O, Ramsden CE, MacIntosh BA, Horowitz M, Zamora D. Dietary fatty acids improve perceived sleep quality, stress, and health in migraine: a secondary analysis of a randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1231054. [PMID: 37954068 PMCID: PMC10634433 DOI: 10.3389/fpain.2023.1231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Background Migraine is a prevalent disabling condition often associated with comorbid physical and psychological symptoms that contribute to impaired quality of life and disability. Studies suggest that increasing dietary omega-3 fatty acid is associated with headache reduction, but less is known about the effects on quality of life in migraine. Methods After a 4-week run-in, 182 adults with 5-20 migraine days per month were randomized to one of the 3 arms for sixteen weeks. Dietary arms included: H3L6 (a high omega-3, low omega-6 diet), H3 (a high omega-3, an average omega-6 diet), or a control diet (average intakes of omega-3 and omega-6 fatty acids). Prespecified secondary endpoints included daily diary measures (stress perception, sleep quality, and perceived health), Patient-Reported Outcome Measurement Information System Version 1.0 ([PROMIS©) measures and the Migraine Disability Assessment (MIDAS). Analyses used linear mixed effects models to control for repeated measures. Results The H3L6 diet was associated with significant improvements in stress perception [adjusted mean difference (aMD): -1.5 (95% confidence interval: -1.7 to -1.2)], sleep quality [aMD: 0.2 (95% CI:0.1-0.2)], and perceived health [aMD: 0.2 (0.2-0.3)] compared to the control. Similarly, the H3 diet was associated with significant improvements in stress perception [aMD: -0.8 (-1.1 to -0.5)], sleep quality [aMD: 0.2 (0.1, 0.3)], and perceived health [aMD: 0.3 (0.2, 0.3)] compared to the control. MIDAS scores improved substantially in the intervention groups compared with the control (H3L6 aMD: -11.8 [-25.1, 1.5] and H3 aMD: -10.7 [-24.0, 2.7]). Among the PROMIS-29 assessments, the biggest impact was on pain interference [H3L6 MD: -1.8 (-4.4, 0.7) and H3 aMD: -3.2 (-5.9, -0.5)] and pain intensity [H3L6 MD: -0.6 (-1.3, 0.1) and H3 aMD: -0.6 (-1.4, 0.1)]. Discussion The diary measures, with their increased power, supported our hypothesis that symptoms associated with migraine attacks could be responsive to specific dietary fatty acid manipulations. Changes in the PROMIS© measures reflected improvements in non-headache pain as well as physical and psychological function, largely in the expected directions. These findings suggest that increasing omega-3 with or without decreasing omega-6 in the diet may represent a reasonable adjunctive approach to reducing symptoms associated with migraine attacks. Trial Registration: ClinicalTrials.gov NCT02012790.
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Affiliation(s)
- Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Jinyoung Park
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Vanessa Miller
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Anthony Domeniciello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - J. Douglas Mann
- Department of Neurology, UNC School of Medicine, Chapel Hill, NC, United States
| | - Susan A. Gaylord
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Chanee E. Lynch
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Olafur Palsson
- Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Christopher E. Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, United States
| | - Beth A. MacIntosh
- Metabolic and Nutrition Research Core, UNC Medical Center, Chapel Hill, NC, United States
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Daisy Zamora
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States
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Atukorala I, Hunter DJ. A review of quality-of-life in elderly osteoarthritis. Expert Rev Pharmacoecon Outcomes Res 2023; 23:365-381. [PMID: 36803292 DOI: 10.1080/14737167.2023.2181791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is the commonest joint disease in the world. Although aging is not invariably associated with OA, aging of the musculoskeletal system increases susceptibility to OA. Pain and reduced function due to OA, negatively impact health-related quality of life (HRQoL) in the elderly. AREAS COVERED We searched PubMed and Google Scholar with search term "osteoarthritis' combined with terms 'elderly' 'ageing' 'healthrelated quality of life' 'burden' "prevalence 'hip osteoarthritis' 'knee osteoarthritis' 'hand osteoarthritis' to identify relevant articles. This article discusses the global impact and joint-specific burden due to OA and the challenges in assessment of HRQoL in elderly with OA. We further describe some HRQoL determinants that particularly impact elderly persons with OA. These determinants include physical activity, falls, psychosocial consequences, sarcopaenia, sexual health, and incontinence. The usefulness of physical performance measures, as an adjunct to assessing HRQoL is explored. The review concludes by outlining strategies to improve HRQoL. EXPERT OPINION Assessment of HRQoL in elderly with OA is mandatory if effective interventions/treatment are to be instituted. But existent HRQoL assessments have shortcomings when used in elderly§. It is recommended that determinants of QoL which are unique to the elderly, be examined with greater detail and weightage in future studies.
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Affiliation(s)
- Inoshi Atukorala
- Senior Lecturer in Clinical Medicine & Consultant Rheumatologist, University Medical Unit, National Hospital Sri Lanka, & Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - David J Hunter
- Florance and Cope Chair of Rheumatology, Co-Director Sydney Musculoskeletal Health Flagship, University of Sydney, Camperdown, Australia
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Arciero E, Desai S, Coury J, Gupta P, Trofa DP, Sardar Z, Lombardi J. Comparison of Psychometric Properties of Patient-Reported Outcomes Measurement Information System With Traditional Outcome Metrics in Spine Surgery. JBJS Rev 2023; 11:01874474-202303000-00006. [PMID: 36947636 DOI: 10.2106/jbjs.rvw.22.00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to address certain shortcomings of traditional, or legacy patient-reported outcome measures (PROMs). Because the use of PROMIS across orthopedic populations continues to increase, the purpose of this study was to provide a comprehensive overview of the use and validation of PROMIS in spine surgery. METHODS PubMed and Google Scholar were searched for relevant articles reporting on the use and validation of PROMIS in spine surgery. The PROMIS formats and individual domains used by investigators were noted. Additionally, psychometric properties reported in validation studies were evaluated. RESULTS Both individual studies and systematic reviews have demonstrated the convergent validity of PROMIS domains, reporting moderate-to-strong correlations with legacy measures in a variety of spine patient populations. Across spine surgery patient populations, PROMIS instruments are consistently efficient, demonstrating decreased question burden compared with legacy PROMs. PROMIS domains overall exhibit responsiveness comparable with legacy measures, and the normalization of PROMIS scores to a general population allows for broad coverage, resulting in acceptable floor and ceiling effects. Despite the many strengths of PROMIS, there remain some populations where PROMIS is not suited to be used in isolation. CONCLUSIONS PROMIS is widely used as an outcome measure in spine surgery and has been validated in a range of patient populations. Although PROMIS domains cannot fully replace legacy measures in spine patients, they can be used in certain settings to provide an efficient and psychometrically sound PROM.
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Affiliation(s)
- Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Khullar OV, Perez A, Dixon M, Binongo JN, Sancheti MS, Pickens A, Gillespie T, Force SD, Fernandez FG. Routine Implementation of Patient-Reported Outcomes Assessment Into Thoracic Surgery Practice. Ann Thorac Surg 2023; 115:526-532. [PMID: 35561801 DOI: 10.1016/j.athoracsur.2022.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) assessment is a necessary component of surgical outcome assessment and patient care. This study examined the success of routine PROs assessment in an academic-based thoracic surgery practice. METHODS PROs, measuring pain intensity, physical function, and dyspnea, were routinely obtained using the National Institutes of Health-sponsored Patient-Reported Outcomes Measurement Information System (PROMIS) on all thoracic surgery patients beginning in April 2018 through January 2021. Questionnaires were administered electronically through a web-based platform at home or during the office visit. Completion rates and barriers were measured. RESULTS A total of 9725 thoracic surgery office visits occurred during this time frame. PROs data were obtained in 6899 visits from a total of 3551 patients. The mean number of questions answered per survey was 22.4 ± 2.2. Overall questionnaire completion rate was 65.7%. A significant decline in survey completion was noted in April 2020, after which adjustments were made to allow for questionnaire completion through a mobile health platform. Overall monthly questionnaire completion rates ranged from 20% (April 2020) to 90% (October 2018). Mean T scores were dyspnea, 41.6 ± 12.3; physical function, 42.7 ± 10.5; and pain intensity, 52.8 ± 10.3. CONCLUSIONS PROs can be assessed effectively in a thoracic surgery clinic setting, with minimal disruption of clinical activities. Future efforts should focus on facilitating PROs collection from disadvantaged patient populations and scaling implementation across programs.
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Affiliation(s)
- Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Aubriana Perez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Meredith Dixon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Manu S Sancheti
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Pickens
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa Gillespie
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Alben MG, Gordon D, Gambhir N, Kim MT, Romeo PV, Rokito AS, Zuckerman JD, Virk MS. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07279-7. [PMID: 36622420 DOI: 10.1007/s00167-022-07279-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR). METHODS The change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor-based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed. RESULTS A total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P-Interference (1.8, 1.5), and P-Intensity (2.3, 2.0). Lower preoperative P-Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE. CONCLUSION A large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P-Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, Baylor University Medical Center Dallas, Dallas, TX, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Matthew T Kim
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Andrew S Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA.
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George SZ, Bolognesi MP, Ryan SP, Horn ME. Sleep disturbance, dyspnea, and anxiety following total joint arthroplasty: an observational study. J Orthop Surg Res 2022; 17:396. [PMID: 35986326 PMCID: PMC9392244 DOI: 10.1186/s13018-022-03288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patient-Reported Outcomes Measurement Information System (PROMIS) domains for sleep disturbance, anxiety, and dyspnea have been under-reported for total joint arthroplasty (TJA). The aims of this study were to report postoperative differences for these domains based on TJA location and chronic pain state. We also investigated whether these domains were associated with physical function and pain interference outcomes. METHODS This was a retrospective, observational study of patients who underwent hip, knee, or shoulder TJA (primary and revision surgeries) at a single academic tertiary referral center. A subset of these patients completed an email-based survey for chronic pain grade (Chronic Pain Grade Scale-Revised) and sleep disturbance, anxiety, dyspnea, physical function, and pain interference (PROMIS short forms). Pre-operative and operative data were extracted from the electronic health record. Data analysis investigated PROMIS domains for differences in TJA location and chronic pain grade. Hierarchical linear regression determined associations of these domains with physical function and pain interference. RESULTS A total of 2638 individuals provided informed consent and completed the email survey. In the ANOVA models for sleep disturbance, anxiety, and dyspnea, there was no location by chronic pain grade interaction (p > 0.05) and no difference based on TJA location (p > 0.05). There were differences for chronic pain grade (p < 0.01). The poorest postoperative outcome score for each domain was associated with high impact chronic pain. Furthermore, sleep disturbance and dyspnea had the strongest associations with physical function and pain interference (p < 0.01). CONCLUSIONS Sleep disturbance, anxiety, and dyspnea did not vary based on TJA location, but were associated with postoperative chronic pain grade. Sleep disturbance and dyspnea were strongly associated with commonly reported outcomes of physical function and pain interference. These findings provide guidance for those interested in expanding TJA outcome assessment to include sleep disturbance, anxiety, and/or dyspnea.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery, Duke University, 200 Morris Street, Durham, NC, 27001, USA.
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University, 200 Morris Street, Durham, NC, 27001, USA
- Division of Adult Reconstruction, Duke University, Durham, NC, USA
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, 200 Morris Street, Durham, NC, 27001, USA
- Division of Adult Reconstruction, Duke University, Durham, NC, USA
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Duke University, 200 Morris Street, Durham, NC, 27001, USA
- Division of Physical Therapy, Duke University, Durham, NC, USA
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Brock L, Hightower B, Moore T, Nees D, Heigle B, Shepard S, Kee M, Ottwell R, Hartwell M, Vassar M. Reporting of Patient-Reported Outcome Measures in Randomized Controlled Trials on Shoulder Rotator Cuff Injuries Is Suboptimal and Requires Standardization. Arthrosc Sports Med Rehabil 2022; 4:e1429-e1436. [PMID: 36033194 PMCID: PMC9402470 DOI: 10.1016/j.asmr.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Lydia Brock
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Address correspondence to Lydia Brock, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107.
| | - Brooke Hightower
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Benjamin Heigle
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Samuel Shepard
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Internal Medicine, University of Oklahoma, School of Community Medicine Tulsa, Oklahoma, U.S.A
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
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Breazeale S, Conley S, Jeon S, Dorsey SG, Kearney J, Yoo B, Redeker NS. Symptom cluster profiles following traumatic orthopaedic injuries. Injury 2022; 53:2524-2532. [PMID: 35351294 PMCID: PMC9232974 DOI: 10.1016/j.injury.2022.03.030] [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: 02/11/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Millions of Americans experience traumatic orthopaedic injuries (TOIs) annually. Post-injury symptoms of acute stress disorder (ASD), anxiety, depression, pain, and sleep disturbance are common. Symptoms often present in clusters. Symptom cluster profiles phenotypically characterize TOI survivors' experiences with clustered symptoms. Expression of brain-derived neurotrophic factor (BDNF) may contribute to the biological underpinnings of symptom cluster profile membership. METHODS We recruited hospitalized TOI survivors within 72 hours of injury. We measured symptoms of ASD with the Acute Stress Disorder Scale and symptoms of anxiety, depression, pain, and sleep disturbance with Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. We measured serum BDNF concentrations with enzyme-linked immunosorbent assay (ELISA) and identified rs6265 genotypes with TaqMan real-time PCR. We performed latent profile analysis to identify the symptom cluster profiles. We identified the variables associated with symptom cluster profile membership with unadjusted and adjusted multinomial logistic regression. RESULTS We identified 4 symptom cluster profiles characterized by symptom severity that we labelled Physical Symptoms Only, and Mild, Moderate, and Severe Psychological Distress. Age, self-identified Black race, resilience, and serum BDNF concentrations were associated with lower odds, and female sex with higher odds, of being in the Psychological Distress clusters. Clinical characteristics and rs6265 genotypes were not associated with symptom cluster profile membership. CONCLUSION TOI survivors experience distinct symptom cluster profiles. Sociodemographic characteristics and serum BDNF concentrations, not clinical characteristics, were associated with symptom cluster profile membership. These findings support comprehensive symptom screening and treatment for all TOI survivors and further evaluating BDNF as a biomarker of post-injury symptom burden.
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Affiliation(s)
- Stephen Breazeale
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA; The University of Pittsburgh School of Nursing, 3500 Victoria Street, Victoria Building, Pittsburgh, PA, 15261, USA.
| | - Samantha Conley
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Sangchoon Jeon
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Susan G Dorsey
- University of Maryland School of Nursing, 655 W. Lombard Street, Baltimore, MD, 21201, USA
| | - Joan Kearney
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Brad Yoo
- Yale School of Medicine, 47 College Place, New Haven, CT, 06510, USA
| | - Nancy S Redeker
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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