Physical functioning, perceived disability, and depressive symptoms in adults with arthritis

Substitution of self-reported measures for objectively assessed grip strength and slow walk in the Physical Frailty Phenotype: ramifications for validity

BACKGROUND

Frailty assessment promises to identify older adults at risk for adverse consequences following stressors and target interventions to improve health outcomes. The Physical Frailty Phenotype (PFP) is a widely-studied, well validated assessment but incorporates performance-based slow walk and grip strength criteria that challenge its use in some clinical settings. Variants replacing performance-based elements with self-reported proxies have been proposed. Our study evaluated whether commonly available disability self-reports could be substituted for the performance-based criteria in the PFP while still identifying as "frail" the same subpopulations of individuals.

METHODS

Parallel analyses were conducted in 3393 female and 2495 male Cardiovascular Health Study, Round 2 participants assessed in 1989-90. Candidate self-reported proxies for the phenotype's "slowness" and "weakness" criteria were evaluated for comparable prevalence and agreement by mode of measurement. For best-performing candidates: Frailty status (3 + positive criteria out of 5) was compared for prevalence and agreement between the PFP and mostly self-reported versions. Personal characteristics were compared between those adjudicated as frail by (a) only a self-reported version; (b) only the PFP; (c) both, using bivariable analyses and multinomial logistic regression.

RESULTS

Self-reported difficulty walking ½ mile was selected as a proxy for the phenotype's slowness criterion. Two self-reported weakness proxies were examined: difficulty transferring from a bed or chair or gripping with hands, and difficulty as just defined or in lifting a 10-pound bag. Prevalences matched to within 4% between self-reported and performance-based criteria in the whole sample, but in all cases the self-reported prevalence for women exceeded that for men by 11% or more. Cross-modal agreement was moderate, with by-criterion and frailty-wide Kappa statistics of 0.55-0.60 in all cases. Frail subgroups (a), (b), (c) were independently discriminated (p < 0.05) by race, BMI, and depression in women; by age in men; and by self-reported health for both.

CONCLUSIONS

Commonly used self-reported disability items cannot be assumed to stand in for performance-based criteria in the PFP. We found subpopulations identified as frail by resultant phenotypes versus the original phenotype to systematically differ. Work to develop self-reported proxies that more closely replicate their objective phenotypic counterparts than standard disability self-reports is needed.

The mediation and interaction of depressive symptoms in activities of daily living and active aging in rural elderly: A cross-sectional survey

Background

Compared with urban areas, old adults in rural areas have limited access to medical and health resources in China. Active of daily living ability (ADL) decline and depressive symptoms are common in rural older adults. In particular, the depressive symptoms of the elderly in rural areas are often ignored. Thus, it is difficult to realize high-level active aging at the individual level. In order to explore the effects of ADL and depressive symptoms on the active aging of rural elderly, we conducted a survey and analyzed the mediation and interaction effects of depressive symptoms of ADL on active aging.

Methods

From July to November 2019, a cross-sectional study of 945 elderly rural individuals was conducted in three townships in Xiangtan County, China. Active aging, ADL, and depressive symptoms were assessed using the positive aging questionnaire (PAEQ), ADL scale, and depression in old age scale (DIA-S), respectively. PROCESS macro program model 4 and logistic regression were used to explore the mediation and interaction between ADL and depressive symptoms on active aging.

Results

The proportions of rural elderly with an active aging level were 23.5% (well above average), 50.9% (above average), 24.1% (below average), 1.5% (well below average), respectively. The rates of ADL decline and depressive symptoms were 44.7 and 19.7%, respectively. Mediated effect analysis showed that the relationship between ADL and active aging could be partly mediated by depressive symptoms (ab = -0.2382, boot SE = 0.0437), and the 95% confidence interval was [-0.3311, -0.1584]. The mediating effect proportion of the total effect was 30.7%. Logistic regression showed that ADL and depressive symptoms have an interactive additive effect on active aging. The relative excess risk of interaction (RERI), the attributable proportion due to interaction (API), and the synergy index (SI) scores were 13.109, 0.621, and 2.871, respectively. Older adults with ADL decline and depressive symptoms had higher (OR = 21.115) odds of well-below-average active aging compared with older adults with ADL decline (OR = 3.258) or only depressive symptoms (OR = 5.749).

Conclusion

The findings suggest that the association between ADL and active aging is persistent and partly mediated by depressive symptoms, and comorbid depressive symptoms and ADL decline have an additive effect on active aging. Maintaining independence is an important factor for realizing active aging. However, for the rural elderly with ADL decline and low-level active aging, we can promote the realization of high-level active aging at the individual level through the prevention and treatment of depressive symptoms based on multidisciplinary care.

Preoperative Physical Function Association With Mental Health Improvement After Anterior Cervical Discectomy and Fusion

STUDY DESIGN

This was a retrospective study.

OBJECTIVE

This study investigates the influence of physical function and their influence on postoperative depressive symptom scores as measured by Patient Health Questionnaire-9 (PHQ-9) among anterior cervical decompression and fusion (ACDF) patients.

BACKGROUND

While ACDF is one of the most commonly performed ambulatory surgeries, research is limited on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores and their influence on depressive symptoms as measured by the PHQ-9.

METHODS

A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to January 2019. Inclusion criteria were primary or revision ACDF procedures. Patients were grouped by preoperative PROMIS score (≥35.0, <35.0), with higher scores indicating greater physical function. The χ2 and Student t tests assessed categorical and continuous variables (eg, demographics, perioperative, and postoperative values). A t test evaluated postoperative improvement in PROMIS Physical Function (PF) scores between subgroups among PROMIS PF scores and PHQ-9 score improvement at 6, 12 weeks, 6 months, and 1 year. Linear regression assessed preoperative PROMIS scores influence on PHQ-9 score improvement.

RESULTS

The 121 subject cohort was 61.2% male with an average age of 49.6±9.8 years. Compared with the PROMIS ≥35.0 group, the PROMIS <35.0 group also had larger improvement of PROMIS scores at 6 weeks. No significant difference in postoperative PHQ-9 improvement was observed between subgroups. There was a negative association between preoperative PROMIS scores and improvement in PROMIS scores at 6, 12 weeks, 6 months, and 1 year. There was a positive association between preoperative PROMIS scores and magnitude of 1-year PHQ-9 change.

CONCLUSIONS

Individuals with lower preoperative PROMIS PF scores had significantly higher PHQ-9 scores at 1 year. Patients with lower preoperative physical function, as evaluated by PROMIS PF scoring, had greater improvement of mental health at 1 year postoperatively. This suggests that many patients experience multidimensional health benefits after ACDF procedures.

Could emotional and sensitization status affect postural sway in adults with knee osteoarthritis?

BACKGROUND AND PURPOSE

The manipulation of sensory conditions and attentional demand affect the postural sway in older adults with knee osteoarthritis (KOA). However, it is not known if emotional and sensitization status affects postural sway in this population. This study aimed to test if older adults with mild and moderate knee osteoarthritis with symptoms of depression and high sensitization would change the profile of postural sway.

METHODS

Design: A cross-sectional study was undertaken.

PARTICIPANTS

The center of pressure parameters of 30 older adults with mild and moderate knee osteoarthritis and 15 healthy controls were evaluated under different conditions manipulating the visual and attentional demand. We used the pressure pain threshold to measure the sensitization status. Furthermore, we applied the Beck Depression Inventory index to assess emotional status.

RESULTS

Manipulating the visual demand affected the center of pressure parameters for both groups, without differences between them. Compared to the healthy control group, the knee osteoarthritis group presented with worse scores on the Beck Depression Inventory, lower pressure pain threshold scores, and the correlations between the symptoms of depression and sensitization status ranged from weak to moderate. Finally, in the knee osteoarthritis group, we observed few and weak significant associations between the center of pressure parameters and the Beck Depression Inventory and the pressure pain threshold scores.

DISCUSSION

Emotional and sensitization status seem not to be more associated with the center of pressure of older adults with mild to moderate KOA than healthy adults. Thus, it suggests that this population can safely maintain postural sway, irrespective of depression symptoms and high sensitization.

Predictors of Depressive Symptoms Based on the Human Capital Model Approach: Findings From the Indonesia Family Life Survey

Depression is the leading factor of disability and the overall global burden of diseases. The human capital model provides an appropriate conceptual model for managing human health. This study aimed to determine the association between human capital (including social, emotional, physical, financial, and intellectual capital) and depressive symptoms among productive age groups in Indonesia. A cross-sectional study was conducted by analyzing data of 9,858 respondents aged 15-59 years that were obtained from the Indonesia Family Life Survey 5 (IFLS 5). Multivariate logistic regression was used to assess the association between human capital components and depressive symptoms. Among respondents, 23.65% had higher depressive symptoms. Social trust and social networks (part of social capital) were significantly related to depressive symptoms. Self-reported satisfaction (part of emotional capital) were also related to depressive symptoms, as well as self-rated health, sleep quality, a number of chronic disease, body mass index (BMI), and physical functioning (part of physical capital). Log income (part of financial capital) and education level (part of intellectual capital) were related to depressive symptoms after controlling for other variables. Of all the components of human capital, physical capital has the most attributes associated with the risk of depressive symptoms. Therefore, depression prevention programs can be prioritized on attributes related to physical capital.

Prevalence and determinants of depressive symptoms among adults in Indonesia: A cross-sectional population-based national survey

AIMS

To analyze the association between personal health conditions (self-rated health, physical function, and chronic conditions) and symptoms of depression in Indonesia.

METHODS

Data were collected from the Indonesian family life survey 5. This study used a cross-sectional study design with a sample size of 17,734 respondents. We included depressive symptoms, self-rated health, physical function, chronic conditions, demographics and socioeconomic variables. The center for epidemiologic studies depression scale was used to measure symptoms of depression. Multivariate logistic regression analysis was used to analyze the data.

RESULTS

The results showed that 23.47% of respondents had depressive symptoms, 20.04% had poor self-rated health, 55.93% had a poor physical function, and 32.37% had at least one chronic disease. Respondents who had poor self-rated health, had poor physical function, or had a chronic condition were all had a significantly higher odds of experiencing symptoms of depression after controlling for demographic variables (age, sex, married, and education level), social-economic, and smoking status.

CONCLUSION

Depressive symptoms were significantly associated with personal health conditions including self-rated health, physical functioning, and chronic conditions among community residents. Strategies that can improve personal health conditions needed to be studied at the community level to improve the level of mental health.

Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

OBJECTIVE

To estimate synergistic effects of hip/knee osteoarthritis (OA) and comorbidities on mobility or self-care limitations among older adults.

METHODS

We used baseline, cross-sectional data from the Oxford Pain, Activity and Lifestyle (OPAL) study. Participants were community-dwelling adults aged 65 years or older who completed a postal questionnaire. Participants reported demographic information, hip/knee OA, comorbidities and mobility and self-care limitations. We used modified Poisson regression models to estimate the independent and combined relative risks (RR) of mobility or self-care limitations, the relative excess risk due to interaction (RERI) between hip/knee OA and comorbidities, attributable proportion of the risk due to the interaction and the ratio of the combined effect and the sum of the individual effects, known as the synergy index.

RESULTS

Of the 4,972 participants included, 1,532 (30.8%) had hip/knee OA, and of them 42.9% reported mobility limitations and 8.4% reported self-care limitations. Synergistic effects impacting self-care limitations were observed between hip/knee OA and anxiety (RR: 3.09, 95% Confidence Interval (CI): 2.00 to 4.78; RERI: 0.93, 95% CI: 0.01 to 1.90), and between hip/knee OA and depressive symptoms (RR: 2.71, 95% CI: 1.75 to 4.20; RERI: 0.58, 95% CI: 0.03 to 1.48). The portion of the total RR attributable to this synergism was 30% and 22% respectively.

CONCLUSIONS

This study demonstrates that synergism between hip/knee OA and anxiety or depressive symptoms contribute to self-care limitations. These findings highlight the importance of assessing and addressing anxiety or depressive symptoms when managing older adults with hip/knee OA to minimize self-care limitations.

The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG: Case report

INTRODUCTION

To date, the anti-gravity treadmill (AlterG), as a representative method of Lower body positive pressure (LBPP) treadmills, has been rarely reported for knee osteoarthritis (KOA) rehabilitation. The purpose of this case study was to setup the clinical protocol example for AlterG intervention on KOA and evaluate treatment effectiveness by 3D gait analysis combined with free EMG to explore the kinematic gait parameter changes.

PATIENT CONCERNS

A 65-year-old female patient (BMI = 26, mild obesity) undergoing "more than 7 years of KOA." The activity of the right knee joint was obviously limited and she suffered from severe pain over the past month.

DIAGNOSIS

Due to the patient's symptoms and radiographic findings, she was diagnosed with acute attack of KOA.

INTERVENTIONS

The patient has performed clinical function evaluation and gait analysis combined at pretreatment, post-treatment, and 4 months follow-up assessment. AlterG training was performed 6 days/week for 2 weeks, with up to 30 min of training per session. The training protocol included two major parts, walking and squatting in AlterG.

OUTCOMES

After 2 weeks of AlterG intervention, the 10-m walking test (10 MWT) and Timed-up-and-go (TUG) test improved significantly post-treatment, whereas the Visual Analog Scale (VAS) score decreased post-treatment. The Modified Barthel Index improved post-treatment and the patient restored basic community walk after treatment. The temporal parameter results showed that stride length (%height), mean velocity (%height), and cadence gradually increased before treatment, after treatment, and at 4-month follow-up. The right range of motion (ROM) of knee flexion-extension were gradually increased. Meanwhile, the synchronized EMG data showed that the RMS (root means square) values of the rectus femoris, semitendinosus, and biceps femoris at post-treatment were improved to different degrees than at pretreatment.

CONCLUSION

We found that for this patient with KOA, AlterG relieved pain, and was also effective at improving spatio-temporal parameters, knee flexion/extension gait pattern, and corresponding muscle strength, thereby restoring certain community activities.

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background

To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods

An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results

After twelve months, there were no statistically significant differences between the intervention group (n = 60) and the control group (n = 61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p = 0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions

No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration

ClinicalTrials.gov: NCT02531282. Registered on August 212,015

Association of Slow Gait Speed With Trajectories of Worsening Depressive Symptoms in Knee Osteoarthritis: An Observational Study

OBJECTIVE

To investigate the association of slow gait speed, defined as walking slower than is necessary for the community, with trajectories of depressive symptoms over 7 years among people with or at high risk of knee OA.

METHODS

Using data from the Osteoarthritis Initiative, we described trajectories of depressive symptoms measured annually with the Center for Epidemiologic Studies Depression Scale. We categorized speed during a 20-meter walk of <1.2 meters/second as slow gait speed. We used a group-based method to agnostically identify homogeneous clusters of depressive symptom trajectories. We then examined the association of slow gait speed with depressive symptom trajectories, using multinomial logistic regression adjusted for potential confounders.

RESULTS

From the 3,939 participants included (mean ± SD age 61.4 ± 9.2 years, body mass index 28.4 ± 4.7, 58% women, and 63% with a college degree), we identified 5 trajectories. The first 3 were stable over time and included 74% of the sample. The remainder had worsening depressive symptoms over time. Slow gait speed was associated with 2.1 times the odds of having the worst depressive symptoms trajectory compared to those without slow gait speed.

CONCLUSION

Slow gait speed may represent an important risk factor for worsening depressive symptoms over time in people with or at high risk of knee OA, and may signal the need for rehabilitation.

Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study

BACKGROUND

People struggling with chronic pain may benefit from different types of non-pharmacological interventions such as self-management courses. Self-management courses aim to increase participants' skills and knowledge in managing chronic conditions. Community health-care services in Norway have increasingly established Healthy Life Centres (HLCs) to offer easily accessible interventions to people in need of support to better handle a life with chronic illness. The aim of this trial is to investigate the expectations, effect and experience of an easily accessible, group-based self-management course delivered at a HLC for people with chronic pain.

METHODS/DESIGN

This is an open pragmatic two-armed randomised controlled trial with an embedded qualitative study. The intervention is a self-management course comprising education, discussions, exchange of experiences between the participants, and physical movement exercises. The control group is offered a drop-in outdoor physical activity. The intervention period is 6 weeks. The primary outcome is patient activation measured by the patient activation measure (PAM). The secondary outcomes include measures of self-efficacy, pain and quality of life. Data will be collected at baseline, and after 3, 6 and 12 months. Using a mixed linear model, the number needed in each arm to achieve a power of 80 % becomes 55. To allow for dropout, the aim is to include 120 participants. Analysis will be done using mixed linear models. In the embedded qualitative study, we will perform semi-structured face-to-face interviews with a sample from both trial arms before randomisation and after 3 and 12 months. The topics elaborated will be motivation for participation and experiences with the activity related to possible changes in managing and coping with chronic pain.

DISCUSSION

There is need for more knowledge on interventions delivering self-care support in an easily accessible way that aim to reach those in need of this kind of health service. This trial will produce important knowledge on the effect and the experiences of participants in such an easily accessible self-management course delivered in Norwegian public primary care.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02531282 . Registered on 21 August 2015.

Impact of Sensory Impairments on Functional Disability in Adults With Arthritis

INTRODUCTION

Mobility is reduced in people with sensory impairments and those with arthritis. The combined impact of these conditions may be underappreciated. This study examines the associations between impairments in vision, hearing, and balance and functional ability in adults with versus without arthritis.

METHODS

Using National Health and Nutrition Examination Survey data from 1999-2004, arthritis status, functional ability, and sensory impairments (vision, hearing, and balance) were assessed from self-reported responses by 6,654 individuals aged ≥50 years (mean age, 63.4 years; 46.3% male). Multivariable regression analyses, conducted in 2014, assessed the associations between sensory impairment and arthritis on functional ability and mobility.

RESULTS

Among study participants, 41.8% reported having arthritis; of these, 27.1%, 44.9%, and 35.1% reported impaired vision, hearing, or balance, respectively. Having multiple sensory impairments was significantly associated with reduced functional ability in people with arthritis; individuals with three sensory impairments reported the highest levels of disability for all functional domains (compared with no impairment; lower extremity mobility, 80.2% vs 39.1%; general physical activities, 94.7% vs 75.9%; activities of daily living, 69.7% vs 27.2%; instrumental activities of daily living, 77.2% vs 37.4%; leisure and social activities, 66.3% vs 30.6%; impaired gait speed, 48.1% vs 16.3%; all p<0.001). Importantly, visual deficits, in combination with arthritis, had the greatest impact on mobility, with odds of impaired mobility at least twice as high as for individuals without arthritis.

CONCLUSIONS

Addressing sensory deficits, especially difficulties with vision, may improve functional ability, which may be particularly helpful for adults with arthritis.

Risk of developing depressive disorders following rheumatoid arthritis: a nationwide population-based study

Background & Aims

To evaluate the risk of depressive disorders among rheumatoid arthritis (RA) by using the Taiwan National Health Insurance Research Database (NHIRD).

Methods

We conducted a retrospective study of a matched cohort of 18 285 participants (3 657 RA patients and 14 628 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 10 years to determine the rates of newly diagnosed depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in RA patients.

Results

During the 10-year follow-up period, 205 (11.2 per 1000 person-years) RA patients and 384 (5.1 per 1000 person-years) control patients were diagnosed with depressive disorders. In RA patients, most depressive disorders (n = 163, 80%) developed with five years of being diagnosed with RA. The incidence risk ratio of depressive disorders between RA patients and control patients was 2.20 (95% confidence interval [CI], 1.84–2.61, P<.001). After adjusting for age, sex, and comorbidities, RA patients were 2.06 times more likely to develop depressive disorders (95% CI, 1.73–2.44, P<.001) compared with the control patients. Hyperthyroidism (HR = 1.67) was an independent risk factor for depressive disorders in patients with RA.

Conclusions

The likelihood of developing depressive disorders is greater among RA patients than among patients without RA. Symptoms of depression should be sought in patients with RA.

Risk of depressive disorder following non-alcoholic cirrhosis: a nationwide population-based study

BACKGROUND & AIMS

To evaluate the risk of depressive disorders among non-alcoholic patients by using the Taiwan National Health Insurance Research Database (NHIRD).

METHODS

We conducted a retrospective study of a matched cohort of 52 725 participants (10 545 non-alcoholic cirrhotic patients and 42 180 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 11 years to determine the rates of newly onset depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in cirrhotic patients.

RESULTS

During the 11-year follow-up period, 395 (3.75%) non-alcoholic cirrhotic patients and 1 183 (2.80%) control patients were diagnosed with depressive disorders. The incidence risk ratio of depressive disorders between non-alcoholic cirrhotic patients and control patients was 1.76 (95% CI, 1.57-1.98, P<.001). After adjusting for age, sex, and comorbidities, non-alcoholic cirrhotic patients were 1.75 times more likely to develop depressive disorders (95% CI, 1.56-1.96, P<.001) compared with the control patients. The hazard ratios for patients younger than 60 years old (1.31) and female (1.25) indicated that each is an independent risk factor for depressive disorders in non-alcoholic cirrhotic patients.

CONCLUSIONS

The likelihood of developing depressive disorders is greater among non-alcoholic cirrhotic patients than among patients without cirrhosis. Symptoms of depression should be sought in patients with cirrhosis.