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Cherrington AL, Tripputi MT, Younes N, Herman WH, Katona A, Groessl EJ, Craig J, Gonzalez JS, Garg R, Casula S, Kuo S, Florez HJ. Impact of Glucose-Lowering Medications on Health-Related Quality of Life in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:603-609. [PMID: 38190625 PMCID: PMC10973906 DOI: 10.2337/dc23-1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Diabetes is associated with reduced health-related quality of life (HRQoL). Information on the relationship between HRQoL and glucose-lowering medications in recently diagnosed type 2 diabetes (T2D) is limited. We assessed changes in HRQoL in participants with T2D receiving metformin plus one of four glucose-lowering medications in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS A total of 5,047 participants, baseline mean age 57 years, with <10 years T2D duration and glycated hemoglobin level 6.8-8.5% and taking metformin monotherapy, were randomly assigned to glargine, glimepiride, liraglutide, or sitagliptin. HRQoL was evaluated at baseline for 4,885 participants, and at years 1, 2, and 3, with use of the self-administered version of the Quality of Well-being Scale (QWB-SA) and SF-36 physical (PCS) and mental (MCS) component summary scales. Linear models were used to analyze changes in HRQoL over time in intention-to-treat analyses. RESULTS None of the medications worsened HRQoL. There were no differences in QWB-SA or MCS by treatment group at any time point. PCS scores improved with liraglutide versus other groups at year 1 only. Greater weight loss during year 1 explained half the improvement in PCS scores with liraglutide versus glargine and glimepiride. Liraglutide participants in the upper tertile of baseline BMI showed the greatest improvement in PCS scores at year 1. CONCLUSIONS Adding liraglutide to metformin in participants within 10 years of T2D diagnosis showed improvement in the SF-36 PCS in comparisons with the other medications at 1 year, which was no longer significant at years 2 and 3. Improvement was related to weight loss and baseline BMI.
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Affiliation(s)
- Andrea L. Cherrington
- Divisions of Preventive and General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mark T. Tripputi
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Aimee Katona
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Erik J. Groessl
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | | | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Endocrinology, Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rajesh Garg
- Department of Medicine, University of Miami, Miami, FL
| | - Sabina Casula
- Endocrinology, Diabetes, and Metabolism, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Hermes J. Florez
- Department of Medicine, University of Miami, Miami, FL
- Geriatric Research, Education, and Clinical Center, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
- Medical University of South Carolina, Charleston, SC
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Lee TC, Fung SE, Hu JQ, Villatoro GA, Park KS, Fung BM, Groessl EJ, Korn BS, Kikkawa DO, Liu CY. Is Blepharoplasty Cost-effective? Utility Analysis of Dermatochalasis and Cost-effectiveness Analysis of Upper Eyelid Blepharoplasty. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00366. [PMID: 38534072 DOI: 10.1097/iop.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE This cross-sectional prospective study measured utility values of upper eyelid dermatochalasis to quantify its impact on quality of life and assess cost-effectiveness of upper blepharoplasty. METHODS Utility of dermatochalasis was assessed using the standard reference gamble and time trade-off methods, with dual anchor points of perfect eye function and perfect health. The utility value obtained was used to create a Markov model and run a cost-effectiveness analysis of blepharoplasty as a treatment for dermatochalasis while utilizing the societal perspective. RESULTS One hundred three patients with dermatochalasis recruited from an urban outpatient ophthalmology clinic completed the utility survey. The authors determined utility values for dermatochalasis ranging from 0.74 to 0.92 depending on the measurement method (standard reference gamble/time trade-off) and anchor points. The cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of $3,146 per quality-adjusted life year, well under the conventional willingness-to-pay threshold of $50,000 per quality-adjusted life year. Probabilistic sensitivity analysis with Monte Carlo simulation demonstrated that blepharoplasty would be cost-effective in 88.1% of cases at this willingness-to-pay threshold. CONCLUSIONS Dermatochalasis has an impact on quality of life that is significantly associated with level of perceived functional impairment. Rising health care costs have underscored the importance of providing value-based treatment to patients, and the results of this study suggest that blepharoplasty is a cost-effective treatment option for symptomatic bilateral upper eyelid dermatochalasis.
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Affiliation(s)
- Tonya C Lee
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Sammie E Fung
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Jenny Q Hu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
| | - George A Villatoro
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
| | - Kathryn S Park
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California, U.S.A
| | - Brian M Fung
- Department of Ophthalmology, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A
| | - Erik J Groessl
- Department of Family Medicine and Public Health, University of California, San Diego Herbert Wertheim School of Public Health, La Jolla, California, U.S.A
- Department of Behavioral Science, UC San Diego Health Services Research Center, San Diego, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
- Division of Plastic Surgery, Department of Surgery, UC San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
- Division of Plastic Surgery, Department of Surgery, UC San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, California, U.S.A
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego
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Starkweather AR, Xu W, Gnall KE, Emrich M, Garnsey CL, Magin ZE, Wu W, Fetta J, Groessl EJ, Park C. Testing Biological and Psychological Pathways of Emotion Regulation as a Primary Mechanism of Action in Yoga Interventions for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56016. [PMID: 38483469 PMCID: PMC10979342 DOI: 10.2196/56016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Interventions that promote adaptive emotion regulation (ER) skills reduce pain in patients with chronic pain; however, whether the effects of yoga practice on chronic low back pain (CLBP) are due to improvements in ER remains to be examined. OBJECTIVE This study will test whether the effects of yoga on CLBP (improved pain severity and interference) are mediated by improved ER, the extent to which effects are related to specific aspects of ER, and the role of pain sensitization as a mediator or moderator of effects. In this study, pain sensitization will be assessed by quantitative sensory testing and gene expression profiles to examine whether pain sensitization moderates yoga's effects on pain or whether yoga and ER abilities reduce pain sensitization, leading to decreased pain severity and interference. METHODS For this 2-arm parallel group blinded randomized controlled trial, we will enroll 204 adults with CLBP who will be randomized to receive the yoga (n=102) or a control stretching and strengthening (n=102) intervention, which are delivered via web-based synchronous biweekly 75-minute sessions over 12 weeks. Participants are encouraged to practice postures or exercises for 25 minutes on other days using accessible prerecorded practice videos that are sent to participants digitally. Participants will be assessed at 5 time points: baseline, midintervention (6 weeks), postintervention (12 weeks), and 3- and 6-month follow-ups. Assessments of ER, pain severity and interference, pain sensitivity including somatosensory and gene expression profiles, and physical strength and flexibility will be conducted at each visit. The fidelity of the interventions is assessed using a manualized checklist to evaluate recorded group sessions to ensure consistent instructor delivery. RESULTS The primary outcome will be the mean change in pain severity as measured by the Brief Pain Inventory-Short Form at 12 weeks. The primary mechanism of action is ER measured by change in the Difficulties in Emotion Regulation Scale total score. Secondary outcomes include pain sensitivity, physical strength and flexibility, pain interference, and quality of life. A mediation path analysis and series of moderated mediation path analyses will be conducted to test the study hypotheses. As of January 2024, we have enrolled 138 participants. We expect the study to be completed by May 2025. CONCLUSIONS The study will provide important data for evaluating whether improvements in ER are responsible for reduced pain perception and pain sensitivity as well as increased quality of life in the context of chronic pain. The study findings have important implications for determining the mechanism of action for yoga and possibly other mind-body interventions as nonpharmacological therapies for pain management. The results of the study will inform the content, delivery, and measures for intervention trials involving yoga as a modality for relieving pain and improving function. TRIAL REGISTRATION ClinicalTrials.gov NCT04678297; https://clinicaltrials.gov/study/NCT04678297. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56016.
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Affiliation(s)
- Angela R Starkweather
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Wanli Xu
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Mariel Emrich
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Camille L Garnsey
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Zachary E Magin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Weizi Wu
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Joseph Fetta
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Erik J Groessl
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, CA, United States
- Veteran's Affairs San Diego Health System, San Diego, CA, United States
| | - Crystal Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
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Larsen B, Gilmer T, Pekmezi D, Hartman SJ, Benitez T, Rabin B, Marcus BH, Mendoza-Vasconez AS, Groessl EJ. Cost effectiveness of a technology-enhanced physical activity intervention for Latinas. Transl Behav Med 2023; 13:675-682. [PMID: 37208924 PMCID: PMC10496433 DOI: 10.1093/tbm/ibad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, AL, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Borsika Rabin
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Erik J Groessl
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- Health Services Research and Development unit, VA San Diego Health Care System, San Diego, CA, USA
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Groessl EJ, Tally SR, Hillery N. Erratum: Cost-Effectiveness of Humidified High-Flow Therapy (HHFT) for COPD Patients on Long-Term Oxygen Therapy [Corrigendum]. Clinicoecon Outcomes Res 2023; 15:331-332. [PMID: 37214083 PMCID: PMC10198267 DOI: 10.2147/ceor.s420449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
[This corrects the article DOI: 10.2147/CEOR.S400739.].
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Groessl EJ, Tally SR, Hillery N. Cost-Effectiveness of Humidified High-Flow Therapy (HHFT) for COPD Patients on Long-Term Oxygen Therapy. Clinicoecon Outcomes Res 2023; 15:239-250. [PMID: 37041933 PMCID: PMC10083032 DOI: 10.2147/ceor.s400739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/04/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality, and is associated with significant respiratory impairment, decreased quality of life, and high health care costs. Recent evidence indicates significant clinical benefit results from adding humidified high-flow therapy (HHFT) to standard long-term oxygen therapy (LTOT) as a home-based therapy in persons with severe COPD. The objective was to evaluate the cost-effectiveness of adding HHFT to standard treatment of COPD patients using LTOT with US healthcare cost estimates. Patients and Methods A Markov state-transition model was developed using data from a prospective clinical trial of adding HHFT to standard therapy for persons with severe COPD using LTOT. The analysis was conducted from the US health care system perspective using a 5-year time horizon and 3% discount rate. QALYs and downstream healthcare costs were modeled. One-way and probabilistic sensitivity analyses were used to examine the impact of input parameters on the incremental net monetary benefit (NMB). Results Incremental QALYs accrued were 0.058 (2.047 vs 1.989 QALYs for HHFT and standard therapy groups respectively). Incremental total costs were -$3939 ($47,516 vs $51,455 for HHFT and standard therapy groups respectively). Thus, HHFT was the dominant treatment in the analysis, resulting on both better health and lower total costs. Varying utility and cost inputs individually never resulted in NMB approaching 0. Probabilistic analyses indicate that HHFT is cost-effective in 84% of simulations. Conclusion Our results indicate that the reductions in acute exacerbations of COPD (AECOPDs) that result from adding HHFT for persons with COPD on LTOT will produce both health benefit (QALYs) and cost savings. Cost savings occur because the HHFT device costs are more than offset by reductions in costly COPD exacerbations. Health care systems and payors can benefit from wider implementation of HHFT with existing treatments.
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Affiliation(s)
- Erik J Groessl
- Health Services Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Steven R Tally
- Health Services Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Naomi Hillery
- Health Services Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
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Clark JD, Bair MJ, Belitskaya-Lévy I, Fitzsimmons C, Zehm LM, Dougherty PE, Giannitrapani KF, Groessl EJ, Higgins DM, Murphy JL, Riddle DL, Huang GD, Shih MC. Sequential and Comparative Evaluation of Pain Treatment Effectiveness Response (SCEPTER), a pragmatic trial for conservative chronic low back pain treatment. Contemp Clin Trials 2023; 125:107041. [PMID: 36496154 DOI: 10.1016/j.cct.2022.107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic low back pain (cLBP) is a common and highly disabling problem world-wide. Although many treatment options exist, it is unclear how to best sequence the multitude of care options to provide the greatest benefit to patients. METHODS The Sequential and Comparative Evaluation of Pain Treatment Effectiveness Response (SCEPTER) trial uses a pragmatic, randomized, stepped design. Enrollment targets 2529 participants from 20 Veterans Affairs (VA) medical centers. Participants with chronic low back pain will first be randomized to one of three options: 1) an internet-based self-management program (Pain EASE); 2) a tailored physical therapy program (Enhanced PT); or 3) continued care with active monitoring (CCAM), a form of usual care. Participants not achieving a 30% or 2-point reduction on the study's primary outcome (Brief Pain Inventory Pain Interference (BPI-PI) subscale), 3 months after beginning treatment may undergo re-randomization in a second step to cognitive behavioral therapy for chronic pain, spinal manipulation therapy, or yoga. Secondary outcomes include pain intensity, back pain-related disability, depression, and others. Participants will be assessed every three months until 12 months after initiating their final trial therapy. Companion economic and implementation analyses are also planned. RESULTS The SCEPTER trial is currently recruiting and enrolling participants. CONCLUSIONS Trial results will inform treatment decisions for the stepped management of chronic low back pain - a common and disabling condition. Additional analyses will help tailor treatment selection to individual patient characteristics, promote efficient resource use, and identify implementation barriers of interventions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT04142177.
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Affiliation(s)
- J David Clark
- Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Ilana Belitskaya-Lévy
- VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Mountain View, CA, USA
| | | | - Lisa M Zehm
- VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Mountain View, CA, USA
| | - Paul E Dougherty
- VA Finger Lakes Health Care System, Canandaigua, NY, USA; Northeast College of Health Sciences, Seneca Falls, NY, USA
| | - Karleen F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Erik J Groessl
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Diana M Higgins
- Durham VA Healthcare System Duram, NC, USA; Boston University School of Medicine, Boston, MA, USA
| | - Jennifer L Murphy
- Department of Veterans Affairs (VA), Specialty Care Program Office, Director of Pain Management, Washington, DC, USA
| | - Daniel L Riddle
- Departments of Physical Therapy, Orthopedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA, USA
| | - Grant D Huang
- Office of Research and Development, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Mountain View, CA, USA
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Wood L, Foster NE, Lewis M, Bronfort G, Groessl EJ, Hewitt C, Miyamoto GC, Reme SE, Bishop A. Matching the Outcomes to Treatment Targets of Exercise for Low Back Pain: Does it Make a Difference? Results of Secondary Analyses From Individual Patient Data of Randomised Controlled Trials and Pooling of Results Across Trials in Comparative Meta-analysis. Arch Phys Med Rehabil 2023; 104:218-228. [PMID: 35934047 DOI: 10.1016/j.apmr.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore whether using a single matched or composite outcome might affect the results of previous randomized controlled trials (RCTs) testing exercise for non-specific low back pain (NSLBP). The first objective was to explore whether a single matched outcome generated greater standardized mean differences (SMDs) when compared with the original unmatched primary outcome SMD. The second objective was to explore whether a composite measure, composed of matched outcomes, generated a greater SMD when compared with the original primary outcome SMD. DESIGN We conducted exploratory secondary analyses of data. SETTING Seven RCTs were included, of which 2 were based in the USA (University research clinic, Veterans Affairs medical center) and the UK (primary care clinics, nonmedical centers). One each were based in Norway (clinics), Brazil (primary care), and Japan (outpatient clinics). PARTICIPANTS The first analysis comprised 1) 5 RCTs (n=1033) that used an unmatched primary outcome but included (some) matched outcomes as secondary outcomes, and the second analysis comprised 2) 4 RCTs (n=864) that included multiple matched outcomes by developing composite outcomes (N=1897). INTERVENTION Exercise compared with no exercise. MAIN OUTCOME MEASURES The composite consisted of standardized averaged matched outcomes. All analyses replicated the RCTs' primary outcome analyses. RESULTS Of 5 RCTs, 3 had greater SMDs with matched outcomes (pooled effect SMD 0.30 [95% confidence interval {CI} 0.04, 0.56], P=.02) compared with an unmatched primary outcome (pooled effect SMD 0.19 [95% CI -0.03, 0.40] P=.09). Of 4 composite outcome analyses, 3 RCTs had greater SMDs in the composite outcome (pooled effect SMD 0.28 [95% CI 0.05, 0.51] P=.02) compared with the primary outcome (pooled effect SMD 0.24 [95% CI -0.04, 0.53] P=.10). CONCLUSIONS These exploratory analyses suggest that using an outcome matched to exercise treatment targets in NSLBP RCTs may produce greater SMDs than an unmatched primary outcome. Composite outcomes could offer a meaningful way of investigating superiority of exercise than single domain outcomes.
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Affiliation(s)
- Lianne Wood
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham, UK.
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Gert Bronfort
- Earl E Bakken Centre for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Erik J Groessl
- University of California San Diego, Herbert Wertheim School of Public Health and UCSD Health Services Research Centre, La Jolla, CA, USA
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, UK
| | - Gisela C Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Silje E Reme
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
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Groessl EJ, Hafey C, McCarthy A, Hernandez RM, Prado-Nava M, Casteel D, McKinnon S, Chang DG, Ayers CR, Rutledge TR, Lang AJ, Bormann JE. Yoga Plus Mantram Repetition to Reduce Chronic Pain in Veterans With Post-Traumatic Stress Disorder: A Feasibility Trial. Glob Adv Integr Med Health 2023; 12:27536130231220623. [PMID: 38152342 PMCID: PMC10752061 DOI: 10.1177/27536130231220623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Background Veterans with post-traumatic stress disorder (PTSD) are more likely to report chronic pain than veterans without PTSD. Yoga has been shown to reduce both chronic pain and PTSD symptoms in clinical trials. The goal of our study was to assess the feasibility and acceptability of conducting a randomized controlled trial (RCT) that combined yoga and mantram repetition (Yoga + MR) into one program for military veterans with both chronic pain and PTSD. Methods In this feasibility RCT, 27 veterans were randomized to either Yoga + MR or a relaxation intervention. Due to the COVID-19 pandemic, in-person recruitment, assessments, and intervention attendance were re-evaluated. Although remote delivery of aspects of the study were utilized, interventions were delivered in-person. Feasibility benchmarks met included full recruitment in 12 months or less, 75%+ retention at initial follow-up assessment, 50%+ attendance rate, and 75%+ of participants satisfied with the interventions. Results The sample was racially and ethnically diverse, and 15% of participants were women. Participant recruitment lasted approximately 11 months. Out of 32 participants initially randomized, two participants asked to be dropped from the study and three did not meet PTSD symptom criteria. For the remaining 27 participants, retention rates were 85% at 12 weeks and 81% at 18 weeks. Participants attended 66% of in-person yoga and 55% of in-person relaxation sessions. Satisfaction was high, with 100% of yoga participants and 75%/88% of relaxation participants agreeing or strongly agreeing they were satisfied with the intervention/instructors. After 12 weeks (end of intervention), Yoga + MR participants reported reduced back-pain related disability (primary outcome), reduced alcohol use, reduced fatigue, and increased quality of life, while relaxation group participants reported reductions in pain severity, PTSD symptoms, and fatigue. Conclusions Amidst many research challenges during the pandemic, recruitment, retention, and efficacy results from this feasibility trial support advancement to a larger RCT to study Yoga + MR for chronic pain and PTSD.
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Affiliation(s)
- Erik J. Groessl
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- UCSD Health Services Research Center, San Diego, CA, USA
| | - Carol Hafey
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- UCSD Health Services Research Center, San Diego, CA, USA
| | - Adhana McCarthy
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- US Army, San Antonio, TX, USA
| | - Rahil M. Hernandez
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Miguel Prado-Nava
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- UCSD Health Services Research Center, San Diego, CA, USA
| | - Danielle Casteel
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- UCSD Health Services Research Center, San Diego, CA, USA
| | - Symone McKinnon
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- UCSD Health Services Research Center, San Diego, CA, USA
| | - Douglas G. Chang
- Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Catherine R. Ayers
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Thomas R. Rutledge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ariel J. Lang
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jill E. Bormann
- VA San Diego Healthcare System, San Diego, CA, USA
- Hahn School of Nursing and Health Sciences, Beyster Institute of Nursing Research, University of San Diego, San Diego, CA, USA
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Groessl EJ, Casteel D, McKinnon S, McCarthy A, Schmalzl L, Chang DE, Fowler IM, Park CL. Comparing Types of Yoga for Chronic Low Back and Neck Pain in Military Personnel: A Feasibility Randomized Controlled Trial. Glob Adv Health Med 2022; 11:2164957X221094596. [PMID: 35734420 PMCID: PMC9208032 DOI: 10.1177/2164957x221094596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/04/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Chronic low back pain (cLBP) and chronic neck pain (cNP) are highly prevalent conditions and common reasons for disability among military personnel. Yoga and other mind-body interventions have been shown to safely decrease pain and disability in persons with cLBP and/or cNP but have not been adequately studied in active duty military personnel. The objective of this study was to examine the feasibility and acceptability of delivering 2 types of yoga (hatha and restorative) to a sample of active-duty military personnel with cLBP/cNP. Methods Military personnel with cLBP and/or cNP (n = 49; 59% men) were randomized to either hatha or restorative yoga interventions. Interventions consisted of in-person yoga 1-2x weekly for 12 weeks. Feasibility and acceptability were measured by rates of recruitment, intervention attendance, attrition, adverse events, and satisfaction ratings. Health outcomes including pain and disability were measured at baseline, 12 weeks, and 6 months. Means and effect sizes are presented. Results Recruitment was completed ahead of projections. Over 90% of participants agreed or strongly agreed that they enjoyed participation, liked the instructor, and would like to continue yoga. Retention rates were 86% and 80% at 12 week and 6 month assessments, respectively. Intervention attendance was adequate but lower than expected. There were small to moderate reductions in back-pain related disability, pain severity and pain interference, and improvements in quality of life, grip strength, and balance. In general, effects were larger for those who attended at least 50% of intervention classes. Participants with cNP tended to have smaller outcome improvements, but conclusions remain tentative given small sample sizes. Conclusions Results demonstrate feasibility for conducting a randomized controlled comparative effectiveness trial of yoga for cLBP and cNP among active duty military personnel. Acceptability was also established. Ongoing work will enhance the intervention for cNP and establish feasibility at another military facility in preparation for a fully-powered comparative effectiveness trial.ClinicalTrials #NCT03504085; registered April 20, 2018.
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Affiliation(s)
- Erik J Groessl
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA
- HSR&D, VA San Diego Healthcare System, San Diego, CA
- Erik J Groessl, PhD, University of California San Diego, 9500 Gilman Dr #0994, La Jolla, CA 92093, USA.
| | - Danielle Casteel
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA
- HSR&D, VA San Diego Healthcare System, San Diego, CA
| | - Symone McKinnon
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA
| | - Adhana McCarthy
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA
- HSR&D, VA San Diego Healthcare System, San Diego, CA
- US Army, 187th Med Student Detachment
| | - Laura Schmalzl
- College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, CA, USA
| | - Douglas E Chang
- Physical Medicine and Rehabilitation, Dept. of Orthopedic Surgery, University of California San Diego, La Jolla, CA
| | - Ian M Fowler
- Naval Medical Center San Diego, United States Navy
| | - Crystal L Park
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
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11
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Brown JD, Wang CY, Groessl EJ, Pahor M, Manini TM. Three-Year, Postintervention, Follow-up Comparison of Health Care Resource Utilization and Costs in the Lifestyle Interventions and Independence for Elders (LIFE) Study. J Gerontol A Biol Sci Med Sci 2021; 76:272-276. [PMID: 32270182 DOI: 10.1093/gerona/glaa088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity (PA) intervention was found to be cost-effective compared to health education (HE). However, long-term effects postintervention are unknown. METHOD This was a secondary analysis of LIFE Study data linked to Medicare claims data (2014-2016). Participants were linked via Social Security Numbers to Medicare claims data. Utilization and cost variables were analyzed using generalized linear models with negative binomial and Tweedie distributions. Unadjusted means and 95% confidence intervals were compared by year and overall stratified. Each model compared PA versus HE and adjusted for other baseline characteristics and stratified by study site. Additional models were stratified by baseline physical functioning assessment scores. RESULTS Of the 1,635 LIFE Study participants, 804 (53.5%) were linked to Medicare claims with an average of 33 months of follow-up time during the 3-year data linkage period. Mean outpatient (6.6 vs 6.8), inpatient (0.40 vs 0.40), and other utilization metrics were similar between PA and HE groups. Costs were also similar for each group and each type of service, for example, outpatient: $2,070 versus $2,093 and inpatient: $4,704 versus $4,792. Regression results indicated no statistically significant differences between PA and HE groups. CONCLUSIONS While the LIFE Study demonstrated that PA reduced mobility disability in older adults and was cost-effective, it did not appear to affect long-term health care utilization costs posttrial. These findings suggest that it remains challenging to affect long-term health care costs using PA interventions effects.
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Affiliation(s)
- Joshua D Brown
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville.,Center for Drug Evaluation & Safety, University of Florida, Gainesville
| | - Ching-Yu Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville
| | - Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla.,VA San Diego Healthcare System, California
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville.,Institute on Aging, University of Florida, Gainesville
| | - Todd M Manini
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville.,Institute on Aging, University of Florida, Gainesville
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12
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Shadyab AH, Manson JE, Luo J, Haring B, Saquib N, Snetselaar LG, Chen JC, Groessl EJ, Wassertheil-Smoller S, Sun Y, Hale L, LeBoff MS, LaCroix AZ. Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women. J Am Geriatr Soc 2020; 68:1970-1978. [PMID: 32329900 PMCID: PMC8580285 DOI: 10.1111/jgs.16467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE To examine associations of coffee and tea consumption with survival to age 90 years. DESIGN Prospective cohort study among participants from the Women's Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018. SETTING The setting included 40 US clinical centers. PARTICIPANTS A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline. MEASUREMENTS Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history. RESULTS A total of 14,659 (53.3%) women survived to age 90 years during follow-up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity. CONCLUSION No amount of coffee or tea consumption was associated with late-age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.
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Affiliation(s)
- Aladdin H. Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Bernhard Haring
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Jiu-Chiuan Chen
- Departments of Preventive Medicine and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Erik J. Groessl
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | | | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Meryl S. LeBoff
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Woman's Hospital, Harvard Medical School, Boston, MA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
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13
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Elson WH, Riley-Powell AR, Morrison AC, Gotlieb EE, Groessl EJ, Cordova JJ, Rios JE, Quiroz WL, Vizcarra AS, Reiner RC, Barker CM, Vazquez-Prokopec GM, Scott TW, Rothman AL, Elder JP, Paz-Soldan VA. Measuring health related quality of life for dengue patients in Iquitos, Peru. PLoS Negl Trop Dis 2020; 14:e0008477. [PMID: 32722709 PMCID: PMC7413550 DOI: 10.1371/journal.pntd.0008477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/07/2020] [Accepted: 06/11/2020] [Indexed: 12/03/2022] Open
Abstract
Previous studies measuring the health-related quality of life (HRQoL) of individuals with dengue focused on treatment seeking populations. However, the vast majority of global dengue cases are unlikely to be detected by health systems. Representative measurements of HRQoL should therefore include patients with disease not likely to trigger treatment-seeking behavior. This study based in Iquitos, Peru used the Quality of Wellbeing Scale-Self Administered, a survey that enquires about not only physical health, but also psychological health, self-care, mobility, and usual social activities, and rates HRQoL between 0 (death) and 1 (optimum function), to evaluate the impact of dengue on HRQoL. In order to enroll treatment and non treatment-seeking participants, three modalities of participant recruitment were used. In addition to clinic and community-based febrile surveillance, a contact-cluster methodology was also employed to identify infected individuals less likely to seek treatment. We measured changes in HRQoL and identified common areas of health impairment in 73 virologically confirmed dengue cases at 3 time points during the participant's illness; the early-acute (days 0-6 post symptom onset), late-acute (days 7-20), and convalescent illness phases (days 21 +). Participants reported HRQoL related impairments at significantly higher frequency during the early-acute versus convalescent illness phase (Fisher's exact: P<0.01). There was substantial heterogeneity in scores during each illness phase with median scores in the early-acute, late-acute and convalescent phases of 0.56 (IQR: 0.41-0.64), 0.70 (IQR: 0.57-0.94), and 1 (IQR: 0.80-1.00), respectively. In all illness phases participants recruited in clinics had on average the lowest HRQoL scores where as those recruited in the contact clusters had the highest. Only 1 individual who was recruited in the contact-clusters had no reduction in HRQoL score during their illness. These data illustrate that dengue should be considered as a disease that may have significant implications for not only physical health but also psychological health and social functioning. The impact of dengue on the HRQoL of non-treatment-seeking individuals, although lower than the impact among treatment-seeking individuals, is not necessarily trivial.
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Affiliation(s)
- William H. Elson
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - Amy R. Riley-Powell
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Participation, Inclusion and Social Change, and Health and Nutrition Research Clusters, Institute of Development Studies at the University of Sussex, Brighton, United Kingdom
| | - Amy C. Morrison
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine University of California Davis, Davis, California, United States of America
- Virology and Emerging Infections Department, United States Naval Medical Research, Washington DC United States of America and Lima/Iquitos, Peru
| | - Esther E. Gotlieb
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Erik J. Groessl
- Department of Family Medicine and Public Health, University of California San Diego and VA San Diego Medical Center, San Diego, California, United States of America
| | - Jhonny J. Cordova
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - J. Esther Rios
- Virology and Emerging Infections Department, United States Naval Medical Research, Washington DC United States of America and Lima/Iquitos, Peru
| | - W. Lorena Quiroz
- Virology and Emerging Infections Department, United States Naval Medical Research, Washington DC United States of America and Lima/Iquitos, Peru
| | - Alfonso S. Vizcarra
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - Robert C. Reiner
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Christopher M. Barker
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine University of California Davis, Davis, California, United States of America
| | | | - Thomas W. Scott
- Department of Entomology and Nematology, University of California Davis, Davis, California, United States of America
| | - Alan L. Rothman
- Institute for Immunology and Informatics and Department of Cell and Molecular Biology, University of Rhode Island, Providence, Rhode Island, United States of America
| | - John P. Elder
- Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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14
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Pahor M, Guralnik JM, Anton SD, Ambrosius WT, Blair SN, Church TS, Espeland MA, Fielding RA, Gill TM, Glynn NW, Groessl EJ, King AC, Kritchevsky SB, Manini TM, McDermott MM, Miller ME, Newman AB, Williamson JD. Impact and Lessons From the Lifestyle Interventions and Independence for Elders (LIFE) Clinical Trials of Physical Activity to Prevent Mobility Disability. J Am Geriatr Soc 2020; 68:872-881. [PMID: 32105353 PMCID: PMC7187344 DOI: 10.1111/jgs.16365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Walking independently is basic to human functioning. The Lifestyle Interventions and Independence for Elders (LIFE) studies were developed to assess whether initiating physical activity could prevent major mobility disability (MMD) in sedentary older adults. METHODS We review the development and selected findings of the LIFE studies from 2000 through 2019, including the planning phase, the LIFE-Pilot Study, and the LIFE Study. RESULTS The planning phase and the LIFE-Pilot provided key information for the successful implementation of the LIFE Study. The LIFE Study, involving 1635 participants randomized at eight sites throughout the United States, showed that compared with health education, the physical activity program reduced the risk of the primary outcome of MMD (inability to walk 400 m: hazard ratio = 0.82; 95% confidence interval = 0.69-0.98; P = .03), and that the intervention was cost-effective. There were no significant effects on cognitive outcomes, cardiovascular events, or serious fall injuries. In addition, the LIFE studies provided relevant findings on a broad range of other outcomes, including health, frailty, behavioral outcomes, biomarkers, and imaging. To date, the LIFE studies have generated a legacy of 109 peer-reviewed publications, 19 ancillary studies, and 38 independently funded grants and clinical trials, and advanced the development of 59 early career scientists. Data and biological samples of the LIFE Study are now publicly available from a repository sponsored by the National Institute on Aging (https://agingresearchbiobank.nia.nih.gov). CONCLUSIONS The LIFE studies generated a wealth of important scientific findings and accelerated research in geriatrics and gerontology, benefiting the research community, trainees, clinicians, policy makers, and the general public. J Am Geriatr Soc 68:872-881, 2020.
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Affiliation(s)
- Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Walter T Ambrosius
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, South Carolina
| | | | - Mark A Espeland
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erik J Groessl
- VA San Diego Healthcare System and Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California
| | - Abby C King
- Department of Health Research and Policy (Epidemiology) and of Medicine (Stanford Prevention Research Center), Stanford University, School of Medicine, Stanford, California
| | - Stephen B Kritchevsky
- Department of Internal Medicine and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E Miller
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff D Williamson
- Department of Internal Medicine and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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15
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Park CL, Finkelstein-Fox L, Groessl EJ, Elwy AR, Lee SY. Exploring how different types of yoga change psychological resources and emotional well-being across a single session. Complement Ther Med 2020; 49:102354. [PMID: 32147083 DOI: 10.1016/j.ctim.2020.102354] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Yoga demonstrates beneficial effects in many populations, yet our understanding of how yoga brings about these effects is quite limited. Among the proposed mechanisms of yoga are increasing psychological resources (mindfulness, body consciousness, self-transcendence, spiritual peace, and social connectedness) that may bring about salutary effects on emotional wellbeing. Further, yoga is a complex practice comprising meditation, active and restorative postures, and breathwork; however little is known about how different components may affect mechanisms. We aimed to determine how an acute session of yoga (and its specific components) related to pre- to post- session changes in proposed mechanisms (psychological resources) and whether those changes were associated with positive changes in emotions. DESIGN 144 regular yoga practitioners completed measures of mindfulness, body consciousness, self-transcendence, social connectedness, spiritual peace, and exercise-induced emotions (positive engagement, revitalization, tranquility, exhaustion) immediately before and after a yoga session (N = 11 sessions, each a different type of yoga). Perceived properties of each yoga session, exercise exertion and engagement with the yoga teacher were assessed immediately following the session. RESULTS Pre-to post- yoga, levels of positive emotions (engagement, tranquility and revitalization) increased while exhaustion decreased. Further, all psychological resources increased and closely tracked improved emotions. Additionally, aspects of the yoga session correlated with changes in psychological resources (mechanisms) and emotions. CONCLUSIONS Yoga may influence multiple psychological mechanisms that influence emotional well-being. Further, different types of yoga may affect different mechanisms. Results can inform yoga interventions aiming to optimize effects through specific mechanisms such as mindfulness or spirituality.
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Affiliation(s)
| | | | | | | | - Sharon Y Lee
- University of Connecticut, USA; University of California, San Diego, USA; Brown University, USA
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16
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Groessl EJ, Liu L, Schmalzl L, Chang DG, McCarthy A, Chun WI, Sinclair C, Bormann JE. Secondary Outcomes from a Randomized Controlled Trial of Yoga for Veterans with Chronic Low-Back Pain. Int J Yoga Therap 2020; 30:69-76. [PMID: 31509451 PMCID: PMC8966177 DOI: 10.17761/2020-d-19-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Chronic low-back pain (cLBP) is a prevalent condition, and rates are higher among military veterans. cLBP is a persistent condition, and treatment options have either modest effects or a significant risk of side-effects, which has led to recent efforts to explore mind-body intervention options and reduce opioid medication use. Prior studies of yoga for cLBP in community samples, and the main results of a recent trial with military veterans, indicate that yoga can reduce back-related disability and pain intensity. Secondary outcomes from the trial of yoga with military veterans are presented here. In the study, 150 military veterans (Veterans Administration patients) with cLBP were randomized to either yoga or a delayed-treatment group receiving usual care between 2013 and 2015. Assessments occurred at baseline, 6 weeks, 12 weeks, and 6 months. Intent-to-treat analyses were conducted. Yoga classes lasting 60 minutes each were offered twice weekly for 12 weeks. Yoga sessions consisted of physical postures, movement, focused attention, and breathing techniques. Home practice guided by a manual was strongly recommended. The primary outcome measure was Roland-Morris Disability Questionnaire scores after 12 weeks. Secondary outcomes included pain intensity, pain interference, depression, fatigue, quality of life, self-efficacy, and medication usage. Yoga participants improved more than delayed-treatment participants on pain interference, fatigue, quality of life, and self-efficacy at 12 weeks and/or 6 months. Yoga participants had greater improvements across a number of important secondary health outcomes compared to controls. Benefits emerged despite some veterans facing challenges with attending yoga sessions in person. The findings support wider implementation of yoga programs for veterans, with attention to increasing accessibility of yoga programs in this population.
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Affiliation(s)
- Erik J Groessl
- VA San Diego Healthcare System; and Department of Family Medicine and Public Health, University of California San Diego
| | - Lin Liu
- VA San Diego Healthcare System; and Department of Family Medicine and Public Health, University of California San Diego
| | - Laura Schmalzl
- College of Science and Integrative Health, Southern California University of Health Sciences, Whittier; and Department of Family Medicine and Public Health, University of California San Diego
| | - Douglas G Chang
- VA San Diego Healthcare System; and Department of Orthopedic Surgery, University of California San Diego
| | - Adhana McCarthy
- SDSU/UC San Diego Joint Doctoral Program in Public Health, La Jolla, Calif.; and Army Medical Department Center and Schools, San Antonio
| | - Won I Chun
- VA San Diego Healthcare System; and Department of Orthopedic Surgery, University of California San Diego
| | | | - Jill E Bormann
- Hahn School of Nursing & Health Sciences, University of San Diego; and VA Center of Excellence in Stress and Mental Health, San Diego
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17
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Agarwal SK, Foster WG, Groessl EJ. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Womens Health 2019; 11:405-410. [PMID: 31413643 PMCID: PMC6661982 DOI: 10.2147/ijwh.s207373] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
Endometriosis is a chronic, painful disease without a cure. Due largely to chronic pain, endometriosis can lead to significant physical, mental, relationship, and financial burdens. Within the conventional single provider model of care—in which the patient is primarily taken care of by her physician and complementary strategies based on psychology, nutrition, pain medicine, pelvic physical therapy, and so on may not be readily available in a coordinated manner—most women with endometriosis live with unresolved pain and the consequences of that pain. We therefore propose that there is an urgent need to search for alternative models of care. In the current paper, we discuss our experiences with an model of care in which we adopt a long-term, patient-focused, and multidisciplinary chronic care model for women with endometriosis. Our objective is to improve long-term clinical outcomes for women with endometriosis. For geographical areas and healthcare systems in which it is feasible, we propose consideration of this multidisciplinary model of care as an alternative to the single provider model and offer guidance for those considering establishment of such a program. We also initiate a conversation about which clinical outcomes pertaining to endometriosis are important and should be tracked to assess the efficacy and value of multidisciplinary and other endometriosis healthcare models.
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Affiliation(s)
- Sanjay K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA 92037, USA
| | - Warren G Foster
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA 92037, USA.,Department of Obstetrics & Gynaecology, Mcmaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Erik J Groessl
- Departments of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92037, USA.,VA San Diego Medical Center, La Jolla, CA 92037, USA
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18
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Garvin JH, Ducom J, Matheny M, Miller A, Westerman D, Reale C, Slagle J, Kelly N, Beebe R, Koola J, Groessl EJ, Patterson ES, Weinger M, Perkins AM, Ho SB. Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis. JMIR Med Inform 2019; 7:e13627. [PMID: 31271153 PMCID: PMC6636234 DOI: 10.2196/13627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 01/16/2023] Open
Abstract
Background There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis. Objective Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow. Methods Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods. Results We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians’ ratings of CirrODS indicated above average usability. Conclusions We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice.
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Affiliation(s)
- Jennifer Hornung Garvin
- Health Information Management and Systems, The Ohio State University, Columbus, OH, United States.,Center for Health Information and Communication, Richard L Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, United States.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States.,Department of Veteran Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States.,Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Julie Ducom
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Michael Matheny
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anne Miller
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dax Westerman
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jason Slagle
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Natalie Kelly
- Department of Veteran Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Russ Beebe
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jejo Koola
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Erik J Groessl
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States
| | - Emily S Patterson
- Health Information Management and Systems, The Ohio State University, Columbus, OH, United States
| | - Matthew Weinger
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Amy M Perkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel B Ho
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Medicine, University of California San Diego, San Diego, CA, United States.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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19
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Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, Glynn NW, King AC, Anton SD, Walkup M, Lu CJ, Reid K, Spring B, Pahor M. Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. Am J Prev Med 2019; 56:141-146. [PMID: 30573142 PMCID: PMC6309909 DOI: 10.1016/j.amepre.2018.09.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Older adults are a rapidly growing segment of the U.S. POPULATION Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability. METHODS Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017. RESULTS The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time. CONCLUSIONS Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Health Services Research and Development Unit, VA San Diego Healthcare System, San Diego, California.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research and Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Michael Walkup
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Ching-Ju Lu
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Kieran Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Bonnie Spring
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
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20
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Groessl EJ, Maiya M, Schmalzl L, Wing D, Jeste DV. Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial. BMC Geriatr 2018; 18:306. [PMID: 30541474 PMCID: PMC6291934 DOI: 10.1186/s12877-018-0988-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background The loss of mobility during aging impacts independence and leads to further disability, morbidity, and reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized controlled trial of yoga for older adults at risk for mobility limitations. Methods Sedentary older adults (n = 46; age 60–89) were recruited and randomized to either yoga or a health education comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions occurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention at assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures of gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks. Results Recruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% - performance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of health education participants attending at least 50% of the sessions. No serious adverse events were reported. Patient satisfaction with the interventions was high. The mean effect size for the physical performance measures was 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36. Conclusions Results indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for mobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes suggest yoga may have important benefits for this population and should be studied further. Trial Registration ClinicalTrials # NCT03544879; Retrospectively registered 4 June, 2018.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA. .,HSR&D, VA San Diego Healthcare System, San Diego, CA, USA. .,UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.
| | - Meghan Maiya
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA
| | - Laura Schmalzl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, CA, USA
| | - David Wing
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,UCSD Exercise and Physical Activity Resource Center (EPARC), La Jolla, CA, USA
| | - Dilip V Jeste
- UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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21
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Groessl EJ, Tally SR, Hillery N, Maciel A, Garces JA. Cost-Effectiveness of a Pharmacogenetic Test to Guide Treatment for Major Depressive Disorder. J Manag Care Spec Pharm 2018; 24:726-734. [PMID: 30058980 PMCID: PMC10397625 DOI: 10.18553/jmcp.2018.24.8.726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent clinical trials indicate that pharmacogenetic-guided treatment of major depressive disorder (MDD) results in higher treatment response rates by genetically matching patients to medications and avoiding a trial-and-error process. OBJECTIVE To evaluate the cost-effectiveness of a pharmacogenetic test (IDGx) that has demonstrated effectiveness compared with standard of care (SOC) medication management among patients with varied MDD severity. METHODS Data from a large prospective, randomized controlled trial of treatment-naive patients or patients with inadequately controlled MDD in general practice and psychiatric treatment settings were used to build a Markov state-transition probability model. Analyses were conducted from the societal perspective. Treatment response rates, mortality rates, direct and indirect medical costs, and utility inputs were derived from the reference study and published scientific literature. The cost of the pharmacogenetic test was $2,000. A 3% discount rate was used to discount costs and effects. Univariate one-way sensitivity analyses were performed to determine the effect of input parameters on net monetary benefit. RESULTS For moderate to severe MDD, the model estimated a cumulative effect over 3 years of 2.07 quality-adjusted life-years (QALYs) for the pharmacogenetic-guided treatment group and 1.97 QALYs for the SOC group, including a lower probability of death from suicide (0.328% and 0.351%, respectively). Total costs over 3 years were $44,697 (IDGx) and $47,295 (SOC). This difference includes a savings of $2,918 in direct medical costs and $1,680 in indirect costs. Results were more pronounced when only severely depressed patients were evaluated. CONCLUSIONS Pharmacogenetic testing among moderate to severe MDD patients improved QALYs and resulted in cost savings. Sensitivity analyses supported the robust nature of the current findings of the dominant IDGx test to guide treatment. DISCLOSURES Funding for this analysis was provided by AltheaDx, which is the manufacturer of the IDgenetix test. AltheaDx personnel assisted in the study design, data collection, and review of the manuscript. Maciel and Garces are employed by AltheaDx. Groessl has received funding as a consultant from American Specialty Health.
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Affiliation(s)
- Erik J Groessl
- 1 Health Services Research Center, University of California, San Diego
| | - Steven R Tally
- 1 Health Services Research Center, University of California, San Diego
| | - Naomi Hillery
- 1 Health Services Research Center, University of California, San Diego
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22
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Callahan KE, Lovato L, Miller ME, Marsh AP, Fielding RA, Gill TM, Groessl EJ, Guralnik J, King AC, Kritchevsky SB, McDermott MM, Manini T, Newman AB, Rejeski WJ. Self-Reported Physical Function As a Predictor of Hospitalization in the Lifestyle Interventions and Independence for Elders Study. J Am Geriatr Soc 2018; 66:1927-1933. [PMID: 30281796 DOI: 10.1111/jgs.15468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To explore whether baseline scores on the Mobility Assessment Tool-short form (MAT-sf), a brief, animated, computer-based means of assessing mobility that predicts mobility disability, are associated with number of hospitalizations and time to first hospitalization over a median follow-up of 2.7 years. DESIGN Post hoc analysis of prospectively gathered data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a randomized clinical trial of lifestyle interventions to preserve mobility in older adults. SETTING Eight U.S. academic medical centers. PARTICIPANTS Of 1,635 sedentary community-dwelling older adults enrolled in LIFE, 1,574 completed baseline physical function screening including the MAT-sf, with baseline scores ranging from 30.2 (low function) to 69.8 (high function) on a scale from 30 to 80. MEASUREMENTS Number of hospitalizations and time to first hospitalization, adjusted for age, sex, race, living alone, clinical site, baseline comorbidities, number of prescription medications, and cognition. RESULTS Of the 1,557 participants with data regarding hospitalization status, 726 (47%) had at least 1 hospitalization; 78% of these had 1 or 2 hospitalizations. For every 10-point lower MAT-sf score, the rate of all hospitalizations was 19% higher in those with lower scores (adjusted rate ratio=1.20, 95% confidence interval (CI)=1.08-1.32, p<.001). Lower baseline MAT-sf scores were also associated with greater risk of first hospitalization (adjusted hazard ratio=1.20, 95% CI=1.09-1.32, p<.01, per 10-point lower MAT-sf score). CONCLUSION Low MAT-sf scores identify older adults at risk of hospitalization; further study is needed to test interventions to reduce hospitalizations in these individuals.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Winston-Salem, North Carolina
| | - Laura Lovato
- Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Miller
- Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Roger A Fielding
- Department of Nutrition, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Thomas M Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Erik J Groessl
- Department of Family Medicine and Public Health, Health Services Research Center, University of California, San Diego, California
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abby C King
- Department of Health Research and Policy, School of Medicine, Stanford University.,Department of Medicine, School of Medicine, Stanford University
| | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Winston-Salem, North Carolina
| | - Mary M McDermott
- Department of Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd Manini
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, Florida
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
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23
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Miller A, Koola JD, Matheny ME, Ducom JH, Slagle JM, Groessl EJ, Minter FF, Garvin JH, Weinger MB, Ho SB. Application of contextual design methods to inform targeted clinical decision support interventions in sub-specialty care environments. Int J Med Inform 2018; 117:55-65. [DOI: 10.1016/j.ijmedinf.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/14/2018] [Accepted: 05/20/2018] [Indexed: 10/16/2022]
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24
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Groessl EJ, Ganiats TG, Hillery N, Trollip A, Jackson RL, Catanzaro DG, Rodwell TC, Garfein RS, Rodrigues C, Crudu V, Victor TC, Catanzaro A. Cost analysis of rapid diagnostics for drug-resistant tuberculosis. BMC Infect Dis 2018; 18:102. [PMID: 29499645 PMCID: PMC5833048 DOI: 10.1186/s12879-018-3013-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/30/2018] [Indexed: 11/14/2022] Open
Abstract
Background Growth-based drug susceptibility testing (DST) is the reference standard for diagnosing drug-resistant tuberculosis (TB), but standard time to result (TTR) is typically ≥ 3 weeks. Rapid tests can reduce that TTR to days or hours, but accuracy may be lowered. In addition to the TTR and test accuracy, the cost of a diagnostic test may affect whether it is adopted in clinical settings. We examine the cost-effectiveness of rapid diagnostics for extremely drug-resistant TB (XDR-TB) in three different high-prevalence settings. Methods 1128 patients with confirmed TB were enrolled at clinics in Mumbai, India; Chisinau, Moldova; and Port Elizabeth, South Africa. Patient sputum samples underwent DST for first and second line TB drugs using 2 growth-based (MGIT, MODS) and 2 molecular (Pyrosequencing [PSQ], line-probe assays [LPA]) assays. TTR was the primary measure of effectiveness. Sensitivity and specificity were also evaluated. The cost to perform each test at each site was recorded and included test-specific materials, personnel, and equipment costs. Incremental cost-effectiveness ratios were calculated in terms of $/day saved. Sensitivity analyses examine the impact of batch size, equipment, and personnel costs. Results Our prior results indicated that the LPA and PSQ returned results in a little over 1 day. Mean cost per sample without equipment or overhead was $23, $28, $33, and $41 for the MODS, MGIT, PSQ, and LPA, respectively. For diagnosing XDR-TB, MODS was the most accurate, followed by PSQ, and LPA. MODS was quicker and less costly than MGIT. PSQ and LPA were considerably faster but cost more than MODS. Batch size and personnel costs were the main drivers of cost variation. Conclusions Multiple factors must be weighed when selecting a test for diagnosis of XDR-TB. Rapid tests can greatly improve the time required to diagnose drug-resistant TB, potentially improving treatment success, and preventing the spread of XDR-TB. Faster time to result must be weighed against the potential for reduced accuracy, and increased costs. Trial registration ClinicalTrials.gov Identifier: NCT02170441. Electronic supplementary material The online version of this article (10.1186/s12879-018-3013-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA. .,VA San Diego Healthcare System, San Diego, CA, USA.
| | - Theodore G Ganiats
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA
| | - Naomi Hillery
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA
| | - Andre Trollip
- Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Roberta L Jackson
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Timothy C Rodwell
- Department of Medicine, University of California, San Diego, CA, USA
| | - Richard S Garfein
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Valeriu Crudu
- Microbiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
| | - Thomas C Victor
- Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
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25
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Park CL, Elwy AR, Maiya M, Sarkin AJ, Riley KE, Eisen SV, Gutierrez I, Finkelstein-Fox L, Lee SY, Casteel D, Braun T, Groessl EJ. The Essential Properties of Yoga Questionnaire (EPYQ): Psychometric Properties. Int J Yoga Therap 2018; 28:23-38. [PMID: 29498893 DOI: 10.17761/2018-00016r2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Yoga interventions are heterogeneous and vary along multiple dimensions. These dimensions may affect mental and physical health outcomes in different ways or through different mechanisms. However, most studies of the effects of yoga on health do not adequately describe or quantify the components of the interventions being implemented. This lack of detail prevents researchers from making comparisons across studies and limits our understanding of the relative effects of different aspects of yoga interventions. To address this problem, we developed the Essential Properties of Yoga Questionnaire (EPYQ), which allows researchers to objectively characterize their interventions. We present here the reliability and validity data from the final phases of this measure-development project. Analyses identified fourteen key dimensions of yoga interventions measured by the EPYQ: acceptance/compassion, bandhas, body awareness, breathwork, instructor mention of health benefits, individual attention, meditation and mindfulness, mental and emotional awareness, physicality, active postures, restorative postures, social aspects, spirituality, and yoga philosophy. The EPYQ demonstrated good reliability, as assessed by internal consistency and test-retest reliability analysis, and evidence suggests that the EPYQ is a valid measure of multiple dimensions of yoga. The measure is ready for use by clinicians and researchers. Results indicate that, currently, trained objective raters should score interventions to avoid reference frame errors and potential rating bias, but alternative approaches may be developed. The EPYQ will allow researchers to link specific yoga dimensions to identifiable health outcomes and optimize the design of yoga interventions for specific conditions.
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Affiliation(s)
- Crystal L Park
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn
| | - A Rani Elwy
- 2. Department of Health Law, Policy & Management, Boston University School of Public Health, Boston.,3. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital, Boston and Bedford, Mass
| | - Meghan Maiya
- 4. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.,5. Health Services Research Center, University of California San Diego, La Jolla, Calif
| | - Andrew J Sarkin
- 4. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.,5. Health Services Research Center, University of California San Diego, La Jolla, Calif
| | - Kristen E Riley
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn.,6. Memorial Sloan Kettering Cancer Center, New York
| | - Susan V Eisen
- 2. Department of Health Law, Policy & Management, Boston University School of Public Health, Boston.,3. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital, Boston and Bedford, Mass
| | - Ian Gutierrez
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn.,7. Louis Stokes Cleveland VA Medical Center, Cleveland
| | - Lucy Finkelstein-Fox
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn
| | - Sharon Y Lee
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn
| | - Danielle Casteel
- 4. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.,5. Health Services Research Center, University of California San Diego, La Jolla, Calif
| | - Tosca Braun
- 1. Department of Psychological Sciences, University of Connecticut, Storrs, Conn
| | - Erik J Groessl
- 4. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.,5. Health Services Research Center, University of California San Diego, La Jolla, Calif.,8. VA San Diego Healthcare System, San Diego
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Liang X, Margolis KL, Hendryx M, Rohan TE, Groessl EJ, Thomson CA, Kroenke CH, Simon MS, Lane D, Stefanick M, Luo J. Metabolic Phenotype and Risk of Colorectal Cancer in Normal-Weight Postmenopausal Women. Cancer Epidemiol Biomarkers Prev 2018; 26:155-161. [PMID: 28148595 DOI: 10.1158/1055-9965.epi-16-0761] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of metabolically unhealthy phenotype in normal-weight adults is 30%, and few studies have explored the association between metabolic phenotype and colorectal cancer incidence in normal-weight individuals. Our aim was to compare the risk of colorectal cancer in normal-weight postmenopausal women who were characterized by either the metabolically healthy phenotype or the metabolically unhealthy phenotype. METHODS A large prospective cohort, the Women's Health Initiative, was used. The analytic sample included 5,068 postmenopausal women with BMI 18.5 to <25 kg/m2 Metabolic phenotype was defined using the Adult Treatment Panel-III definition, excluding waist circumference; therefore, women with one or none of the four components (elevated triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose) were classified as metabolically healthy. Multivariable Cox proportional hazards regression was used to estimate adjusted HRs for the association between metabolic phenotype and risk of colorectal cancer. RESULTS Among normal-weight women, those who were metabolically unhealthy had higher risks of colorectal cancer (HR, 1.49; 95% CI, 1.02-2.18) compared with those who were metabolically healthy. CONCLUSIONS A metabolically unhealthy phenotype was associated with higher risk of colorectal cancer among normal-weight women. IMPACT Normal-weight women should still be evaluated for metabolic health and appropriate steps taken to reduce their risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev; 26(2); 155-61. ©2017 AACR.
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Affiliation(s)
- Xiaoyun Liang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
| | | | - Michael Hendryx
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.,VA San Diego Healthcare System, San Diego, California
| | | | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Michael S Simon
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Dorothy Lane
- Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, New York
| | - Marcia Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana Univerisity Bloomington, Bloomington, Indiana
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Hurst S, Maiya M, Casteel D, Sarkin AJ, Libretto S, Elwy AR, Park CL, Groessl EJ. Yoga therapy for military personnel and veterans: Qualitative perspectives of yoga students and instructors. Complement Ther Med 2017; 40:222-229. [PMID: 30219455 DOI: 10.1016/j.ctim.2017.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/19/2017] [Accepted: 10/26/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Millions of military personnel and veterans live with chronic mental and physical health conditions that often do not respond well to pharmacological treatments. Serious side effects and lack of treatment response have led to widespread efforts to study and promote non-pharmacological and behavioral health treatments for many chronic health conditions. Yoga is an increasingly popular mind-body intervention that has growing research support for its efficacy and safety. Our objective was to explore the attitudes, perspectives, and preferences of military personnel and veterans toward yoga as a therapeutic modality, thus providing needed information for designing and promoting yoga interventions for this population. METHODS Participants included 24 individuals with yoga experience and current or past military service and 12 instructors who have taught yoga for military personnel and/or veterans. A semi-structured set of questions guided interviews with each participant. RESULTS Five themes emerged from the interviews: (1) mental health benefits experienced from yoga practice; (2) physical health benefits experienced from yoga practice; (3) important yoga elements and conditions that support effective practice; (4) facilitators for engaging military in yoga practice; and (5) challenges and barriers to yoga practice for military. CONCLUSIONS The study highlights consistent reports of mental and physical benefits of yoga practice, ongoing stigma resulting in the need for combatting and demystifying yoga and other complementary and integrative health (CIH) practices, the importance of designing interventions to address the unique mental health issues and perspectives of this population, and the importance of efforts by military leadership to bring CIH to military personnel and veterans. Rigorous research addressing these findings, along with further research on the efficacy and effectiveness of yoga interventions for treating various conditions are needed.
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Affiliation(s)
- Samantha Hurst
- University of California San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States
| | - Meghan Maiya
- University of California San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States; UCSD - Health Services Research Center, La Jolla, CA, United States
| | - Danielle Casteel
- University of California San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States; UCSD - Health Services Research Center, La Jolla, CA, United States
| | - Andrew J Sarkin
- University of California San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States; UCSD - Health Services Research Center, La Jolla, CA, United States
| | | | - A Rani Elwy
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, United States; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Crystal L Park
- University of Connecticut, Department of Psychological Sciences, Storrs, CT, United States
| | - Erik J Groessl
- University of California San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States; UCSD - Health Services Research Center, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States.
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Groessl EJ, Liu L, Chang DG, Wetherell JL, Bormann JE, Atkinson JH, Baxi S, Schmalzl L. Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. Am J Prev Med 2017; 53:599-608. [PMID: 28735778 PMCID: PMC6399016 DOI: 10.1016/j.amepre.2017.05.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is prevalent, especially among military veterans. Many cLBP treatment options have limited benefits and are accompanied by side effects. Major efforts to reduce opioid use and embrace nonpharmacological pain treatments have resulted. Research with community cLBP patients indicates that yoga can improve health outcomes and has few side effects. The benefits of yoga among military veterans were examined. DESIGN Participants were randomized to either yoga or delayed yoga treatment in 2013-2015. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and 6 months. Intention-to-treat analyses occurred in 2016. SETTING/PARTICIPANTS One hundred and fifty military veterans with cLBP were recruited from a major Veterans Affairs Medical Center in California. INTERVENTION Yoga classes (with home practice) were led by a certified instructor twice weekly for 12 weeks, and consisted primarily of physical postures, movement, and breathing techniques. MAIN OUTCOME MEASURES The primary outcome was Roland-Morris Disability Questionnaire scores after 12 weeks. Pain intensity was identified as an important secondary outcome. RESULTS Participant characteristics were mean age 53 years, 26% were female, 35% were unemployed or disabled, and mean back pain duration was 15 years. Improvements in Roland-Morris Disability Questionnaire scores did not differ between the two groups at 12 weeks, but yoga participants had greater reductions in Roland-Morris Disability Questionnaire scores than delayed treatment participants at 6 months -2.48 (95% CI= -4.08, -0.87). Yoga participants improved more on pain intensity at 12 weeks and at 6 months. Opioid medication use declined among all participants, but group differences were not found. CONCLUSIONS Yoga improved health outcomes among veterans despite evidence they had fewer resources, worse health, and more challenges attending yoga sessions than community samples studied previously. The magnitude of pain intensity decline was small, but occurred in the context of reduced opioid use. The findings support wider implementation of yoga programs for veterans. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02524158.
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Affiliation(s)
- Erik J Groessl
- VA San Diego Healthcare System, San Diego, California; Department of Family Medicine and Public Health, University of California San Diego, San Diego, California.
| | - Lin Liu
- VA San Diego Healthcare System, San Diego, California; Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Douglas G Chang
- VA San Diego Healthcare System, San Diego, California; Department of Orthopaedic Surgery, University of California San Diego, San Diego, California
| | - Julie L Wetherell
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Jill E Bormann
- VA San Diego Healthcare System, San Diego, California; Hahn School of Nursing and Health Sciences, University of San Diego, San Diego, California; VA Center of Excellence in Stress and Mental Health, San Diego, California
| | - J Hamp Atkinson
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Sunita Baxi
- VA San Diego Healthcare System, San Diego, California; Department of Medicine, University of California San Diego, San Diego, California
| | - Laura Schmalzl
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California; College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, California
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Fishman LM, Groessl EJ, Bernstein P. Two Isometric Yoga Poses Reduce the Curves in Degenerative and Adolescent Idiopathic Scoliosis. Topics in Geriatric Rehabilitation 2017. [DOI: 10.1097/tgr.0000000000000159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Despite the emergence of new hepatitis C virus (HCV) antiviral medications, many people with chronic HCV know little about their disease, are at risk for transmitting HCV to others, and/or are not considered good treatment candidates. Self-management interventions can educate HCV-infected persons, improve their quality of life, and prepare them for treatment. PURPOSE A cost-effectiveness analysis of the HCV Self-Management Program is presented. METHOD Effectiveness data in quality-adjusted life years (QALYs) were derived from the previously published prospective, randomized controlled trial ( n = 134). Health care utilization was abstracted from medical records in 2011 for the 12 months before and after study enrollment. Intervention costs were tracked from the payer's perspective and combined with health care costs. Sensitivity analyses were used to examine assumptions. Data were analyzed in 2014. RESULTS Estimated intervention costs including organizational overhead were $1,760 per 6-week workshop, or $229/person. Health care costs were $815 lower/person for self-management participants, resulting in a cost savings of $586/person. Self-management participants had an average net gain of 0.02975 QALYs after 1 year. When removing inpatient substance use treatment days from analyses, costs were similar between groups, producing an incremental cost-effectiveness ratio of $6,218/QALY. Sensitivity analyses showed that the results and conclusions change little when assumptions were varied. CONCLUSIONS When compared to information-only, the HCV Self-Management Program led to more QALYs and cost savings in the randomized controlled trial. Independent of health care costs, the intervention is low-cost and educates HCV-infected individuals about antiviral treatment and avoiding viral transmission. Low-cost interventions that can enhance the outcomes derived from expensive antiviral treatments should be studied further.
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Affiliation(s)
- Erik J Groessl
- 1 VA San Diego Healthcare System, San Diego, CA, USA.,2 University of California, San Diego, CA, USA
| | - Marisa Sklar
- 3 SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Kate Lorig
- 4 Stanford University School of Medicine, Stanford, CA, USA
| | | | - Samuel B Ho
- 1 VA San Diego Healthcare System, San Diego, CA, USA.,2 University of California, San Diego, CA, USA
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Groessl EJ, Kaplan RM, Castro Sweet CM, Church T, Espeland MA, Gill TM, Glynn NW, King AC, Kritchevsky S, Manini T, McDermott MM, Reid KF, Rushing J, Pahor M. Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability. J Gerontol A Biol Sci Med Sci 2016; 71:656-62. [PMID: 26888433 PMCID: PMC5007742 DOI: 10.1093/gerona/glw001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention. METHODS The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150 min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon. RESULTS The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions. CONCLUSIONS The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla. VA San Diego Healthcare System, California.
| | - Robert M Kaplan
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Cynthia M Castro Sweet
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, California
| | - Timothy Church
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research & Policy and Medicine, Stanford University School of Medicine, California
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Todd Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Mary M McDermott
- Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kieran F Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Julia Rushing
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville
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Saper RB, Lemaster CM, Elwy AR, Paris R, Herman PM, Plumb DN, Sherman KJ, Groessl EJ, Lynch S, Wang S, Weinberg J. Yoga versus education for Veterans with chronic low back pain: study protocol for a randomized controlled trial. Trials 2016; 17:224. [PMID: 27129472 PMCID: PMC4850721 DOI: 10.1186/s13063-016-1321-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic low back pain is the most frequent pain condition in Veterans and causes substantial suffering, decreased functional capacity, and lower quality of life. Symptoms of post-traumatic stress, depression, and mild traumatic brain injury are highly prevalent in Veterans with back pain. Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials. However, it is unknown if results from previously published trials generalize to military populations. METHODS/DESIGN This study is a parallel randomized controlled trial comparing yoga to education for 120 Veterans with chronic low back pain. Participants are Veterans ≥18 years old with low back pain present on at least half the days in the past six months and a self-reported average pain intensity in the previous week of ≥4 on a 0-10 scale. The 24-week study has an initial 12-week intervention period, where participants are randomized equally into (1) a standardized weekly group yoga class with home practice or (2) education delivered with a self-care book. Primary outcome measures are change at 12 weeks in low back pain intensity measured by the Defense and Veterans Pain Rating Scale (0-10) and back-related function using the 23-point Roland Morris Disability Questionnaire. In the subsequent 12-week follow-up period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. We also assess cost-effectiveness from three perspectives: the Veteran, the Veterans Health Administration, and society using electronic medical records, self-reported cost data, and study records. DISCUSSION This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities. TRIAL REGISTRATION ClinicalTrials.gov: NCT02224183.
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Affiliation(s)
- Robert B. Saper
- />Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Chelsey M. Lemaster
- />Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - A. Rani Elwy
- />Center for Information Dissemination and Education Resources, VA Boston Healthcare System, Boston, MA USA
- />Department of Health Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Ruth Paris
- />Boston University School of Social Work, Boston, MA USA
| | | | - Dorothy N. Plumb
- />Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Karen J. Sherman
- />Group Health Research Institute, Seattle, WA USA
- />Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Erik J. Groessl
- />VA San Diego Healthcare System, San Diego, CA USA
- />Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego, CA USA
| | - Susan Lynch
- />There & Back Again, Inc., Wakefield, MA USA
| | - Shihwe Wang
- />Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Janice Weinberg
- />Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
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Wells SY, Lang AJ, Schmalzl L, Groessl EJ, Strauss JL. Yoga as an Intervention for PTSD: a Theoretical Rationale and Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0068-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chang DG, Holt JA, Sklar M, Groessl EJ. Yoga as a treatment for chronic low back pain: A systematic review of the literature. J Orthop Rheumatol 2016; 3:1-8. [PMID: 27231715 PMCID: PMC4878447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP. METHODS A literature search through the beginning of 2015 was conducted in Pub Med for randomized control trials addressing treatment of CLBP with yoga. RESULTS In this review we evaluate the use of yoga as a treatment for CLBP. Specifically we evaluate how yoga impacts physical functioning and disability, pain, and associated psychological symptoms. We also evaluate possible mediators of the effect of yoga and the safety of yoga. DISCUSSION With few exceptions, previous studies and the recent randomized control trials (RCTs) indicate that yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Some studies also indicate that yoga may improve psychological symptoms, but these effects are currently not as well established.
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Affiliation(s)
- Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, USA,Address for Correspondence: Douglas Chang, MD, PhD, Chief, Physical Medicine and Rehabilitation and Associate Clinical Professor, Department of Orthopaedic Surgery, University of California, San Diego 350 Dickinson St, Suite 121, San Diego, CA 92103-8894, USA, Tel: (619) 543-2694; Fax: (619) 543-2540;
| | - Jacquelyn A. Holt
- Department of Orthopaedic Surgery, University of California, San Diego, USA
| | - Marisa Sklar
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
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Groessl EJ, Maiya M, Elwy AR, Riley KE, Sarkin AJ, Eisen SV, Braun T, Gutierrez I, Kidane L, Park CL. The Essential Properties of Yoga Questionnaire: Development and Methods. Int J Yoga Therap 2015; 25:51-9. [PMID: 26667289 PMCID: PMC6943820 DOI: 10.17761/1531-2054-25.1.51] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Yoga interventions have considerable heterogeneity, are multi-dimensional, and may impact health in different ways. However, most research reports regarding the effects of yoga on health and wellbeing do not adequately describe the components of the yoga interventions being used. Thus, drawing comparisons across studies or understanding the relative effects of specific aspects of a yoga intervention are rarely possible. To address this problem, we created the Essential Properties of Yoga Questionnaire (EPYQ) Project, an NCCAM-funded set of studies to develop a translational tool for yoga researchers. Here we describe the methods and developmental processes used in the EPYQ Project in detail. The project consists of four main phases. Phase I was designed to gain a comprehensive understanding of the relevant aspects of yoga by conducting a comprehensive systematic literature review and conducting focus groups with stakeholders including a wide variety of yoga teachers and students. In Phase II, a pool of potential questionnaire items was developed for the prototypic questionnaire using information from Phase I. Cognitive interviews were conducted with the preliminary EPYQ items to assess the perceived clarity, meaning, and importance of each item. In Phase III, the prototypic questionnaire was administered to two large samples of yoga students and instructors. Military personnel and veterans who practiced or taught yoga (n = 329) were recruited to participate. Factor analysis and item response theory were used to identify factors and select the final questionnaire items. Phase IV is ongoing and will collect reliability and validity data on the final instrument. Results are expected to be available in 2016. The EPYQ will provide an objective tool for describing the amount of various components of yoga interventions, eventually allowing researchers to link specific yoga components to health benefits, and facilitating the design of yoga interventions for specific health conditions.
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Affiliation(s)
- Erik J Groessl
- University of California San Diego, Health Services Research Center, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Meghan Maiya
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - A Rani Elwy
- Boston University School of Public Health, Department of Health Policy and Management, Boston, MA
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
| | - Kristen E Riley
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Andrew J Sarkin
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - Susan V Eisen
- Boston University School of Public Health, Department of Health Policy and Management, Boston, MA
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
| | - Tosca Braun
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Ian Gutierrez
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
| | - Luwam Kidane
- University of California San Diego, Health Services Research Center, La Jolla, CA
| | - Crystal L Park
- University of Connecticut, Department of Clinical Psychology, Storrs, CT
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Ho SB, Bräu N, Cheung R, Liu L, Sanchez C, Sklar M, Phelps TE, Marcus SG, Wasil MM, Tisi A, Huynh L, Robinson SK, Gifford AL, Asch SM, Groessl EJ. Integrated Care Increases Treatment and Improves Outcomes of Patients With Chronic Hepatitis C Virus Infection and Psychiatric Illness or Substance Abuse. Clin Gastroenterol Hepatol 2015; 13:2005-14.e1-3. [PMID: 25724704 DOI: 10.1016/j.cgh.2015.02.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/22/2014] [Accepted: 02/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies are needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multidisciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct-acting antiviral agents) and achieve a sustained virologic response (SVR). METHODS We performed a prospective randomized trial at 3 medical centers in the United States. Participants (n = 363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were assigned randomly to groups that received IC or usual care (controls) from March 2009 through February 2011. A midlevel mental health practitioner was placed at each HCV clinic to provide IC with brief mental health interventions and case management, according to formal protocol. The primary end point was SVR. RESULTS Of the study participants, 63% were non-white, 51% were homeless in the past 5 years, 64% had psychiatric illness, 65% were substance abusers within 1 year before enrollment, 57% were at risk for post-traumatic stress disorder, 71% had active depression, 80% were infected with HCV genotype 1, and 23% had advanced fibrosis. Over a mean follow-up period of 28 months, a greater proportion of patients in the IC group began receiving antiviral therapy (31.9% vs 18.8% for controls; P = .005) and achieved a SVR (15.9% vs 7.7% of controls; odds ratio, 2.26; 95% confidence interval, 1.15-4.44; P = .018). There were no differences in serious adverse events between groups. CONCLUSIONS Integrated care increases the proportion of patients with HCV infection and psychiatric illness and/or substance abuse who begin antiviral therapy and achieve SVRs, without serious adverse events. ClinicalTrials.gov # NCT00722423.
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Affiliation(s)
- Samuel B Ho
- Gastroenterology Section, Medicine Service, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Medicine, University of California, San Diego, San Diego, California.
| | - Norbert Bräu
- Infectious Disease Section, James J. Peters VA Medical Center, Bronx, New York; Divisions of Infectious Disease and Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramsey Cheung
- Gastroenterology Section, Medicine Service, VA Palo Alto Healthcare System, Palo Alto, California; Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
| | - Lin Liu
- Division of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California
| | - Courtney Sanchez
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Marisa Sklar
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Tyler E Phelps
- Gastroenterology Section, Medicine Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - Sonja G Marcus
- Research Service, James J. Peters VA Medical Center, Bronx, New York
| | - Michelene M Wasil
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Amelia Tisi
- Research Service, James J. Peters VA Medical Center, Bronx, New York
| | - Lia Huynh
- Research Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - Shannon K Robinson
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Allen L Gifford
- Infectious Disease Section, Medicine Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts; Departments of Health Policy and Management and Medicine, Boston University, Boston, Massachusetts
| | - Steven M Asch
- Research Service, VA Palo Alto Healthcare System, Palo Alto, California; Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, California
| | - Erik J Groessl
- Division of Health Services Research & Development, Research Service, VA San Diego Healthcare System, San Diego, California; Division of Behavioral Medicine, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California
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Abstract
OBJECTIVES We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. METHODS We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22,394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0-1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. RESULTS For total IMR (log-likelihood ratio χ(2)[1] = 4696.97; P < .001) and IMR Factor 2 Management scores (log-likelihood ratio χ(2)[1] = 7.9; P = .005), increases in mental health recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. CONCLUSIONS Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH.
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Affiliation(s)
- Marisa Sklar
- Marisa Sklar is with San Diego State University-University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego. Gregory A. Aarons is with Department of Psychiatry, University of California San Diego, La Jolla. Maria O'Connell and Larry Davidson are with Department of Psychiatry, Yale School of Medicine, New Haven, CT. Erik J. Groessl is with Department of Family and Preventive Medicine, University of California San Diego
| | - Gregory A Aarons
- Marisa Sklar is with San Diego State University-University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego. Gregory A. Aarons is with Department of Psychiatry, University of California San Diego, La Jolla. Maria O'Connell and Larry Davidson are with Department of Psychiatry, Yale School of Medicine, New Haven, CT. Erik J. Groessl is with Department of Family and Preventive Medicine, University of California San Diego
| | - Maria O'Connell
- Marisa Sklar is with San Diego State University-University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego. Gregory A. Aarons is with Department of Psychiatry, University of California San Diego, La Jolla. Maria O'Connell and Larry Davidson are with Department of Psychiatry, Yale School of Medicine, New Haven, CT. Erik J. Groessl is with Department of Family and Preventive Medicine, University of California San Diego
| | - Larry Davidson
- Marisa Sklar is with San Diego State University-University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego. Gregory A. Aarons is with Department of Psychiatry, University of California San Diego, La Jolla. Maria O'Connell and Larry Davidson are with Department of Psychiatry, Yale School of Medicine, New Haven, CT. Erik J. Groessl is with Department of Family and Preventive Medicine, University of California San Diego
| | - Erik J Groessl
- Marisa Sklar is with San Diego State University-University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego. Gregory A. Aarons is with Department of Psychiatry, University of California San Diego, La Jolla. Maria O'Connell and Larry Davidson are with Department of Psychiatry, Yale School of Medicine, New Haven, CT. Erik J. Groessl is with Department of Family and Preventive Medicine, University of California San Diego
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Abstract
Background: Non-surgical techniques for treating scoliosis frequently focus on realigning the spine, typically by muscular relaxation or muscular or ligamentous stretching. However, such treatments, which include physical therapeutic, chiropractic, and bracing techniques, are inconsistently supported by current evidence. In this study, we assess the possible benefits of asymmetrical strengthening of truncal muscles on the convex side of the scoliotic curve through a single yoga pose, the side plank pose, in idiopathic and degenerative scoliosis. Methods: Twenty-five patients with idiopathic or degenerative scoliosis and primary curves measuring 6 to 120 degrees by the Cobb method had spinal radiographs and were then taught the side plank pose. After 1 week performing the pose with convexity downward for 10 to 20 seconds, they were instructed to maintain the posture once daily for as long as possible on that one side only. A second series of spinal radiographs was taken 3 to 22 months later. Pre- and post-yoga Cobb measurements were compared. Results: The mean self-reported practice of the yoga pose was 1.5 minutes per day, 6.1 days per week, for a mean follow-up period of 6.8 months. Among all patients, a significant improvement in the Cobb angle of the primary scoliotic curve of 32.0% was found. Among 19 compliant patients, the mean improvement rose to 40.9%. Improvements did not differ significantly among adolescent idiopathic and degenerative subtypes (49.6% and 38.4%, respectively). Conclusions: Asymmetrically strengthening the convex side of the primary curve with daily practice of the side plank pose held for as long as possible for an average of 6.8 months significantly reduced the angle of primary scoliotic curves. These results warrant further testing.
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Affiliation(s)
- Loren M Fishman
- Columbia College of Physicians and Surgeons New York (Dr Fishman), United States
| | - Erik J Groessl
- University of California San Diego, VA San Diego Healthcare System (Dr Groessl), United States
| | - Karen J Sherman
- Karen J. Sherman, PhD, MPH, Group Health Research Institute, Seattle, Washington, United States
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Hillery N, Groessl EJ, Trollip A, Catanzaro D, Jackson L, Rodwell TC, Garfein RS, Lin SYG, Eisenach K, Ganiats TG, Park D, Valafar F, Rodrigues C, Crudu V, Victor TC, Catanzaro A. The Global Consortium for Drug-resistant Tuberculosis Diagnostics (GCDD): design of a multi-site, head-to-head study of three rapid tests to detect extensively drug-resistant tuberculosis. Trials 2014; 15:434. [PMID: 25377177 PMCID: PMC4232628 DOI: 10.1186/1745-6215-15-434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/24/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) remains a threat to global public health, owing to the complexity and delay of diagnosis and treatment. The Global Consortium for Drug-resistant Tuberculosis Diagnostics (GCDD) was formed to develop and evaluate assays designed to rapidly detect DR-TB, so that appropriate treatment might begin more quickly. This paper describes the methodology employed in a prospective cohort study for head-to-head assessment of three different rapid diagnostic tools. METHODS Subjects at risk of DR-TB were enrolled from three countries. Data were gathered from a combination of patient interviews, chart reviews, and laboratory testing from each site's reference laboratory. The primary outcome of interest was reduction in time from specimen arrival in the laboratory to results of rapid drug susceptibility tests, as compared with current standard mycobacterial growth indicator tube (MGIT) drug susceptibility tests. RESULTS Successful implementation of the trial in diverse multinational populations is explained, in addition to challenges encountered and recommendations for future studies with similar aims or populations. CONCLUSIONS The GCDD study was a head-to-head study of multiple rapid diagnostic assays aimed at improving accuracy and precision of diagnostics and reducing overall time to detection of DR-TB. By conducting a large prospective study, which captured epidemiological, clinical, and biological data, we have produced a high-quality unique dataset, which will be beneficial for analyzing study aims as well as answering future DR-TB research questions. Reduction in detection time for XDR-TB would be a major public health success as it would allow for improved treatment and more successful patient outcomes. Executing successful trials is critical in assessment of these reductions in highly variable populations. TRIAL REGISTRATION ClinicalTrials.gov NCT02170441.
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Affiliation(s)
- Naomi Hillery
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Erik J Groessl
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Andre Trollip
- />Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Donald Catanzaro
- />Division of Bioinformatics and Medical Informatics, San Diego State University, San Diego, CA USA
| | - Lynn Jackson
- />Department of Medicine, University of California, San Diego, CA USA
| | - Timothy C Rodwell
- />Department of Medicine, University of California, San Diego, CA USA
| | - Richard S Garfein
- />Department of Medicine, University of California, San Diego, CA USA
| | - S-Y Grace Lin
- />California Department of Public Health, Richmond, CA USA
| | - Kathleen Eisenach
- />Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Theodore G Ganiats
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Daniel Park
- />Department of Medicine, University of California, San Diego, CA USA
| | - Faramarz Valafar
- />Division of Bioinformatics and Medical Informatics, San Diego State University, San Diego, CA USA
| | | | - Valeriu Crudu
- />Microbiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
| | - Thomas C Victor
- />Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
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Trollip AP, Moore D, Coronel J, Caviedes L, Klages S, Victor T, Romancenco E, Crudu V, Ajbani K, Vineet VP, Rodrigues C, Jackson RL, Eisenach K, Garfein RS, Rodwell TC, Desmond E, Groessl EJ, Ganiats TG, Catanzaro A. Second-line drug susceptibility breakpoints for Mycobacterium tuberculosis using the MODS assay. Int J Tuberc Lung Dis 2014; 18:227-32. [PMID: 24429318 DOI: 10.5588/ijtld.13.0229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To establish breakpoint concentrations for the fluoroquinolones (moxifloxacin [MFX] and ofloxacin [OFX]) and injectable second-line drugs (amikacin [AMK], kanamycin [KM] and capreomycin [CPM]) using the microscopic observation drug susceptibility (MODS) assay. SETTING A multinational study conducted between February 2011 and August 2012 in Peru, India, Moldova and South Africa. DESIGN In the first phase, breakpoints for the fluoroquinolones and injectable second-line drugs (n = 58) were determined. In the second phase, MODS second-line drug susceptibility testing (DST) as an indirect test was compared to MGIT™ DST (n = 89). In the third (n = 30) and fourth (n = 156) phases, we determined the reproducibility and concordance of MODS second-line DST directly from sputum. RESULTS Breakpoints for MFX (0.5 μg/ml), OFX (1 μg/ml), AMK (2 μg/ml), KM (5 μg/ml) and CPM (2.5 μg/ml) were determined. In all phases, MODS results were highly concordant with MGIT DST. The few discrepancies suggest that the MODS breakpoint concentrations for some drugs may be too low. CONCLUSION MODS second-line DST yielded comparable results to MGIT second-line DST, and is thus a promising alternative. Further studies are needed to confirm the accuracy of the drug breakpoints and the reliability of MODS second-line DST as a direct test.
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Affiliation(s)
- A P Trollip
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - D Moore
- TB Centre and Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Coronel
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Caviedes
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S Klages
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - T Victor
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - E Romancenco
- Microbiology and Morphology Laboratory, Phthisiopneumology Institute, Chisinau, Moldova
| | - V Crudu
- Microbiology and Morphology Laboratory, Phthisiopneumology Institute, Chisinau, Moldova
| | - K Ajbani
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - V P Vineet
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - C Rodrigues
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - R L Jackson
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - K Eisenach
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - R S Garfein
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - T C Rodwell
- Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, California, USA
| | - E Desmond
- Mycobacteriology and Mycology Section, Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
| | - E J Groessl
- University of California San Diego, Veterans' Affairs San Diego Healthcare System, La Jolla, California, USA
| | - T G Ganiats
- University of California San Diego Health Services Research Center, UCSD, La Jolla, California, USA
| | - A Catanzaro
- University of California San Diego School of Medicine, La Jolla, California, USA
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Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, Espeland MA, Fielding RA, Gill TM, Groessl EJ, King AC, Kritchevsky SB, Manini TM, McDermott MM, Miller ME, Newman AB, Rejeski WJ, Sink KM, Williamson JD. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311:2387-96. [PMID: 24866862 PMCID: PMC4266388 DOI: 10.1001/jama.2014.5616] [Citation(s) in RCA: 928] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. DESIGN, SETTING, AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. INTERVENTIONS Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]). CONCLUSIONS AND RELEVANCE A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.
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Affiliation(s)
| | - Jack M. Guralnik
- University of Florida, Gainesville FL
- University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | - Erik J. Groessl
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA
| | - Abby C. King
- Stanford University, School of Medicine, Stanford, CA
| | | | | | | | | | | | - W Jack Rejeski
- Wake Forest University & School of Medicine, Winston-Salem, NC
| | - Kaycee M. Sink
- Wake Forest University & School of Medicine, Winston-Salem, NC
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Sklar M, Groessl EJ, O'Connell M, Davidson L, Aarons GA. Instruments for measuring mental health recovery: a systematic review. Clin Psychol Rev 2013; 33:1082-95. [PMID: 24080285 DOI: 10.1016/j.cpr.2013.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/27/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Persons in recovery, providers, and policymakers alike are advocating for recovery-oriented mental health care, with the promotion of recovery becoming a prominent feature of mental health policy in the United States and internationally. One step toward creating a recovery-oriented system of care is to use recovery-oriented outcome measures. Numerous instruments have been developed to assess progress towards mental health recovery. This review identifies instruments of mental health recovery and evaluates the appropriateness of their use including their psychometric properties, ease of administration, and service-user involvement in their development. A literature search using the Medline and Psych-INFO databases was conducted, identifying 21 instruments for potential inclusion in this review, of which thirteen met inclusion criteria. Results suggest only three instruments (25%) have had their psychometric properties assessed in three or more unique samples of participants. Ease of administration varied between instruments, and for the majority of instruments, development included service user involvement. This review updates and expands previous reviews of instruments to assess mental health recovery. As mental health care continues to transform to a recovery-oriented model of service delivery, this review may facilitate selection of appropriate assessments of mental health recovery for systems to use in evaluating and improving the care they provide.
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Affiliation(s)
- Marisa Sklar
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 9500 Gilman Drive, San Diego, CA 92093-0994, United States.
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Marsh AP, Lovato LC, Glynn NW, Kennedy K, Castro C, Domanchuk K, McDavitt E, Rodate R, Marsiske M, McGloin J, Groessl EJ, Pahor M, Guralnik JM. Lifestyle interventions and independence for elders study: recruitment and baseline characteristics. J Gerontol A Biol Sci Med Sci 2013; 68:1549-58. [PMID: 23716501 DOI: 10.1093/gerona/glt064] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recruitment of older adults into long-term clinical trials involving behavioral interventions is a significant challenge. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled multisite trial, designed to compare the effects of a moderate-intensity physical activity program with a successful aging health education program on the incidence of major mobility disability (the inability to walk 400 m) in sedentary adults aged 70-89 years, who were at high risk for mobility disability (scoring ≤ 9 on the Short Physical Performance Battery) at baseline. METHODS Recruitment methods, yields, efficiency, and costs are described together with a summary of participant baseline characteristics. Yields were examined across levels of sex, race and ethnicity, and Short Physical Performance Battery, as well as by site. RESULTS The 21-month recruiting period resulted in 14,812 telephone screens; 1,635 participants were randomized (67.2% women, 21.0% minorities, 44.7% with Short Physical Performance Battery scores ≤ 7). Of the telephone-screened participants, 37.6% were excluded primarily because of regular participation in physical activity, health exclusions, or self-reported mobility disability. Direct mailing was the most productive recruitment strategy (59.5% of randomized participants). Recruitment costs were $840 per randomized participant. Yields differed by sex and Short Physical Performance Battery. We accrued 11% more participant follow-up time than expected during the recruitment period as a result of the accelerated recruitment rate. CONCLUSIONS The LIFE Study achieved all recruitment benchmarks. Bulk mailing is an efficient method for recruiting high-risk community-dwelling older persons (including minorities), from diverse geographic areas for this long-term behavioral trial.
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Affiliation(s)
- Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109-7868.
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Groessl EJ, Sklar M, Cheung RC, Bräu N, Ho SB. Increasing antiviral treatment through integrated hepatitis C care: a randomized multicenter trial. Contemp Clin Trials 2013; 35:97-107. [PMID: 23669414 DOI: 10.1016/j.cct.2013.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 12/14/2022]
Abstract
Most individuals infected with the hepatitis C have not received antiviral treatment, with mental health and substance abuse problems being the primary barrier. Interventions have been developed to address these barriers among HCV patients considered "high-risk" for antiviral treatment. We present the design and methods of a prospective, randomized controlled multisite trial being conducted in the Veterans Affairs Healthcare System. The study employed a parallel design and the three study sites randomized a total of 364 VA patients with HCV to either Integrated Care (IC) or Usual Care (UC). The IC intervention consisted of a mental health provider (MHP) performing a) brief interventions to address risk factors; b) collaborative consultation with the HCV treatment clinicians; and c) case management prior to and during antiviral treatment. Clinical outcomes were abstracted from patient medical records and self-report questionnaires were completed at baseline, 4-months, 16-months, and 22-months after enrollment. The primary outcome of the study was sustained viral response (SVR). Secondary clinical outcomes were HCV treatment initiation and completion rates. Other secondary outcomes included substance use, depression, PTSD symptoms, quality of life, healthcare satisfaction, and healthcare utilization. The Integrated Care intervention has the potential to transform HCV antiviral treatment by increasing the number of HCV-infected individuals that can be successfully treated.
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Groessl EJ, Ho SB, Asch SM, Stepnowsky CJ, Laurent D, Gifford AL. The hepatitis C self-management program: sustainability of primary outcomes at 1 year. Health Educ Behav 2013; 40:730-40. [PMID: 23445604 DOI: 10.1177/1090198113477112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to liver wellness and improved quality of life. Our objective was to evaluate whether the effects of the HCV self-management program were sustained at the 12-month follow-up assessment. METHODS Veteran Affairs patients with hepatitis C (N = 134; mean age = 54.6 years, 95% male, 41% ethnic minority, 48% homeless in last 5 years) were randomized to either a 6-week self-management workshop or an information-only intervention. The weekly 2-hour self-management sessions were based on a cognitive-behavioral program with hepatitis C-specific modules. Outcomes including hepatitis C knowledge, depression, energy, and health-related quality of life were measured at baseline, 6 weeks, 6 months, and 12 months later. Data were analyzed using repeated measures ANOVA. RESULTS Compared with the information-only group, participants attending the self-management workshop improved more on HCV knowledge (p < .005), SF-36 energy/vitality (p = .016), and the Quality of Well-Being Scale (p = .036). Similar trends were found for SF-36 physical functioning and Center for Epidemiologic Studies Short Depression Scale. CONCLUSION Better outcomes were sustained among self-management participants at the 12-month assessment despite the intervention only lasting 6 weeks. HCV health care providers should consider adding self-management interventions for patients with chronic HCV.
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Groessl EJ, Liu L, Sklar M, Tally SR, Kaplan RM, Ganiats TG. Measuring the impact of cataract surgery on generic and vision-specific quality of life. Qual Life Res 2012; 22:1405-14. [PMID: 23015266 DOI: 10.1007/s11136-012-0270-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Cataracts are the leading cause of blindness worldwide and cause visual impairment for millions of adults in the United States. We compared the sensitivity of a vision-specific health-related quality of life (HRQOL) measure to that of multiple generic measures of HRQOL before and at 2 time points after cataract surgery. METHODS Participants completed 1 vision-specific and 5 generic quality of life measures before cataract surgery, and again 1 and 6 months after surgery. Random effects modeling was used to measure changes over the three assessment points. RESULTS The NEI-VFQ25 total score and all 11 subscales showed significant improvements during the first interval (baseline and 1 month). During the second interval (1-6 months post-surgery), significant improvements were observed on the total score and 5 of 11 NEI-VFQ25 subscales. There were significant increases in HRQOL during the first interval on some preference-based generic HRQOL measures, though changes during the second interval were mostly non-significant. None of the SF-36v2™ or SF6D scales changed significantly between any of the assessment periods. CONCLUSIONS The NEI-VFQ25 was sensitive to changes in vision-specific domains of QOL. Some preference-based generic HRQOL measures were also sensitive to change and showed convergence with the NEI-VFQ25, but the effects were small. The SF-36v2™ and SF-6D did not change in a similar manner, possibly reflecting a lack of vision-related content. Studies seeking to document both the vision-specific and generic HRQOL improvements of cataract surgery should consider these results when selecting measures.
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Affiliation(s)
- Erik J Groessl
- UCSD Health Services Research Center, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA 92037, USA.
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48
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Affiliation(s)
- Erik J. Groessl
- VA San Diego Healthcare System, San Diego, CA
- University of California San Diego, San Diego, CA
| | | | | | - Sunita Baxi
- VA San Diego Healthcare System, San Diego, CA
- University of California San Diego, San Diego, CA
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Archer E, Groessl EJ, Sui X, McClain AC, Wilcox S, Hand GA, Meriwether RA, Blair SN. An economic analysis of traditional and technology-based approaches to weight loss. Am J Prev Med 2012; 43:176-82. [PMID: 22813682 DOI: 10.1016/j.amepre.2012.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 02/20/2012] [Accepted: 04/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The financial burden and human losses associated with noncommunicable diseases necessitate cost-effective and efficacious interventions. PURPOSE An economic analysis of the Lifestyle Education for Activity and Nutrition (LEAN) Study; an RCT that examined the efficacy of traditional and technology-based approaches to weight loss. METHODS Economic analyses from an organizational perspective were conducted for four approaches: standard care control (SC); group weight-loss education (GWL); a multisensor armband (SWA); and the armband in combination with group weight-loss education (GWL+SWA). Data were collected in 2008-2009. Weight loss was the primary outcome. Total costs, costs per participant, costs per kilogram lost, and incremental cost-effectiveness ratios (ICERs) were calculated in 2010-2011. All costs are the actual expenses (i.e., staff time and materials) incurred by the LEAN study (except where noted) and reported in 2010 U.S. dollars. RESULTS In the sample population of 197 sedentary, overweight, and obese adults (mean [±SD] age=46.9 ± 0.8 years, BMI=33.3 ± 5.2, weight=92.8 ± 18.4 kg), the GWL+SWA was the most expensive intervention in costs/participant ($365/partic) while yielding the greatest weight loss/partic (6.59 kg). The GWL was next in cost/partic ($240), but the SWA was less expensive in cost/partic ($183) and more efficacious (3.55 vs 1.86 kg/partic). The SC did not achieve significant weight loss. The SWA was the most cost effective ($51/partic/kg lost), followed by the GWL+SWA ($55) and GWL alone ($129). The ICER suggests that for each additional kilogram lost, the GWL+SWA cost $60 more than the SWA alone. CONCLUSIONS The SWA was the most cost-effective intervention ($51/partic/kg lost). The addition of the GWL increased the efficacy of the SWA intervention but increased costs by $60/partic for each additional kilogram lost. The technology-based approaches were more cost effective and efficacious than traditional approaches in promoting weight loss via lifestyle changes in sedentary, overweight, and obese adults.
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Affiliation(s)
- Edward Archer
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, 29201-3937, USA.
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Groessl EJ, Liu L, Ho SB, Kanwal F, Gifford AL, Asch SM. National patterns and predictors of liver biopsy use for management of hepatitis C. J Hepatol 2012; 57:252-9. [PMID: 22521358 DOI: 10.1016/j.jhep.2012.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 02/16/2012] [Accepted: 03/12/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Liver biopsy remains the standard, recommended method for assessing liver damage associated with chronic hepatitis C (HCV) infection. However, there is considerable debate about how liver biopsy should best be used, especially with the advent of more efficacious antiviral therapies. To identify the factors that influence the use of liver biopsy for HCV patients, we describe variations in liver biopsy use at the delivery system and patient level in a national VA sample. METHODS We analyzed VA HCV registry data for 171,893 VA patients with confirmed chronic HCV. Delivery system characteristics included geographic region and specialist time. Patient characteristics included antiviral treatment indicators, contraindications, volume of healthcare visits, and demographic variables. Logistic regression was used to explore correlates of biopsy use. RESULTS Liver biopsy use in the VA system increased from 1997 to 2003 but began declining in 2004. Rates of liver biopsy from 2004 to 2006 varied by VA region, ranging from 5% to 18%. Treatment contraindications and laboratory tests were significantly associated with more biopsies. Demographic variables (higher age, lower BMI, race/ethnicity, and less% service connected disability) were associated with fewer biopsies. Regional variability remained significant independent of volume of care and specialist time. CONCLUSIONS Liver biopsy rates in the VA system have variability that seems unrelated to clinical need. New antiviral therapies and non-invasive assessment techniques may create additional uncertainty for the role of liver biopsy, perhaps explaining its decline in recent years. The availability of more effective antiviral therapies may also affect biopsy rates in the future.
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Affiliation(s)
- Erik J Groessl
- VA San Diego Healthcare System, San Diego, CA 92161, USA.
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