المؤلفون: Messier, Stephen P., Gill, Malia E., Mihalko, Shannon L., Beavers, Daniel P., Queen, Kate, Miller, Gary D., Losina, Elena, Katz, Jeffrey N., Loeser, Richard F., DeVita, Paul, Hunter, David J., Quandt, Sara A., Lyles, Mary F., Hudson, David, Callahan, Leigh F.

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: Arthritis Care & Research ; volume 76, issue 4, page 503-510 ; ISSN 2151-464X 2151-4658

الوصف: Objective The purpose of this study was to determine whether clinical, health‐related quality of life (HRQL), and gait characteristics in adults with knee osteoarthritis (OA) differed by obesity category. Methods This cross‐sectional analysis of 823 older adults (mean age 64.6 years, SD 7.8 years) with knee OA and overweight or obesity compared clinical, HRQL, and gait outcomes among obesity classifications (overweight or class I, body mass index [BMI] 27.0–34.9; class II, BMI 35.0–39.9; class III BMI ≥40.0). Results Patients with class III obesity had worse Western Ontario McMasters Universities Arthritis Index knee pain (0–20) than the overweight or class I (mean 8.6 vs 7.0; difference 1.5; 95% confidence interval [CI] 1.0–2.1; P < 0.0001) and class II (mean 8.6 vs 7.4; difference 1.1; 95% CI 0.6–1.7; P = 0.0002) obesity groups. The Short Form 36 physical HRQL measure was lower in the class III obesity group compared to the overweight or class I (mean 31.0 vs 37.3; difference −6.2; 95% CI −7.8 to −4.7; P < 0.0001) and class II (mean 31.0 vs 35.0; difference −3.9; 95% CI −5.6 to −2.2; P < 0.0001) obesity groups. The class III obesity group had a base of support (cm) during gait that was wider than that for the overweight or class I (mean 14.0 vs 11.6; difference 3.3; 95% CI 2.6–4.0; P < 0.0001) and class II (mean 14.0 vs 11.6; difference 2.4; 95% CI 1.6–3.2; P < 0.0001) obesity groups. Conclusion Among adults with knee OA, those with class III obesity had significantly higher pain levels and worse physical HRQL and gait characteristics compared to adults with overweight or class I or class II obesity. image

الإتاحة: https://doi.org/10.1002/acr.25265Test

المؤلفون: Peters, Susan E., Gundersen, Daniel A., Katz, Jeffrey N., Sorensen, Glorian, Wagner, Gregory R.

المصدر: American Journal of Industrial Medicine ; volume 66, issue 4, page 281-296 ; ISSN 0271-3586 1097-0274

الوصف: Introduction Thriving from Work is defined as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential at work, at home, and in the community. The purpose of this study was to develop a psychometrically‐sound questionnaire measuring the positive contribution that work can have on one's well‐being both at, and outside of, their work. Methods We used both a qualitative and quantitative approach of item reduction, domain mapping dimensionality testing, development of “long‐” and “short‐” versions of the questionnaire, reliability, and construct and criterion validity testing. This was established in two independent online samples of US based workers ( n = 1550, n = 500). Results We developed a bi‐factor model 30‐item long‐form and a uni‐factorial 8‐item short‐version. The long‐form measures both the latent construct of Thriving from Work and six domains (psychological/emotional; work‐life integration; social; experience of work; basic needs; health). Both long‐ and short‐ forms were found to have high empirical reliability (0.93 and 0.87 respectively). The short‐form captures 94% of variance of the long‐form. Construct and criterion validity were supported. Test‐retest reliability was high. Conclusions The Thriving from Work Questionnaire appears to be a valid and reliable measure of work‐related well‐being in United States workers. Further testing is needed to refine and test the instrument in specific industries, unique worker populations, and across geographic regions.

الإتاحة: https://doi.org/10.1002/ajim.23465Test

المؤلفون: McDermott, Gregory C., Monshizadeh, Armaan, Selzer, Faith, Zhao, Sizheng S., Ermann, Joerg, Katz, Jeffrey N.

المساهمون: National Institute for Health and Care Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Spondyloarthritis Research and Treatment Network, Versus Arthritis

المصدر: Arthritis Care & Research ; volume 76, issue 4, page 541-549 ; ISSN 2151-464X 2151-4658

الوصف: Objective Patients with axial spondyloarthritis (axSpA) often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay. Methods We identified patients meeting modified New York criteria for ankylosing spondylitis (AS) or 2009 Assessment of Spondyloarthritis International Society criteria for axSpA in the Mass General Brigham health care system between December 1990 and October 2021. We determined the duration of diagnostic delay, defined as the duration of back pain symptoms reported at diagnosis, as well as disease manifestations and specialty care prior to diagnosis from the electronic health record. We obtained each patient's Social Vulnerability Index (SVI) by mapping their address to the US Centers for Disease Control SVI Atlas. We examined associations among disease manifestations, SVI, and diagnostic delay using ordinal logistic regression. Results Among 554 patients with axSpA who had a median diagnostic delay of 3.8 years (interquartile range 1.1–10), peripheral arthritis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45–0.93) and older age at symptom onset (OR 0.83, 95% CI 0.78–0.88 per five years) were associated with shorter delay. AS at diagnosis (OR 1.85, 95% CI 1.30–2.63), a history of uveitis prior to diagnosis (OR 2.77, 95% CI 1.73–4.52), and higher social vulnerability (defined as national SVI 80th to 99th percentiles; OR 1.99, 95% CI 1.06–3.84) were associated with longer diagnostic delay. Conclusion Older age at back pain onset and peripheral arthritis were associated with shorter delay, whereas uveitis was associated with longer diagnostic delay. Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors.

الإتاحة: https://doi.org/10.1002/acr.25264Test

المؤلفون: Kopp, Paul T., Yang, Catherine, Yang, Heidi, Katz, Jeffrey N., Paltiel, A. David, Hunter, David J., Callahan, Leigh F., Mihalko, Shannon L., Newman, Jovita J., DeVita, Paul, Loeser, Richard F., Miller, Gary D., Messier, Stephen P., Losina, Elena

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases, Centers for Disease Control and Prevention

المصدر: Arthritis Care & Research ; ISSN 2151-464X 2151-4658

الوصف: Objective Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE‐CAN) study, a community‐based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/m 2 relative to a group‐based health education (HE) intervention. We sought to determine the incremental cost‐effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the “next‐best” strategy ranked by increasing lifetime cost. Methods We used the Osteoarthritis Policy Model to project long‐term clinical and economic benefits of the WE‐CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE‐CAN trial. Our outcomes included quality‐adjusted life years (QALYs), cost, and incremental cost‐effectiveness ratios (ICERs). Results In a cohort with mean age 65 years, BMI 37 kg/m 2 , and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0–100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY. Conclusion The community‐based D + E program for persons with knee OA and BMI >27kg/m 2 could be cost‐effective for willingness‐to‐pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community‐based D + E programs into OA care may be beneficial for public health. image

الإتاحة: https://doi.org/10.1002/acr.25323Test

المؤلفون: Khan, Nazleen F., Bykov, Katsiaryna, Katz, Jeffrey N., Glynn, Robert J., Vine, Seanna M., Kim, Seoyoung C.

المساهمون: National Institute on Aging, National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: Pharmacoepidemiology and Drug Safety ; volume 33, issue 3 ; ISSN 1053-8569 1099-1557

الوصف: Background Osteoarthritis (OA) patients taking prescription opioids for pain are at increased risk of fall or fracture, and the concomitant use of interacting drugs may further increase the risk of these events. Aims To identify prescription opioid‐related medication combinations associated with fall or fracture. Materials & Methods We conducted a case‐crossover‐based screening of two administrative claims databases spanning 2003 through 2021. OA patients were aged 40 years or older with at least 365 days of continuous enrollment and 90 days of continuous prescription opioid use before their first eligible fall or fracture event. The primary analysis quantified the odds ratio (OR) between fall and non‐opioid medications dispensed in the 90 days before the fall date after adjustment for prescription opioid dosage and confounding using a case‐time‐control design. A secondary analogous analysis evaluated medications associated with fracture. The false discovery rate (FDR) was used to account for multiple testing. Results We identified 41 693 OA patients who experienced a fall and 24 891 OA patients who experienced a fracture after at least 90 days of continuous opioid therapy. Top non‐opioid medications by ascending p‐value with OR > 1 for fall were meloxicam (OR 1.22, FDR = 0.08), metoprolol (OR 1.06, FDR >0.99), and celecoxib (OR 1.13, FDR > 0.99). Top non‐opioid medications for fracture were losartan (OR 1.20, FDR = 0.80), alprazolam (OR 1.14, FDR > 0.99), and duloxetine (OR 1.12, FDR = 0.97). Conclusion Clinicians may seek to monitor patients who are co‐prescribed drugs that act on the central nervous system, especially in individuals with OA.

الإتاحة: https://doi.org/10.1002/pds.5773Test

المؤلفون: Waddell, Lily M., Musbahi, Omar, Collins, Jamie E., Jones, Morgan H., Selzer, Faith, Losina, Elena, Katz, Jeffrey N.

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH

المصدر: Arthritis Care & Research ; volume 76, issue 6, page 882-888 ; ISSN 2151-464X 2151-4658

الوصف: Objective Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. Methods We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. Results In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. Conclusion These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.

الإتاحة: https://doi.org/10.1002/acr.25298Test

المؤلفون: Williams, Emma E., Katz, Jeffrey N., Leifer, Valia P., Collins, Jamie E., Neogi, Tuhina, Suter, Lisa G., Levy, Bruce, Farid, Alexander, Safran‐Norton, Clare E., Paltiel, A. David, Losina, Elena

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: ACR Open Rheumatology ; volume 4, issue 10, page 853-862 ; ISSN 2578-5745 2578-5745

الوصف: Objective We examined the cost‐effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT). Methods We used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT‐only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5‐year time horizon, discounted costs, and quality‐adjusted life‐years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost‐effectiveness ratios. Results Relative to PT‐only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost‐effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost‐effectiveness ratio = $473,800 per QALY). Incremental cost‐effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost‐effective in 51% of simulations at willingness‐to‐pay thresholds of both $50,000 per QALY and $100,000 per QALY. Conclusion First‐line arthroscopic partial meniscectomy has a prohibitively high incremental cost‐effectiveness ratio. Under base case assumptions, second‐line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost‐effective at willingness‐to‐pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic ...

الإتاحة: https://doi.org/10.1002/acr2.11480Test

المؤلفون: Williams, Jessica A.R., Vriniotis, Mary G., Gundersen, Daniel A., Boden, Leslie I., Collins, Jamie E., Katz, Jeffrey N., Wagner, Gregory R., Sorensen, Glorian

المصدر: Health Science Reports ; volume 4, issue 2 ; ISSN 2398-8835 2398-8835

الوصف: Background and Aims Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non‐response error and comparison of nursing home's characteristics to their population values as a measure of representation error. Methods We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. Results The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. Conclusion A single‐mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.

الإتاحة: https://doi.org/10.1002/hsr2.304Test

المؤلفون: Zhang, MaryAnn, Selzer, Faith, Losina, Elena, Collins, Jamie E., Katz, Jeffrey N.

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: ACR Open Rheumatology ; volume 3, issue 9, page 583-592 ; ISSN 2578-5745 2578-5745

الوصف: Objective To examine impact of pre‐existing and incident problematic musculoskeletal (MSK) areas after total knee replacement (TKR) on postoperative 60‐month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/function scores. Methods Using data from a randomized controlled trial of subjects undergoing TKR for osteoarthritis, we assessed problematic MSK areas in six body regions before TKR and 12, 24, 36, and 48 months after TKR. We defined the following two variables: 1 ) density count (number of problematic MSK areas occurring after TKR; range 0‐24) and 2 ) cumulative density count (problematic MSK areas both before and after TKR, categorized into four levels: no preoperative areas and density count of 0‐1 [reference group]; no preoperative areas and density count of 2 or more; one or more preoperative areas and density count of 0‐1; and one or more preoperative areas and density count of 2 or greater). We evaluated the associations between categorized 60‐month WOMAC and cumulative density count by ordinal logistic regression. Results Among 230 subjects, 24% reported one or more preoperative problematic MSK area. After TKR, 75% reported a density count of 0 to 1; 25% reported a density count of 2 or more. Compared with the reference group, each cumulative density count category was associated with an increased odds of having a higher category of 60‐month WOMAC pain score, as follows: 2.97 (95% confidence interval [CI], 1.48‐5.98) for no preoperative problematic areas and density count of 2 or greater, 3.31 (95% CI, 1.64‐6.66) for one or more preoperative problematic areas and density count of 0 to 1, and 2.85 (95% CI, 0.97‐8.39) for one or more preoperative problematic areas and density count of 2 or greater. Similar associations were observed with 60‐month WOMAC function score. Conclusion In TKR recipients, the presence of problematic musculoskeletal areas beyond the index knee—preoperatively and/or postoperatively—was associated with worse 60‐month WOMAC pain/function score.

الإتاحة: https://doi.org/10.1002/acr2.11241Test

المؤلفون: MacFarlane, Lindsey A., Arant, Kaetlyn R., Kostic, Aleksandra M., Mass, Hanna, Jones, Morgan H., Collins, Jamie E., Losina, Elena, Katz, Jeffrey N.

المساهمون: Rheumatology Research Foundation

المصدر: Arthritis Care & Research ; volume 75, issue 8, page 1783-1787 ; ISSN 2151-464X 2151-4658

الوصف: Objective Inflammation is a potential pain generator and treatment target in knee osteoarthritis (OA). Inflammation can be detected on magnetic resonance imaging (MRI) and by synovial fluid white blood cell count (WBC). However, the performance characteristics of synovial fluid WBC for the detection of synovitis have not been established. This study was undertaken to determine the sensitivity and specificity of synovial fluid WBC in identifying inflammation in knee OA using MRI effusion‐synovitis as the gold standard. Methods We identified records of patients seen at an academic center with a diagnosis code for knee OA, a procedural code for knee aspiration, and a laboratory order for synovial fluid WBC in the same encounter, as well as an MRI within 12 months of the aspiration. MRIs were read for effusion‐synovitis using the MRI OA Knee Score (MOAKS). We dichotomized effusion‐synovitis as 1) none or small, or 2) medium or large. We calculated the sensitivity and specificity of synovial fluid WBC using MRI effusion‐synovitis (medium/large) as the gold standard. We used the Youden index to identify the best cut point. Results We included 75 patients. Mean ± SD age was 63 ± 12 years, and 69% were female. The synovial fluid WBC was higher in the medium/large effusion‐synovitis group (median 335 [interquartile range (IQR) 312]) than in the none/small group (median 194 [IQR 272]). The optimal cut point was 242, yielding a sensitivity of 71% (95% confidence interval [95% CI] 56–83%) and specificity of 63% (95% CI 41–81%). Conclusion The sensitivity and specificity of synovial fluid WBC in identifying effusion‐synovitis on MRI were limited. Further research is needed to better understand the association between MRI and effusion‐synovitis measured by synovial fluid and to determine which measure more strongly relates to synovial histopathology and patient outcomes.

الإتاحة: https://doi.org/10.1002/acr.25040Test