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

المصدر: Arthritis Care & Research; Jul2024, Vol. 76 Issue 7, p1018-1027, 10p

مصطلحات موضوعية: KNEE osteoarthritis, COST effectiveness, OBESITY, QUALITY-adjusted life years, WEIGHT loss

مستخلص: 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/m2 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/m2, 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/m2 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. [ABSTRACT FROM AUTHOR]

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

المصدر: Arthritis Care & Research; Jun2024, Vol. 76 Issue 6, p882-888, 7p

مصطلحات موضوعية: PAIN measurement, ORTHOPEDIC surgery, ELECTIVE surgery

مستخلص: 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. [ABSTRACT FROM AUTHOR]

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المؤلفون: Acosta Julbe, José I., Gottreich, Julia R., Ermann, Joerg, Isaac, Zacharia, DeFilipp, Miriam, Andrew, Michael N., Yuchiao Chang, Zampini, Jay M., Katz, Jeffrey N., Mandell, Jacob C.

المصدر: Spine (03622436); 5/15/2024, Vol. 49 Issue 10, p733-740, 8p

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

المصدر: Arthritis Care & Research; Apr2024, Vol. 76 Issue 4, p541-549, 9p

مصطلحات موضوعية: DELAYED diagnosis, SPONDYLOARTHROPATHIES, ANKYLOSING spondylitis, ELECTRONIC health records, IRIDOCYCLITIS, BACKACHE

الشركة/الكيان: MASSACHUSETTS General Hospital

مستخلص: 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. [ABSTRACT FROM AUTHOR]

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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.

المصدر: Arthritis Care & Research; Apr2024, Vol. 76 Issue 4, p503-510, 8p

مصطلحات موضوعية: QUALITY of life, KNEE osteoarthritis, GAIT in humans, ADULTS, BODY mass index

مستخلص: 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. [ABSTRACT FROM AUTHOR]

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المؤلفون: Acosta, José I., Ermann, Joerg, Isaac, Zacharia, DeFilipp, Miriam, Gottreich, Julia R., Andrew, Michael N., Yuchiao Chang, Zampini, Jay M., Katz, Jeffrey N., Mandell, Jacob C.

المصدر: Spine (03622436); Mar2024, Vol. 49 Issue 5, p332-340, 9p

المؤلفون: Gottreich, Julia R., Katz, Jeffrey N., Jones, Morgan H.

المصدر: Orthopaedic Journal of Sports Medicine; Mar2024, Vol. 12 Issue 3, p1-12, 12p

مصطلحات موضوعية: KNEE anatomy, KNEE physiology, EFFECT sizes (Statistics), ANTERIOR cruciate ligament surgery, DATA analysis, SYNOVIAL fluid, ARTHROSCOPY, POSTOPERATIVE pain, PREOPERATIVE care, TREATMENT effectiveness, SYNOVITIS, SYSTEMATIC reviews, MEDLINE, REOPERATION, STATISTICS, ONLINE information services, CHEMOKINE receptors, KNEE surgery, INTERLEUKINS

مستخلص: Background: Biomarkers collected in synovial tissue and fluid have been identified as potential predictors of outcomes after arthroscopy. Purpose: To provide a narrative review of the current literature that assesses the associations between preoperative biomarkers in the synovial fluid or synovial tissue and patient outcomes after knee arthroscopy. Study Design: Narrative review. Methods: We searched the PubMed database with keywords, "biomarkers AND arthroscopy," "biomarkers AND anterior cruciate ligament reconstruction," and "biomarkers AND meniscectomy." To be included, studies must have collected synovial fluid or synovial tissue from patients before or during arthroscopic knee surgery and analyzed the relationship of biomarkers to postoperative patient outcomes. Biomarkers were classified into 4 main categories: metabolism of aggrecan in cartilage, metabolism of collagen in cartilage (type II collagen), noncollagenous proteins in the knee, and other. When biomarker levels and outcomes were expressed with continuous variables, we abstracted the Pearson or Spearman correlation coefficients as the effect measure. If the biomarker values were continuous and the outcomes binary, we abstracted the mean or median biomarker values in those with favorable versus unfavorable outcomes. We calculated effect sizes as the difference between means of both groups divided by the standard deviation from the mean in the group with better outcomes. Results: Eight studies were included in the review. Each study reported different patient outcomes. Biomarkers associated with metabolism of aggrecan, type II collagen metabolism, and noncollagenous proteins as well as inflammatory biomarkers had statistically significant associations with a range of patient outcomes after knee arthroscopy. Difference across studies in sample size and outcome measures precluded choosing a single biomarker that best predicted patient outcomes. Conclusion: The findings suggest that biomarkers associated with metabolism of aggrecan, type II collagen metabolism, noncollagenous proteins, as well as inflammatory biomarkers may help surgeons and their patients anticipate surgical outcomes. [ABSTRACT FROM AUTHOR]

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

المصدر: Pharmacoepidemiology & Drug Safety; Mar2024, Vol. 33 Issue 3, p1-9, 9p

مستخلص: 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. [ABSTRACT FROM AUTHOR]

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المؤلفون: Lowenstein, Natalie A., Chang, Yuchiao, Mass, Hanna, Mercurio, Angela M., Ukogu, Chierika, Katz, Jeffrey N., Matzkin, Elizabeth G.

المصدر: American Journal of Sports Medicine; Jan2024, Vol. 52 Issue 1, p116-123, 8p

مصطلحات موضوعية: PREOPERATIVE care, STATISTICS, CONFIDENCE intervals, ARTHROSCOPY, MULTIPLE regression analysis, AGE distribution, MENISCECTOMY, HEALTH outcome assessment, CASE-control method, VISUAL analog scale, ACTIVITIES of daily living, PRE-tests & post-tests, DECISION making, DESCRIPTIVE statistics, QUALITY assurance, ODDS ratio, BODY mass index, MENISCUS injuries, PAIN management

مستخلص: Background: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. Purpose: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. Results: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. Conclusion: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

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المؤلفون: Dykes, Patricia C., Curtin-Bowen, Mica, Franz, Calvin, Syrowatka, Ania, Lipsitz, Stuart, Sainlaire, Michael, Businger, Alexandra, Tien Thai, Chen, Antonia F., Schoenfeld, Andrew J., Lieberman, Jay R., Iorio, Richard, O'Brien, Todd, Blanchfield, Bonnie, Katz, Jeffrey N., Jiranek, William A., Melnic, Christopher, Bates, David W.

المصدر: Journal of Patient Safety; Dec2023, Vol. 19 Issue 8, p539-546, 8p