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: Collins, Jamie E., Shrestha, Swastina, Losina, Elena, Marx, Robert G., Guermazi, Ali, Jarraya, Mohamed, Jones, Morgan H., Levy, Bruce A., Mandl, Lisa A., Williams, Emma E., Wright, Rick W., Spindler, Kurt P., Katz, Jeffrey N.

المصدر: Arthritis & Rheumatology; Aug2022, Vol. 74 Issue 8, p1333-1342, 10p

مصطلحات موضوعية: KNEE osteoarthritis, RELATIVE medical risk, CARTILAGE, CONFIDENCE intervals, SYNOVITIS, ARTHROSCOPY, PHYSICAL therapy, TIME, MENISCECTOMY, REGRESSION analysis, TREATMENT effectiveness, DESCRIPTIVE statistics, MENISCUS injuries, SECONDARY analysis, POISSON distribution, EVALUATION

مستخلص: Objective: To estimate the risk of magnetic resonance imaging (MRI)–based structural changes in knee osteoarthritis (OA) among individuals with meniscal tear and knee OA, using MRIs obtained at baseline and 18 and 60 months after randomization in a randomized controlled trial of arthroscopic partial meniscectomy (APM) versus physical therapy (PT). Methods: We used data from the Meniscal Tear in Osteoarthritis Research (METEOR) trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed‐effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical changes in knee joint structure. Analyses assessed changes in OA between baseline and month 18 and between months 18 and 60. We performed both intention‐to‐treat and as‐treated analyses. Results: The analytic sample included 302 participants. For both treatment groups, more OA changes were seen during the early interval than during the later interval. ITT analysis revealed that, between baseline and month 18, APM was significantly associated with an increased risk of having a worsening cartilage surface area score, involving both any worsening across all knee joint subregions (risk ratio [RR] 1.35 [95% confidence interval (95% CI) 1.14, 1.61]) and the number of subregions damaged (RR 1.44 [95% CI 1.13, 1.85]) having a worsening effusion‐synovitis score (RR 2.62 [95% CI 1.32, 5.21]), and having ≥1 additional subregion with osteophytes (RR 1.24 [95% CI 1.02, 1.50]). Significant associations were detected between months 18 and 60 only for having any subregion with a worsening osteophyte score (RR 1.28 [95% CI 1.04, 1.58]). Conclusion: These findings suggest that the association between APM and MRI‐based structural changes in knee OA is most apparent during the initial 18 months after surgery. The reason for attenuation of this association over longer follow‐up merits further investigation. [ABSTRACT FROM AUTHOR]

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المؤلفون: Spindler, Kurt P., Imrey, Peter B., Yalcin, Sercan, Beck, Gerald J., Calbrese, Gary, Cox, Charles L., Fadale, Paul D., Farrow, Lutul, Fitch, Robert, Flanigan, David, Fleming, Braden C., Hulstyn, Michael J., Jones, Morgan H., Kaeding, Christopher, Katz, Jeffrey N., Kriz, Peter, Magnussen, Robert, McErlean, Ellen, Melgaard, Carrie, Owens, Brett D.

المصدر: Orthopaedic Journal of Sports Medicine; Jan2022, Vol. 10 Issue 1, p1-13, 13p

مصطلحات موضوعية: TRAUMA surgery, RESEARCH, CONFIDENCE intervals, MEDICAL cooperation, HEALTH outcome assessment, TREATMENT effectiveness, RANDOMIZED controlled trials, DESCRIPTIVE statistics, ANTERIOR cruciate ligament surgery, STATISTICAL sampling, EVALUATION

مستخلص: Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial's strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions. [ABSTRACT FROM AUTHOR]

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المؤلفون: Katz, Jeffrey N.¹ jnkatz@bwh.harvard.edu, Shrestha, Swastina¹, Losina, Elena¹, Jones, Morgan H.², Marx, Robert G.³, Mandl, Lisa A.³, Levy, Bruce A.⁴, MacFarlane, Lindsey A.¹, Spindler, Kurt P.², Silva, Genevieve S.¹, Collins, Jamie E.¹, Brophy, Robert, Cole, Brian J., Stuart, Michael J., Matava, Matthew J., Wright, Rick W., Safran‐Norton, Clare E.

المصدر: Arthritis & Rheumatology. Feb2020, Vol. 72 Issue 2, p273-281. 9p.

مصطلحات موضوعية: *ARTHROSCOPY, *CONFIDENCE intervals, *MATHEMATICAL models, *MENISCECTOMY, *MENISCUS injuries, *OSTEOARTHRITIS, *PAIN, *PHYSICAL therapy, *TOTAL knee replacement, *THEORY, *TREATMENT effectiveness, *DISEASE incidence, *PROPORTIONAL hazards models, *MIDDLE age

مستخلص: Objective: To determine the 5‐year outcome of treatment for meniscal tear in osteoarthritis. Methods: We examined 5‐year follow‐up data from the Meniscal Tear in Osteoarthritis Research trial (METEOR) of physical therapy versus arthroscopic partial meniscectomy. We performed primary intent‐to‐treat (ITT) and secondary as‐treated analyses. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale; total knee replacement (TKR) was a secondary outcome measure. We used piecewise linear mixed models to describe change in KOOS pain. We calculated 5‐year cumulative TKR incidence and used a Cox model to estimate hazard ratios (HRs) for TKR, with 95% confidence intervals (95% CIs). Results: Three hundred fifty‐one participants were randomized. In the ITT analysis, the KOOS pain scores were ~46 (scale of 0 [no pain] to 100 [most pain]) at baseline in both groups. Pain scores improved substantially in both groups over the first 3 months, continued to improve through the next 24 months (to ~18 in each group), and were stable at 24–60 months. Results of the as‐treated analyses of the KOOS pain score were similar. Twenty‐five participants (7.1% [95% CI 4.4–9.8%]) underwent TKR over 5 years. In the ITT model, the HR for TKR was 2.0 (95% CI 0.8–4.9) for subjects randomized to the arthroscopic partial meniscectomy group, compared to those randomized to the physical therapy group. In the as‐treated analysis, the HR for TKR was 4.9 (95% CI 1.1–20.9) for subjects ultimately treated with arthroscopic partial meniscectomy, compared to those treated nonoperatively. Conclusion: Pain improved considerably in both groups over 60 months. While ITT analysis revealed no statistically significant differences following TKR, greater frequency of TKR in those undergoing arthroscopic partial meniscectomy merits further study. [ABSTRACT FROM AUTHOR]

المؤلفون: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Jarraya, Mohamed, Guermazi, Ali, Mandl, Lisa A., Martin, Scott D., Wright, John, Losina, Elena, Katz, Jeffrey N., Brophy, Robert H., Levy, Bruce A., Marx, Robert G., Matava, Mathew, Safran‐Norton, Clare, Spindler, Kurt P., Stuart, Michael, Dahm, Diane L., Wright, Rick

المصدر: Arthritis & Rheumatology; Jan2019, Vol. 71 Issue 1, p73-81, 9p

مصطلحات موضوعية: CARTILAGE diseases, CONFIDENCE intervals, KNEE diseases, MAGNETIC resonance imaging, MENISCUS injuries, OSTEOARTHRITIS, PHYSICAL therapy, POISSON distribution, REGRESSION analysis, RELATIVE medical risk, SYNOVITIS, DISEASE progression, DISEASE complications, DISEASE risk factors, DIAGNOSIS, THERAPEUTICS

مستخلص: Objective: Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion‐synovitis and changes in effusion‐synovitis with changes in cartilage damage in a cohort with OA and meniscal tear. Methods: We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery versus physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion‐synovitis and cartilage damage on magnetic resonance imaging, and dichotomized effusion‐synovitis as none/small (minimal) and medium/large (extensive). We assessed the association of baseline effusion‐synovitis and changes in effusion‐synovitis with changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for patient demographic characteristics, treatment, and baseline cartilage damage. Results: We analyzed 221 participants. Over 18 months, effusion‐synovitis was persistently minimal in 45.3% and persistently extensive in 21.3% of the patients. The remaining 33.5% of the patients had minimal synovitis on one occasion and extensive synovitis on the other. In adjusted analyses, patients with extensive effusion‐synovitis at baseline had a relative risk (RR) of progression of cartilage damage depth of 1.7 (95% confidence interval [95% CI] 1.0–2.7). Compared to those with persistently minimal effusion‐synovitis, those with persistently extensive effusion‐synovitis had a significantly increased risk of progression of cartilage damage depth (RR 2.0 [95% CI 1.1–3.4]). Conclusion: Our findings indicate that the presence of extensive effusion‐synovitis is associated with subsequent progression of cartilage damage over 18 months. The persistence of extensive effusion‐synovitis over time is associated with the greatest risk of concurrent cartilage damage progression. [ABSTRACT FROM AUTHOR]

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المؤلفون: Collins, Jamie E., Losina, Elena, Nevitt, Michael C., Roemer, Frank W., Guermazi, Ali, Lynch, John A., Katz, Jeffrey N., Kent Kwoh, C., Kraus, Virginia B., Hunter, David J.

المصدر: Arthritis & Rheumatology; Oct2016, Vol. 68 Issue 10, p2422-2431, 10p

مصطلحات موضوعية: ARTICULAR cartilage, BIOMARKERS, CONFIDENCE intervals, KNEE, KNEE diseases, MAGNETIC resonance imaging, MATHEMATICAL models, MENISCUS (Anatomy), OSTEOARTHRITIS, PAIN, PROBABILITY theory, RESEARCH funding, SYNOVIAL membranes, TIME, LOGISTIC regression analysis, THEORY, MULTIPLE regression analysis, PAIN measurement, CASE-control method, DISEASE progression, DATA analysis software, ODDS ratio

مستخلص: Objective To determine the association between changes in semiquantitative magnetic resonance imaging (MRI) biomarkers over 24 months and radiographic and pain progression over 48 months in knees with mild-to-moderate osteoarthritis (OA). Methods We undertook a nested case-control study as part of the Foundation for the National Institutes of Health Biomarkers Consortium Project. We used multivariable logistic regression models to examine the association between change over 24 months in semiquantitative MRI markers and radiographic and pain progression in knee OA. MRIs were read according to the MRI OA Knee Score system. We focused on changes in cartilage, osteophytes, meniscus, bone marrow lesions, Hoffa-synovitis, and effusion-synovitis. Results The most parsimonious model included changes in cartilage thickness and surface area, effusion-synovitis, Hoffa-synovitis, and meniscal morphology (C statistic 0.740). Compared with no worsening, worsening in cartilage thickness in ≥3 subregions was associated with 2.8-fold (95% confidence interval [95% CI] 1.3-5.9) greater odds of being a case, and worsening in cartilage surface area in ≥3 subregions was associated with 2.4-fold (95% CI 1.3-4.4) greater odds of being a case. Worsening of meniscal morphology in any region was associated with 2.2-fold (95% CI 1.3-3.8) greater odds of being a case. Worsening effusion-synovitis and Hoffa-synovitis were also associated with a greater odds of being a case (odds ratios 2.7 and 2.0, respectively). Conclusion Twenty-four-month changes in cartilage thickness, cartilage surface area, effusion-synovitis, Hoffa-synovitis, and meniscal morphology were independently associated with OA progression, suggesting that these factors may serve as efficacy biomarkers in clinical trials of disease-modifying interventions for knee OA. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kim, Seoyoung C., Schneeweiss, Sebastian, Liu, Jun, Karlson, Elizabeth W., Katz, Jeffrey N., Feldman, Sarah, Solomon, Daniel H.

المصدر: Arthritis & Rheumatology; Sep2016, Vol. 68 Issue 9, p2106-2113, 8p

مصطلحات موضوعية: CERVIX uteri diseases, DYSPLASIA, CERVICAL intraepithelial neoplasia, ALGORITHMS, ANTIRHEUMATIC agents, BIOLOGICAL products, CONFIDENCE intervals, LONGITUDINAL method, MEDICAID, RESEARCH funding, RHEUMATOID arthritis, LOGISTIC regression analysis, PROPORTIONAL hazards models, DATA analysis software, DISEASE risk factors

مستخلص: Objective Recent research showed an increased risk of high-grade cervical dysplasia and cervical cancer associated with rheumatoid arthritis (RA). The purpose of this study was to examine whether this risk was associated with the use of biologic versus nonbiologic disease-modifying antirheumatic drugs (DMARDs). Methods We identified RA patients in the US Medicaid and commercial insurance databases (for the years 2000-2012) who were starting treatment with either a biologic or a nonbiologic DMARD. High-grade cervical dysplasia or cervical cancer was identified with a validated claims-based algorithm, and we assessed utilization of gynecologic procedures. To control for potential confounders, those starting therapy with a biologic DMARD were matched 1:1 to those starting therapy with a nonbiologic DMARD according to the propensity score (PS). Hazard ratios (HRs) and rate ratios (RRs) in the PS-matched Medicaid and commercial insurance cohorts were pooled by an inverse variance-weighted fixed-effects model. Results We included 14,729 pairs of patients initiating biologic and nonbiologic DMARDs from the Medicaid cohort and 7,538 pairs from the commercial insurance cohort. During 73,389 person-years of active treatment with either biologic or nonbiologic DMARDs, 95 cases of high-grade cervical dysplasia or cervical cancer occurred in the 2 cohorts. The HR for high-grade cervical dysplasia or cervical cancer associated with biologic DMARD use was 1.25 (95% confidence interval [95% CI] 0.78-2.01) in the Medicaid cohort and 1.63 (95% CI 0.62-4.27) in the commercial insurance cohort, with a pooled HR of 1.32 (95% CI 0.86-2.01). The rate of gynecologic procedures involving the uterine cervix was not different between the 2 groups (pooled RR 0.96 [95% CI 0.90-1.02]). Conclusion Among women with RA, initiation of therapy with a biologic DMARD was associated with a numerically significant, but not statistically significant, increase in the risk of high-grade cervical dysplasia or cervical cancer as compared to initiation of a nonbiologic DMARD. [ABSTRACT FROM AUTHOR]

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المؤلفون: Drain, Paul K., Losina, Elena, Coleman, Sharon M., Bogart, Laura, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Bassett, Ingrid V.

المصدر: AIDS Care; Oct2015, Vol. 27 Issue 10, p1231-1240, 10p, 3 Charts, 2 Graphs

مصطلحات موضوعية: DIAGNOSIS of HIV infections, CONFIDENCE intervals, COUNSELING, LONGITUDINAL method, MEDICAL screening, MENTAL health, MULTIVARIATE analysis, REGRESSION analysis, RESEARCH funding, SELF-perception, STATISTICS, SOCIAL support, RANDOMIZED controlled trials, CROSS-sectional method, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio

مصطلحات جغرافية: SOUTH Africa

مستخلص: Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study’s Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18;p< 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing. [ABSTRACT FROM AUTHOR]

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المؤلفون: Fung, Teresa T., Arasaratnam, Meredith H., Grodstein, Francine, Katz, Jeffrey N., Rosner, Bernard, Willett, Walter C., Feskanich, Diane

المصدر: American Journal of Clinical Nutrition; Sep2014, Vol. 100 Issue 3, p953-958, 6p, 2 Charts

مصطلحات موضوعية: RISK factors of fractures, CARBONATED beverages, CONFIDENCE intervals, BONE fractures, HIP joint injuries, LONGITUDINAL method, MULTIVARIATE analysis, QUESTIONNAIRES, RESEARCH funding, SELF-evaluation, T-test (Statistics), BODY mass index, RELATIVE medical risk, PROPORTIONAL hazards models, POSTMENOPAUSE, DATA analysis software, INJURY risk factors

مستخلص: Background: The frequency of soda consumption remains high in the United States. Soda consumption has been associated with poor bone health in children, but few studies have examined this relation in adults, and to our knowledge, no study has examined the relation of soda consumption with risk of hip fractures. Objective: We examined the association of soda, including specific types of soda, and risk of hip fracture in postmenopausal women. Design: An analysis was conducted in postmenopausal women from the Nurses' Health Study cohort (n = 73,572). Diet was assessed at baseline by using a semiquantitative food-frequency questionnaire and updated approximately every 4 y. In ≤30 y of follow-up, we identified 1873 incident hip fractures. We computed RRs for hip fractures by the amount of soda consumption by using Cox proportional hazards models with adjustment for potential confounders. Results: In multivariable models, each additional serving of total soda per day was associated with a significant 14% increased risk of hip fracture (RR: 1.14; 95% CI: 1.06, 1.23). The attributable risk in our cohort for total soda consumption was 12.5%. Risk was significantly elevated in consumers of both regular soda (RR: 1.19; 95% CI: 1.02, 1.38) and diet soda (RR: 1.12; 95% CI: 1.03, 1.21) and also did not significantly differ between colas and noncolas or sodas with or without caffeine. The association between soda and hip fractures did not differ by body mass index or diagnosis of diabetes. Conclusion: Increased soda consumption of all types may be associated with increased risk of hip fracture in postmenopausal women; however, a clear mechanism was not apparent on the basis of these observational data. [ABSTRACT FROM AUTHOR]

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المؤلفون: Dempsey, Kyle E., Collins, Jamie E., Ghazinouri, Roya, Alcantara, Luis, Thornhill, Thomas S., Katz, Jeffrey N.

المصدر: Rheumatology; Oct2013, Vol. 52 Issue 10, p1802-1808, 7p

مصطلحات موضوعية: ACADEMIC medical centers, ANALYSIS of variance, ARTHROPLASTY, CONFIDENCE intervals, DEVELOPING countries, HEALTH surveys, LIFE skills, MULTIVARIATE analysis, HEALTH outcome assessment, REGRESSION analysis, RESEARCH funding, TREATMENT effectiveness, DESCRIPTIVE statistics

مصطلحات جغرافية: DOMINICAN Republic, MASSACHUSETTS

مستخلص: Objective. In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functional outcomes. We determined whether similar associations exist in a developing country.Methods. Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes—improvement in functional status over 12 months and functional status at 12 months—using analysis of variance with multivariable linear regression.Results. Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys.Conclusion. Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries. [ABSTRACT FROM AUTHOR]

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