Dietary and Supplemental Vitamin C and D on Symptom Severity and Physical Function in Knee Osteoarthritis.

Vitamins C and D have been associated with decreasing pain and increasing function but these associations are not definitive. This cross-sectional study explores what relationships supplemental and dietary intake of vitamins C and D have on pain severity and physical function in patients with knee osteoarthritis. Using data from the Osteoarthritis Initiative, we performed regression analyses to examine relationships between vitamins C and D, pain, and function. Dietary vitamin D and dietary vitamin C were divided into >90th, 50th-90th, and <50th percentile. The high percentile group for supplemental vitamin D was divided into >85th percentile, whereas the high percentile group for supplemental vitamin C was divided into >90th percentile. We found the 90th/85th percentile levels of dietary and supplemental vitamin D to be positively associated with pain (ß = 0.180; p = 0.028) and inversely related to physical function (ß = -0.150, p = 0.028), respectively. Daily intake of vitamin C showed no statistical significance. We found that supplementary vitamin D was strongly associated with lessened disability for knee OA patients. The unexpected finding that associated dietary vitamin D with greater knee pain merits further study.

Examination of the PROMIS upper extremity item bank.

STUDY DESIGN: Clinical measurement. INTRODUCTION: The psychometric properties of the PROMIS v1.2 UE item bank were tested on various samples prior to its release, but have not been fully evaluated among the orthopaedic population. PURPOSE OF THE STUDY: This study assesses the performance of the UE item bank within the UE orthopaedic patient population. METHODS: The UE item bank was administered to 1197 adult patients presenting to a tertiary orthopaedic clinic specializing in hand and UE conditions and was examined using traditional statistics and Rasch analysis. RESULTS: The UE item bank fits a unidimensional model (outfit MNSQ range from 0.64 to 1.70) and has adequate reliabilities (person = 0.84; item = 0.82) and local independence (item residual correlations range from -0.37 to 0.34). Only one item exhibits gender differential item functioning. Most items target low levels of function. DISCUSSION: The UE item bank is a useful clinical assessment tool. Additional items covering higher functions are needed to enhance validity. CONCLUSIONS: Supplemental testing is recommended for patients at higher levels of function until more high function UE items are developed. LEVEL OF EVIDENCE: 2c.

The relationship between family support; pain and depression in elderly with arthritis.

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

Evaluation of the Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test.

PURPOSE: The Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test (UE CAT) has recently been made available by the National Institutes of Health to measure physical function outcomes in the upper extremity. We hypothesized that the UE CAT would psychometrically outperform the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Patient-Reported Outcomes Measurement Information System Physical Function Computer Adaptive Test (PF CAT) in a hand patient population. METHODS: The UE CAT, PF CAT, and DASH were each electronically administered to all adult patients who presented to a tertiary hand and upper extremity (nonshoulder) orthopedic clinic. Patient responses were retrospectively studied to determine the validity, reliability, and floor/ceiling effects of all 3 instruments using the Rasch Partial Credit Model. Responder burden and Pearson correlations were calculated for each instrument. RESULTS: A total of 379 patients completed the UE CAT, PF CAT, and the DASH. On average, 6 UE CAT, 9 PF CAT, and 30 DASH questions were administered to each patient. All 3 instruments were each highly correlated with each other. Floor effects were low and similar between all instruments; however, ceiling effects were higher in the UE CAT (10.82%) than in the PF CAT (1.32%) or DASH (5.28%). High person reliability (PR) and item reliability (IR) were found for all 3 metrics: UE CAT (α = 0.99; PR = 0.91; IR = 0.94); PF CAT (α = 0.95; PR = 0.89; IR = 0.96); and DASH (α = 0.97; PR = 0.95; IR = 0.99). The UE CAT questions had the best item-fit: only 1 of 15 UE CAT items had poor fit in contrast to 4 of 30 DASH items and 7 of 33 PF CAT items. CONCLUSIONS: The psychometric properties of the UE CAT compare favorably with the PF CAT and the DASH in nonshoulder upper extremity patients. The relatively large ceiling effect found in the UE CAT could be improved with item bank expansion to include items at the upper end of function. CLINICAL RELEVANCE: The UE CAT is a useful patient-reported outcome measure that merits further investigation.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

BACKGROUND: Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. OBJECTIVE: The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. METHODS: Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. RESULTS: The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. CONCLUSIONS: We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.