Dissatisfaction With Total Knee Arthroplasty at 1 Year Post Surgery Can be Predicted Using a Short Questionnaire Early in the Recovery Process.

BACKGROUND: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this study was to create an easily administered short questionnaire to identify patients likely to be dissatisfied at 1 year post surgery early in the recovery process. METHODS: The study included 275 patients who underwent primary TKA for osteoarthritis. Individual 3-month postsurgery questionnaire items from the Knee Injury and Osteoarthritis Outcome Score and Knee Society Knee Scoring System were pooled together and used as candidate items to create 3 different short questionnaires. Items included in each questionnaire were selected using least absolute shrinkage and selection operator logistic regressions, a backward elimination method, and theory-based approaches. The area under the curve for each short questionnaire was calculated to evaluate predictive performances. RESULTS: All 3 questionnaires contained a small number of items and appeared to successfully predict 1-year postsurgery dissatisfaction early in the recovery process. The least absolute shrinkage and selection operator logistic regression, backward elimination, and theory-based questionnaires were comprised of 4, 7, and 5 items and had the area under the curve scores of 0.893, 0.902, and 0.890, respectively. A question evaluating rising from sitting and activities of daily living appeared in all of the created questionnaires. CONCLUSION: A short questionnaire that is easy to administer and interpret can effectively predict TKA patient dissatisfaction at 1 year post surgery early in the recovery process.

Exercise behaviors and resource use among graduate students at a Canadian university: A cross-sectional study.

OBJECTIVE: Participation in regular exercise among post-secondary students is often low. Our cross-sectional study aimed to assess exercise levels, perceived barriers/motivators to exercise, and knowledge and use of exercise resources in graduate students. PARTICIPANTS: We recruited graduate students across various disciplines at a large Canadian university. METHODS: Participants (n = 540) completed an anonymous mixed methods online survey. RESULTS: Approximately 11% of participants reported not participating in any form of weekly exercise, and only 9.4% met the Canadian Physical Activity Guidelines. The most common barrier and motivator to exercise was time commitment and improving physical health, respectively. Some participants were aware of available exercise services but most did not use them. Suggestions for improving services included having graduate-dedicated exercise space and resources. CONCLUSIONS: Low exercise participation among graduate students may be due to a lack of education of available resources or a lack of existing resources that meet their specific needs.

Comparing the prevalence of nomophobia and smartphone addiction among university students pre-COVID-19 and during COVID-19.

BACKGROUND: This study aimed to: (a) explore differences in the prevalence of nomophobia and smartphone addiction (SA) from pre- to during COVID-19; (b) identify students' self-reported changes in smartphone reliance and screen time during COVID-19; and (c) examine whether self-perceived changes in smartphone usage predicted nomophobia and SA scores. METHODS: Scores on the Nomophobia Questionnaire and Smartphone Addiction Scale between two surveys administered at two timepoints were compared: Sample 1 (September 2019-January 2020; N = 878) and Sample 2 (May-June 2020; N = 258). RESULTS: No significant differences were found between samples on nomophobia or SA. Nearly all of Sample 2 reported using some type of app more, using their smartphone a little more, and about the same perceived smartphone reliance during COVID-19. Increased screen time, smartphone reliance, and social media significantly predicted nomophobia and SA. CONCLUSION: COVID-19 does not appear to have exacerbated the prevalence of nomophobia or SA.

Logistic Regression and Machine Learning Models Cannot Discriminate Between Satisfied and Dissatisfied Total Knee Arthroplasty Patients.

BACKGROUND: Approximately 20% of total knee arthroplasty (TKA) patients are found to be dissatisfied or unsure of their satisfaction at 1-year post-surgery. This study attempted to predict 1-year post-surgery dissatisfied/unsure TKA patients with pre-surgery and surgical variables using logistic regression and machine learning methods. METHODS: A retrospective analysis of patients who underwent primary TKA for osteoarthritis between 2012 and 2016 at a single institution was completed. Patients were split into satisfied and dissatisfied/unsure groups. Potential predictor variables included the following: demographic information, patella re-surfaced, posterior collateral ligament sacrificed, and subscales from the Knee Society Knee Scoring System, the Knee Society Clinical Rating System, the Western Ontario and McMaster Universities Osteoarthritis Index, and the 12-Item Short Form Health Survey version 2. Logistic regression and 6 different machine learning methods were used to create prediction models. Model performance was evaluated using discrimination (AUC [area under the receiver operating characteristic curve]) and calibration (Brier score, Cox intercept, and Cox slope) metrics. RESULTS: There were 1432 eligible patients included in the analysis, 313 were considered to be dissatisfied/unsure. When evaluating discrimination, the logistic regression (AUC = 0.736) and extreme gradient boosted tree (AUC = 0.713) models performed best. When evaluating calibration, the logistic regression (Brier score = 0.141, Cox intercept = 0.241, and Cox slope = 1.31) and gradient boosted tree (Brier score = 0.149, Cox intercept = 0.054, and Cox slope = 1.158) models performed best. CONCLUSION: The models developed in this study do not perform well enough as discriminatory tools to be used in a clinical setting. Further work needs to be done to improve the performance of pre-surgery TKA dissatisfaction prediction models.

Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

BACKGROUND: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction. METHODS: Patients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function. RESULTS: Significant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly. CONCLUSION: Met expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations. LEVEL OF EVIDENCE: Level IV.

Limb Salvage Versus Amputation in Conventional Appendicular Osteosarcoma: a Systematic Review.

The overall survivorship in patients with appendicular osteosarcoma has increased in the past few decades. However, controversies and questions about performing an amputation or a limb salvage procedure still remain. Using three peer-reviewed library databases, a systematic review of the literature was performed to evaluate all studies that have evaluated the outcomes of appendicular osteosarcoma, either with limb salvage or amputation. The mean 5-year overall survivorship was 62% for salvage and 58% for amputation (p > 0.05). At mean 6-year follow-up, the local recurrence rates were 8.2% for salvage and 3.0% for amputation (p > 0.05). Additionally, at mean 6-year follow-up, the rate for metastasis was 33% for salvage and 38% for amputation (p > 0.05). The revision rates were higher with salvage (31 vs. 28%), and there were more complications in the salvage groups (52 vs. 34%; p > 0.05). Despite the heterogeneity of studies available for review, we observed similar survival rates between the two procedures. Although there was no significant statistical difference between rates of recurrence and metastasis, the local recurrence rate and risk of complications were higher for limb salvage as compared to amputation. Cosmetic satisfaction is often higher with limb salvage, whereas long-term expense is higher with amputation. Overall, current literature supports limb salvage procedures when wide surgical margins can be achieved while still retaining a functional limb.