Measuring Outcomes: Pain and Quality of Life 48 Months After Acute Postoperative Total Knee Prosthetic Joint Infection.

BACKGROUND: Measuring HRQOL is simple, inexpensive, permits the health status to be measured over time, and is useful to compare or initiate treatments and evaluate results, facilitating homogenization in patient inclusion. OBJECTIVES: To evaluate disease-specific and generic HRQOL and influence of associated factors in patients undergoing open debridement for acute postsurgical knee prosthetic joint infection after TKR at 12 and 48 months after completing antibiotic treatment and considered cured of infection. METHODS: Health-related quality-of-life measures were administered at baseline (WOMAC) and 12 and 48 months (WOMAC and SF-36) in patients with prosthesis retention, no symptoms of infection, and CRP (≤ 1 mg/dL). RESULTS: Thirty patients were included, and 24 were evaluated at 48 months. WOMAC scores improved significantly (P < 0.01) at 12 and 48 months. The effect size was 0.72 for stiffness, 2.01 for pain, and 2.15 for function. At 48 months, improvements were greater (P < 0.02) except for stiffness. The most frequently isolated microorganisms were Staphylococcus aureus (14 patients) and coagulase-negative staphylococci (9 patients). SF-36 physical role, bodily pain, emotional role, and mental health dimension scores at 12 and 48 months were significantly worse in patients with isolates of Staphylococcus aureus (P < 0.05). CONCLUSIONS: Health-related quality-of-life measures detected significant differences in outcomes in patients infected by S. aureus compared with patients infected by other microorganisms. HRQOL measures may provide useful complementary information on outcomes after acute postoperative infection.

Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

BACKGROUND: Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care. METHODS/DESIGN: A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression. DISCUSSION: We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain, and to reduce the duration of non-specific low back pain episodes. If the intervention is effective, it could be applied to Primary Health Care Centres. TRIAL REGISTRATION: ISRCTN21392091.

[Health indicators: the health status of the population attended to by a at home care program]. / Indicadores de salud. Estado de salud de ia población atendida en un Programa de Atención Domiciliaria.

The authors describe health indicators in their functional, social, mental and cognitive dimensions for patients included in an at home care program by means of an observational study of prevalences; these patients are part of the 12,000 patients included in the "Health at Home" Program run by the Primary Health Care Teams of the Catalonian Health Institute in the city of Barcelona. Information was obtained on 517 subjects. In spite of the fact that half of these patients have poor results recorded in their files under health indicators, only one fourth of these patients had a complete geriatric evaluation.

Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people.

AIM: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. BACKGROUND: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. DESIGN: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. FINDINGS: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as "obese" and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. CONCLUSION: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.

[Characterization of patients with rheumatoid arthritis according to the health care level]. / Caracterización de pacientes con artritis reumatoide según el nivel asistencial.

OBJECTIVE: To characterize rheumatoid arthritis patients seen in Rheumatology Units at different health care levels. MATERIAL AND METHODS: Questionnaire and clinical examination of rheumatoid arthritis patients seen as outpatients in Rheumatology Units from Primary Care, county Hospitals and Reference Hospitals. Demographic, social, labour and disease data were collected. Statistical study included a description of the variables and a multiple correspondence analysis to define patient profiles. RESULTS: Eight hundred and twelve patients with rheumatoid arthritis were included. There were significant differences in patient profiles at the different care level. In Primary Care, patients were older, with basic studies, and with short duration and generally mild rheumatoid arthritis. In local hospitals the typical patient was a man, qualified worker, with low income, and an erosive disease with extraarticular manifestations. At reference Hospitals prevailing patients were young women with a long duration disease and requiring biological therapy. CONCLUSION: There are significant differences in rheumatoid arthritis patient profiles at different health care levels.