Protocol for the POMELO (Prevention Of MusclE Loss in Osteoarthritis) randomized pilot feasibility trial.

Objective: Individuals with advanced knee osteoarthritis (OA) and a large body size [a body mass index (BMI) ≥35 â€‹kg/m2] have a higher risk of complications with total knee arthroplasty (TKA), and hence may be ineligible for surgery unless they reduce their BMI. However, pre-TKA weight-loss has not been shown to reduce surgical infection risk and may inadvertently increase risk for muscle loss and development of sarcopenic obesity (low muscle and low strength with higher fat mass). This suggests that a knee OA management approach that doesn't focus on weight change (weight-neutral) may be beneficial. This study examines if a weight-neutral behavioural intervention is feasible and acceptable to participants, and improves muscle mass and physical function in comparison to usual care. Design: This pilot randomized clinical trial compares a 12-week multimodal intervention [including targeted nutrition, progressive resistance exercise, and arthritis self-management support] to usual care. Co-primary outcomes are feasibility and acceptability, with secondary outcomes of change in lean soft tissue and physical function within and between groups at 3-months and 9-months from baseline. Change in waist circumference, fat mass, blood biomarkers, energy metabolism, OA-related pain and function, health-related quality of life, self-efficacy for arthritis management, and interest in pursuing a TKA within and between groups will be explored. Conclusion: This study will inform future development of more personalized knee OA treatment approaches for adults with larger bodies. Further, this will contribute to effective alternative treatment pathways that reduce inequities in access to OA care for this understudied patient population.

Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial.

INTRODUCTION: Bariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have a history of mental health disorder. The COVID-19 pandemic has made it difficult for people living with obesity to manage their weight even after undergoing bariatric surgery, which combined with pandemic-related increases in mental health distress, has the potential to adversely impact obesity outcomes such as weight loss and quality of life. Reviews of virtual mental health interventions during COVID-19 have not identified any interventions that specifically address psychological distress or disordered eating in patients with obesity, including those who have had bariatric surgery. METHODS AND ANALYSIS: A randomised controlled trial will be conducted with 140 patients across four Ontario Bariatric Centres of Excellence to examine the efficacy of a telephone-based cognitive behavioural therapy intervention versus a control intervention (online COVID-19 self-help resources) in postoperative bariatric patients experiencing disordered eating and/or psychological distress. Patients will be randomised 1:1 to either group. Changes in the Binge Eating Scale and the Patient Health Questionnaire 9-Item Scale will be examined between groups across time (primary outcomes). Qualitative exit interviews will be conducted, and data will be used to inform future adaptations of the intervention to meet patients' diverse needs during and post-pandemic. ETHICS AND DISSEMINATION: This study has received ethics approvals from the following: Clinical Trials Ontario (3957) and the University Health Network Research Ethics Committee (22-5145), the Board of Record. All participants will provide written informed consent prior to enrolling in the study. Results will be made available to patients with bariatric surgery, the funders, the supporting organisations and other researchers via publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT05258578.

The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review.

BACKGROUND: The progressive, debilitating nature of knee and hip osteoarthritis can result in severe, persistent pain and disability, potentially leading to a need for total joint arthroplasty (TJA) in end-stage osteoarthritis. TJA in adults with obesity is associated with increased surgical risk and prolonged recovery, yet classifying obesity only using body mass index (BMI) precludes distinction of obesity phenotypes and their impact on surgical risk and recovery. The sarcopenic obesity phenotype, characterized by high adiposity and low skeletal muscle mass, is associated with higher infection rates, poorer function, and slower recovery after surgery in other clinical populations, but not thoroughly investigated in osteoarthritis. The rising prevalence and impact of this phenotype demands further attention in osteoarthritis treatment models of care, particularly as osteoarthritis-related pain, disability, and current treatment practices may inadvertently be influencing its development. METHODS: A scoping review was used to examine the extent of evidence of sarcopenic obesity in adults with hip or knee osteoarthritis. Medline, CINAHL, Web of Science and EMBASE were systematically searched from inception to December 2017 with keywords and subject headings related to obesity, sarcopenia and osteoarthritis. RESULTS: Eleven studies met inclusion criteria, with indications that muscle weakness, low skeletal muscle mass or sarcopenia are present alongside obesity in this population, potentially impacting therapeutic outcomes, and TJA surgical risk and recovery. CONCLUSIONS: Consideration of sarcopenic obesity should be included in osteoarthritis patient assessments.

Hospital rehabilitation for patients with obesity: a scoping review.

PURPOSE: To explore the evidence on rehabilitation for hospitalized patients with obesity. METHODS: Medline, Embase, CENTRAL, CINAHL, and PubMed were searched from 1994 to May 2016. Grey literature was hand-searched. Two reviewers independently selected studies examining patients with obesity receiving hospital-based therapy for a physical impairment. One reviewer extracted the data and a second reviewer verified a random sample. RESULTS: Thirty-nine studies (two trials, 37 observational) were included. Patients underwent rehabilitation following orthopaedic surgery (n = 25), neurological conditions (n = 7), acute medical illnesses (n = 3), or various procedures (n = 4). Three studies investigated the effectiveness of a specific rehabilitation program in patients with obesity; however, two lacked a control group, precluding inferences of causal associations. Most studies compared functional outcomes across patients in different BMI categories (n = 33). There was much variability in the rehabilitation components, intensity, and providers used across the studies. The most frequent components were gait training and mobility (n = 17) and training in assistive devices (n = 12). Across the 50 outcomes measured, length of hospital stay (n = 24) and Functional Independence Measure (n = 15) were assessed most frequently. CONCLUSIONS: Evidence to guide rehabilitation for patients with obesity is sparse and weak. Rigorous comparative studies with clearly defined interventions and consensus outcome measures are needed. Implications for Rehabilitation Obesity rates have dramatically increased among patients requiring rehabilitation following joint arthroplasty, stroke, injury, or an acute medical event. There are currently no guidelines by which to define best practice for rehabilitating patients with obesity and comparative studies on rehabilitation programs are needed. Professional development focused on patient-centered rehabilitation and sensitivity training is known to promote quality care, reduce weight bias, and improve patient satisfaction. Access to and knowledge about equipment is necessary to promote patient and health care provider safety.

Differences in Short- and Long-Term Mortality Associated With BMI Following Coronary Revascularization.

BACKGROUND: The association between obesity and mortality risks following coronary revascularization is not clear. We examined the associations of BMI (kg/m2) with short-, intermediate-, and long-term mortality following coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with different coronary anatomy risks and diabetes mellitus status. METHODS AND RESULTS: Data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry were analyzed. Using normal BMI (18.5-24.9) as a reference, multivariable-adjusted hazard ratios for all-cause mortality within 6 months, 1 year, 5 years, and 10 years were individually calculated for CABG and PCI with 4 prespecified BMI categories: overweight (25.0-29.9), obese class I (30.0-34.9), obese class II (35.0-39.9), and obese class III (≥40.0). The analyses were repeated after stratifying for coronary risks and diabetes mellitus status. The cohorts included 7560 and 30 258 patients for CABG and PCI, respectively. Following PCI, overall mortality was lower in patients with overweight and obese class I compared to those with normal BMI; however, 5- and 10-year mortality rates were significantly higher in patients with obese class III with high-risk coronary anatomy, which was primarily driven by higher mortality rates in patients without diabetes mellitus (5-year adjusted hazard ratio, 1.78 [95% CI, 1.11-2.85] and 10-year adjusted hazard ratio, 1.57 [95% CI, 1.02-2.43]). Following CABG, overweight was associated with lower mortality risks compared with normal BMI. CONCLUSIONS: Overweight was associated with lower mortality following CABG and PCI. Greater long-term mortality in patients with obese class III following PCI, especially in those with high-risk coronary anatomy without diabetes mellitus, warrants further investigation.

Severe Obesity Is Associated With Increased Risk of Early Complications and Extended Length of Stay Following Coronary Artery Bypass Grafting Surgery.

BACKGROUND: Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in-hospital length of stay following coronary artery bypass grafting surgery. METHODS AND RESULTS: We analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m(2)) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11-1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% CI 1.21-2.01). Subgroup analyses identified obesity as an independent risk factor for infection (BMI 30.0-34.9: adjusted odds ratio 1.60, 95% CI 1.24-2.05; BMI 35.0-39.9: adjusted odds ratio 2.34, 95% CI 1.73-3.17; BMI ≥40.0: adjusted odds ratio 3.29, 95% CI 2.30-4.71). Median length of stay was longer with BMI ≥40.0 than with BMI 18.5 to 24.9 (median 7.0 days [interquartile range 5 to 10] versus 6.0 days [interquartile range 5 to 9], P=0.026). CONCLUSIONS: BMI ≥40.0 was an independent risk factor for longer length of stay, and infection was a potentially modifiable risk factor. Greater perioperative attention and intervention to control the risks associated with infection and length of stay in patients with BMI ≥40.0 may improve patient care quality and efficiency.

On-site programmatic attendance to cardiac rehabilitation and the healthy-adherer effect.

BACKGROUND: On-site attendance to prescheduled cardiac rehabilitation visits has been shown to be associated with improved outcomes following cardiac rehabilitation. The extent to which on-site programmatic attendance represents a healthy-adherer effect remains unknown. METHODS: This retrospective cohort study consisted of 17,000 consecutively referred patients to a cardiac rehabilitation program in Ontario, Canada. On-site attendance at prescheduled visits was our primary exposure variable. The primary outcome was all-cause death or hospitalization at two years following the expected program completion date, irrespective of drop-out. Secondary outcomes included adherence to statins, health-seeking preventative health visits, and changes in clinical risk-profiles. Cox proportional hazards adjusted for baseline sociodemographic, clinical and comorbid characteristics. RESULTS: Among the 12,440 patients who attended at least one prescheduled on-site visit, on-site attendance was inversely correlated with baseline smoking rates and body mass index at program entry. After adjustment for baseline factors, the risk of death or hospitalization progressively fell with incremental increases in on-site attendance (adjusted hazard ratio for each 10% increase in on-site attendance: 0.96; 95% confidence interval: 0.93-0.99, p = 0.007). Such associations were driven predominantly by differences in non-cardiovascular hospitalizations. Incremental increases in on-site attendance were associated with improvements in cardiopulmonary fitness and body mass index (both p < 0.001), better attendance of preventative care physician visits (p < 0.001) and higher medication adherence to statins (p = 0.007). CONCLUSIONS: Associations between on-site attendance at cardiac rehabilitation and outcomes may represent a healthy-adherer effect. Future research must evaluate the clinical utility of on-site attendance as a behavioral health-adherence metric for cardiac rehabilitation monitoring and surveillance.