RESUMO
OBJECTIVE: To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes. DESIGN: Data were from the 2013-2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race. RESULTS: In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m2) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals. CONCLUSIONS: Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities.
RESUMO
In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.
RESUMO
Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.
Assuntos
Força da Mão , Estilo de Vida , Humanos , Masculino , Feminino , Idoso , Valores de Referência , Fatores SexuaisRESUMO
The transition from acute to chronic low back pain (LBP) in community settings has yet to be well understood. We recruited n=131 participants with acute LBP from the community and followed them for 3 and 6-month outcomes. Acute LBP was defined by a duration of < 4 weeks, and participants must have reported a 30-day LBP-free period before the current acute episode. Chronic LBP was defined as pain most or every day over the past 3 months. Baseline psychological, social, and demographic factors were examined as predictors of transition to chronic LBP at 3 months or continuation of chronic LBP at 6 months. The transition from acute to chronic LBP at 3 months was 32.2% ( 38/118). At 6 months, 80.7% (25/111) of participants who transitioned at 3 months continued to have chronic LBP. At 6 months, participants who identified as Black or African American were more likely than white participants to transition to chronic LBP (RR=1.76, 95% CI 1.05, 2.95) and more likely to continue to have chronic LBP (RR=2.19, 95% CI 1.14, 4.21). Those classified at baseline by both LBP most or every day and intensity of at least 30/100 were more likely to transition to chronic LBP (RR=3.13, 95% CI 1.84, 5.30) and continue to have chronic LBP at 6 months (RR=2.58, 95% CI 1.43, 4.16). The STarT Back Screening Tool and the OSPRO-YF were associated with the transition to chronic LBP at 3 months and continuation at 6 months. Participants with higher PROMIS General Health and PROMIS Physical Health scores were less likely to transition to chronic LBP or continue to have chronic LBP at 6 months. These findings identify factors of acute LBP in the community that may predict the transition to chronic LBP. Larger studies are needed to confirm these findings and better understand the mechanisms driving the transition to chronic LBP.
RESUMO
Acute low back pain (LBP) is a common experience, however, the associated pain severity, pain frequency, and characteristics of individuals with acute LBP in community settings have yet to be well understood. In this manuscript, three acute LBP severity categorization definitions were used based on LBP frequency combined with either 1) pain impact frequency (impact-based) or 2) pain intensity (intensity-based), as well as LBP pain interference frequency (interference only-based) severity categories. The purpose of this manuscript is to describe and then compare these acute LBP severity groups in the following characteristics: 1) sociodemographic, 2) general and physical health, and 3) psychological. This cross-sectional study used baseline data from 131 community-based participants with acute LBP (<4 weeks duration before screening and ≥30 pain-free days before acute LBP onset). Descriptive associations were calculated as prevalence ratios for categorical variables and Hedges' g for continuous variables. Our analyses identified several large associations for impact-based and intensity-based categories with global mental health, global physical health, STarT Back Screening Tool risk category, and general health. Larger associations were found with social constructs (racially and ethnically minoritized, performance of social roles, and isolation) when using the intensity-based versus impact-based categorization. The interference-based category did not capture as much variability between acute LBP severity categories. This study adds to the literature by providing standard ways to characterize community-based individuals experiencing acute LBP. The robust differences observed between these categorization approaches suggest that how we define acute LBP severity is consequential; these different approaches may be used to improve the early identification of factors potentially contributing to the development of chronic LBP.
RESUMO
U.S. military veterans experience higher pain prevalence than nonveterans. However, it is unclear how the disparities in pain prevalence have changed over time because previous trend studies are limited to veterans using the Veterans Health Administration. This repeated cross-sectional study aimed to characterize pain prevalence trends in the overall population of U.S. veterans compared to nonveterans, using nationally representative data. We analyzed 17 years of data from the National Health Interview Survey (2002-2018), with a mean annual unweighted sample of 29,802 U.S. adults (total unweighted n = 506,639) and mean annual weighted population of 229.7 million noninstitutionalized adults. The weighted proportion of veterans ranged from 11.48% in 2002 (highest) to 8.41% in 2017 (lowest). We found that veterans experience a similar or higher prevalence of pain than nonveterans across the study period, except for severe headaches or migraine and facial pain. Pain prevalence among veterans increased over time, with a higher rate of increase compared to nonveterans for all pain variables. From 2002 to 2018, there was an absolute increase (95% confidence interval) in pain prevalence among veterans (severe headache or migraine: 2.0% [1.6-2.4%]; facial pain: 1.9% [1.4-2.4%]; neck pain: 4.7% [4.1-5.2%]; joint pain: 11.4% [10.8-11.9%]; low back pain: 10.3% [9.5-11.1%]; any pain: 10.0% [9.6-10.4%]; and multiple pains: 9.9% [9.2-10.6%]). The continued pain prevalence increase among veterans may have implications for health care utilization, highlighting the need for improved pain prevention and care programs for this population with a disproportionate pain burden. PERSPECTIVE: This article uses routinely-collected cross-sectional data that are nationally representative of U.S. adults to present changes in pain prevalence among military veterans compared to nonveterans. The findings underscore the need for improved prevention and pain care programs for veterans, who experienced a widening disproportionate pain burden from 2002 to 2018.
RESUMO
Objective: The measurement of in vivo intervertebral disc (IVD) mechanics may be used to understand the etiology of IVD degeneration and low back pain (LBP). To this end, our lab has developed methods to measure IVD morphology and uniaxial compressive deformation (% change in IVD height) resulting from dynamic activity, in vivo, using magnetic resonance images (MRI). However, due to the time-intensive nature of manual image segmentation, we sought to validate an image segmentation algorithm that could accurately and reliably reproduce models of in vivo tissue mechanics. Design: Therefore, we developed and evaluated two commonly employed deep learning architectures (2D and 3D U-Net) for the segmentation of IVDs from MRI. The performance of these models was evaluated for morphological accuracy by comparing predicted IVD segmentations (Dice similarity coefficient, mDSC; average surface distance, ASD) to manual (ground truth) measures. Likewise, functional reliability and precision were assessed by evaluating the intraclass correlation coefficient (ICC) and standard error of measurement (SEm) of predicted and manually derived deformation measures. Results: Peak model performance was obtained using the 3D U-net architecture, yielding a maximum mDSC â= â0.9824 and component-wise ASDx â= â0.0683 âmm; ASDy â= â0.0335 âmm; ASDz â= â0.0329 âmm. Functional model performance demonstrated excellent reliability ICC â= â0.926 and precision SEm â= â0.42%. Conclusions: This study demonstrated that a deep learning framework can precisely and reliably automate measures of IVD function, drastically improving the throughput of these time-intensive methods.
RESUMO
Importance: U.S. military veterans experience higher pain prevalence and severity than nonveterans. However, it is unclear how these differences have changed over time. Previous studies are limited to veterans receiving care from the Veterans Health Administration. Objective: To characterize pain prevalence trends in the overall population of U.S. veterans compared to nonveterans, using nationally-representative data. Design: Repeated cross-sectional study. Data: National Health Interview Survey, 2002-2018. Analysis: January 2023. Setting: Population-based survey of noninstitutionalized U.S. adults. Participants: Across the 17-year period, mean annual weighted population was 229.7 million adults (unweighted sample total: n=506,639; unweighted sample annual mean: n=29,802). Exposure: Veteran status. Main Outcomes: Crude and demographics-adjusted pain prevalence trend differences between veterans and nonveterans across five pain variables (severe headache or migraine, facial pain, neck pain, low back pain, and joint pain) and two composite variables (any pain [≥1 prevalent pain] and multiple pains [≥2 prevalent pains]). Results: Weighted proportion of veterans varied from 11.48% in 2002 (highest) to 8.41% in 2017 (lowest). Across the study period, crude prevalence was generally similar or higher among veterans than nonveterans for all pain variables except for severe headache or migraine and facial pain. When equalizing age, sex, race, and ethnicity, pain prevalence among veterans remained similar or higher than nonveterans for all pain variables. From 2002 to 2018 there was an absolute increase (95% CI) in pain prevalence among veterans (severe headache or migraine: 2.0% [1.6% to 2.4%]; facial pain: 1.9% [1.4% to 2.4%]; neck pain: 4.7% [4.1% to 5.2%]; joint pain: 11.4% [10.8% to 11.9%]; low back pain: 10.3% [9.5% to 11.1%]; any pain: 10.0% [9.6% to 10.4%]; and multiple pains: 9.9% [9.2% to 10.6%]. Crude and adjusted analyses indicated prevalence of all pain variables increased more among veterans than nonveterans from 2002 to 2018. Conclusion and Relevance: Veterans had similar or higher adjusted prevalence and higher rates of increase over time for all pain variables compared to nonveterans. Continued pain prevalence increase among veterans may impact healthcare utilization (within and outside of the VHA), underscoring the need for improved pain prevention and care programs for these individuals with disproportionate pain burden.
RESUMO
Objective: To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA). Design: Qualitative study using individual semistructured telephone interviews. Setting: Durham Veterans Health Administration Health Care System. Participants: A total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021. Results: Patient-level factors influencing PT initiation included confusion with navigating the health system, efficacy beliefs about PT, and thoughts about physical therapists' ability to diagnose their pain. At the provider level, discussion about PT care appeared to increase initiation of PT. At the system level, influences included wait times, availability of appointments outside business hours, and easy-to-access locations. Motivational themes included respondents' symptoms and functional limitations that drove them to initiate care. Respondents suggested that changes to wait times through same-day or rapid appointments, assistance and increased ease of the scheduling process, transportation support, convenient care locations, and information about PT, including its benefits, could improve PT care access. Conclusions: This study of patient perceptions of initiating PT care after referral identified tangible barriers to care at patient, provider, and system levels for respondents with LBP or knee OA. Patient knowledge and system-level barriers, including how challenging the system is to navigate, are major factors that reduce patients' use of PT after referral. Health systems and physical therapists should address barriers to care through patient education, scheduling assistance, and changes to the health care system, including options for same-day appointments.
RESUMO
BACKGROUND: Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS: The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN: Descriptive laboratory study. METHODS: Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS: The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION: The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE: Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
Assuntos
Lesões do Ligamento Cruzado Anterior , Contusões , Traumatismos do Joelho , Humanos , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/patologia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Tíbia/patologia , Fêmur/patologia , Contusões/diagnóstico por imagem , Contusões/patologia , Epífises/patologia , Imageamento por Ressonância Magnética/métodos , Hematoma/patologia , Fenômenos BiomecânicosRESUMO
INTRODUCTION: Although evidence-based guidelines recommend non-pharmacologic treatments as first-line care for chronic low back pain (LBP), uptake has been limited, particularly in rural, low-income and ethnically diverse communities. The BeatPain study will evaluate the implementation and compare the effectiveness of two strategies to provide non-pharmacologic treatment for chronic LBP. The study will use telehealth to overcome access barriers for persons receiving care in federally qualified health centres (FQHCs) in the state of Utah. METHODS AND ANALYSIS: BeatPain Utah is a pragmatic randomised clinical trial with a hybrid type I design investigating different strategies to provide non-pharmacologic care for adults with chronic LBP seen in Utah FQHCs. The intervention strategies include a brief pain consult (BPC) and telehealth physical therapy (PT) component provided using either an adaptive or sequenced delivery strategy across two 12-week treatment phases. Interventions are provided via telehealth by centrally located physical therapists. The sequenced delivery strategy provides the BPC, followed by telehealth PT in the first 12 weeks for all patients. The adaptive strategy uses a stepped care approach and provides the BPC in the first 12 weeks and telehealth PT to patients who are non-responders to the BPC component. We will recruit 500 English-speaking or Spanish-speaking participants who will be individually randomised with 1:1 allocation. The primary outcome is the Pain, Enjoyment and General Activity measure of pain impact with secondary outcomes including the additional pain assessment domains specified by the National Institutes (NIH) of Health Helping to End Addiction Long Initiative and implementation measures. Analyses of primary and secondary measures of effectiveness will be performed under longitudinal mixed effect models across assessments at baseline, and at 12, 26 and 52 weeks follow-ups. ETHICS AND DISSEMINATION: Ethics approval for the study was obtained from the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with NIH data sharing policies. TRIAL REGISTRATION NUMBER: NCT04923334.
Assuntos
Academias de Ginástica , Dor Lombar , Telemedicina , Adulto , Humanos , Dor Lombar/terapia , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Utah , Ensaios Clínicos Pragmáticos como AssuntoRESUMO
Low back pain (LBP) disproportionately impacts US military veterans compared with nonveterans. Although the effect of psychological conditions on LBP is regularly studied, there is little published to date investigating nightmare disorder (NMD) and LBP. The purpose of this study was to (1) investigate whether an association exists between NMD and LBP and (2) estimate the effect of NMD diagnosis on time to LBP. We used a retrospective cohort design with oversampling of those with NMD from the Veterans Health Administration (n = 15 983). We used logistic regression to assess for a cross-sectional association between NMD and LBP and survival analysis to estimate the effect of NMD on time to LBP, up to 60-month follow-up, conditioning on age, sex, race, index year, Charlson Comorbidity Index, depression, anxiety, insomnia, combat exposure, and prisoner of war history to address confounding. Odds ratios (with 95% confidence intervals [CIs]) indicated a cross-sectional association of 1.35 (1.13 to 1.60) and 1.21 (1.02 to 1.42) for NMD and LBP within 6 months and 12 months pre- or post-NMD diagnosis, respectively. Hazard ratios (HRs) indicated the effect of NMD on time to LBP that was time-dependent-HR (with 95% CIs) 1.27 (1.02 to 1.59), 1.23 (1.03 to 1.48), 1.19 (1.01 to 1.40), and 1.10 (0.94 to 1.29) in the first 3, 6, 9, and 12 months post-diagnosis, respectively-approximating the null (1.00) at >12 months. The estimated effect of NMD on LBP suggests that improved screening for NMD among veterans may help clinicians and researchers predict (or intervene to reduce) risk of future back pain.
RESUMO
Objective: Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP. Methods: Using data from the Johnston County Osteoarthritis Project (2006-2010), we measured serum N-cadherin, Keratin-19, Lumican, CXCL6, RANTES, HA, IL-6, BDNF, OPG, and NPY, and urinary CTX-II. Biomarkers were used to group participants using k-means cluster analysis. Logistic regression models were used to compare biomarker clusters. Results: The sample consisted of 731 participants with biospecimens and lumbar spine radiographic data. Three biomarker subgroups were identified: one characterized by structural degenerative changes; another characterized by structural degenerative changes and inflammation, with pain; and a referent cluster with lower levels of biomarkers, pain, and structural degenerative changes. Compared to the referent subgroup, the structural change subgroup was associated with DSN (OR = 1.94, 95% CI 1.30-2.90) and FOA (OR = 1.72, 95% CI 1.12-2.62), and the subgroup with structural degenerative change, inflammation, and pain was associated with OST with LBP (OR = 1.60, 95% CI 1.04-2.46), FOA with LBP (OR = 1.59, 95% CI 1.04-2.45), and LBP (OR = 1.63, 95% CI 1.11-2.41). The subgroup with structural degenerative changes was more likely to have OST (OR = 1.82, 95% CI 1.06-3.13) and less likely to have FOA with LBP (OR = 0.62, 95% CI 0.40-0.96) compared to the group with inflammation and pain. Conclusion: Clustering by biomarkers may assist in differentiating patients for specific clinical interventions aimed at decreasing LBP.
RESUMO
Introduction: Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain. Methods: This cross-sectional analysis included 689 community-based participants. Self-reported symptoms (ie, pain, aching, or stiffness) were ascertained about the neck, upper back/thoracic, low back, shoulders, elbows, wrist, hands, hips, knees, ankles, and feet. Measured analytes included CXCL-6, RANTES, HA, IL-6, BDNF, OPG and NPY. A standard dolorimeter measured PPT. Logistic regression was used determine the association between biomarkers and PPT with individual and summed sites of pain. Results: Increased IL-6 and HA were associated with knee pain (OR=1.30, 95% CI 1.03, 1.64) and (OR=1.32, 95% CI 1.01, 1.73) respectively; HA was also associated with elbow/wrist/hand pain (OR=1.60, 95% CI 1.22, 2.09). Those with increased NPY levels were less likely to have shoulder pain (OR=0.56, 95% CI 0.33, 0.93). Biomarkers HA (OR=1.50, 95% CI 1.07, 2.10), OPG (OR=1.74, 95% CI 1.00, 3.03), CXCL-6 (OR=1.75, 95% CI 1.02, 3.01) and decreased PPT (OR=3.97, 95% CI 2.22, 7.12) were associated with multiple compared to no sites of pain. Biomarker HA (OR=1.57, 95% CI 1.06, 2.32) and decreased PPT (OR=3.53, 95% CI 1.81, 6.88) were associated with multiple compared to a single site of pain. Conclusion: Biomarkers of inflammation (HA, OPG, IL-6 and CXCL-6), pain (NPY) and PPT may help to understand the etiology of single and multiple pain sites.
RESUMO
BACKGROUND: Lumbar spinal stenosis (LSS) is a common degenerative condition that contributes to back and back-related leg pain in older adults. Most patients with symptomatic LSS initially receive non-operative care before surgical consultation. However, there is a scarcity of data regarding prognosis for patients seeking non-surgical care. The overall goal of this project is to develop and evaluate a clinically useful model to predict long-term physical function of patients initiating non-surgical care for symptomatic LSS. METHODS: This is a protocol for an inception cohort study of adults 50 years and older who are initiating non-surgical care for symptomatic LSS in a secondary care setting. We plan to recruit up to 625 patients at two study sites. We exclude patients with prior lumbar spine surgeries or those who are planning on lumbar spine surgery. We also exclude patients with serious medical conditions that have back pain as a symptom or limit walking. We are using weekly, automated data pulls from the electronic health records to identify potential participants. We then contact patients by email and telephone within 21 days of a new visit to determine eligibility, obtain consent, and enroll participants. We collect data using telephone interviews, web-based surveys, and queries of electronic health records. Participants are followed for 12 months, with surveys completed at baseline, 3, 6, and 12 months. The primary outcome measure is the 8-item PROMIS Physical Function (PF) Short Form. We will identify distinct phenotypes using PROMIS PF scores at baseline and 3, 6, and 12 months using group-based trajectory modeling. We will develop and evaluate the performance of a multivariable prognostic model to predict 12-month physical function using the least absolute shrinkage and selection operator and will compare performance to other machine learning methods. Internal validation will be conducted using k-folds cross-validation. DISCUSSION: This study will be one of the largest cohorts of individuals with symptomatic LSS initiating new episodes of non-surgical care. The successful completion of this project will produce a cross-validated prognostic model for LSS that can be used to tailor treatment approaches for patient care and clinical trials.
Assuntos
Vértebras Lombares , Estenose Espinal , Estudos de Coortes , Constrição Patológica/complicações , Humanos , Vértebras Lombares/cirurgia , Prognóstico , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/terapiaRESUMO
Background: The lumbar discs are large, dense tissues that are primarily avascular, and cells residing in the central region of the disc are up to 6-8 mm from the nearest blood vessel in adults. To maintain homeostasis, disc cells rely on nutrient transport between the discs and adjacent vertebrae. Thus, diminished transport has been proposed as a factor in age-related disc degeneration. Methods: In this study, we used magnetic resonance imaging (MRI) to quantify diurnal changes in T2 relaxation time, an MRI biomarker related to disc hydration, to generate 3D models of disc fluid distribution and determine how diurnal changes in fluid varied by spinal level. We recruited 10 participants (five males/five females; age: 21-30 years; BMI: 19.1-29.0 kg/m2) and evaluated the T2 relaxation time of each disc at 8:00 AM and 7:00 PM, as well as degeneration grade (Pfirrmann). We also measured disc height, volume, and perimeter in a subset of individuals as a preliminary comparison of geometry and transport properties. Results: We found that the baseline (AM) T2 relaxation time and the diurnal change in T2 relaxation time were greatest in the cranial lumbar discs, decreasing along the lumbar spine from cranial to caudal. In cranial discs, T2 relaxation times decreased in each disc region (nucleus pulposus [NP], inner annulus fibrosus [IAF], and outer annulus fibrosus [OAF]), whereas in caudal discs, T2 relaxation times decreased in the NP but increased in the AF. Conclusions: Fluid transport varied by spinal level, where transport was greatest in the most cranial lumbar discs and decreased from cranial to caudal along the lumbar spine. Future work should evaluate what level-dependent factors affect transport.
RESUMO
BACKGROUND: Existing clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents. RESEARCH QUESTION: Does an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge? METHODS: Ambulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge. RESULTS: 45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60-0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45-40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01-47.52) and correctly classified 79.5% of the participants. SIGNIFICANCE: The obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.
Assuntos
Alta do Paciente , Acidente Vascular Cerebral , Assistência ao Convalescente , Hospitais , Humanos , Projetos Piloto , Equilíbrio Postural , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnósticoRESUMO
BACKGROUND: The Patient-Reported Outcome Measurement Information System (PROMIS) can be used to monitor patients in population-health-based programs. However, it is unknown which measures are most appropriate to differentiate patients who will undergo hip or knee total joint arthroplasty (TJA) in a cohort of patients with osteoarthritis. METHODS: A retrospective cohort of new patients consulting for treatment from November 17, 2017 to April 20, 2020 (cases: hip: n = 157, knee: n = 112; randomly selected nonsurgical controls: hip: n = 314, knee: n = 224) was extracted from the electronic health record. We recorded demographics, comorbidity, and PROMIS scores for 8 domains (physical function, pain interference, pain intensity, anxiety, depression, sleep disturbance, ability to participate in social roles and activities, and fatigue). We performed descriptive statistics to characterize the cohorts and baseline PROMIS scores and conducted logistic regression models to determine which PROMIS domains differentiated patients undergoing hip and knee TJA. RESULTS: In univariate comparisons of PROMIS domains, the hip and knee surgical cohorts differed from controls in physical function (P < .01), pain interference (P < .01), and ability to participate in social roles and activities (P < .02). In logistic regression models informed by univariate analyses, PROMIS physical function was the only PROMIS measure to differentiate undergoing surgery in both hip and knee cohorts (P < .01). CONCLUSION: PROMIS physical function can differentiate TJA cases from nonsurgical controls in both hip and knee patients. These findings have implications for considering which PROMIS measures to administer in patients with hip and knee osteoarthritis.
Assuntos
Artroplastia do Joelho , Osteoartrite do Quadril , Osteoartrite do Joelho , Estudos de Casos e Controles , Humanos , Sistemas de Informação , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Dor , Medidas de Resultados Relatados pelo Paciente , Estudos RetrospectivosRESUMO
PURPOSE: Magnetic resonance imaging (MRI) is routinely used to evaluate spine pathology; however, standard imaging findings weakly correlate to low back pain. Abnormal disc mechanical function is implicated as a cause of back pain but is not assessed using standard clinical MRI. Our objective was to utilize our established MRI protocol for measuring disc function to quantify disc mechanical function in a healthy cohort. METHODS: We recruited young, asymptomatic volunteers (6 male/6 female; age 18-30 years; BMI < 30) and used MRI to determine how diurnal deformations in disc height, volume, and perimeter were affected by spinal level, disc region, MRI biomarkers of disc health (T2, T1rho), and Pfirrmann grade. RESULTS: Lumbar discs deformed by a mean of -6.1% (95% CI: -7.6%, -4.7%) to -8.0% (CI: -10.6%, -5.4%) in height and -5.4% (CI: -7.6%, -3.3%) to -8.5% (CI: -11.0%, -6.0%) in volume from AM to PM across spinal levels. Regional deformations were more uniform in cranial lumbar levels and concentrated posteriorly in the caudal levels, reaching a maximum of 13.1% at L5-S1 (CI:-16.1%, -10.2%). T2 and T1rho relaxation times were greatest in the nucleus and varied circumferentially within the annulus. T2 relaxation times were greatest at the most cranial spinal levels and decreased caudally. In this young healthy cohort, we identified a weak association between nucleus T2 and the diurnal change in the perimeter. CONCLUSIONS: Spinal level is a key factor in determining regional disc deformations. Interestingly, deformations were concentrated in the posterior regions of caudal discs where disc herniation is most prevalent.