Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury.

Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

CONTEXT: The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE: Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN: Consensus process. SETTING: Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS: The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S): The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS: The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS: This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.

Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis.

Background: For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management. Objectives: The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine whether there is a disconnect between what patients want to know about nutrition and OA management and what information health-care professionals (HCPs) are providing to patients. Methods: The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in 4 domains: 1) strategies for weight management and a healthy lifestyle; 2) vitamins, minerals, and other supplements; 3) foods or nutrients that may reduce inflammation; and 4) diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources. Results: Survey responses from 338 individuals with OA and 104 HCPs were included. The highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods and nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices and herbs (65%), fruits and vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%), and fasting or intermittent fasting (15%). There was greater than 20% discrepancy between interests reported by individuals with OA and discussions reported by HCPs on: weight loss strategies, general information on vitamins and minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion sizes, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging. Conclusions: There is disparity between the nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats. This study explored the information gap between what individuals with OA want to know and what HCPs believe they need to know.

Is the thrombolysis in myocardial infarction (TIMI) score a reliable source in a rural hospital for the management of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI)?

Background: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital. Methods: A retrospective chart review study in a rural hospital was conducted for subjects that received left heart catheterizations, exercise stress tests, or chemical stress tests for a diagnosis of UA/NSTEMI. A total of 399 subjects who underwent left heart catheterization and/or stress testing were recruited for this study. A total of 153 subjects who were transferred out to a larger facility, transitioned to comfort care, refused intervention, or passed away were excluded from the study. The 246 remaining subjects were classified into two groups, those with TIMI 0-2 compared with those having TIMI ≥ 3. A null hypothesis was postulated that there was no significant difference between the two groups with regard to prevalence of either positive stress test or evidence of obstructive coronary disease following coronary angiography. T-test and Wilcoxon rank-sum analysis were performed through SPSS statistical analysis. Results: Formal statistical analysis using T-test as well as Wilcoxon rank-sum test comparing the two groups showed p = 0.34 for T-test and p = 0.60 for Wilcoxon rank-sum test. This is consistent with the postulated null hypothesis: that there is no significant difference between the two surgery groups with respect to the mean/median TIMI score. Conclusion: There was no statistical difference between high and low TIMI score in the intervention of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in a rural hospital.