Psychosocial Determinants of Knee Osteoarthritis Progression: Results from the Promoting Independence in Our Seniors with Arthritis Study.

BACKGROUND: Knee osteoarthritis (OA) is a common cause of physical disability among older adults. While established risk factors for knee OA include age and increased body weight, few studies have examined psychosocial risk factors or progression of knee OA. METHODS: The Promoting Independence in our Seniors with Arthritis study recruited participants aged 65 years and over from orthopedic outpatients and community engagement events. Participants were invited to annual visits during which knee OA symptoms were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), social network using the 6-item Lubben Social Network Scale and anxiety and depression using the Hospital Anxiety and Depression scale. Knee OA worsening was defined by a 5% reduction in mean KOOS scores at the last visit compared to the first visit. RESULTS: Data were available from 148 participants, mean age 66.2±6.5 years and 74.1% female, of whom 28 (18.9%) experienced OA worsening over a median follow-up period of 29 months. Univariate analyses revealed that age, sex, height, grip strength, and social network were associated with OA worsening. Social network remained statistically significantly associated with OA worsening after adjustment for age and sex difference (odds ratio=0.924; 95% confidence interval, 0.857-0.997). The relationship between social network and OA worsening were attenuated by both depression and handgrip strength at baseline. CONCLUSION: Psychological status and muscle strength may be modifiable risk factors for social network which may in turn prevent knee OA worsening and should be targeted in future intervention studies.

Physical and psychosocial characteristics differ between individuals with knee pain and different knee osteoarthritis diagnostic criteria.

PURPOSE: Knee pain and osteoarthritis (OA) are common and often lead to disability among older adults. Existing published evidence, however, utilizes differing criteria to define studies' knee OA populations. We, therefore, aimed to determine whether differences exist in the characteristics of individuals with the presence of knee pain and different diagnostic criteria for knee OA. METHODS: The Promoting Independence in Seniors with Arthritis (PISA) study is a longitudinal observational study of individuals with and without knee pain and knee OA recruited from the orthopaedics clinic of the Universiti Malaya Medical Centre and the local hospital catchment. Patients were diagnosed with OA based on the American College of Rheumatology (ACR) criteria, the presence of knee pain, and a history of physician-diagnosed knee OA. Psychosocial parameters were measured using validated measures for social participation, independence, and ability to perform activities of daily living, and life satisfaction. RESULTS: Of the 230 included participants, mean age was 66.9 years (standard deviation: 7.2) and 166 (72.2%) were women. Kappa agreement between ACR criteria and knee pain was 0.525 and for ACR and physician-diagnosed OA it was 0.325. Binomial logistic regression analysis showed that weight, anxiety, and handgrip strength (HGS) were predictive of ACR OA. Knee pain was only predicted by HGS but not weight and anxiety. Physician-diagnosed OA was predicted by weight and HGS but not anxiety. HGS was predictive of ACR OA, knee pain, and physician-diagnosed OA. CONCLUSION: Our study showed that the characteristics of patients with OA are different, physically and psychosocially, depending on the criteria used. Poor agreement was observed between radiological diagnosis and the other diagnostic criteria. Our findings have important implications for the interpretation and comparison of published studies using different OA criteria.

Body Fat Percentage and the Long-term Risk of Fractures. The EPIC-Norfolk Prospective Population Cohort Study.

BACKGROUND: This cohort study aimed to determine the association between body fat percentage (BF%), incident fractures and calcaneal broadband ultrasound attenuation (BUA). METHODS: Participants were drawn from the EPIC-Norfolk Prospective Population Cohort Study (median follow-up = 16.4 years). Cox models analysed the relationship between BF% and incident fractures (all and hip). Linear and restricted cubic spline (RCS) regressions modelled the relationship between BF% and BUA. RESULTS: 14,129 participants (56.2 % women) were included. There were 1283 and 537 incident all and hip fractures respectively. The participants had a mean (standard deviation) age of 61.5 (9.0) years for women and 62.9 (9.0) years for men. Amongst men, BF% was not associated with incident all fractures. While BF% < 23 % (median) was not associated with hip fractures, BF% > 23 % was associated with increased risk of hip fractures by up to 50 % (hazard ratio (95 % confidence interval) = 1.49 (1.06-2.12)). In women, BF% < 39 % (median) was associated with up to 32 % higher risk of all fractures (1.32 (1.13-1.44)), while BF% > 35 % was not associated with this outcome. Higher BF% was associated with lower risk of incident hip fractures in women. Higher BF% was associated with higher BUA amongst women. Higher BF% up to ~23 % was associated with higher BUA amongst men. CONCLUSIONS: Higher BF% is associated with lower risk of fractures in women. While there was no association between BF% and all fractures in men, increasing BF% >23 % was associated with higher risk of hip fractures in men. This appears to be independent of estimated bone mineral density. Fracture prevention efforts need to consider wider physical, clinical, and environmental factors.

Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study.

PURPOSE: To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment. METHODS: Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire. RESULTS: Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group. CONCLUSIONS: Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.

A five-year prospective evaluation of anticholinergic cognitive burden and falls in the Malaysian elders longitudinal research (MELoR) study.

BACKGROUND: While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR). METHODS: Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded. RESULTS: Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥3. Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB≥3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders. CONCLUSION: Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.

The Value of Interprofessional Learning Through Patient Simulation in Developing Interprofessional Relationships: Medical Students' Perspectives.

OBJECTIVE: This study aimed to explore the value of interprofessional learning in developing interprofessional relationships, as perceived by medical students participating as simulated patients for chiropractic students. METHODS: A cross-sectional study of university medical students, using an online survey and interview sessions, was conducted at the International Medical University, Malaysia, from July 2020 to October 2020. Only students who had previously participated as a simulated patient within a chiropractic examination setting were included; this involved interacting with chiropractic students in observed structured clinical examinations, including history taking, physical examination or motion palpation, and adjustment setups for end-of-semester examinations. Survey responses focused on themes of interprofessional learning, with values of reduction of prejudice, increase in understanding, and improved collaborative attitude. These responses were grouped as positive, neutral, or negative based on Likert scores. Interview responses were analyzed and categorized according to the survey themes. RESULTS: Fifteen male medical students aged 23 to 26 years completed the questionnaire and interview. Respondents perceived that their experience helped clarify doubts on the scope of chiropractic (66.7%), the role of a chiropractor (80%), and chiropractic professional practices (80%). A majority of respondents (80%) felt that being a simulated patient increased their willingness to learn collaboratively with chiropractic students. Most (93.3%) responded positively to being more willing to work with other health care professionals. CONCLUSION: This study showed an overall positive perception among medical students of developing interprofessional relationships with chiropractors and other health care professionals. The results suggest that opportunities for interprofessional learning between chiropractic and other health care programs may assist with the long-term goal of promoting patient-centered care.

Use of Radiography for New Patients Presenting to a Chiropractic Teaching Clinic: A Cross-sectional Analysis.

OBJECTIVE: The aim of this study was to identify the number and type of indications for radiographs ordered in a chiropractic teaching clinic in Malaysia. METHODS: A cross-sectional retrospective analysis was conducted using the medical health records of new patients who presented to the International Medical University Bukit Jalil teaching clinic for chiropractic care between August 2018 and July 2019. Data about sociodemographic characteristics, region of presenting complaint, radiography ordering rates, and referral indications were collected. We compared indications reported in the patient records with those listed in the International Medical University Chiropractic Clinical Manual. We conducted χ2 and logistic regression analysis to identify the association between radiography indications and the number of radiographs ordered. RESULTS: Data were collected for 1451 patients (741 [51.1%] women and 700 [48.9%] men). The most common body region for the presenting complaint was the lumbar/pelvic region (39.0%), and the overall radiograph use rate was 2.7%, with the highest number of radiographs for the lumbar spine. CONCLUSION: For the patient files sampled in this study, the overall radiograph order rate in the International Medical University Bukit Jalil Chiropractic teaching clinic was 2.7%.

Demographics and Clinical Profiles of Patients Visiting a Chiropractic Teaching Clinic in Malaysia.

Objective: The objective of this study was to describe the demographics and clinical profiles of patients visiting a chiropractic teaching clinic in Malaysia. Methods: A retrospective descriptive study was conducted using existing medical records of all new patients who visited the International Medical University Bukit Jalil teaching clinic between August 2018 and July 2019. Sociodemographic and lifestyle factors, information on location of presenting complaints, duration of complaint and referral sources were reviewed. Descriptive analyses including mean, mode, standard deviations (SDs), and frequencies were performed. Results: Of the 1451 patients included in this study, the mean age was (SD) 34.3 (16.1) with 51.1% female. Most of the patients were Chinese (76.0%), followed by Malay (11.6%), Indian (7.72%), and others such as Punjabi and Sabah and Sarawak native (5.0%). Comparing referral sources, the main referrals were self-referred (26.6%) followed by friends and family referrals (25.0%) and other forms of social media and advertising (10.0%). The most frequent location of complaint was the lumbar and pelvic regions, 562 (38.73%) followed by head and neck 400 (27.57%), lower limb 173 (11.92%), upper limb 154 (10.61%), thoracic 133 (9.17%), and full spine 29 (2%). Conclusion: This study provides important information that allows better understanding of patients presenting to a chiropractic teaching clinic in Malaysia. Such findings may contribute to the benchmark data for future strategic planning to ensure sufficient exposure on case mix among chiropractic interns in Malaysia.

Body shape, fear of falling, physical performance, and falls among individuals aged 55 years and above.

PURPOSE: To evaluate the relationship between waist-to-hip ratio (WHR) and fall-related outcomes in community-dwelling individuals aged 55 and above. METHODS: Cross-sectional data obtained from the first wave of the Malaysian Elders Longitudinal Research (MELoR) study were utilized for this study. Participants aged 55 years and over were recruited using simple random sampling from the electoral rolls of three local parliamentary constituencies. Socio-demographics, falls history and medical history were obtained through home-based computer-assisted interviews while anthropometric measurements, including WHR, and physical performance were obtained during hospital-based health checks. WHR was categorized into three arbitrary categories stratified by gender. RESULTS: Data on both falls and WHR were available for 1335 participants, mean age ± standard deviation (SD) = 68.4 ± 7.1 years. Logistic regression analyses using dummy variables revealed that individuals within the higher WHR group were significantly more likely to report a history of fall in the preceding 12 months {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.78 (1.18-2.67)}, fear of falling [aOR (95% CI) = 1.58 (1.08-2.32)], impaired timed-up-and-go [2.14 (1.44-3.17)] and reduced functional reach [1.68 (1.18-2.38)] compared to those with lower WHR. A higher WHR remained independently associated with increased risk of falls compared to those with lower WHR after additional adjustment for fear of falling and functional performance. CONCLUSION: Our finding suggests WHR as an independent risk factor for higher risk of fall which may indicate body shape as a potentially modifiable risk factor for falls in adults in aged 55 years and over.