High kinesiophobia and pain catastrophizing in people with articular cartilage defects in the knee and associations with knee function.

PURPOSE: The purpose of this study was to evaluate the extent to which individuals with knee articular cartilage defects (ACDs) have kinesiophobia and pain catastrophizing, and how these psychological factors relate to self-reported knee outcomes. METHODS: Thirty-five individuals seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls without history of knee injury participated in the study. Kinesiophobia was measured with the Tampa Scale of Kinesiophobia (TSK), and scored using the modified 11-item (TSK-11) methods. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). Data were analyzed using descriptive statistics, independent t-tests, chi-squared tests and Spearman's correlation coefficients, as appropriate (α = 0.05). RESULTS: Participants with ACDs reported higher TSK-11 scores (median 27 [IQR 25-29]) and higher PCS scores (median 10 [IQR 4-18]) than controls (median TSK-11 16 [IQR 14-17], p < 0.001; median PCS 0 [IQR 0-9], p < 0.001). Within those with knee ACDs, higher TSK-11 scores were associated with worse knee pain, function on activities of daily living, sports/recreation, and knee-related quality of life scores (rho = -0.38 to -0.61). Higher pain catastrophizing was associated with worse function with activities of daily living and knee-related quality of life (rho = -0.37 to -0.40). CONCLUSIONS: Kinesiophobia and pain catastrophizing in people with knee ACDs were higher than controls. Higher kinesiophobia and pain catastrophizing were associated with worse function and quality of life. Further study of the impact of these psychological factors on outcomes and prognosis in people with knee ACDs is warranted.

Translation, cross-cultural adaptation and validation of the Slovenian version of Harris Hip Score.

INTRODUCTION: The Harris Hip Score is the most widely used outcome measure for the assessment of hip pathologies. An official Slovenian version has not been culturally adapted and validated. The aim of this study was to create a Slovenian valid and reliable version of the HHS. MATERIALS AND METHOD: The HHS was translated and modified in Slovenian. The measurement properties of the Slovenian HHS were tested in 42 patients suffering from different hip pathologies. Reliability, responsiveness, construct validity, convergent/divergent validity and content validity of the Slovenian version of the HHS were tested. RESULTS: Only minor adaptation was required in the translation process. The internal consistency of the HHS expressed by Cronbach's alpha was 0.94. The test-retest reliability expressed by the intraclass correlation coefficient was 0.983. The correlations of the HHS scale with the WOMAC scale (r = - 0.877) and the VAS scale (r = - 0.717) were statistically significant. The highest correlation between the HHS and SF-36 was with the General Health dimension (r = 0.61). while the lowest correlation was with the SF-36 Mental Health dimension (r = 0.43). MDC95% was 10.1. No floor or ceiling effects were found. CONCLUSION: Slovenian version of HHS seems to has an acceptable level of reliability and validity. Slovenian HHS is short, comprehensible and easy to administer and interpret. TRIAL REGISTRATION: Approved by the Slovenian National Medical Ethics Committee (0120-46/2019/19).

Physiotherapy interventions for pain management in haemophilia: A systematic review.

PURPOSE: Approximately 35%-50% of people with haemophilia (PWH) report living with chronic musculoskeletal pain. Although exercise based rehabilitation is effective for pain in other arthritises, there are no published guidelines for management of chronic pain in PWH. This review aims to evaluate and appraise the current evidence of effectiveness of physiotherapy interventions on (a) pain intensity, (b) quality of life (QoL) and (c) function in PWH. METHODS: A systematic review of five databases AMED and CINAHL, EMBASE and MEDLINE and PEDro, as well as trial registries, grey literature and hand searching key journals was completed. Included studies were critically appraised and evaluated for risk of bias. The GRADE approach was used to rate the quality of the evidence. RESULTS: Nine trials consisting of 235 participants met the inclusion criteria. All studies had an overall risk of bias with low methodological quality. Meta-analysis was not possible due to heterogeneity across trials. Studies comparing a range of physiotherapy interventions against no intervention showed no clear beneficial effect on pain intensity or QoL. Only one study, investigating hydrotherapy or land-based exercise against control, showed positive effect for pain intensity, but rated very low on GRADE assessment. Studies comparing one physiotherapy intervention against another showed no clear benefit on pain intensity, QoL or function. LASER with exercise and hydrotherapy were shown to have some positive effects on pain intensity, but no clear benefit on function. CONCLUSIONS: At present, there is limited evidence for the use of physiotherapy interventions in addressing the issue of pain in PWH. Better designed trials with higher quality and explicit methodology along with user involvement are needed to assess the efficacy of any proposed intervention.

The Association Between Fear of Movement, Pain Catastrophizing, Pain Anxiety, and Protective Motor Behavior in Persons With Peripheral Joint Conditions of a Musculoskeletal Origin: A Systematic Review.

OBJECTIVE: The aim of the study was to investigate alterations in motor behavior related to pain-related beliefs in persons with peripheral joint conditions. DESIGN: This is a systematic review. RESULTS: Our database search (PubMed, Web of Science, Embase, PsycINFO) identified 7390 articles (until September 2019), and nine articles (344 participants) were selected based on the eligibility criteria for selecting studies, i.e., studies in adults with primary peripheral joint conditions, assessing the influence of fear of movement, catastrophizing or anxiety on motor behavior in terms of kinematics, kinetics, and muscle activity during active movements.In the acute stage after knee or radius surgery, more catastrophizing and fear were associated with less active joint motion in the operated and adjacent joints. In knee patients in the chronic stage after surgery, increased hip adduction and knee valgus were linked to increased fear of movement during the performance of challenging tasks. Similar results were found in persons with nonsurgical chronic knee pain. During gait, no relation between lower limb kinematics and fear of movement was observed. CONCLUSIONS: Kinematic alterations appear in tandem with pain-related perceptions in acute stages after surgery. Altered kinematics influenced by pain-related beliefs are also seen in persons with chronic nonsurgical and surgical knee pain, when challenging tasks are performed.

Escala de convivencia con un proceso crónico: estudio piloto en pacientes con enfermedades crónicas / Living with Chronic Illness Scale: Pilot study in patients with several chronic diseases

OBJETIVO: Presentar el estudio piloto de la Escala de Convivencia con un proceso crónico (EC-PC) en pacientes con diabetes mellitus tipo 2, insuficiencia cardiaca crónica, enfermedad pulmonar obstructiva crónica y artrosis. DISEÑO: Estudio observacional, transversal y multicéntrico. Emplazamiento: Dos hospitales de atención especializada de Navarra y Madrid. PARTICIPANTES: 64 pacientes con diversos procesos crónicos, mayores de 18 años que acudan a centros de atención primaria y/o consultas externas. Los pacientes con deterioro cognitivo diagnosticado y/o trastornos psiquiátricos fueron excluidos. INTERVENCIONES: Las evaluaciones tuvieron una duración media de 15 minutos por paciente. Mediciones principales: Se evaluó la variable Convivencia con un proceso crónico, mediante la EC-PC. Se analizó la viabilidad/aceptabilidad, consistencia interna y validez de constructo. RESULTADOS: Para la muestra total, la EC-PC mostró una buena viabilidad y aceptabilidad, sin datos faltantes. El coeficiente alfa de Cronbach alcanzó valores entre 0,64 y 0,76, y el índice de homogeneidad fue superior a 0,30 en todos los dominios de la escala. Los valores de validez interna oscilaron entre 0,04 y 0,30. No se encontraron diferencias significativas en la puntuación total de la escala en función del sexo o las diferentes patologías. Los pacientes describieron la escala como sencilla y útil. CONCLUSIONES: El estudio piloto de la EC-PC en pacientes con diversos procesos crónicos indica que es una medida breve, de fácil uso, fiable y válida. La EC-PC servirá para conocer de manera individualizada cómo el paciente convive con su proceso crónico y prevenir posibles aspectos negativos del día a día con la enfermedad

OBJECTIVE: To present the pilot study of the Living with Chronic Illness Scale (EC-PC) in patients with diabetes mellitus type 2, chronic heart failure, chronic obstructive pulmonary disease and osteoarthritis. DESIGN: Observational, cross-sectional and multicenter study. LOCATION: Two specialized hospitals in Navarre and Madrid. PARTICIPANTS: 64 patients with several chronic diseases, older than 18 years old, that go to primary health centre and/or outpatients. Patients with cognitive deterioration and/or psychiatric disorders were excluded. INTERVENTIONS: Evaluations had an average duration of 15 minutes per patient. MAIN MEASUREMENTS: Patients completed the EC-PC and a questionnaire related to the scale. Feasibility/acceptability, internal consistency and construct validity was analyzed. RESULTS: For the total sample, the EC-PC showed a good viability and acceptability, without missing data and with almost 100% of the computable data. Cronbach's alpha coefficient reached values between 0.64 and 0.76, and the homogeneity index was higher than 0.30 in all domains of the scale. The values of internal validity ranged between 0.04 and 0.30. No significant differences were found (p> 0.05) in the total score of the scale according to gender or the different pathologies. The patients described the scale as simple and useful. CONCLUSIONS: The pilot study of the EC-PC in patients with different chronic illnesses showed that it is a brief, easy to use, reliable and valid measure. The EC-PC will serve to know in an individualized way, how the patient is living with his/her chronic process and to prevent possible negative aspects of the daily living with the disease

Predicting outcomes of total joint arthroplasty using the distress and risk assessment method.

BACKGROUND: Psychological distress is presumed to be an important factor that can adversely impact the outcome of orthopaedic procedures. The Distress and Risk Assessment Method (DRAM) is an evaluation tool which assesses psychological distress in patients with low back pain. The purpose of this prospective study was to assess the influence of preoperative psychological distress, as determined by the DRAM score, on the functional outcomes of total joint arthroplasty (TJA). MATERIALS AND METHODS: A prospective study of 61 TJAs was performed at a single institution. The DRAM questionnaire and a variety of functional measures (12-Item Short Form Health Survey [SF-12], visual analogue scale [VAS], Oxford Hip Score [OHS], Oxford Knee Score [OKS], and Oswestry Disability Questionnaire [ODQ]) were administered to the patient at baseline, 1 month, and 6 months postoperatively. Mixed model regressions and Mann-Whitney tests were utilised to evaluate the relationship of the DRAM score with functional outcomes. RESULTS: The summed quantitative DRAM score was predictive of functional outcomes. With each 1 point increase in psychological distress, VAS pain increased by 0.023 (p = 0.015), OKS decreased by 0.34 (p = 0.01), ODQ increased by 0.065 (p = 0.02), and MCS decreased by 0.14 (p = 0.015). In addition, patients with lower preoperative distress scores had higher rates of improvement than patients with higher preoperative distress scores for VAS pain (p = 0.034). DISCUSSION: Psychological distress was associated with decreased baseline mental health and function in the early postoperative period, which has important implications for bundled payments. However, patients with psychological distress still demonstrated functional improvements and TJA should thus not be contraindicated in these patients.

The Lysholm score: Cross cultural validation and evaluation of psychometric properties of the Spanish version.

BACKGROUND: This study aims at assessing the validity and reliability of the Spanish version of the Lysholm score, a widely used instrument for assessing knee function and activity level after ligament injuries. METHODS: Ninety-five participants (67.4% male, 22±5 years) completed the questionnaire twice within 7 days and a subsample of 42 participants completed a test-retest reliability. Reliability, validity and feasibility psychometric properties were studied. The validity of the questionnaire was analysed using ceiling and floor effects. Factor structure and construct validity were analysed with the SF-36, the Hip and Knee Questionnaire (HKQ) and one leg jump test (OLJT). RESULTS: Criterion validity with the SF-36 Physical State was moderate (r = 0.50 and p<0.01), poor and inverse relationship (r = -0.31, p<0.01) with HKQ and positive moderate (r = 0.59, p<0.01) with OLJT. Measurement error from MDC90 was 3.9%. Exploratory factor analysis demonstrated a one-factor solution explaining 51.5% of total variance. The x2 test for the one-factor model was significant (x2 = 29.58, df = 20, p < 0.08). Test-retest reliability level was high (ICC2.1 = 0.92, p<0.01) and also the internal consistency (α = 0.77). CONCLUSION: The Spanish Lysholm score demonstrated that it is a reliable and valid instrument that can be used to assess knee function after ligament injuries.

Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185].

BACKGROUND: Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN: This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION: We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION: DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.

Clinical manifestations and risk factors of arthropathy in cystic fibrosis.

BACKGROUND: Recurrent joint pain is frequently observed in patients with CF and can lead to reduced activity and quality of life. We conducted this observational study to assess the clinical manifestations, frequency, and risk factors of CF associated arthropathy. METHODS: Clinical data were collected using a digital quality management system, medical records, and by conducting structured interviews. Univariate and multivariate statistical analysis were performed for statistical interpretation. STUDY DESIGN: retrospective observational study including 186 patients. RESULTS: Of 186 patients (Demographics: Mean age 27 years, female gender 104/186 (57%), CFTR F508del homozygous 82/186 (44%) included in the study, 54/186 (29%) had experienced joint symptoms. Joint pain and swelling were the most frequent symptoms. The joints of the hands (JOH) followed by the joints of the feet were most affected. No specific pattern of autoantibodies was discovered. The level of total serum IgG, age, female gender, and pulmonary exacerbations per year were significant risk factors for arthropathy in the study cohort. CONCLUSIONS: Joint symptoms in CF are a frequent and clinically relevant phenomenon with a distinct clinical pattern. Pulmonary exacerbations and elevated levels of total serum IgG may reflect chronic inflammation in patients with CF and may lead to a specific arthropathy associated with this condition.

Relationship Between PROMIS Computer Adaptive Tests and Legacy Hip Measures Among Patients Presenting to a Tertiary Care Hip Preservation Center.

BACKGROUND: Legacy hip outcome measures may be burdensome to patients and sometimes yield floor or ceiling effects. Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) allow for low-burden data capture and limited ceiling and floor effects. PURPOSE/HYPOTHESIS: The purpose of this study was to determine whether the PROMIS CAT domains demonstrate correlation against commonly used legacy patient-reported outcome measures in a population of patients presenting to a tertiary care hip preservation center. The authors hypothesized the following: (1) PROMIS CAT scores based on physical function (PF), pain interference (PIF), pain behavior, and pain intensity would show strong correlation with the following legacy scores: modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score (HOS) Sports and Activities of Daily Living subscales, and Veterans RAND-6D (VR-6D) utility measure. (2) The mental and physical health portions of the VR-6D legacy measure would show weak correlation with mental- and psychosocial-specific PROMIS elements-depression, anxiety, fatigue, sleep, and ability to participate in social roles and activities. (3) All PROMIS measures would exhibit fewer floor and ceiling effects than legacy scores. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Prospective data were collected on 125 patients in the hip preservation clinics. Enrollees completed legacy scores (visual analog scale for pain, mHHS, iHOT-12, HOS, and VR-6D) and PROMIS CAT questionnaires (PF, PIF, pain behavior, anxiety, depression, sleep, social roles and activities, pain intensity, fatigue). Spearman rank correlations were calculated, with rs values of 0 to 0.3 indicating negligible correlation; 0.3 to 0.5, weak correlation; 0.5 to 0.7, moderately strong correlation; and >0.7, strong correlation. Floor and ceiling effects were evaluated. RESULTS: As anticipated, the PF-CAT yielded strong correlations with the iHOT-12, mHHS, HOS-Sports, HOS-Activities of Daily Living, and VR-6D, with rs values of 0.76, 0.71, 0.81, 0.87, and 0.71, respectively. The PIF-CAT was the only pain score to show moderately strong to strong correlation with all 14 patient-reported outcome measures. A strong correlation was observed between the VR-6D and the social roles and activities CAT ( rs = 0.73). The depression CAT had a significant floor effect at 19%. No additional floor or ceiling effect was present for any other legacy or PROMIS measure. CONCLUSION: The PF-CAT shows strong correlation with legacy patient-reported outcome scores among patients presenting to a tertiary care hip preservation center. The PIF-CAT also correlates strongly with legacy and PROMIS measures evaluating physical and mental well-being. PROMIS measures are less burdensome and demonstrate no floor or ceiling effects, making them a potential alternative to legacy patient-reported outcome measures for the hip.

Effect of preoperative patient expectations on outcomes after reverse total shoulder arthroplasty.

BACKGROUND: The purpose of this study was to determine the effect of preoperative expectations on outcomes after reverse shoulder arthroplasty (RSA). We hypothesized that patients with greater expectations would have better outcomes. METHODS: Patients undergoing primary RSA completed the Hospital for Special Surgery's Shoulder Expectations Survey preoperatively. Preoperative and 2-year postoperative clinical outcomes were measured with the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Shoulder Activity Scale (SAS), 36-Item Short Form Health Survey (SF-36), and visual analog scales (VASs). Pearson correlations were used to assess the relationship between the number of expectations and outcomes. Differences in outcomes between those with higher and lower levels of expectations for each expectation question were assessed by independent samples t test. Multivariable linear regression analysis was used to control for potential confounding factors. RESULTS: We evaluated 135 patients at 2 years postoperatively. Patients had higher expectations for relieving pain, improving self-care, improving ability to perform daily activities, and improving ability to drive or put on a seatbelt. Patients with a greater number of high expectations preoperatively did not have better ASES, SAS, or VAS pain scores postoperatively. However, higher expectations for relieving nighttime pain was associated with ASES (ß = 7.0, P = .048) and VAS pain scores (ß = -5.9, P = .047) as well as 2-year improvement of VAS pain (ß = -6.1, P = .039). Higher expectations for improving the ability to participate in nonoverhead sports was associated with improvements in SAS (ß = 2.8, P = .020). CONCLUSION: A higher level of expectations for relief of nighttime pain and improving ability to participate in nonoverhead sports is associated with improved outcomes after RSA.

Range of motion after total knee arthroplasty in hemophilic arthropathy.

BACKGROUND: Outcomes of total knee replacement in cases of hemophilic patients are worse than in patients who undergo operations due to osteoarthritis. Previous publications have reported varying rates of complications in hemophilic patients, such as infection and an unsatisfactory range of motion, which have influenced the survival of prostheses. Our retrospective study evaluated the data of hemophilic patients regarding changes in the development of the range of motion. METHODS: The data and clinical outcomes of 72 total knee replacements in 45 patients with hemophilia types A and B were reviewed retrospectively. Patients were operated between 1998 and 2013. All of the patients were systematically followed up to record the range of motion and other parameters before and after surgery. RESULTS: The mean preoperative flexion contracture was 17° ± 11° (range, 0°-40°), and it was 7° ± 12° (range, 0°-60°) postoperatively. The mean flexion of the knee was 73° ± 30° (range, 5°-135°) before the operation and 80° ± 19° (range, 30°-110°) at the last follow-up. The mean range of motion was 56° ± 34° (range, 0°-130°) before the operation and 73° ± 24° (range, 10°-110°) at the last follow-up. CONCLUSIONS: Statistical analysis suggested that the range of motion could be improved until the 9th postoperative week. The patient should be operated on until the flexion contracture reaches 22° to obtain a contracture < 15° postoperatively or until the contracture reaches 12° to obtain less than 5°. The operation generally does not change the flexion of the knee in cases of hemophilic patients, but it reduces the flexion contracture and therefore improves the range.

Mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty.

BACKGROUND: Mental health conditions are associated with poor outcomes in patients with chronic disease as well as various orthopedic conditions. The purpose of this study was to describe the relationship between mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty. METHODS: Data, including mental health diagnoses, were prospectively collected from patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty from 2009 to 2015 at a single academic institution. Shoulder range of motion, visual analog scale, 12-Item Short Form Health Survey, and American Shoulder and Elbow Surgeons scores were collected preoperatively and at 1 and 2 years postoperatively. Data were analyzed using multivariate mixed-effect regression analysis. RESULTS: The study included 280 patients, 105 (37.5%) of whom had a mental health diagnosis of depression, anxiety, schizophrenia, or bipolar disorder. Both groups of patients had similar shoulder range of motion, pain, and function before shoulder arthroplasty. Hospital length of stay, discharge destination, and readmissions were similar for both groups. There were similar improvements in pain, function, and range of motion after shoulder arthroplasty in patients with and without diagnosed mental health conditions. CONCLUSIONS: Overall, the presence of a psychiatric diagnosis was not predictive of outcomes. Although psychiatric conditions are often considered surgical comorbidities, mental health diagnoses should not be a barrier to performing clinically indicated shoulder arthroplasty, because both groups of patients appear to benefit from pain relief and improved shoulder function.

The effect of arthropathies on illness perceptions, coping strategies, outcomes, and their changes over time in patients with inflammatory bowel disease: a 12-month follow-up study.

OBJECTIVES: Arthropathies are a common extraintestinal manifestation (EIM) in inflammatory bowel disease (IBD). This study evaluated the differences in illness perceptions, coping strategies, and illness outcomes between patients with IBD with and without arthropathies at baseline and examined changes at 12 months in these variables in patients with arthropathies. METHODS: In total, 204 patients with (n=123) and without (n=81) arthropathies completed questionnaires at baseline and after 1 year, assessing illness perceptions, coping strategies, quality of life, and work and activity impairment. A linear regression analysis assessed the effect of arthropathies on these factors compared with patients without arthropathies. A mixed model analysis evaluated changes in illness perceptions, coping strategies, and outcomes in patients with arthropathies over time. RESULTS: Patients with arthropathies had more persistent thoughts on symptomatology and the variability of symptoms, held more negative views on the effects of illness, had heightened emotions that affected daily functioning, and had a poorer understanding of IBD than patients without arthropathies. Patients with arthropathies could more efficiently divert attention, felt more useful to others, and perceived a reduced physical and mental health and an increased activity impairment compared with patients without arthropathies. At follow-up, patients with arthropathies were more sceptical about the effectiveness of medical treatment but were better able to adapt their activities to their complaints compared with baseline. CONCLUSION: Patients with arthropathies in IBD adopt different illness perceptions and coping strategies and have different outcomes compared with patients without arthropathies, which is important to know when designing behavioral and physical interventions to improve functioning.

Gradual Onset Diseases: Misperception of Disease Onset.

PURPOSE: Gradual onset diseases (eg, carpal tunnel syndrome, cubital tunnel syndrome, and trapeziometacarpal arthrosis) tend to go unnoticed for years. When a slowly progressive disease transitions from asymptomatic to symptomatic, it may seem like an acute event. The primary aim of this study was to determine the percentage of patients who perceive the slowly progressive disease as having started within 1 year. We also hypothesized that (1) there would be no factors associated with perception of an onset of disease within 1 year, more specifically among patients with advanced disease; and (2) there would be no difference in a decision to pursue operative treatment between patients who perceived the onset of the disease to be recent and those who perceived it to be long-standing. METHODS: In this retrospective study, we reviewed the medical records of 732 patients newly diagnosed with carpal tunnel syndrome (n = 114), cubital tunnel syndrome (n = 276), or trapeziometacarpal arthrosis (n = 342), for the onset of symptoms. Multiple factors were assessed for (1) association with perception of disease onset within 1 year, and (2) choice for operative treatment in bivariate and multivariable analyses. RESULTS: A total of 69% of all subjects and 68% of patients with advanced disease perceived the disease as having started within 1 year. A perceived provocation (such as an injury or surgery) was associated with a perception of recent onset. A decision to pursue operative treatment was not different between the 2 groups. CONCLUSIONS: Slowly progressive diseases are often misperceived as relatively new. CLINICAL RELEVANCE: Effective communication strategies are important to ensure that people make choices consistent with their values and not based on misconceptions.

Association between joint stiffness and health-related quality of life in community-dwelling older adults.

OBJECTIVE: This study aimed to examine the association between joint stiffness and health-related quality of life (HRQOL) in community-dwelling older adults. METHODS: Participants in this cross-sectional study were 530 Japanese community-dwelling older adults (mean age, 73.9 years; women, 64.3%). Joint stiffness was assessed at the neck, low back, shoulder, elbow, hand or wrist, hip, knee, and ankle or feet; the duration of joint stiffness was also evaluated. We assessed HRQOL using the Short Form-12 (SF-12) and EuroQOL-5 Dimension (EQ-5D) questionnaires. We calculated the physical component summary scores (PCS) and mental component summary scores (MCS) from SF-12 and the EQ-5D index from EQ-5D. RESULTS: The prevalence of joint stiffness was 54.0%. Joint stiffness at two or more sites and at each site had a meaningful impact on PCS. Joint stiffness that lasted for 30min or more was meaningfully associated with low PCS and EQ-5D scores (PCS, 30-60min: beta=-6.122, P<0.05; >60min: beta=-5.962, P<0.01; EQ-5D index, 30-60min: beta=-0.068, P<0.01; >60min: beta=-0.070, P<0.01). Further, joint stiffness that lasted over 60min extended over MCS (MCS, >60min: beta=-3.212, P<0.05). CONCLUSIONS: Joint stiffness is associated with HRQOL. Assessing joint stiffness and intervention could be beneficial for HRQOL.

Association of Anxiety and Depression With Pain and Quality of Life in Patients With Chronic Foot and Ankle Diseases.

BACKGROUND: The purposes of this study were to clarify the incidence of anxiety and depression among patients with chronic foot and ankle diseases and to examine the independent association of anxiety and depression with pain and quality of life. METHODS: Patients who visited the foot and ankle clinic from April 2015 to November 2016 were recruited. Anxiety and depression in patients were assessed using the Hospital Anxiety and Depression Scale. Pain and quality of life were evaluated using the visual analog scale (VAS) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q), respectively. Furthermore, patient characteristics, including age, sex, body mass index, pain in other body areas, social support, employment, and household income, were surveyed. A multiple regression analysis was performed to examine the independent association of anxiety and depression with pain and quality of life. A total of 250 patients were included in the analysis. RESULTS: The prevalence of anxiety and depression was 30% and 27%, respectively. The VAS and all SAFE-Q subscale scores were significantly worse in patients with anxiety or depression than in patients without the same (median VAS 63 vs 49 for anxiety, P = .005; 68 vs 47 for depression, P < .001). Furthermore, the multiple regression analyses showed that the presence of anxiety ( P = .02) and depression ( P < .001) was independently associated with increased pain, and it led to low scores on all SAFE-Q subscales ( P < .001 for all subscales). CONCLUSION: About 30% of patients with chronic foot and ankle disease had anxiety or depression. The presence of these psychological symptoms was independently associated with worse pain and impaired quality of life after controlling for patient characteristics. Clinicians need to recognize the possibility of concurrent anxiety and depression to provide a more holistic treatment for chronic foot and ankle disease. LEVEL OF EVIDENCE: Level IV, case series.

Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review.

BACKGROUND: Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. OBJECTIVE: To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. DESIGN: Systematic review. DATA SOURCES: MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. SELECTION CRITERIA: Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. REVIEW METHODS: Data were extracted by two independent investigators and consensus was reached with involvement of a third. Given the heterogeneous nature of study designs, methods, and limited number of studies, a narrative synthesis is presented. RESULTS: Of 4,213 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions. CONCLUSION: The findings demonstrate that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. However, our review highlights a lack of evidence about support strategies for patients undergoing treatment for PJI and other adverse occurrences following hip or knee arthroplasty. There is a need to design, implement and evaluate interventions to support these patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2015: CRD42015027175.

Seasonal variations in mood and behavior associate with common chronic diseases and symptoms in a population-based study.

The purpose of this study was to assess how seasonality is associated with some of the most common non-communicable diseases (NCDs) in the general Finnish population. The global seasonality score (GSS) was used to measure the magnitude of seasonality in 4689 participants, in addition to which they reported the extent to which the seasonal variations in mood and behavior were experienced as a problem. Regression models and the odds ratios were adopted to analyze the associations adjusted for a range of covariates. Seventy percent of the participants had seasonal variations in sleep duration, social activity, mood, or energy level, and forty percent those in weight and appetite. Angina pectoris and depression were significantly associated with seasonality throughout the analysis. Hypertension, high cholesterol levels, diabetes, other (than rheumatoid) joint diseases and other (than depressive) psychological illnesses were significantly associated with experiencing a problem due to the seasonal variations, with an increase in the GSS, and with seasonal affective disorder and its subsyndromal form. The co-occurrence of the seasonal variations in mood and behavior with certain common NCDs warrants future research to have insights into the etiology and potentially shared pathways and mechanisms of action.