RESUMO
BACKGROUND/OBJECTIVE: Sleep disturbance is common among adults with osteoarthritis (OA), but little is known about patterns over time. In this cohort study, we identified restless sleep trajectories and associated factors in adults with or at high risk for knee OA. METHODS: Longitudinal (2004-2014) restless sleep (≥3 nights/week) annual reports over 8 years from 4359 Osteoarthritis Initiative participants were analyzed. Group-based trajectory modeling identified heterogeneous temporal patterns. Logistic regression identified baseline health and behavioral predictors of trajectory membership. RESULTS: Four restless sleep trajectory groups were identified: good (69.7%, persistently low restless sleep probabilities), worsening (9.1%), improving (11.7%), and poor (9.5%, persistently high). Among 2 groups initially having low restless sleep prevalence, the worsening trajectory group had an increased likelihood of baseline cardiovascular disease (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.01-2.33), pulmonary disease (OR, 1.48; 95% CI, 1.07-2.05), lower physical activity (OR, 1.29; 95% CI, 1.03-1.61), knee pain (OR, 1.04; 95% CI, 1.00-1.07), depressive symptoms (OR, 1.03; 95% CI, 1.01-1.06), and a decreased likelihood of better mental health (OR, 0.97; 95% CI, 0.95-0.98) at baseline. Among 2 groups initially having high restless sleep prevalence, the poor group had an increased likelihood of baseline depressive symptoms (OR, 1.03; 95% CI, 1.00-1.05). CONCLUSIONS: Four trajectories of restless sleep over 8 years were identified using data collected from over 4000 older adults aged 45 to 79 years with or at higher risk for knee OA. The presence of depressive symptoms, less physical activity, knee pain, poor mental health, cardiovascular disease, or pulmonary disease was each associated with unfavorable trajectories.
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Osteoartrite do Joelho , Transtornos do Sono-Vigília , Idoso , Estudos de Coortes , Humanos , Articulação do Joelho , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologiaRESUMO
Physical activity ameliorates fatigue in systemic lupus erythematosus (SLE) patients by an unknown mechanism. Adipokines, which are influenced by adiposity and physical activity, may be associated with patient-reported fatigue. We describe cross-sectional associations between adipokines and fatigue, physical activity, and SLE disease activity. We measured adipokines, self-reported fatigue, and objective physical activity in 129 SLE patients. Fatigue was assessed with the Fatigue Severity Scale (FSS) and Patient Reported Outcomes Measurement Information System® (PROMIS®) Fatigue score. Disease activity was measured with the Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI). Participants wore an accelerometer for 7 days to measure physical activity. Leptin, adiponectin, and resistin were measured in stored serum with a Luminex bead-based assay. Multivariable regression models assessed relationships between fatigue and adipokines, and Spearman correlation coefficients summarized associations between adipokines, physical activity, and SELENA-SLEDAI. Median adipokine levels were: leptin 30.5 ng/ml (Interquartile Range 14.0, 56.6), adiponectin 11.6 µg/ml (7.2, 16.8) and resistin 1.4 ng/ml (1.0, 2.2). Associations between adipokines and FSS or PROMIS fatigue were not significant. Body mass index (BMI) ≥ 30 kg/m2 was associated with FSS and PROMIS fatigue in regression analyses (p < 0.05). Weak correlations between leptin, adiponectin, leptin/adiponectin (L/A) ratio, and physical activity and between adiponectin and SELENA-SLEDAI score were not significant after adjusting for BMI. Adipokines were not associated with fatigue in SLE. Adipokines were correlated with physical activity (leptin, adiponectin, L/A ratio) and SLE disease activity (adiponectin), but most of these associations were explained by BMI.
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Adipocinas/sangue , Exercício Físico/fisiologia , Fadiga , Lúpus Eritematoso Sistêmico/sangue , Estudos Transversais , Feminino , Humanos , Leptina , Lúpus Eritematoso Sistêmico/patologia , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo PacienteRESUMO
OBJECTIVE: To investigate the relationship between sedentary behavior and quality-adjusted life years (QALYs) among participants in the Osteoarthritis Initiative. DESIGN: Longitudinal, observational design. SETTING: Osteoarthritis Initiative cohort. PARTICIPANTS: Individuals (N=1794) from a prospective, multicenter longitudinal cohort were classified into quantile groups based on average daily sedentary time (most sedentary, quartile 1 [Q1] ≥11.6h; 10.7h≤ Q2 <11.6h; 9.7h≤ Q3 <10.7h; least sedentary, Q4 <9.7h). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Individual QALYs were estimated over 2 years from the area under the curve of health-related utility scores derived from the Medical Outcomes Study 12-Item Short-Form Health Survey versus time. The relationship between baseline sedentary behavior and median 2-year QALYs was estimated using quantile regression adjusted for socioeconomic factors and body mass index. RESULTS: Lower QALYs over 2 years were more frequently found among the most sedentary (Q1, median 1.59), and QALYs increased as time spent in baseline sedentary behavior decreased (median QALYs for Q2, 1.64; Q3, 1.65; Q4, 1.65). The relationship of sedentary time and median QALY change was only significant for the most sedentary Q1 group, where an additional hour of sedentary behavior significantly reduced QALYs by -.072 (95% confidence interval, -.121 to -.020). CONCLUSIONS: Our findings suggest that individuals with the most extreme sedentary profiles may be vulnerable to additional losses of quality of life if they become more sedentary. Targeting these individuals to decrease sedentary behavior has the potential to be cost-effective.
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Osteoartrite/psicologia , Qualidade de Vida/psicologia , Anos de Vida Ajustados por Qualidade de Vida , Comportamento Sedentário , Acelerometria , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Grupos Raciais , Fatores Sexuais , Fatores SocioeconômicosRESUMO
OBJECTIVE: To describe the qualitative process used to develop attributes and attribute levels for inclusion in a discrete choice experiments (DCE) for older adult physical activity interventions. DESIGN: Five focus groups (n=41) were conducted, grounded in the Health Action Process Approach framework. Discussion emphasized identification and prioritization attributes for a DCE on physical activity. Semi-structured interviews (n=6) investigated attribute levels and lay-language for the DCE. A focus group with physical activity researchers and health care providers was the final stakeholder group used to establish a comprehensive approach for the generation of attributes and levels. A DCE pilot test (n=8) was then conducted with individuals of the target patient population. All transcripts were analyzed using a constant comparative approach. SETTING: General community and university-based research setting. PARTICIPANTS: Volunteers (N=55) aged >45 years with knee pain, aches, or stiffness for at least 1 month over the previous 12 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interview guides, attributes, attribute levels, and discrete choice experiment. RESULTS: The most influential identified attributes for physical activity were time, effort, cost, convenience, enjoyment, and health benefits. Each attribute had 3 levels that were understandable in the pilot test of the DCE. CONCLUSIONS: The identification of 6 physical activity attributes that are most salient to adults with knee osteoarthritis resulted from a systematic qualitative process, including attribute-ranking exercises. A DCE will provide insight into the relative importance of these attributes for participating in physical activity, which can guide intervention development.
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Comportamento de Escolha , Exercício Físico/psicologia , Osteoartrite do Joelho/reabilitação , Preferência do Paciente/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Fatores de TempoRESUMO
BACKGROUND: Most knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes. METHODS: Patients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis. RESULTS: Twenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m2). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight. CONCLUSIONS: This study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.
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Artroplastia do Joelho/psicologia , Preferência do Paciente , Redução de Peso , Programas de Redução de Peso , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Knee replacement typically results in reduced pain and improved function, but it is unclear if these improvements lead to weight loss. OBJECTIVE: The purpose of this study was to examine weight change patterns preoperatively and postoperatively among overweight/obese knee replacement patients. METHODS: The study evaluated 210 overweight/obese patients from the Osteoarthritis Initiative who underwent a knee replacement during an 8-year longitudinal study. Average annual weight changes during 1- to 2-year intervals prior to, including, and subsequent to knee replacement were categorized as loss (≥-2.5%), maintain (>-2.5% to <2.5%), and gain (≥2.5%). Weight changes across time intervals were compared using logistic regression with generalized estimating equations, adjusting for demographic, health, and knee factors. RESULTS: On average, patients lost -0.6 kg/y during the interval when the surgery was performed, but weight gain (0.9 kg/y) in the initial postoperative interval represented an overall net weight gain (0.3 kg/y) compared with presurgery. Continued weight gain (0.3 kg/y) was also seen among patients with additional follow-ups. Patients were significantly less likely to have a meaningful weight loss in the time interval immediately following the surgery compared with the interval in which the surgery took place (odds ratio, 0.37; 95% confidence interval, 0.18-0.79). CONCLUSIONS: Overweight and obese patients initially lost weight during the interval including knee replacement; however, they were less likely to lose more than 2.5% of their weight in the 1 to 2 years immediately after the surgery. Knee replacement patients may benefit from weight management interventions both preoperatively and postoperatively.
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Artroplastia do Joelho , Articulação do Joelho , Obesidade , Osteoartrite do Joelho , Redução de Peso , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Índice de Massa Corporal , Feminino , Humanos , Illinois , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Período Pós-Operatório , Fatores de Risco , Estatística como Assunto , Aumento de PesoRESUMO
BACKGROUND: Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults. OBJECTIVES: The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative. METHODS: Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score. RESULTS: Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P < 0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability. CONCLUSIONS: Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.
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Pessoas com Deficiência , Exercício Físico , Osteoartrite do Joelho , Acelerometria/métodos , Atividades Cotidianas , Idoso , Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/reabilitação , Avaliação de Resultados da Assistência ao PacienteRESUMO
OBJECTIVES: This prospective longitudinal study investigated the association between baseline objectively measured sedentary time and 2-year onset of physical frailty. METHODS: We studied 1333 Osteoarthritis Initiative participants 55 to 83 years of age who were at risk for physical frailty, as assessed via low gait speed (< 0.6 m per second) or inability to perform a single chair stand. Baseline sedentary time was assessed through accelerometer monitoring. Hazard ratios (HRs) for physical frailty onset were estimated with discrete survival methods that controlled for moderate physical activity, sociodemographic characteristics, baseline gait and chair stand functioning, and health factors. RESULTS: The incidence of physical frailty in this high-risk group was 20.7 per 1000 person-years. Greater baseline sedentary time (adjusted HR = 1.36 per sedentary hour; 95% confidence interval [CI] = 1.02, 1.79) was significantly related to incident physical frailty after control for time spent in moderate-intensity activities and other covariates. CONCLUSIONS: Our prospective data demonstrated a strong relationship between daily sedentary time and development of physical frailty distinct from insufficient moderate activity. Interventions that promote reductions in sedentary behaviors in addition to increases in physical activity may help decrease physical frailty onset.
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Idoso Fragilizado/estatística & dados numéricos , Comportamento Sedentário , Acelerometria , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atividade Motora , Osteoartrite/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVES: We examined whether objectively measured sedentary behavior is related to subsequent functional loss among community-dwelling adults with or at high risk for knee osteoarthritis. METHODS: We analyzed longitudinal data (2008-2012) from 1659 Osteoarthritis Initiative participants aged 49 to 83 years in 4 cities. Baseline sedentary time was assessed by accelerometer monitoring. Functional loss (gait speed and chair stand testing) was regressed on baseline sedentary time and covariates (baseline function; socioeconomics [age, gender, race/ethnicity, income, education], health factors [obesity, depression, comorbidities, knee symptoms, knee osteoarthritis severity, prior knee injury, other lower extremity pain, smoking], and moderate-to-vigorous activity). RESULTS: This cohort spent almost two thirds of their waking hours (average=9.8 h) in sedentary behaviors. Sedentary time was significantly positively associated with subsequent functional loss in both gait speed (-1.66 ft/min decrease per 10% increment sedentary percentage waking hours) and chair stand rate (-0.75 repetitions/min decrease), controlling for covariates. CONCLUSIONS: Being less sedentary was related to less future decline in function, independent of time spent in moderate-to-vigorous activity. Both limiting sedentary activities and promoting physical activity in adults with knee osteoarthritis may be important in maintaining function.
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Marcha/fisiologia , Atividade Motora , Osteoartrite do Joelho/etiologia , Comportamento Sedentário , Acelerometria/instrumentação , Acelerometria/métodos , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Osteoartrite do Joelho/prevenção & controle , Fatores de Proteção , Fatores de Risco , Fatores de Tempo , Estados UnidosRESUMO
BACKGROUND: To characterize sleep disturbance in patients with established rheumatoid arthritis (RA) and explore the relationship between sleep and mechanisms of central nervous system pain regulation. METHODS: Forty-eight RA participants completed wrist-worn actigraphy monitoring and daily sleep diaries for 14 days to assess sleep-wake parameters. Participants underwent quantitative sensory testing to assess pressure pain thresholds, temporal summation, and conditioned pain modulation. Data were analyzed using descriptive statistics, Spearman's correlation, and multivariable median regression analyses. RESULTS: Median actigraphy and sleep diary derived sleep duration was 7.6 h (interquartile range (IQR) 7.0, 8.2) and 7.1 h (IQR 6.7, 7.6), respectively. Actigraphy based sleep fragmentation (rho = 0.34), wake after sleep onset (rho = 0.36), and sleep efficiency (rho = -0.32) were each related to higher temporal summation values in unadjusted analyses, but these relationships did not persist after controlling for age, body mass index, disease duration, and swollen joint count. No significant relationships were observed between sleep with pressure pain thresholds and conditioned pain modulation. CONCLUSION: Actigraphy and sleep diary monitoring are well tolerated in established RA patients. Future investigations should include both subjective and objective assessments, as they may provide information relating to different components and mechanisms.
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OBJECTIVE AND DESIGN: Antiphospholipid antibodies (APA) have been associated with clinical cardiovascular disease, but it remains unclear whether APA are associated with sub-clinical atherosclerosis. This study examined the relationship between APA and sub-clinical atherosclerosis, measured as coronary artery calcification (CAC), in participants from the prospective Coronary Artery Risk Development in Young Adults (CARDIA) Study. SUBJECTS AND METHOD: 2,203 black and white participants with sera available from the CARDIA year 7 examination and CAC measured by computed tomography at years 15 or 20 were selected. RESULTS: Anti-ß2-glycoprotein I (anti-ß2-GPI) immunoglobulin (Ig) M, IgG, and IgA were positive in 7.0, 1.4, and 1.8 % of participants, respectively; anti-cardiolipin (aCL) IgM and IgG were positive in 1.5 and 1.0 %, respectively. 9.5 % of participants had CAC score >0 at year 15. Anti-ß2-GPI IgM, IgG, IgA, and aCL IgG positivity were associated with CAC >0 at year 15 after adjustment for traditional cardiovascular risk factors; [odds ratios (95 % confidence intervals) were 1.7 (1.0, 3.1), 6.4 (2.4, 16.8), 5.6 (2.3, 13.2), and 5.1 (1.4, 18.6), respectively]. Anti-ß2-GPI IgG was associated with year 20 CAC >0, and anti-ß2-GPI IgA and aCL IgG were marginally associated. CONCLUSIONS: These findings indicate that APA positivity during young adulthood is a risk factor for subsequent sub-clinical atherosclerosis and might play a role in the pathogenesis of atherosclerosis
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Anticorpos Antifosfolipídeos/sangue , Aterosclerose/sangue , Calcinose/sangue , Doença da Artéria Coronariana/sangue , Adulto , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Fatores de RiscoRESUMO
OBJECTIVE: To identify modifiable physical and behavioural factors associated with widespread pain (WSP) in older adults with radiographic evidence of knee osteoarthritis (OA). METHODS: Cross-sectional initial visit data of participants with radiographic knee OA (Kellgren-Lawrence grade of ≥2) from the Osteoarthritis Initiative Study were analysed. WSP was defined as pain on both sides of the body, above and below the waist, and in the axial skeleton. Time (hrs/d) spent participating in sitting and moderate-strenuous physical activities were calculated from the Physical Activity Scale for the Elderly questionnaire. Physical function was quantified using gait speed and the chair stand test. Restless sleep was assessed using an item on the CES-D Scale. Logistic regression models were constructed to examine the strength of the associations between primary exposures and WSP in unadjusted and adjusted analyses. RESULTS: Among the 2637 participants (mean age 62.6 years, 58.6% female), 16.8% met the criteria for WSP. All primary measures of interest were related to WSP in unadjusted analyses. In adjusted multivariable analysis, slow gait speed (adjusted odds ratio [aOR] 1.43; 95% CI 1.01, 2.02), lower chair stand rate (aOR 0.98; 95% CI 0.97-0.99), and restless sleep (aOR 1.61; 95% CI 1.25-2.08) maintained significant associations with WSP. CONCLUSION: Poor sleep behaviours and low physical function capacity are associated with WSP in adults with radiographic knee OA. These findings highlight the importance of assessing sleep, physical function, and pain distribution in this population. Interventions to improve physical function and sleep behaviours should be investigated as potential strategies to mitigate WSP.
Assuntos
Osteoartrite do Joelho , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Estudos Transversais , Dor/etiologia , Exercício Físico , Depressão , Articulação do JoelhoRESUMO
OBJECTIVE: Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be administered via computerized adaptive testing (CAT) or fixed short forms (FSFs), but the empirical benefits of CAT versus FSFs are unknown in juvenile myositis (JM). The present study was undertaken to assess whether PROMIS CAT is feasible, precise, correlated with FSFs, and less prone to respondent burden and floor/ceiling effects than FSFs in JM. METHODS: Patients 8-17 years of age (self-report and parent proxy) and parents of patients 5-7 years of age (only parent proxy) completed PROMIS fatigue, pain interference, upper extremity function, mobility, anxiety, and depressive symptoms measures. Pearson correlations, paired t-tests, and Cohen's d were calculated between PROMIS CAT and FSFs. McNemar's test assessed floor/ceiling effects between CAT and FSFs. Precision and respondent burden were examined across the T score range. RESULTS: Data from 67 patient-parent dyads were analyzed. CAT and FSF mean scores did not significantly differ except in parent proxy anxiety and fatigue (effect size 0.23 and 0.19, respectively). CAT had less pronounced floor/ceiling effects at the less symptomatic extreme in all domains except self-report anxiety. Increased item burden and higher SEs were seen in less symptomatic scorers for CAT. Modified stopping rules limiting CAT item administration did not decrease precision. CONCLUSION: PROMIS CAT appears to be feasible and correlated with FSFs. CAT had less pronounced floor/ceiling effects, allowing detection of individual differences in less symptomatic patients. Modified stopping rules for CAT may decrease respondent burden. CAT can be considered for long-term follow-up of JM patients.
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Dermatomiosite , Medidas de Resultados Relatados pelo Paciente , Humanos , Teste Adaptativo Computadorizado , Extremidade Superior , Sistemas de InformaçãoRESUMO
OBJECTIVE: Expected outcomes (e.g., expected survivorship after a cancer treatment) have improved decision-making around treatment options in many clinical fields. Our objective was to evaluate the effect of expected values of 3 widely available total knee arthroplasty (TKA) outcomes (risk of serious complications, time to revision, and improvement in pain and function at 2 years after surgery) on clinical recommendation of TKA. METHODS: The RAND/University of California Los Angeles appropriateness criteria method was used to evaluate the role of the 3 expected outcomes in clinical recommendation of TKA. The expected outcomes were added to 5 established preoperative factors from the modified Escobar appropriateness criteria. The 8 indication factors were used to develop 279 clinical scenarios, and a panel of 9 clinicians rated the appropriateness of TKA for each scenario as inappropriate, inconclusive, and appropriate. Classification tree analysis was applied to these ratings to identify the most influential of the 8 factors in discriminating TKA appropriateness classifications. RESULTS: Ratings for the 279 appropriateness scenarios deemed 34.4% of the scenarios as appropriate, 40.1% as inconclusive, and 25.5% as inappropriate. Classification tree analyses showed that expected improvement in pain and function and expected time to revision were the most influential factors that discriminated among the TKA appropriateness classification categories. CONCLUSION: Our results showed that clinicians would use expected postoperative outcome factors in determining appropriateness for TKA. These results call for further work in this area to incorporate estimates of expected pain/function and revision outcomes into clinical practice to improve decision-making for TKA.
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Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Tomada de Decisão Clínica , Dor , Articulação do Joelho , Resultado do TratamentoRESUMO
OBJECTIVE: Physical activity improves function in adults with arthritis, but it is unknown if there is a graded relationship between physical activity and functional benefit. This study was undertaken to examine the cross-sectional and longitudinal relationship between self-reported physical activity and observed functional performance in adults with knee osteoarthritis (OA). METHODS: The Osteoarthritis Initiative cohort included 2,589 patients with knee OA (2,301 with longitudinal followup data) who were ages 45-79 years at baseline. Prospective annual functional performance was assessed for 2 years using timed 20-meter walk tests. We used linear regression to estimate differences across physical activity quartiles in subsequent function (baseline and 1-year activity predicts 1-year and 2-year function, respectively) adjusted for demographic factors (age, sex, race/ethnicity, education level, and marital status) and health factors (OA severity, knee symptoms, knee pain, knee injury, body mass index, comorbidity, depression, smoking, alcohol use, and other joint pain). RESULTS: Increasing physical activity levels had a significant graded relationship to functional performance. Adults in physical activity quartile groups from least active to most active had an average gait speed of 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, at baseline (P for trend<0.001) and 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, after 1 year (P for trend<0.001); increasing trends remained significant after adjusting for covariates. Findings were similar within sex and age groups. CONCLUSION: These prospective data indicate a consistent graded relationship between physical activity level and better performance in adults with knee OA. These findings support guidelines that encourage patients with arthritis who cannot attain minimum recommended physical activity to be as active as possible.
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Atividades Cotidianas , Atividade Motora/fisiologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: Osteoarthritis (OA) clinical practice guidelines identify a substantial therapeutic role for physical activity, but objective information about the physical activity of this population is lacking. The aim of this study was to objectively measure levels of physical activity in adults with knee OA and report the prevalence of meeting public health physical activity guidelines. METHODS: Cross-sectional accelerometry data from 1,111 adults with radiographic knee OA (49-84 years old) participating in the Osteoarthritis Initiative accelerometry monitoring ancillary study were assessed for meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans (≥150 minutes/week moderate-to-vigorous-intensity activity lasting ≥10 minutes). Quantile regression was used to test median sex differences in physical activity levels. RESULTS: Aerobic physical activity guidelines were met by 12.9% of men and 7.7% of women with knee OA. A substantial proportion of men and women (40.1% and 56.5%, respectively) were inactive, having done no moderate-to-vigorous activity that lasted 10 minutes or more during the 7 days. Although men engaged in significantly more moderate-to-vigorous activity (average daily minutes 20.7 versus 12.3), they also spent more time in no or very-low-intensity activity than women (average daily minutes 608.2 versus 585.8). CONCLUSION: Despite substantial health benefits from physical activity, adults with knee OA were particularly inactive based on objective accelerometry monitoring. The proportions of men and women who met public health physical activity guidelines were substantially less than those previously reported based on self-reported activity in arthritis populations. These findings support intensified public health efforts to increase physical activity levels among people with knee OA.
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Terapia por Exercício/estatística & dados numéricos , Exercício Físico/fisiologia , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/reabilitação , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Saúde Pública , Radiografia , Fatores de RiscoRESUMO
OBJECTIVE: To analyze change over 6 months in accelerometer-measured physical activity for participants with arthritis in a physical activity promotion trial. We tested the hypothesis that participants with the highest baseline functional capacity, regardless of their intervention status, experienced the greatest increases in physical activity levels at 6-month follow-up. DESIGN: At baseline, participants were interviewed in person, completed a 5-minute timed walk, and wore a biaxial accelerometer for 1 week, with a subsequent week of accelerometer wear at 6 months. We present data on the changes in accelerometer-measured physical activity across baseline function quartiles derived from participants' walking speed. Analyses were controlled for sociodemographic, health status, and seasonal covariates as well as exposure to the study's behavioral intervention. SETTING: A Midwest academic medical center. PARTICIPANTS: Participants (N=226) with knee osteoarthritis or rheumatoid arthritis currently enrolled in the Improving Motivation for Physical Activity in Persons With Arthritis Clinical Trial. INTERVENTION: Counseling by physical activity coaches versus control group physician advice to exercise. MAIN OUTCOME MEASURE: Change in average daily counts between baseline and 6-month follow-up. RESULTS: Contrary to our hypothesis, and after controlling for other predictors of change, the lowest quartile function participants had the largest mean absolute and relative physical improvement over baseline, regardless of intervention group status. CONCLUSIONS: Participants at a higher risk of immanent mobility loss may have been more committed to improve lifestyle physical activity, reflecting the wisdom of targeting older adults at risk of mobility loss for physical activity behavior change interventions.
Assuntos
Aceleração , Monitorização Fisiológica/instrumentação , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/reabilitação , Aptidão Física/fisiologia , Caminhada/fisiologia , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/psicologia , Artrite Reumatoide/reabilitação , Terapia Comportamental/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Análise Multivariada , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Resultado do TratamentoRESUMO
BACKGROUND: Translational research typically requires data abstracted from medical records as well as data collected specifically for research. Unfortunately, many data within electronic health records are represented as text that is not amenable to aggregation for analyses. We present a scalable open source SQL Server Integration Services package, called Regextractor, for including regular expression parsers into a classic extract, transform, and load workflow. We have used Regextractor to abstract discrete data from textual reports from a number of 'machine generated' sources. To validate this package, we created a pulmonary function test data mart and analyzed the quality of the data mart versus manual chart review. METHODS: Eleven variables from pulmonary function tests performed closest to the initial clinical evaluation date were studied for 100 randomly selected subjects with scleroderma. One research assistant manually reviewed, abstracted, and entered relevant data into a database. Correlation with data obtained from the automated pulmonary function test data mart within the Northwestern Medical Enterprise Data Warehouse was determined. RESULTS: There was a near perfect (99.5%) agreement between results generated from the Regextractor package and those obtained via manual chart abstraction. The pulmonary function test data mart has been used subsequently to monitor disease progression of patients in the Northwestern Scleroderma Registry. In addition to the pulmonary function test example presented in this manuscript, the Regextractor package has been used to create cardiac catheterization and echocardiography data marts. The Regextractor package was released as open source software in October 2009 and has been downloaded 552 times as of 6/1/2012. CONCLUSIONS: Collaboration between clinical researchers and biomedical informatics experts enabled the development and validation of a tool (Regextractor) to parse, abstract and assemble structured data from text data contained in the electronic health record. Regextractor has been successfully used to create additional data marts in other medical domains and is available to the public.
Assuntos
Mineração de Dados/normas , Pesquisa Translacional Biomédica , Mineração de Dados/métodos , Processamento Eletrônico de Dados , Registros Eletrônicos de Saúde , Humanos , Informática Médica , Testes de Função Respiratória , Escleroderma Sistêmico , Esclerose , Software/normas , Estados UnidosRESUMO
OBJECTIVE: Little is known regarding what difference in functional performance measures is significant in individuals with chronic medical disease. Our objective was to examine the important differences in gait speed in adults with radiographic knee osteoarthritis. METHODS: Functional performance was measured by gait speed using 20-meter and 400-meter walk tests performed at a self-selected usual pace among adults with radiographic knee osteoarthritis participating in the Osteoarthritis Initiative at baseline and 2 years later. Both distribution-based methods and anchor-based methods were used to calculate the important differences in gait speed. Anchor-based methods used the chair stand rate and self-reported function to estimate gait speed differences related to physical function. RESULTS: We included 2,527 participants with radiographic knee osteoarthritis. Distribution-based important difference estimates for the 20-meter walk ranged from 4.1 to 6.4 meters/minute and 400-meter walk estimates ranged from 2.9 to 6.5 meters/minute. Prevalent (cross-sectional) anchor-based estimates for the 20-meter walk ranged from 5.4 to 6.9 meters/minute and for the 400-meter walk ranged from 3.0 to 6.9 meters/minute. Longitudinal anchor-based estimates were deemed unreliable. Combining distribution-based with prevalent anchor-based methods showed that an important gait speed difference for the 20-meter walk is between 4.1 and 6.9 meters/minute and for the 400-meter walk is between 2.9 and 6.9 meters/minute. CONCLUSION: Our results found that the important difference in gait speed for the 20-meter walk and the 400-meter walk is consistent with important difference estimates for older adult populations. These findings can provide benchmarks for assessing and understanding functional performance outcomes when comparing exposure groups and can be used in designing future studies targeting adults with radiographic knee osteoarthritis.