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Chowdhury AR, Graham PL, Schofield D, Costa DS, Nicholas M. Productivity outcomes from chronic pain management interventions in the working age population; a systematic review. Pain 2024; 165:1233-1246. [PMID: 38323645 PMCID: PMC11090028 DOI: 10.1097/j.pain.0000000000003149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
ABSTRACT Productivity loss because of chronic pain in the working age population is a widespread concern internationally. Interventions for chronic pain in working age adults might be expected to achieve enhanced productivity in terms of reduced costs of workers' compensation insurance, reduced disability support, and improved rates of return to work for injured workers. This would require the use of measures of productivity in the evaluation of chronic pain management interventions. The aim of this review was to identify and interpret the productivity outcomes of randomised controlled trials reported by studies that conducted economic evaluations (eg, cost-effectiveness and cost-utility) of chronic pain management interventions in the working age population published from database inception to March 2023. Econlit, Embase, and Pubmed electronic databases were searched, yielding 12 studies that met the selection criteria. All 12 studies used absenteeism to measure productivity, translating return to work measures into indirect costs. Only one study included return to work as a primary outcome. Ten studies found no statistically significant improvements in productivity-related costs. Despite evidence for reduced pain-related disability after pain management interventions, this review suggests that the use of measures for assessing productivity gains is lacking. Including such measures would greatly assist administrators and payers when considering the broader societal benefits of such interventions.
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Affiliation(s)
- Anonnya Rizwana Chowdhury
- Faculty of Medicine and Health, Pain Management Research Institute, University of Sydney, Sydney, Australia
| | - Petra L. Graham
- School of Mathematical and Physical Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney, Australia
| | - Daniel S.J. Costa
- Faculty of Medicine and Health, Pain Management Research Institute, University of Sydney, Sydney, Australia
| | - Michael Nicholas
- Faculty of Medicine and Health, Pain Management Research Institute, University of Sydney, Sydney, Australia
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2
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Hooten WM, Backonja M, Williams KA, Sturgeon JA, Gross JB, Borodianski S, Wang V, Tuan WJ, Zgierska AE, Moeller-Bertram T, Kriegel ML. Integrated pain care models and the importance of aligning stakeholder values. Pain Rep 2024; 9:e1160. [PMID: 38646660 PMCID: PMC11029933 DOI: 10.1097/pr9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 04/23/2024] Open
Abstract
Sustained widespread deployment of clinically and cost-effective models of integrated pain care could be bolstered by optimally aligning shared stakeholder values.
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Affiliation(s)
- W. Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miroslav Backonja
- Division of Intramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Kayode A. Williams
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jacob B. Gross
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Wen-Jan Tuan
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Aleksandra E. Zgierska
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
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Wenghofer J, He Beange K, Ramos WC, Mavor MP, Graham RB. Dynamic assessment of spine movement patterns using an RGB-D camera and deep learning. J Biomech 2024; 166:112012. [PMID: 38443276 DOI: 10.1016/j.jbiomech.2024.112012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
In clinical practice, functional limitations in patients with low back pain are subjectively assessed, potentially leading to misdiagnosis and prolonged pain. This paper proposes an objective deep learning (DL) markerless motion capture system that uses a red-green-blue-depth (RGB-D) camera to measure the kinematics of the spine during flexion-extension (FE) through: 1) the development and validation of a DL semantic segmentation algorithm that segments the back into four anatomical classes and 2) the development and validation of a framework that uses these segmentations to measure spine kinematics during FE. Twenty participants performed ten cycles of FE with drawn-on point markers while being recorded with an RGB-D camera. Five of these participants also performed an additional trial where they were recorded with an optical motion capture (OPT) system. The DL algorithm was trained to segment the back and pelvis into four anatomical classes: upper back, lower back, spine, and pelvis. A kinematic framework was then developed to refine these segmentations into upper spine, lower spine, and pelvis masks, which were used to measure spine kinematics after obtaining 3D global coordinates of the mask corners. The segmentation algorithm achieved high accuracy, and the root mean square error (RMSE) between ground truth and predicted lumbar kinematics was < 4°. When comparing markerless and OPT kinematics, RMSE values were < 6°. This work demonstrates the feasibility of using markerless motion capture to assess FE spine movement in clinical settings. Future work will expand the studied movement directions and test on different demographics.
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Affiliation(s)
- Jessica Wenghofer
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kristen He Beange
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada
| | - Wantuir C Ramos
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Matthew P Mavor
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada.
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Zhou X, Zhou Y, Zhang X, Jiang F. Economic evaluation of management strategies for complex regional pain syndrome (CRPS). Front Pharmacol 2024; 15:1297927. [PMID: 38318140 PMCID: PMC10839065 DOI: 10.3389/fphar.2024.1297927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background: The economic impact of Complex Regional Pain Syndrome (CRPS) on both patients and the global healthcare system continues to escalate. However, the economic implications associated with management interventions for CRPS have received limited attention. Therefore, our objective is to perform a thorough examination of published economic assessments of the various management strategies utilized for CRPS. Methods: A thorough search spanning four general medical databases and three health economic databases to identify full economic evaluations on CRPS management strategies from January 1994 to June 2023 were conducted. The quality of these studies were evaluated by employing the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. To enable cross-study comparisons conducted in different countries, we adjusted the costs reported in the selected studies for inflation and converted them into 2023 US dollars. Results: A total of nine economic evaluations, consisting of eight high-quality and one medium-quality, were identified across five nations during a span of 29 years. The findings suggest that the most economically efficient intervention for CRPS are interventional approaches of Spinal Cord Stimulation (SCS) in comparison to conventional management for long periods of time. Furthermore, in situations where there is a limited time period of less than 1 year, rehabilitation therapies, particularly physical therapy, have been demonstrated to be more effective in terms of both cost and clinical outcomes. Conclusion: The interventional management strategies, particularly for severe and persistent CRPS over long periods, may offer the greatest cost efficiency. In conditions with limited timelines, rehabilitation measures, such as rehabilitation therapies, can be cost-effective. However, insufficient data for other common interventions prevents the formation of a definitive conclusion. Similarly, it is crucial to recognize that the results of these interventions might be affected by the selection of comparator and the threshold for willingness to pay.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Pain, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yi Zhou
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiaofei Zhang
- Department of Neuro-Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Feng Jiang
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Chowdhury AR, Schofield D, Shrestha R, Nicholas M. Economic analysis of patient-related effects of an interdisciplinary pain self-management program. Pain 2023; 164:2491-2500. [PMID: 37326690 PMCID: PMC10578420 DOI: 10.1097/j.pain.0000000000002959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/09/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACT Active Day Patient Treatment (ADAPT) is a well-established 3 week intensive cognitive-behavioural, interdisciplinary pain management program for patients with disabling chronic pain. The aim of this analysis was to conduct an economic analysis of patient-related effects of ADAPT using hospital administrative data, specifically, to compare the costs and health outcomes for patients 1 month after participating in the program, with the preprogram period when they were receiving standard care. This retrospective cohort study included 230 patients who completed ADAPT (including follow-ups) between 2014 and 17 at the Pain Management and Research Centre at the Royal North Shore Hospital in Sydney, Australia. Data on pain-related healthcare utilization and costs before and after the program were assessed. Primary outcome measures were labour force participation for patients' average weekly earnings and cost per clinically meaningful change in Pain Self-efficacy Questionnaire, Brief Pain Inventory (BPI) Severity, and BPI interference scores (n = 224). We estimated patients, on average, earned $59 more each week at 1 month follow-up compared with baseline. The cost per clinically meaningful change in pain severity and interference score based on the BPI severity and BPI interference were AU$9452.32 (95% CI: $7031.76-$12,930.40) and AU$3446.62 (95% CI: $2851.67-$4126.46), respectively. The cost per point improvement and per clinically meaningful change in the Pain Self-efficacy Questionnaire were $483 (95% CI: $411.289-$568.606) and $3381.02, respectively. Our analysis showed a better health outcome, reduced healthcare services' cost, and reduced number of medications taken 1 month after participating in ADAPT.
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Affiliation(s)
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Australia
| | - Rupendra Shrestha
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia
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Eiamtanasate S, Smithiseth K, Zinboonyahgoon N, Korwisi B, Barke A, Rief W, Treede RD. The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting. Pain 2023; 164:2009-2015. [PMID: 37027141 DOI: 10.1097/j.pain.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023]
Abstract
ABSTRACT The International Classification of Diseases ( ICD ) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD ( ICD-10 ), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11 . The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.
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Affiliation(s)
- Sarasate Eiamtanasate
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
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Garreta-Catala I, Planas-Balagué R, Abouzari R, Carnaval T, Nolla JM, Videla S, Agulló-Ferré JL. Feasibility of a multidisciplinary group videoconferencing approach for chronic low back pain: a randomized, open-label, controlled, pilot clinical trial (EN-FORMA). BMC Musculoskelet Disord 2023; 24:642. [PMID: 37558990 PMCID: PMC10410913 DOI: 10.1186/s12891-023-06763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Low back pain is a common condition that becomes even more prevalent with aging. A non-pharmacological multidisciplinary approach for chronic non-specific low back pain (CNSLBP) has been recommended, but integrating different healthcare professionals is challenging. A multidisciplinary group videoconferencing approach (MGVA) can be helpful. Our aim was to provide evidence on MGVA's feasibility in managing CNSLBP and its impact on clinical practice. METHODS We conducted an open-label, randomized, controlled, parallel-group pilot clinical trial with CNSLBP patients irresponsive to conservative treatment. Patients between 18 and 67 years of age were randomly assigned (1:1) to either Standard-of-Care + MGVA (experimental group) or Standard-of-Care alone (control group). MGVA consisted of integrated sessions for physical rehabilitation/physiotherapy, psychology, and social work treatments. The control group received standard clinical practice treatment. The feasibility was assessed by the number of study procedures completed to at least 80% as planned. The impact on clinical practice was evaluated by the number of patients who changed their status from "candidate" to "non-candidate" to low back surgery as the treatment of choice for CNSLBP. The SF-36, Oswestry Disability Index, and TMMS-24 questionnaires were used. We performed a whole population-based descriptive analysis. RESULTS We included 20 patients, but only 18 were randomized (2 withdrew consent before randomization). The mean (SD) age was 53.1 (5.9) years, and mostly women (13/18); 7 were actively employed. In the experimental group, 6/9 (67%, 95%CI:35-88%) patients attended at least 80% of the scheduled procedures, while in the control group, 8/9 (89%, 95%CI:57-98%) did. Additionally, 1 out of 4 (25%) patients in the experimental group changed their status from "candidate" for low back surgery to "non-candidate". None of the 2 patients in the control group did so. We found differences between groups in the SF-36 mental health component (p-value:0.061), Oswestry Disability Index (p-value:0.032), and TMMS-24 Repair component (p-value:0.014) at the end of the trial favoring MGVA. CONCLUSIONS The multidisciplinary group videoconferencing approach to managing chronic non-specific low back pain was feasible, suggesting overall beneficial effects on patients' health and could play a role in changing a patient's status from "candidate" to "non-candidate" for surgery. TRIAL REGISTRATION NCT05093543 (ClinicalTrials.gov), first registered in 26/10/2021.
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Affiliation(s)
- Iago Garreta-Catala
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rosa Planas-Balagué
- Rehabilitation and Physical Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Reza Abouzari
- Rehabilitation and Physical Medicine Department, Delta del Llobregat Primary Care Center, Barcelona, El Prat de Llobregat, Spain
| | - Thiago Carnaval
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José-Luis Agulló-Ferré
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Chatprem T, Puntumetakul R, Siritaratiwat W, Hunsawong T, Boucaut R. Prevalence of Thai People with Lumbar Instability and Associated Factors: A Cross-Sectional Study. J Pain Res 2022; 15:3287-3297. [PMID: 36304488 PMCID: PMC9592730 DOI: 10.2147/jpr.s381270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Lumbar instability has been extensively reported; however, the risk factors for lumbar instability remain poorly defined, and understanding this condition better would help health professionals and their patients. Proposal To determine the prevalence of lumbar instability in Thai people with chronic low back pain (CLBP) and explore the factors associated with lumbar instability in these patients. Patients and Methods Using multistage random sampling methods, 1762 participants with CLBP were enrolled in the study from six regions of Thailand. Data were collected using a paper-based questionnaire. Participants were interviewed by physical therapists in the hospital they attended. They were classified as having lumbar instability when they attained ≥7/14 items on the lumbar instability screening tool. Univariate and multivariate regression analysese were used to determine the possible factors associated with lumbar instability. Results There were 961 (54.54%) participants with lumbar instability and 801 (45.46%) participants without. The eight factors associated with lumbar instability were: (i) age ≥40 years (AOR: 1.36; 95% CI: 1.09-1.69); (ii) body mass index ≥25 kg/m2 (AOR: 1.42; 95% CI: 1.16-1.74); (iii) having an underlying disease (AOR: 1.32; 95% CI: 1.06-1.65); (iv) frequent lifting ≥5 kg in occupational habits (AOR: 1.69; 95% CI: 1.36-2.09); (v) prolonged walking ≥4 hours per day (AOR: 1.31; 95% CI: 1.04-1.64); (vi) gardening in leisure time (AOR: 1.37; 95% CI: 1.10-1.71); (vii) other area of pain (AOR: 1.24; 95% CI: 1.01-2.52): and (viii) other area of numbness (AOR: 1.85; 95% CI: 1.50-2.27). When considering only women, prior pregnancy was associated with lumbar instability with OR of 1.76 (95% CI: 1.36-2.22), p-value <0.0001. Conclusion When treating patients with CLBP who are suspected to have lumbar instability, healthcare professionals should consider associated factors that might be modifiable targets for interventions to improve outcomes.
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Affiliation(s)
- Thiwaphon Chatprem
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Rungthip Puntumetakul, Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand, Tel +66 83 419 6186, Email
| | - Wantana Siritaratiwat
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Torkamol Hunsawong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Rose Boucaut
- International Centre for Allied Health Evidence; University of South Australia, Allied Health and Human Performance, Adelaide, Australia
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Bumma N, Kahwash R, Parikh SV, Isfort M, Freimer M, Vallakati A, Redder E, Campbell CM, Sharma N, Efebera Y, Stino A. Multidisciplinary amyloidosis care in the era of personalized medicine. Front Neurol 2022; 13:935936. [PMID: 36341129 PMCID: PMC9630033 DOI: 10.3389/fneur.2022.935936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
Amyloidosis refers to a group of conditions where abnormal protein-or amyloid-deposits in tissues or organs, often leading to organ malfunction. Amyloidosis affects nearly any organ system, but especially the heart, kidneys, liver, peripheral nervous system, and gastrointestinal tract. Neuromuscular deficits comprise some of its ubiquitous manifestations. Amyloidosis can be quite challenging to diagnose given its clinical heterogeneity and multi-system nature. Early diagnosis with accurate genetic and serologic subtyping is key for effective management and prevention of organ decline. In this review, we highlight the value of a multidisciplinary comprehensive amyloidosis clinic. While such a model exists at numerous clinical and research centers across the globe, the lack of more widespread adoption of such a model remains a major hindrance to the timely diagnosis of amyloidosis. Such a multidisciplinary care model allows for the timely and effective diagnosis of amyloidosis, be it acquired amyloid light amyloidosis (AL), hereditary transthyretin amyloidosis (hATTR), or wild type amyloidosis (TTR-wt), especially in the current era of personalized genomic medicine. A multidisciplinary clinic optimizes the delivery of singular or combinatorial drug therapies, depending on amyloid type, fibril deposition location, and disease progression. Such an arrangement also helps advance research in the field. We present our experience at The Ohio State University, as one example out of many, to highlight the centrality of a multi-disciplinary clinic in amyloidosis care.
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Affiliation(s)
- Naresh Bumma
- Division of Hematology-Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samir V. Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael Isfort
- Division of Neuromuscular Medicine, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Miriam Freimer
- Division of Neuromuscular Medicine, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Elyse Redder
- Oncology Rehabilitation, The Ohio State University James Cancer Center, Columbus, OH, United States
| | - Courtney M. Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Cardiovascular Division, Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States
| | - Nidhi Sharma
- Division of Hematology-Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yvonne Efebera
- Ohio Health, Department of Hematology/Oncology and Blood and Marrow Transplant, Columbus, OH, United States
| | - Amro Stino
- Division of Neuromuscular Medicine, Department of Neurology, The University of Michigan Medical School, Ann Arbor, MI, United States
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