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Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, Perruccio AV. Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity-Matched Analysis. Arthritis Care Res (Hoboken) 2024; 76:682-690. [PMID: 38191793 DOI: 10.1002/acr.25293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE We estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for knee osteoarthritis (OA). METHODS Patients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in an Edu+Ex program based on a propensity score fitted to a range of pretreatment covariates. After matching, between-group differences in improvement (the treatment effect) in Knee Injury and Osteoarthritis Outcome Score 12-item version (0, worst to 100, best) pain, function, and quality of life from baseline to 3 and 12 months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching. RESULTS The matched sample consisted of 522 patients (Edu+Ex, n = 261; TKA, n = 261) who were balanced on all pretreatment characteristics. At 12-month follow-up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% confidence interval [95% CI] 19.7-25.8), function (MD 21.2; 95% CI 17.7-24.4), and quality of life (MD 18.3; 15.0-21.6). Even so, at least one-third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12 months compared with 75% of patients with TKA. CONCLUSION TKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed.
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Affiliation(s)
- James J Young
- University Health Network, Toronto, Ontario, Canada, and University of Southern Denmark, Odense, Denmark
| | - Michael G Zywiel
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Vinod Chandran
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - J Rod Davey
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- University Health Network, Toronto, Ontario, Canada
| | | | - Y Raja Rampersaud
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- University Health Network and University of Toronto, Toronto, Ontario, Canada
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Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, Perruccio AV. Total Hip Arthroplasty Versus Education and Exercise: A Propensity-Matched Analysis of 266 Patients Who Have Hip Osteoarthritis. J Arthroplasty 2024:S0883-5403(24)00420-0. [PMID: 38697319 DOI: 10.1016/j.arth.2024.04.072] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) for osteoarthritis (OA) is a major health system cost. Education and exercise (Edu+Ex) programs may reduce the number of THAs needed, but supporting data is limited. This study aimed to estimate the treatment effect of THA versus Edu+Ex on pain, function, and quality of life outcomes 3- and 12-months after treatment initiation for hip OA. METHODS Patients who had hip OA who underwent THA or an Edu+Ex program were included in this propensity-matched study. In 778 patients (Edu+Ex n = 303; THA n = 475), propensity scores were based on pre-treatment characteristics, and patients were matched on a 1:1 ratio. Between-group treatment effects (pain, function, and quality of life) were estimated as the mean difference in change from pre-treatment to 3- and 12-month follow-up using linear mixed models. RESULTS The matched sample consisted of 266 patients (Edu+Ex n = 133; THA n = 133) that were balanced on all pre-treatment characteristics except opioid use. At 12-month follow-up, THA resulted in significantly greater improvements in pain (mean difference [MD] 35.4; 95% CI [confidence interval] 31.4 to 39.4), function (MD 30.5; 95% CI 26.3 to 34.7), and quality of life (MD 33.6; 95% CI 28.8 to 38.4). Between 17 and 30% of patients receiving Edu+Ex experienced a surgical threshold for clinically meaningful improvement in outcomes, compared to 84 and 90% of THA patients. CONCLUSIONS A THA provides greater improvements in pain, function, and quality of life. A significant proportion of Edu+Ex patients had clinically meaningful improvements, suggesting Edu+Ex may result in THA deferral in some patients, but confirmatory trials are needed.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - Vinod Chandran
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - J Rod Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Christian J H Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Power JD, Trifoi F, Canizares M, Perruccio AV, Shanmugaraj A, Gandhi R, Davey JR, Syed K, Mahomed NN, Veillette C, Rampersaud YR. The impact of diabetes on physical and mental health status and patient satisfaction after total hip and knee arthroplasty. PLoS One 2024; 19:e0302315. [PMID: 38656990 PMCID: PMC11042719 DOI: 10.1371/journal.pone.0302315] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To assess the impact of diabetes on physical and mental health status, as well as patient satisfaction, one-year following knee and hip total joint arthroplasty (TJA) for osteoarthritis (OA). METHODS Participants were 626 hip and 754 knee TJA patients. Pre-surgery data were collected on socio-demographics and health status. The 12-item Short Form Health Survey (SF-12) was collected pre- and one year post-surgery, and physical (PCS) and mental component (MCS) summary scores computed. One-year patient satisfaction was also recorded. Four regression models tested the effect of diabetes on: 1) PCS change score; 2) MCS change score; 3) achieving minimal clinically important improvement (MCII) on PCS; and 4) patient satisfaction ('Somewhat or Very Satisfied' vs. 'Somewhat or Very Dissatisfied'). An interaction between surgical joint and diabetes was tested in each model. RESULTS Self-reported diabetes prevalence was 13.0% (95% CI: 11.2%-14.7%) and was more common in knee 16.1% (95% CI: 13.4%-18.7%) than hip 9.3% (95% CI: 7.0%-11.5%) patients. In adjusted analyses, change scores were 2.3 units less on the PCS for those with diabetes compared to those without (p = 0.005). Patients with diabetes were about half as likely to achieve MCII as patients without diabetes (p = 0.004). Diabetes was not significantly associated with satisfaction or changes in MCS scores. Diabetes effects did not differ by surgical joint. CONCLUSIONS Findings support that diabetes has a negative impact on improvements in physical health after TJA. Considering the growing prevalence of OA and diabetes in the population, our findings support the importance of perioperative screening and management of diabetes in patients undergoing TJA.
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Affiliation(s)
- J. Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
| | - Flaviu Trifoi
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
| | - Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - J. Roderick Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N. Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Y. Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
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Mesaroli G, Davidge KM, Davis AM, Perruccio AV, Choy S, Walker SM, Stinson JN. Age and sex Differences in Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: A Scoping Review. Clin J Pain 2024:00002508-990000000-00178. [PMID: 38616343 DOI: 10.1097/ajp.0000000000001217] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Age and sex differences may exist in the frequency (incidence, prevalence) or symptoms of neuropathic pain (NP) and complex regional pain syndrome (CRPS) due to biopsychosocial factors (e.g., neurodevelopment, physiological and hormonal changes, psychosocial differences) that evolve through childhood and adolescence.2 Age and sex differences may have implications for evaluating screening and diagnostic tools and treatment interventions. OBJECTIVE To map the existing literature on pediatric NP and CRPS with respect to age and sex distributions, and age and sex differences in symptomology and frequency. METHODS A scoping literature review was conducted. Databases were searched from inception to January 2023. Data were collected on study design, setting, demographics, and age and sex differences in frequency and symptoms. RESULTS Eighty-seven studies were included. Distribution of participants with CRPS (n=37 studies) was predominantly early adolescence (10-14 years) and female sex, while NP (n=42 studies) was most commonly reported throughout adolescence (10-19 years) in both sexes. Forty-one studies examined age and sex differences in frequency; 6 studies reported higher frequency in adolescence. Very few studies (n=11) examined differences in symptomology. DISCUSSION Large epidemiological studies are required to further understand age and sex differences in frequency of pediatric NP and CRPS. Age and sex differences must be considered when evaluating screening and diagnostic tools and treatment interventions to ensure relevance and validity to both sexes and across ages. Validated tools will improve understanding of age- and sex-dependent differences in symptoms, pathophysiology, and psychosocial impact of pediatric NP and CRPS.
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Affiliation(s)
- Giulia Mesaroli
- Department of Physical Therapy, University of Toronto; Department of Rehabilitation, The Hospital for Sick Children and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kristen M Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aileen M Davis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Samantha Choy
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Suellen M Walker
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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Canizares M, Power JD, Perruccio AV, Paterson M, Mahomed NN, Rampersaud YR. High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study. J Health Serv Res Policy 2024; 29:92-99. [PMID: 38099445 PMCID: PMC10910823 DOI: 10.1177/13558196231213298] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND The characterization and influence of preoperative health care use on quality-of-care indicators (e.g., readmissions) has received limited attention in populations with musculoskeletal disorders. The purpose of this study was to characterize preoperative health care use and examine its effect on quality-of-care indicators among patients undergoing elective surgery for osteoarthritis. METHODS Data on health care use for 124,750 patients with elective surgery for osteoarthritis in Ontario, Canada, from April 1, 2015 to March 31, 2018 were linked across health administrative databases. Using total health care use one-year previous to surgery, patients were grouped from low to very high users. We used Poisson regression models to estimate rate ratios, while examining the relationship between preoperative health care use and quality-of-care indicators (e.g., extended length of stay, complications, and 90-day hospital readmissions). We controlled for covariates (age, sex, neighborhood income, rural/urban residence, comorbidities, and surgical anatomical site). RESULTS We found a statistically significant trend of increasing worse outcomes by health care use gradients that persisted after controlling for patient demographics and comorbidities. Findings were consistent across surgical anatomical sites. Moreover, very high users have relatively large numbers of visits to non-musculoskeletal specialists. CONCLUSIONS Our findings highlight that information on patients' preoperative health care use, together with other risk factors (such as comorbidities), could help decision-making when benchmarking or reimbursing hospitals caring for complex patients undergoing surgery for osteoarthritis.
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Affiliation(s)
- Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute - University Health Network, Toronto, ON, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute - University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute - University Health Network, Toronto, ON, Canada
| | - Michael Paterson
- Program Lead & Interim Chief Science Officer, ICES, Toronto, ON, Canada
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute - University Health Network, Toronto, ON, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute - University Health Network, Toronto, ON, Canada
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Perruccio AV, Young JJ, Wilfong JM, Denise Power J, Canizares M, Badley EM. Osteoarthritis year in review 2023: Epidemiology & therapy. Osteoarthritis Cartilage 2024; 32:159-165. [PMID: 38035975 DOI: 10.1016/j.joca.2023.11.012] [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: 09/19/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To highlight some important findings from osteoarthritis (OA) epidemiology and therapy research undertaken over the past year. METHODS Search of MEDLINE and EMBASE databases between April 1, 2022 to March 3, 2023 using "exp *Osteoarthritis/" as the preliminary search term. The search was limited to articles published in English and including human subjects. Final inclusions were based on perceived importance and results that may inform improved identification of risk factors or OA treatments, as well as OA subgroups of potential relevance to risk factors or treatment approaches. RESULTS 3182 studies were screened, leaving 208 eligible for inclusion. This narrative review of thirty-three selected studies was arranged into: a) OA predictors - population-based studies, b) Specific predictors of OA and OA outcome; c) Intra-articular injections, and d) OA phenotypes. There was some suggestion of sex differences in predictors of incidence or outcomes. Body mass index changes appear largely to affect knee OA outcomes. Evidence points to a lack of benefit of viscosupplementation in knee OA; findings were variable for other injectables. Studies of OA phenotypes reveal potentially relevant clinical and pathophysiological differences. CONCLUSIONS Identifying risk factors for the incidence/progression of OA represents an ongoing and important area of OA research. Sex may play a role in this understanding and bears consideration and further study. For knee injectables other than viscosupplementation, additional high-quality trials appear warranted. Continued investigation and application of phenotyping across the OA disease, illness and care spectrum may be key to developing disease-modifying agents and their appropriate selection for individuals.
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Affiliation(s)
- Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Sandhu A, Espin-Garcia O, Rockel JS, Lively S, Perry K, Mohamed NN, Raja Rampersaud Y, Perruccio AV, Robin Poole A, Gandhi R, Kapoor M. Association of synovial fluid and urinary C2C-HUSA levels with surgical outcomes post-total knee arthroplasty. Osteoarthritis Cartilage 2024; 32:98-107. [PMID: 37805006 DOI: 10.1016/j.joca.2023.09.009] [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: 02/16/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES After total knee arthroplasty (TKA), ∼30% of knee osteoarthritis (KOA) patients show little symptomatic improvement. Earlier studies have correlated urinary (u) type 2 collagen C terminal cleavage peptide assay (C2C-HUSA), which detects a fragment of cartilage collagen breakdown, with KOA progression. This study determines whether C2C levels in urine, synovial fluid, or their ratio, are associated with post-surgical outcomes. METHODS From a large sample of 489 subjects, diagnosed with primary KOA undergoing TKA, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores were collected at baseline (time of surgery) and one-year post-TKA. Baseline urine (u) and synovial fluid (sf) were analysed using the IBEX-C2C-HUSA assay, with higher values indicating higher amounts of cartilage degradation. For urine, results were normalised to creatinine. Furthermore, subjects' changes in WOMAC scores were categorised based on percent reduction in pain or improvement in function, compared to baseline, such that >66.7%, >33.3 to ≤66.7%, and ≤33.3% denoted "strong", "moderate" and "mild/worse" responses, respectively. Associations of individual biofluid C2C-HUSA levels, or their ratio, with change in WOMAC pain and function scores up to one-year post-TKA, or category of change, were analysed by linear, logistic, or cumulative odds models. RESULTS Higher baseline uC2C-HUSA levels or a lower ratio of baseline sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC pain by linear multivariable modelling [odds ratio -0.40 (95% confidence interval -0.76, -0.05) p = 0.03; 0.36 (0.01, 0.71), p = 0.04, respectively], while sfC2C-HUSA alone was not. However, lower ratios of sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC function [1.37 (0.18, 2.55), p = 0.02], while sfC2C-HUSA and uC2C-HUSA alone were not. Lower ratios of sfC2C-HUSA to uC2C-HUSA were also associated with an increased likelihood of a subject being categorised in a group where TKA was beneficial in both univariable [pain, 0.81 (0.68, 0.96), p = 0.02; function, 0.92 (0.85, 0.99), p = 0.035] and multivariable [pain, 0.81 (0.68, 0.97) p = 0.02; function, 0.92 (0.85, 1.00), p = 0.043] ordinal modelling, while sfC2C-HUSA and uC2C-HUSA alone were not. CONCLUSIONS Overall, ratios of baseline sfC2C-HUSA to uC2C-HUSA, and baseline uC2C-HUSA, may play an important role in studying post-TKA surgical outcomes.
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Affiliation(s)
- Amit Sandhu
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Dalla Lana School of Public Health and Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jason S Rockel
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kimberly Perry
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Nizar N Mohamed
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A Robin Poole
- Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Rajiv Gandhi
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Perruccio AV, Wilfong JM, Badley EM. Reply. Arthritis Care Res (Hoboken) 2023; 75:2541-2543. [PMID: 37431088 DOI: 10.1002/acr.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Anthony V Perruccio
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Jessica M Wilfong
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
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Perruccio AV, Badley EM, Antflek D, Power JD, Baltzer H. Frequency of multisite non-hand joint involvement in patients with thumb-base osteoarthritis, and associations with functional and patient-reported outcomes. Osteoarthr Cartil Open 2023; 5:100397. [PMID: 37609061 PMCID: PMC10440563 DOI: 10.1016/j.ocarto.2023.100397] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose In OA studies, the focus often is on an index-joint; other affected joint sites are often overlooked. In this thumb-base OA study, we documented the frequency of symptomatic non-hand joint sites and investigated whether their count was associated with thumb-specific functional and patient-reported outcome measures. Design Patients seeking care for thumb-base OA (conservative or surgical) were included. A patient-completed questionnaire captured sociodemographic and health characteristics, symptomatic hand and non-hand joint sites, and outcome measures (thumb-base pain intensity, symptoms and disability (TASD) and upper-extremity disability/symptoms (quickDASH)). Grip and pinch strength were measured. Linear regressions examined the association between each outcome and symptomatic joint site count, adjusted for several covariates. Results The mean age of the 145 patients was 62 years, 72% were female. Mean symptomatic non-hand joint site count was 3.6. Ten percent reported only their hands as symptomatic; 30% reported 2-3 other symptomatic sites, and 49% reported 4+. From cross-sectional multivariable analyses, a higher symptomatic non-hand joint site count was associated with worse scores for all patient-reported outcomes and grip strength. Every unit increase in joint site count (49% had a 4+ count) was associated with a 2.1-3.3 unit increase (worse) in patient-reported outcome scores (all p < 0.02). Conclusions In this sample, nearly 80% of patients had 2+ symptomatic non-hand joint sites. These symptoms were associated with worse thumb- and hand-specific outcomes, suggesting a need for awareness of whole body OA burden, with implications for outcome score interpretations, study designs, and provision of care in thumb-base OA.
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Affiliation(s)
- Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
| | - Elizabeth M. Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daniel Antflek
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - Heather Baltzer
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
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Canizares M, Power JD, Perruccio AV, Veillette C, Mahomed N, Rampersaud YR. Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study. BMJ Open 2023; 13:e074423. [PMID: 37963700 PMCID: PMC10649703 DOI: 10.1136/bmjopen-2023-074423] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery. DESIGN Population-based study. SETTING Ontario, Canada. PARTICIPANTS Ontario residents aged 66+ years who had elective orthopaedic surgery from April 2004 to March 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1 year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery. RESULTS We included 464 460 elective orthopaedic surgeries in 2004/2005-2017/2018: 80% of patients used opioids within 1 year of surgery-25.1% were chronic users. There was an 8% increase in opioid use within 1 year of surgery, from 75.1% in 2004/2005 to 80.9% in 2017/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids. CONCLUSIONS Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3 months. During a period of general increase in awareness of opioid harms and dissemination of guidelines/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.
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Affiliation(s)
- Mayilee Canizares
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Christian Veillette
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Nizar Mahomed
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
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11
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Wilfong JM, Perruccio AV, Badley EM. Examination of the Increased Risk for Falls Among Individuals With Knee Osteoarthritis: A Canadian Longitudinal Study on Aging Population-Based Study. Arthritis Care Res (Hoboken) 2023; 75:2336-2344. [PMID: 37221150 DOI: 10.1002/acr.25163] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/21/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To characterize the profile of individuals with and without knee osteoarthritis (OA) who fell, and to identify factors contributing to an individual with knee OA experiencing 1 or multiple injurious falls. METHODS Data are from the baseline and 3-year follow-up questionnaires of the Canadian Longitudinal Study on Aging, a population-based study of people ages 45-85 years at baseline. Analyses were limited to individuals either reporting knee OA or no arthritis at baseline (n = 21,710). Differences between falling patterns among those with and without knee OA were tested using chi-square tests and multivariable-adjusted logistic regression models. An ordinal logistic regression model examined predictors of experiencing 1 or more injurious falls among individuals with knee OA. RESULTS Among individuals reporting knee OA, 10% reported 1 or more injurious falls; 6% reported 1 fall, and 4% reported 2+ falls. Having knee OA significantly contributed to the risk of falling (odds ratio [OR] 1.33 [95% confidence interval (95% CI) 1.14-1.56]), and individuals with knee OA were more likely to report having a fall indoors while standing or walking. Among individuals with knee OA, reporting a previous fall (OR 1.75 [95% CI 1.22-2.52]), previous fracture (OR 1.42 [95% CI 1.12-1.80]), and having urinary incontinence (OR 1.38 [95% CI 1.01-1.88]) were significant predictors of falling. CONCLUSION Our findings support the idea that knee OA is an independent risk factor for falls. The circumstances in which falls occur differ from those for individuals without knee OA. The risk factors and environments that are associated with falling may provide opportunities for clinical intervention and fall prevention strategies.
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Affiliation(s)
- Jessica M Wilfong
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, University Health Network, Dalla Lana School of Public Health, University of Toronto, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
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12
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Rampersaud YR, Sundararajan K, Docter S, Perruccio AV, Gandhi R, Adams D, Briggs N, Davey JR, Fehlings M, Lewis SJ, Magtoto R, Massicotte E, Sarro A, Syed K, Mahomed NN, Veillette C. Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study. BMC Health Serv Res 2023; 23:1150. [PMID: 37880706 PMCID: PMC10598977 DOI: 10.1186/s12913-023-10055-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries. METHODS Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors. RESULTS The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs. CONCLUSIONS This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
| | - Kala Sundararajan
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Shgufta Docter
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Diana Adams
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Natasha Briggs
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - J Rod Davey
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Rosalie Magtoto
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Eric Massicotte
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Angela Sarro
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Khalid Syed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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13
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Power JD, Perruccio AV, Canizares M, McIntosh G, Abraham E, Attabib N, Bailey CS, Charest-Morin R, Dea N, Finkelstein J, Fisher C, Glennie RA, Hall H, Johnson MG, Kelly AM, Kingwell S, Manson N, Nataraj A, Paquet J, Singh S, Soroceanu A, Thomas KC, Weber MH, Rampersaud YR. Determining minimal clinically important difference estimates following surgery for degenerative conditions of the lumbar spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) registry. Spine J 2023; 23:1323-1333. [PMID: 37160168 DOI: 10.1016/j.spinee.2023.05.001] [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: 10/06/2022] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND CONTEXT There is significant variability in minimal clinically important difference (MCID) criteria for lumbar spine surgery that suggests population and primary pathology specific thresholds may be required to help determine surgical success when using patient reported outcome measures (PROMs). PURPOSE The purpose of this study was to estimate MCID thresholds for 3 commonly used PROMs after surgical intervention for each of 4 common lumbar spine pathologies. STUDY DESIGN/SETTING Observational longitudinal study of patients from the Canadian Spine Outcomes and Research Network (CSORN) national registry. PATIENT SAMPLE Patients undergoing surgery from 2015 to 2018 for lumbar spinal stenosis (LSS; n = 856), degenerative spondylolisthesis (DS; n = 591), disc herniation (DH; n = 520) or degenerative disc disease (DDD n = 185) were included. OUTCOME MEASURES PROMs were collected presurgery and 1-year postsurgery: the Oswestry Disability Index (ODI), and back and leg Numeric Pain Rating Scales (NPRS). At 1-year, patients reported whether they were 'Much better'/'Better'/'Same'/'Worse'/'Much worse' compared to before their surgery. Responses to this item were used as the anchor in analyses to determine surgical MCIDs for benefit ('Much better'/'Better') and substantial benefit ('Much better'). METHODS MCIDs for absolute and percentage change for each of the 3 PROMs were estimated using a receiving operating curve (ROC) approach, with maximization of Youden's index as primary criterion. Area under the curve (AUC) estimates, sensitivity, specificity and correct classification rates were determined. All analyses were conducted separately by pathology group. RESULTS MCIDs for ODI change ranged from -10.0 (DDD) to -16.9 (DH) for benefit, and -13.8 (LSS) to -22.0 (DS,DH) for substantial benefit. MCID for back and leg NPRS change were -2 to -3 for each group for benefit and -4.0 for substantial benefit for all groups on back NPRS. MCID estimates for percentage change varied by PROM and pathology group, ranging from -11.1% (ODI for DDD) to -50.0% (leg NPRS for DH) for benefit and from -40.0% (ODI for DDD) to -66.6% (leg NPRS for DH) for substantial benefit. Correct classification rates for all MCID thresholds ranged from 71% to 89% and were relatively lower for absolute vs percent change for those with high or low presurgical scores. CONCLUSIONS Our findings suggest that the use of generic MCID thresholds across pathologies in lumbar spine surgery is not recommended. For patients with relatively low or high presurgery PROM scores, MCIDs based on percentage change, rather than absolute change, appear generally preferable. These findings have applicability in clinical and research settings, and are important for future surgical prognostic work.
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Affiliation(s)
- J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; Orthopaedics, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4(th) floor, Toronto, Ontario, M5T 3M6, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, 10 Armstrong Cresent, Markdale, Ontario N0C 1H0, Canada
| | - Edward Abraham
- Canada East Spine Center and Horizon Health Network, 400 University Avenue, 3C South, Saint John, New Brunswick, E2L 4L4, Canada
| | - Najmedden Attabib
- Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, 400 University Avenue, 3B North, Saint John, New Brunswick E2L 4L4, Canada
| | - Christopher S Bailey
- London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, 1151 Richmond Street, London, Ontario N6A 5C1, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada
| | - Nicholas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada
| | - Joel Finkelstein
- Spine Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada
| | - R Andrew Glennie
- Department of Surgery, Division of Orthopedics, Dalhousie University, 6230 Coburg Rd, Halifax, Nova Scotia B3H 4J5, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, Ontario M5T 1P5, Canada
| | - Michael G Johnson
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Adrienne M Kelly
- Sault Area Hospital, Northern Ontario School of Medicine, 750 Great Northern Rd, Sault Ste. Marie, Ontario P6B 0A8, Canada
| | - Stephen Kingwell
- Division of Orthopaedic Surgery, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Neil Manson
- Canada East Spine Center and Horizon Health Network, 400 University Avenue, 3C South, Saint John, New Brunswick, E2L 4L4, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, University of Alberta, 8440 112 St NW, Edmonton, Alberta T6G 2B7, Canada
| | - Jérôme Paquet
- Hôpital de L'Enfant-Jésus, Laval University, 401 18E Rue, Quebec City, Quebec G1J 1Z4, Canada
| | - Supriya Singh
- London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, 1151 Richmond Street, London, Ontario N6A 5C1, Canada
| | - Alex Soroceanu
- University of Calgary Spine Program, University of Calgary, 2500 University Dr, NW, Calgary, Alberta T2N 1N4, Canada
| | - Kenneth C Thomas
- University of Calgary Spine Program, University of Calgary, 2500 University Dr, NW, Calgary, Alberta T2N 1N4, Canada
| | - Michael H Weber
- Division of Orthopaedics, McGill University Health Centre, 3650 Rue Saint-Urbain Bureau K 124, Montreal, Quebec H2X 2P4, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; Orthopaedics, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada.
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Young JJ, Perruccio AV, Veillette CJH, McGlasson RA, Zywiel MG. The GLA:D® Canada program for knee and hip osteoarthritis: A comprehensive profile of program participants from 2017 to 2022. PLoS One 2023; 18:e0289645. [PMID: 37535587 PMCID: PMC10399832 DOI: 10.1371/journal.pone.0289645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. METHODS The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. RESULTS At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. CONCLUSION We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian J H Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhona A McGlasson
- Bone and Joint Canada, Canadian Orthopaedic Foundation, Toronto, Ontario, Canada
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Birk M, Sidhu K, Filezio MR, Singh V, Ferri-de-Barros F, Chan V, Shumilak G, Nataraj A, Langston H, Yee NJ, Iorio C, Shkumat N, Rocos B, Ertl-Wagner B, Lebel D, Camp MW, Dimentberg E, Saran N, Laflamme M, Ouellet JA, Wenghofer J, Livock H, Beaton L, Tice A, Smit K, Graham R, Duarte MP, Roy-Beaudry M, Turgeon I, Joncas J, Mac-Thiong JM, Labelle H, Barchi S, Parent S, Gholamian T, Livock H, Tice A, Smit K, Yoon S, Zulfiqar A, Rocos B, Murphy A, Bath N, Moll S, Sorbara J, Lebel D, Camp MW, Nallet JA, Rocos B, Lebel DE, Zeller R, Dermott JA, Kim DJ, Anthony A, Zeller R, Lebel DE, Wang Z, Shen J, Kamel Y, Liu J, Shedid D, Al-Shakfa F, Yuh SJ, Boubez G, Rizkallah M, Rizkallah M, Shen J, Boubez G, Kamel Y, Liu J, Shedid D, Al-Shakfa F, Lavoie F, Yug SJ, Wang Z, Alavi F, Nielsen C, Rampersaud R, Lewis S, Cheung AM, Cadieux C, Fernandes R, Brzozowski P, Zdero R, Bailey C, Rasoulinejad P, Cherry A, Manoharan R, Xu M, Srikandarajah N, Iorio C, Raj A, Nielsen C, Rampersaud R, Lewis S, Beange K, Graham R, Livock H, Smit K, Manoharan R, Cherry A, Srikandarajah N, Raj A, Xu M, Iorio C, Nielsen CJ, Rampersaud YR, Lewis SJ, Nasrabadi AAM, Moammer G, Phee JM, Walker T, Urquhart JC, Glennie RA, Rampersaud YR, Fisher CG, Bailey CS, Herrington BJ, Fernandes RR, Urquhart JC, Rasoulinejad P, Siddiqi F, Bailey CS, Urquhart J, Fernandes RR, Glennie RA, Rampersaud YR, Fisher CG, Bailey CS, Yang MMH, Riva-Cambrin J, Cunningham J, Casha S, Cadieux CN, Urquhart J, Fernandes R, Glennie A, Fisher C, Rampersaud R, Xu M, Manoharan R, Cherry A, Raj A, Srikandarajah N, Iorio C, Nielsen C, Lewis S, Rampersaud R, Cherry A, Raj A, McIntosh G, Manoharan R, Murray JC, Nielsen C, Xu M, Srikandarajah N, Iorio C, Perruccio A, Canizares M, Rampersaud R, El-Mughayyar D, Bigney E, Richardson E, Manson N, Abraham E, Attabib N, Small C, Kolyvas G, LeRoux A, Outcomes CS, Investigators RN, Hebert J, Baisamy V, Rizkallah M, Shen J, Cresson T, Vazquez C, Wang Z, Boubez G, Lung T, Canizares M, Perruccio A, Rampersaud R, Crawford EJ, Ravinsky RA, Perruccio AV, Rampersaud YR, Coyte PC, Bond M, Street J, Fisher C, Charest-Morin R, Sutherland JM, Bartolozzi AR, Barzilai O, Chou D, Laufer I, Verlaan JJ, Sahgal A, Rhines LD, Scuibba DM, Lazary A, Weber MH, Schuster JM, Boriani S, Bettegowda C, Arnold PM, Clarke MJ, Fehlings MG, Reynolds JJ, Gokaslan ZL, Fisher CG, Dea N, Versteeg AL, Charest-Morin R, Laufer I, Teixeira W, Barzilai O, Gasbarrini A, Fehlings MG, Chou D, Johnson MG, Gokaslan ZL, Dea N, Verlaan JJ, Goldschlager T, Shin JH, O'Toole JE, Sciubba DM, Bettegowda C, Clarke MJ, Weber MH, Mesfin A, Kawahara N, Goodwin R, Disch A, Lazary A, Boriani S, Sahgal A, Rhines L, Fisher CG, Versteeg AL, Gal R, Reich L, Tsang A, Aludino A, Sahgal A, Verlaan JJ, Fisher CG, Verkooijen L, Rizkallah M, Wang Z, Yuh SJ, Shedid D, Shen J, Al-Shakfa F, Belguendouz C, AlKafi R, Boubez G, MacLean MA, Georgiopoulos M, Charest-Morin R, Germscheid N, Goodwin CR, Weber M, International AS, Rizkallah M, Boubez G, Zhang H, Al-Shakfa F, Brindamour P, Boule D, Shen J, Shedid D, Yuh SJ, Wang Z, Correale MR, Soever LJ, Rampersaud R, Malic CC, Dubreuil M, Duke K, Kingwell SP, Lin Z, MacLean MA, Julien LC, Patriquin G, LeBlanc J, Green R, Alant J, Barry S, Glennie RA, Oxney W, Christie SD, Sarraj M, Alqahtani A, Thornley P, Koziarz F, Bailey CS, Freire-Archer M, Bhanot K, Kachur E, Bhandari M, Oitment C, Malhotra AK, Balas M, Jaja BNR, Harrington EM, Hofereiter J, Jaffe RH, He Y, Byrne JP, Wilson JR, Witiw CD, Brittain KCM, Christie S, Pillai S, Dvorak MF, Evaniew N, Chen M, Waheed Z, Rotem-Kohavi N, Fallah N, Noonan VK, Fisher CG, Charest-Morin R, Dea N, Ailon T, Street J, Kwon BK, Sandarage RV, Galuta A, Ghinda D, Kwan JCS, TsaI EC, Hachem LD, Hong J, Velumian A, Mothe AJ, Tator CH, Fehlings MG, Shakil H, Jaja BNR, Zhang P, Jaffe R, Malhotra AK, Wilson JR, Witiw CD, Rotem-Kohavi N, Dvorak MF, Dea N, Evaniew N, Chen M, Waheed Z, Xu J, Fallah N, Noonan V, Kwon B, Dandurand C, Muijs S, Dvorak M, Schnake K, Cumhur, Ouml Ner, Greene R, Furlong B, Smith-Forrester J, Swab M, Christie SD, Hall A, Leck E, Marshall E, Christie S, Dvorak MF, Cumhur F, Ouml Ner, Vaccaro AR, Benneker LM, Rajasekaran S, El-Sharkawi M, Popescu EC, Tee JW, Paquet J, France JC, Allen R, Lavelle WF, Hirschfeld M, Pneumaticos S, Dandurand C, Cumhur, Ouml Ner, Muijs S, Schnake K, Dvorak M, Fernandes RR, Thornley P, Urquhart J, Kelly S, Alenezi N, Alahmari A, Siddiqi F, Singh S, Rasoulinejad P, Bailey C, Evaniew N, Burger LD, Dea N, Cadotte DW, McIntosh G, Jacobs B, St-Laurent-Lebeux L, Bourassa-Moreau É, Sarraj M, Majeed M, Guha D, Pahuta M, Laflamme M, McIntosh G, Dea N, Bak AB, Alvi MA, Moghaddamjou A, Fehlings MG, Silva YGMD, Goulet J, McIntosh G, Bedard S, Pimenta N, Blanchard J, Couture J, LaRue B, Investigators C, Adams T, Cunningham E, El-Mughayyar D, Bigney E, Vandewint A, Manson N, Abraham E, Small C, Attabib N, Richardson E, Hebert J, Bond M, Street J, Fisher C, Charest-Morin R, Sutherland JM, Hillier T, Bailey CS, Fisher C, Rampersaud R, Koto P, Glennie RA, Soroceanu A, Nicholls F, Thomas K, Evaniew N, Lewkonia P, Bouchard J, Jacobs B, Ben-Israel D, Crawford EJ, Fisher C, Dea N, Spackman E, Rampersaud R, Thomas KC, Srikandarajah N, Murray JC, Nielsen C, Manoharan R, Cherry A, Raj A, Xu M, Iorio C, Bailey C, Dea N, Fisher C, Hall H, Manson N, Thomas K, Canizares M, Rampersaud YR, Urquhart J, Fernandes RR, Glennie RA, Rampersaud YR, Fisher CG, Bailey C, Yang MMH, Far R, Sajobi T, Riva-Cambrin J, Casha S, Bond M, Street J, Fisher C, Charest-Morin R, Sutherland JM, Silva Y, Pimenta NG, LaRue B, Bedard S, Oviedo SC, Goulet J, Couture J, Blanchard J, McDonald J, Al-Jahdali F, Urquhart J, Alahmari A, Rampersaud R, Fisher C, Bailey C, Glennie A, Evaniew N, Coyle M, Rampersaud YR, Bailey CS, Jacobs WB, Cadotte DW, Thomas KC, Attabib N, Paquet J, Nataraj A, Christie SD, Weber MH, Phan P, Charest-Morin R, Fisher CG, Hall H, McIntosh G, Dea N, Malhotra AK, Davis AM, He Y, Harrington EM, Jaja BNR, Zhu MP, Shakil H, Dea N, Jacobs WB, Cadotte DW, Paquet J, Weber MH, Phan P, Christie SD, Nataraj A, Bailey CS, Johnson MG, Fisher CG, Manson N, Rampersaud YR, Thomas KC, Hall H, Fehlings MG, Ahn H, Ginsberg HJ, Witiw CD, Wilson JR, Althagafi A, McIntosh G, Charest-Morin R, Rizzuto MA, Ailon T, Dea N, Evaniew N, Jacobs BW, Paquet J, Rampersaud R, Hall H, Bailey CS, Weber M, Johnson MG, Nataraj A, Attabib N, Cadotte DW, Manson N, Stratton A, Christie SD, Thomas KC, Wilson JR, Fisher CG, Charest-Morin R, Bak AB, Alvi MA, Moghaddamjou A, Fehlings MG, Bak AB, Alvi MA, Moghaddamjou A, Fehlings MG, Soroceanu A, Nicholls F, Thomas K, Evaniew N, Salo P, Bouchard J, Jacobs B, Dandurand C, Laghaei PF, Ailon T, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon BK, Paquette S, Street J, Soroceanu A, Nicholls F, Thomas K, Evaniew N, Bouchard J, Salo P, Jacobs B, Varshney VP, Sahjpaul R, Paquette S, Osborn J, Bak AB, Moghaddamjou A, Fehlings MG, Leck E, Marshall E, Christie S, Elkaim LM, Lasry OJ, Raj A, Murray JC, Cherry A, McIntosh G, Nielsen C, Srikandarajah N, Manoharan R, Iorio C, Xu M, Perruccio A, Canizares M, Rampersaud YR, Stratton A, Tierney S, Wai EK, Phan P, Kingwell S, Magnan MC, Soroceanu A, Nicholls F, Thomas K, Evaniew N, Salo P, Bouchard J, Jacobs B, Spanninga B, Hoelen TCA, Johnson S, Arts JJC, Bailey CS, Urquhart JC, Glennie RA, Rampersaud YR, Fisher CG, Levett JJ, Elkaim LM, Alotaibi NM, Weber MH, Dea N, Abd-El-Barr MM, Cherry A, Yee A, Jaber N, Fehlings M, Cunningham E, Adams T, El-Mughayyar D, Bigney E, Vandewint A, Manson N, Abraham E, Small C, Attabib N, Richardson E, Hebert J, Werier J, Smit K, Villeneuve J, Sachs A, Abdelbary H, Al-Mosuli YK, Rakhra K, Phan P, Nagata K, Gum JL, Brown ME, Daniels CL, Carreon LY, Bonello JP, Koucheki R, Abbas A, Lex J, Nucci N, Whyne C, Larouche J, Ahn H, Finkelstein J, Lewis S, Toor J, Lee NJ, Orosz LD, Gum JL, Poulter GT, Jazini E, Haines CM, Good CR, Lehman RA, Crawford EJ, Ravinsky RA, Perruccio AV, Coyte PC, Rampersaud YR, Freire-Archer M, Sarraj M, AlShaalan F, Koziarz A, Thornley P, Alnemari H, Oitment C, Bharadwaj L, El-Mughayyar D, Bigney E, Manson N, Abraham E, Small C, Attabib N, Richardson E, Kearney J, Kundap U, Investigators C, Hebert J, Elkaim LM, Levett JJ, Niazi F, Bokhari R, Alotaibi NM, Lasry OJ, Bissonnette V, Yen D, Muddaluru VS, Gandhi P, Mastrolonardo A, Guha D, Pahuta MA, Christie SD, Vandertuin T, Ritcey G, Rainham D, Alhawsawi M, Mumtaz R, Abdelnour M, Qumquji F, Soroceanu A, Swamy G, Thomas K, Wai E, Phan P, Bhatt FR, Orosz LD, Yamout T, Good CR, Schuler TC, Nguyen T, Jazini E, Haines CM, Oppermann M, Gupta S, Ramjist J, Oppermann PS, Yang VXD, Levett JJ, Elkaim LM, Niazi F, Weber MH, Ioro-Morin C, Bonizzato M, Weil AG, Oppermann M, Ramjist J, Gupta S, Oppermann PS, Yang VXD, Jung Y, Muddalaru V, Gandhi P, Guha D, Koucheki R, Bonello JP, Abbas A, Lex JR, Nucci N, Whyne C, Yee A, Ahn H, Finkelstein J, Larouche J, Lewis S, Toor J, Dhawan A, Dhawan J, Sharma AN, Azzam DB, Cherry A, Fehlings MG, Orosz LD, Lee NJ, Yamout T, Gum JL, Lehman RA, Poulter GT, Haines CM, Jazini E, Good CR, Ridha BB, Persad A, Fourney D, Byers E, Gallagher M, Sugar J, Brown JL, Wang Z, Shen J, Boubez G, Al-Shakfa F, Yuh SJ, Shedid D, Rizkallah M, Singh M, Singh PK, Lawrence PL, Dell S, Goodluck-Tyndall R, Wade K, Morgan M, Bruce C, Silva YGMD, Pimenta N, LaRue B, Aldakhil S, Blanchard J, Couture J, Goulet J, Bednar DA, Raj R, Urquhart J, Bailey C, Christie SD, Greene R, Chaves JPG, Zarrabian M, Sigurdson L, Manoharan R, Cherry A, Iorio C, Srikandarajah N, Xu M, Raj A, Nielsen CJ, Rampersaud YR, Lewis SJ. Canadian Spine Society: 23rd Annual Scientific Conference, Wednesday, March 1 - Saturday, March 4, Fairmont Le Château Frontenac, Québec, Que., Canada. Can J Surg 2023; 66:S1-S53. [PMID: 37567613 DOI: 10.1503/cjs.006523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
| | | | | | | | | | - Vivien Chan
- Division of Neurosurgery, University of Alberta, Edmonton, Alta
- UCLA Health, Los Angeles, Calif
| | - Geoffrey Shumilak
- Division of Neurosurgery, University of Alberta, Edmonton, Alta
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, Sask
| | - Andrew Nataraj
- Division of Neurosurgery, University of Alberta, Edmonton, Alta
| | | | - Nicholas J Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Hospital for Sick Children, Toronto, Ont
| | | | | | | | | | - David Lebel
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Hospital for Sick Children, Toronto, Ont
| | - Mark W Camp
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Hospital for Sick Children, Toronto, Ont
| | | | - Neil Saran
- Division of Orthopaedic Surgery, McGill University, Montréal, Que
| | | | - Jean A Ouellet
- Division of Orthopaedic Surgery, McGill University, Montréal, Que
| | | | - Holly Livock
- Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Luke Beaton
- Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Andrew Tice
- Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Kevin Smit
- Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Ryan Graham
- Health Science Department, University of Ottawa, Ottawa, Ont
| | - Matias Pereira Duarte
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
- Division of Orthopaedic Surgery, Université de Montréal, Montréal, Que
| | | | | | - Julie Joncas
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
| | - Jean-Marc Mac-Thiong
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
- Division of Orthopaedic Surgery, Université de Montréal, Montréal, Que
| | - Hubert Labelle
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
- Division of Orthopaedic Surgery, Université de Montréal, Montréal, Que
| | - Soraya Barchi
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
| | - Stefan Parent
- Centre hospitalier universitaire Sainte-Justine, Montréal, Que
- Division of Orthopaedic Surgery, Université de Montréal, Montréal, Que
| | - Tara Gholamian
- Faculty of Medicine, University of Ottawa, Ottawa, Ont
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont
| | - Holly Livock
- Department of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Andrew Tice
- Department of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Kevin Smit
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont
- Department of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Samuel Yoon
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Hospital for Sick Children, Toronto, Ont
| | | | | | | | | | | | | | - David Lebel
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Hospital for Sick Children, Toronto, Ont
| | - Mark W Camp
- Hospital for Sick Children, Toronto, Ont
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chloe Cadieux
- London Health Sciences Centre, London, Ont
- Department of Orthopaedic Surgery, Western University, London, Ont
| | - Renan Fernandes
- London Health Sciences Centre, London, Ont
- Department of Orthopaedic Surgery, Western University, London, Ont
| | | | - Radovan Zdero
- Department of Orthopaedic Surgery, Western University, London, Ont
| | - Chris Bailey
- London Health Sciences Centre, London, Ont
- Department of Orthopaedic Surgery, Western University, London, Ont
| | - Parham Rasoulinejad
- London Health Sciences Centre, London, Ont
- Department of Orthopaedic Surgery, Western University, London, Ont
| | | | | | | | | | | | | | | | | | | | - Kristen Beange
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ont
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Ont
| | - Ryan Graham
- Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, Ont
- School of Human Kinetics, University of Ottawa, Ottawa, Ont
| | - Holly Livock
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Kevin Smit
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | | | | | | | | | | | | | | | | | | | | | - Gemah Moammer
- Grand River Hospital, Waterloo, Ont
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - John Mc Phee
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ont
| | - Taryn Walker
- London Health Sciences Centre Combined Neurosurgical and Orthpaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Jennifer C Urquhart
- London Health Sciences Centre Combined Neurosurgical and Orthpaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - R Andrew Glennie
- Departments of Orthopedics and Neurosurgery, Dalhousie University, Halifax, N.S
| | | | - Charles G Fisher
- Department of Surgery, University of British Columbia, Vancouver, B.C
| | - Chris S Bailey
- London Health Sciences Centre Combined Neurosurgical and Orthpaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Brandon J Herrington
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Schulich School of Medicine and Dentistry, Department of Surgery, Western University, London, Ont
| | - Renan R Fernandes
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Schulich School of Medicine and Dentistry, Department of Surgery, Western University, London, Ont
| | - Jennifer C Urquhart
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Lawson Health Research Institute, London Health Sciences Centre, London, Ont
| | - Parham Rasoulinejad
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Schulich School of Medicine and Dentistry, Department of Surgery, Western University, London, Ont
- Lawson Health Research Institute, London Health Sciences Centre, London, Ont
| | - Fawaz Siddiqi
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Schulich School of Medicine and Dentistry, Department of Surgery, Western University, London, Ont
- Lawson Health Research Institute, London Health Sciences Centre, London, Ont
| | - Christopher S Bailey
- London Health Sciences Centre combined Neurosurgical and Orthopaedic spine program, London, Ont
- Schulich School of Medicine and Dentistry, Department of Surgery, Western University, London, Ont
- Lawson Health Research Institute, London Health Sciences Centre, London, Ont
| | - Jennifer Urquhart
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Renan R Fernandes
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - R Andrew Glennie
- Departments of Orthopedics and Neurosurgery, Dalhousie University, Halifax, N.S
| | | | - Charles G Fisher
- Department of Surgery, University of British Columbia, Vancouver, B.C
| | - Chris S Bailey
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Michael M H Yang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
- O'Brien Institute of Public Health, Calgary, Alta
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | | | - Steven Casha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Chloe N Cadieux
- Division of Orthopaedic Surgery, Western University, London, Ont
| | | | - Renan Fernandes
- Division of Orthopaedic Surgery, Western University, London, Ont
| | - Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, N.S
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Raja Rampersaud
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | | | | | | | | | | | | | | | | | | | | | | | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | | | | | | | - Mark Xu
- Krembil Research Institute Arthritis Institute, Toronto, Ont
| | | | | | | | | | | | - Dana El-Mughayyar
- Canada East Spine Centre, Saint John, N.B
- Department of Kinesiology, University of New Brunswick, Fredericton, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Erin Bigney
- Canada East Spine Centre, Saint John, N.B
- Department of Kinesiology, University of New Brunswick, Fredericton, N.B
- Horizon Health Network, Saint John, N.B
| | - Eden Richardson
- Canada East Spine Centre, Saint John, N.B
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Neil Manson
- Canada East Spine Centre, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
- Saint John Orthopaedics, Saint John, N.B
| | - Edward Abraham
- Canada East Spine Centre, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
- Saint John Orthopaedics, Saint John, N.B
| | - Najmedden Attabib
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Chris Small
- Canada East Spine Centre, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
- Saint John Orthopaedics, Saint John, N.B
| | - George Kolyvas
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Andre LeRoux
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | | | | | - Jeff Hebert
- Department of Kinesiology, University of New Brunswick, Fredericton, N.B
| | | | | | - Jesse Shen
- Centre hospitalier de l'Université de Montréal, Montréal, Que
| | | | | | - Zhi Wang
- Centre hospitalier de l'Université de Montréal, Montréal, Que
| | - Ghassan Boubez
- Centre hospitalier de l'Université de Montréal, Montréal, Que
| | - Tiffany Lung
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ont
| | - Anthony Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ont
| | - Raja Rampersaud
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ont
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ont
| | - Eric J Crawford
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Robert A Ravinsky
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, S.C
| | - Anthony V Perruccio
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
- Schroeder Arthritis Institute, University Health Network, Toronto, Ont
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, University Health Network, Toronto, Ont
- Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Ont
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Michael Bond
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | - John Street
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Raphaele Charest-Morin
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | - Arthur R Bartolozzi
- Combined Neurological and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Ori Barzilai
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | - Dean Chou
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | - Ilya Laufer
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | - Arjun Sahgal
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | | | - Aron Lazary
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | - Michael H Weber
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | - Stefano Boriani
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | - Paul M Arnold
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | | | | | - Ziya L Gokaslan
- AO Spine Knowledge Forum Tumor, Davos, Graubünden, Switzerland
| | | | - Nicolas Dea
- Combined Neurological and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
- AO Foundation, Davos, Graubünden, Switzerland
| | | | - Raphaele Charest-Morin
- Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, B.C
| | - Ilya Laufer
- Department of Neurosurgery, New York University Langone Health, New York, N.Y
| | - William Teixeira
- Department of Orthopedic, Spine Surgery Division, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ont
| | - Dean Chou
- Department of Neurosurgery, Division of Spine Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Nicolas Dea
- Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, B.C
| | | | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, Mass
| | - John E O'Toole
- Department of Neurosurgery, Rush University, Chicago, Ill
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, N.Y
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Michael H Weber
- Spine Surgery Program, Department of Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - Addisu Mesfin
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, N.Y
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Rory Goodwin
- Department of Neurosurgery, Spine Division, Duke University, Durham, N.C
| | - Alexander Disch
- Department of Orthopaedics, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Saxony, Germany
| | - Aron Lazary
- National Center for Spinal Disorders, Budapest, Hungary
| | | | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Laurence Rhines
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Centre, Houston, Tex
| | - Charles G Fisher
- Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, B.C
| | - Anne L Versteeg
- Division of Surgery, Department of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roxanne Gal
- Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leilani Reich
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, B.C
| | - Angela Tsang
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, B.C
| | - Allan Aludino
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, B.C
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Charles G Fisher
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, B.C
| | - Lenny Verkooijen
- Division of Imaging and Cancer, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | | | | | | | | | | | | - Mark A MacLean
- Department of Surgery, Dalhousie University, Halifax, N.S
| | | | | | | | - C Rory Goodwin
- Duke University Medical Center, Duke University, Durham, N.C
| | - Michael Weber
- Combined Neurological and Orthopedic Spine Program, McGill University, Montréal, Que
| | | | | | | | | | | | | | | | | | | | | | | | - Marcia Rebecca Correale
- University Health Network, Toronto Western Hospital, Schroeder Arthritis Institute, Toronto, Ont
- Department of Physical Therapy, University of Toronto, Toronto, Ont
| | - Leslie Jayne Soever
- University Health Network, Toronto Western Hospital, Schroeder Arthritis Institute, Toronto, Ont
- Department of Physical Therapy, University of Toronto, Toronto, Ont
| | - Raja Rampersaud
- University Health Network, Toronto Western Hospital, Schroeder Arthritis Institute, Toronto, Ont
- Department of Surgery, University of Toronto, Toronto, Ont
- Krembil Research Institute, Toronto, Ont
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mohamed Sarraj
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | | | - Patrick Thornley
- Division of Orthopaedic Surgery, Western University, London, Ont
| | - Frank Koziarz
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | | | | | | | - Edward Kachur
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Colby Oitment
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | - Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Michael Balas
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Blessing N R Jaja
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Erin M Harrington
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Johann Hofereiter
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Rachael H Jaffe
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Yingshi He
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - James P Byrne
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | | | | | | | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | | | | | | | | | | | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - John Street
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Brian K Kwon
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Ryan V Sandarage
- Neurosurgery Division, University of Ottawa, Ottawa, Ont
- The Ottawa Hospital, Ottawa, Ont
| | - Ahmad Galuta
- Neurosurgery Division, University of Ottawa, Ottawa, Ont
| | | | - Jason C S Kwan
- Neurosurgery Division, University of Ottawa, Ottawa, Ont
| | - Eve C TsaI
- Neurosurgery Division, University of Ottawa, Ottawa, Ont
- The Ottawa Hospital, Ottawa, Ont
| | - Laureen D Hachem
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - James Hong
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - Alexander Velumian
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - Andrea J Mothe
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - Charles H Tator
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont
- Krembil Research Institute, University Health Network, Toronto, Ont
| | - Husain Shakil
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, Ont
- Unity Health Toronto, Toronto, Ont
| | | | | | - Rachael Jaffe
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, Ont
- Unity Health Toronto, Toronto, Ont
| | - Armaan K Malhotra
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, Ont
- Unity Health Toronto, Toronto, Ont
| | - Jefferson R Wilson
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, Ont
- Unity Health Toronto, Toronto, Ont
| | - Christopher D Witiw
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, Ont
- Unity Health Toronto, Toronto, Ont
| | | | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | - Melody Chen
- Praxis Spinal Cord Institute, Vancouver, B.C
| | | | - Jijie Xu
- Praxis Spinal Cord Institute, Vancouver, B.C
| | | | | | - Brian Kwon
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Sander Muijs
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Klaus Schnake
- Malteser Waldkrankenhaus Erlangen, Erlangen, Bavaria, Germany
| | | | - Ouml Ner
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Ryan Greene
- Division of Neurosurgery, Dalhousie University, Halifax, N.S
- Neurosurgery Division, Memorial University of Newfoundland, St. John's, N.L
| | - Bradley Furlong
- Neurosurgery Division, Memorial University of Newfoundland, St. John's, N.L
| | | | - Michelle Swab
- Neurosurgery Division, Memorial University of Newfoundland, St. John's, N.L
| | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, N.S
| | - Amanda Hall
- Neurosurgery Division, Memorial University of Newfoundland, St. John's, N.L
| | | | | | | | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | | | - Ouml Ner
- University Medical Centre Utrecht, Utrecht, Netherlands
| | | | | | | | | | | | - Jin Wee Tee
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | - John C France
- Orthopedics, West Virginia University, Morgantown, W.V
| | - Richard Allen
- Department of Orthopaedic Surgery, University of California at San Diego, San Diego, Calif
| | | | | | | | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | | | - Ouml Ner
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Sander Muijs
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaus Schnake
- Malteser Waldkrankenhaus Erlangen, Erlangen, Bavaria, Germany
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | | | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | | | | | | | | | | | | | | | - Mathieu Laflamme
- Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | | | | | | | | | | | - Julien Goulet
- Orthopaedic Surgery Division, Université de Sherbrooke, Sherbrooke, Que
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Sonia Bedard
- Neurosurgery Division, Université de Sherbrooke, Sherbrooke, Que
| | - Newton Pimenta
- Neurosurgery Division, Université de Sherbrooke, Sherbrooke, Que
| | - Jocelyn Blanchard
- Orthopaedic Surgery Division, Université de Sherbrooke, Sherbrooke, Que
| | - Jerome Couture
- Orthopaedic Surgery Division, Université de Sherbrooke, Sherbrooke, Que
| | - Bernard LaRue
- Orthopaedic Surgery Division, Université de Sherbrooke, Sherbrooke, Que
| | | | - Tyler Adams
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Erin Cunningham
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Dana El-Mughayyar
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Erin Bigney
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Amanda Vandewint
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
| | - Niel Manson
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Edward Abraham
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Chris Small
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Najmedden Attabib
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Eden Richardson
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Jeffery Hebert
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
| | - Michael Bond
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | - John Street
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Raphaele Charest-Morin
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | - Troy Hillier
- Faculty of Medicine, Dalhousie University, Halifax, N.S
| | - Chris S Bailey
- Orthopaedic Surgery Division, Western University, London, Ont
| | - Charles Fisher
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Raja Rampersaud
- Orthopaedic Surgery Division, University of Toronto, Toronto, Ont
| | | | - R Andrew Glennie
- Orthopaedic Surgery Division, Dalhousie University, Halifax, N.S
| | | | | | | | | | | | | | | | - David Ben-Israel
- Department of Orthopaedic Surgery and Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Eric J Crawford
- Orthopaedic Surgery Division, University of Toronto, Toronto, Ont
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Nicolas Dea
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Eldon Spackman
- Department of Orthopaedic Surgery and Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Raja Rampersaud
- Orthopaedic Surgery Division, University of Toronto, Toronto, Ont
| | - Kenneth C Thomas
- Department of Orthopaedic Surgery and Clinical Neurosciences, University of Calgary, Calgary, Alta
| | | | | | | | | | - Ahmed Cherry
- Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Aditiya Raj
- Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Mark Xu
- Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Carlo Iorio
- Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Chris Bailey
- London Health Sciences Centre, London, Ont
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Nicolas Dea
- Canadian Spine Outcomes and Research Network, Markdale, Ont
- Vancouver Spine Surgery Institute, Vancouver, B.C
| | - Charles Fisher
- Canadian Spine Outcomes and Research Network, Markdale, Ont
- Vancouver Spine Surgery Institute, Vancouver, B.C
| | - Hamilton Hall
- Canadian Spine Outcomes and Research Network, Markdale, Ont
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Neil Manson
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Kenneth Thomas
- Canadian Spine Outcomes and Research Network, Markdale, Ont
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | - Mayilee Canizares
- Canadian Spine Outcomes and Research Network, Markdale, Ont
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ont
| | - Yoga Raja Rampersaud
- Toronto Western Hospital, University Health Network, Toronto, Ont
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Jennifer Urquhart
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Renan R Fernandes
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - R Andrew Glennie
- Departments of Orthopedics and Neurosurgery, Dalhousie University, Halifax, N.S
| | | | - Charles G Fisher
- Department of Surgery, University of British Columbia, Vancouver, B.C
| | - Chris Bailey
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Michael M H Yang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
- O'Brien Institute of Public Health, Calgary, Alta
| | - Rena Far
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Tolulope Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Steven Casha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Michael Bond
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | - John Street
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Raphaele Charest-Morin
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C
| | | | | | | | | | | | | | | | | | - James McDonald
- Division of Orthopaedics, Department of Surgery, Memorial University of Newfoundland, St. John's, N.L
| | | | | | - Abdulmajeed Alahmari
- Division of Orthopaedics, Department of Surgery, Western University, London, Ont
| | - Raja Rampersaud
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Charles Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital and the University of British Columbia, Vancouver, B.C
| | - Chris Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, Ont
| | - Andrew Glennie
- Division of Orthopedics, Dalhousie University, Halifax, N.S
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | - Matthew Coyle
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | | | | | - W Bradley Jacobs
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | - David W Cadotte
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | - Kenneth C Thomas
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta
| | | | - Jérôme Paquet
- Department of Surgery, Université de Québec, Québec, Que
| | - Andrew Nataraj
- Neurosurgery Division, University of Alberta, Edmonton, Alta
| | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, N.S
| | - Michael H Weber
- Orthopaedic Surgery Division, McGill University, Montréal, Que
| | - Philippe Phan
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Charles G Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ont
| | | | - Nicolas Dea
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C
| | - Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont
| | - Aileen M Davis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont
| | - Yingshi He
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
| | - Erin M Harrington
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
| | - Blessing N R Jaja
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
| | - Mary P Zhu
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
| | - Husain Shakil
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - W Bradley Jacobs
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - David W Cadotte
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Jérôme Paquet
- Centre de recherche du Centre hospitalier universitaire (CHU) de Québec, CHU de Québec-Université Laval, Québec, Que
| | - Michael H Weber
- Division of Orthopedic Surgery, McGill University, Montréal, Que
| | | | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, N.S
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alta
| | - Christopher S Bailey
- Division of Orthopaedics, Western University, London Health Sciences Centre, London, Ont
| | - Michael G Johnson
- Department of Surgery, Section of Orthopaedics and Neurosurgery, University of Manitoba, Winnipeg, Man
| | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, Vancouver, B.C
| | - Neil Manson
- Canada East Spine Centre, Saint John Orthopedics, Dalhousie University, Saint John, N.B
| | - Y Raja Rampersaud
- Division of Orthopaedic Surgery and Neurosurgery, Toronto Western Hospital, Toronto, Ont
| | - Kenneth C Thomas
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ont
| | - Michael G Fehlings
- Division of Orthopaedic Surgery and Neurosurgery, Toronto Western Hospital, Toronto, Ont
| | - Henry Ahn
- Division of Orthopedic Surgery, St Michael's Hospital, Toronto, Ont
| | - Howard J Ginsberg
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, Ont
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont
| | - Jefferson R Wilson
- Canada East Spine Centre, Saint John Orthopedics, Dalhousie University, Saint John, N.B
| | - Alwalaa Althagafi
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, B.C
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, B.C
| | - Michael A Rizzuto
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, B.C
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, B.C
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, B.C
| | - Nathan Evaniew
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | - Bradley W Jacobs
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alta
| | - Jerome Paquet
- Centre de recherche du Centre hospitalier universitaire (CHU) de Québec, CHU de Québec-Université Laval, Québec, Que
| | - Raja Rampersaud
- Divisions of Orthopaedics and Neurosurgery, University of Toronto, Toronto, Ont
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ont
| | - Christopher S Bailey
- Department of Orthopedic Surgery, London Health Sciences Centre, Western University, London, Ont
| | - Michael Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Que
| | - Michael G Johnson
- Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Man
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alta
| | - Najmedden Attabib
- Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, N.B
| | - David W Cadotte
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alta
| | - Neil Manson
- Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, N.B
| | | | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, N.S
| | - Kenneth C Thomas
- Divisions of Orthopaedics and Neurosurgery, University of Toronto, Toronto, Ont
| | | | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, B.C
| | - Raphaele Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, B.C
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vishal P Varshney
- Department of Anesthesia, Providence Healthcare, Vancouver, B.C
- Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, B.C
| | - Ramesh Sahjpaul
- Department of Anesthesia, Providence Healthcare, Vancouver, B.C
- Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, B.C
- Division of Neurosurgery, University of British Columbia, Vancouver, B.C
| | - Scott Paquette
- Department of Anesthesia, Providence Healthcare, Vancouver, B.C
- Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, B.C
- Division of Neurosurgery, University of British Columbia, Vancouver, B.C
| | - Jill Osborn
- Department of Anesthesia, Providence Healthcare, Vancouver, B.C
- Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, B.C
| | | | | | | | | | | | | | | | | | | | | | | | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | | | | | | | | | - Mark Xu
- University Health Network, Toronto, Ont
| | | | | | | | - Alexandra Stratton
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - Sarah Tierney
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - Eugene K Wai
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - Philippe Phan
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - Stephen Kingwell
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | | | | | | | | | | | | | - Barend Spanninga
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, Maastricht University, Maastricht, Limburg, Netherlands
| | - Thomáy-Claire A Hoelen
- Department of Orthopaedic Surgery, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Limburg, Netherlands
| | | | - Jacobus J C Arts
- Department of Orthopaedic Surgery, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Limburg, Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, North Brabant, Netherlands
| | - Chris S Bailey
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - Jennifer C Urquhart
- London Health Sciences Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ont
| | - R Andrew Glennie
- Departments of Orthopedics and Neurosurgery, Dalhousie University, Halifax, N.S
| | | | - Charles G Fisher
- Department of Surgery, University of British Columbia, Vancouver, B.C
| | | | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montréal, Que
| | - Naif M Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Michael H Weber
- Department of Orthopaedic Surgery, McGill University, Montréal, Que
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, B.C
| | | | | | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Nadia Jaber
- University of Toronto Spine Program, University of Toronto, Toronto, Ont
| | | | - Erin Cunningham
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Tyler Adams
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Dana El-Mughayyar
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Erin Bigney
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
| | - Amanda Vandewint
- Canada East Spine Centre, Saint John, N.B
- Faculty of Medicine, Dalhousie University, Saint John, N.B
| | - Neil Manson
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Edward Abraham
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Chris Small
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | | | | | - Jeffery Hebert
- Faculty of Medicine, University of New Brunswick, Fredericton, N.B
| | - Joel Werier
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | - Kevin Smit
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
- Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - James Villeneuve
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | - Adam Sachs
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | - Hesham Abdelbary
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | | | - Kawan Rakhra
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | - Philippe Phan
- Ottawa Hospital, Ottawa, Ont
- Ottawa Hospital Research Institute, Ottawa, Ont
- Orthopaedic Surgery Division, University of Ottawa, Ottawa, Ont
| | | | | | | | | | | | | | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ont
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Johnathan Lex
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ont
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
| | - Nicholas Nucci
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ont
| | - Cari Whyne
- Holland Musculoskeletal Research Program, Sunnybrook Research Institute, Toronto, Ont
| | - Jeremie Larouche
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
- Department of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Henry Ahn
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
- Department of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Joel Finkelstein
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
- Department of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Stephen Lewis
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
- Department of Orthopedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Jay Toor
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ont
| | - Nathan J Lee
- Columbia University Medical Center, New York, N.Y
| | | | | | | | | | | | | | | | - Eric J Crawford
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Robert A Ravinsky
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, S.C
| | - Anthony V Perruccio
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
- Schroeder Arthritis Institute, University Health Network, Toronto, Ont
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, University Health Network, Toronto, Ont
- Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Ont
| | | | - Mohamed Sarraj
- Orthopaedic Surgery Division, McMaster University, Hamilton, Ont
| | - Fawaz AlShaalan
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alex Koziarz
- Orthopaedic Surgery Division, McMaster University, Hamilton, Ont
| | | | | | - Colby Oitment
- Orthopaedic Surgery Division, McMaster University, Hamilton, Ont
| | - Lalita Bharadwaj
- Orthopaedic Surgery Division, University of New Brunswick, Fredericton, N.B
| | - Dana El-Mughayyar
- Orthopaedic Surgery Division, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Erin Bigney
- Orthopaedic Surgery Division, University of New Brunswick, Fredericton, N.B
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
| | - Neil Manson
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Edward Abraham
- Canada East Spine Centre, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
- Saint John Orthopaedics, Saint John, N.B
| | - Chris Small
- Canada East Spine Centre, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
- Saint John Orthopaedics, Saint John, N.B
| | - Najmedden Attabib
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Dalhousie Medicine New Brunswick, Saint John, N.B
| | - Eden Richardson
- Canada East Spine Centre, Saint John, N.B
- Horizon Health Network, Saint John, N.B
- Canadian Spine Outcomes and Research Network, Markdale, Ont
| | | | | | | | - Jeffrey Hebert
- Orthopaedic Surgery Division, University of New Brunswick, Fredericton, N.B
| | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montréal, Que
| | | | - Farbod Niazi
- Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Rakan Bokhari
- Department of Neurology and Neurosurgery, McGill University, Montréal, Que
| | | | - Oliver J Lasry
- Department of Neurology and Neurosurgery, McGill University, Montréal, Que
| | | | | | - Varun S Muddaluru
- Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Pranjan Gandhi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont
| | | | - Daipayan Guha
- Division of Neurosurgery, McMaster University, Hamilton, Ont
| | - Markian A Pahuta
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont
| | | | | | | | | | - Mamdoh Alhawsawi
- King Saud Medical City, Riyadh, Saudi Arabia
- Ottawa Civic Hospital, Ottawa, Ont
| | | | | | - Feras Qumquji
- King Saud Medical City, Riyadh, Saudi Arabia
- Ottawa Civic Hospital, Ottawa, Ont
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcelo Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Shaurya Gupta
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Joel Ramjist
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Priscila Santos Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Victor X D Yang
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | | | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montréal, Que
| | - Farbod Niazi
- Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Michael H Weber
- Department of Orthopaedic Surgery, McGill University, Montréal, Que
| | - Christian Ioro-Morin
- Service de neurochirurgie, Département de chirurgie, Université de Sherbrooke, Sherbrooke, Que
| | - Marco Bonizzato
- Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, Que
- Department of Neuroscience and Centre interdisciplinaire sur le cerveau et l'apprentissage, Université de Montréal, Montréal, Que
| | - Alexander G Weil
- Division of Neurosurgery, St-Justine University Hospital, Montréal, Que
| | - Marcelo Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Joel Ramjist
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Shaurya Gupta
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Priscila S Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Victor X D Yang
- Department of Clinical Neurological Science, Schulich School of Medicine & Dentistry, Western University, London, Ont
- Department of Electrical Computer & Biomedical Engineering, Toronto Metropolitan University, Toronto, Ont
| | - Youngkyung Jung
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont
| | - Varun Muddalaru
- Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Pranjan Gandhi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont
| | - Daipayan Guha
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont
| | | | | | - Aazad Abbas
- Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Johnathan R Lex
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Nicholas Nucci
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ont
| | - Cari Whyne
- Sunnybrook Holland Musculoskeletal Research Program, Toronto, Ont
| | - Albert Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Henry Ahn
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- St. Michael's Hospital, Toronto, Ont
| | - Joel Finkelstein
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Jeremie Larouche
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
- Toronto Western Hospital, Toronto, Ont
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Alaina Dhawan
- Faculty of Health Sciences, Queen's University, Kingston, Ont
| | - Jillian Dhawan
- Faculty of Health Sciences, Queen's University, Kingston, Ont
| | - Ajay N Sharma
- Faculty of Health Sciences, University of California, Irvine, Calif
| | - Daniel B Azzam
- Faculty of Health Sciences, Tufts University, Boston, Mass
| | - Ahmed Cherry
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | | | | | - Nathan J Lee
- Columbia University Medical Center, New York, N.Y
| | | | | | | | | | | | | | | | | | | | | | - Elizabeth Byers
- Biomedical Engineering, Pennsylvania State University, University Park, Pa
| | | | | | - Justin L Brown
- Biomedical Engineering, Pennsylvania State University, University Park, Pa
| | | | | | | | | | | | | | | | | | | | | | - Shevaughn Dell
- University Hospital of the West Indies, Kingston, Jamaica
| | | | - Kevin Wade
- University Hospital of the West Indies, Kingston, Jamaica
| | | | - Carl Bruce
- Department of Surgery, University of the West Indies, Jamaica
| | | | - Newton Pimenta
- Surgery Department, Université de Sherbrooke, Sherbrooke, Que
| | - Bernard LaRue
- Surgery Department, Université de Sherbrooke, Sherbrooke, Que
| | - Salman Aldakhil
- Surgery Department, Université de Sherbrooke, Sherbrooke, Que
| | | | - Jerome Couture
- Surgery Department, Université de Sherbrooke, Sherbrooke, Que
| | - Julien Goulet
- Surgery Department, Université de Sherbrooke, Sherbrooke, Que
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Fine N, Lively S, Séguin CA, Perruccio AV, Kapoor M, Rampersaud R. Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum. Nat Rev Rheumatol 2023; 19:136-152. [PMID: 36702892 DOI: 10.1038/s41584-022-00888-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
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Affiliation(s)
- Noah Fine
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cheryle Ann Séguin
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Bone and Joint Institute, University of Western Ontario London, London, Ontario, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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17
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Sidhu K, Kim D, Lebel D, Alshammari A, Photopoulos G, Duarte MP, Provost M, Nielsen C, Oitment C, Cowley R, Dumas E, Dea N, Versteeg A, Eltit F, Rampersaud YR, Dandurand C, Grassner L, Alduwaisan A, Kennedy C, Christie S, Toobaie A, Algarni N, El-Mughayyar D, Pahuta M, Grassner L, Pelletier-Roy R, Bak AB, Singh S, Abbas A, Abbas A, Abbas A, Ajisebutu A, Aldahamsheh O, Martin S, Baron N, Basiratzadeh S, Beresford-Cleary N, Good C, Thomson A, Bhatt F, Bhatt F, Good C, Thomson A, Blake N, Briand MM, Shah V, Chen T, Cherry A, Rocos B, Cherry A, Chua R, Chua R, Cotter T, Coyle MJ, Dandurand C, Dandurand C, Dandurand C, Dauphinee E, Dionne A, El Bojairami I, Duarte MP, Duarte MP, Elahi MT, Ellingwood N, Ells B, Fallah N, Fernandes R, Fernandes R, Fleury C, Flórez-Jiménez S, Li P, Gennari A, Georgiopoulos M, Greene R, Yu C, Werthmann N, Hakimjavadi R, Hakimjavadi R, Heard B, Hutchison C, Kemna C, Kennedy C, Laflamme M, Laskin J, MacLean M, Mac-Thiong JM, Manson N, Manson N, Manson N, Urquhart J, Kuepper E, Pahuta M, Pahuta M, Parker E, Persad A, Phan K, Rachevitz M, Ridha B, Dhaliwal P, Sakoto S, Sarraj M, Sarraj M, Hache P, Singh S, Slosar P, Sun M, Sundararajan K, Sundararajan K, Thornley P, Thornley P, Thornley P, Thornley P, Thorogood N, Toobaie A, Belhouari S, Olotu O, Du JT, Saleh I, Varga A, Varshney V, Versteeg A, Visnjevac O, Wang Z, Wasim A, Wasim A, Wu J, Filezio M, Singh V, Ferri-de-Barros F, Dermott J, Lebel D, Machida M, Bath N, Levin D, Campbell F, Koyle M, Isaac L, Ruskin D, Brennenstuh S, Stinson J, Navarro-Ramirez R, Rabau O, Ouellet JA, Hurry J, Brooks J, Fitzgerald R, Louer C, Murphy J, Shaw KA, Smit K, El-Hawary R, Joncas J, Parent S, Duval M, Chèmaly O, Brassard F, Mac-Thiong JM, Barchi S, Labelle H, Beauséjour M, Ishimo MC, Joncas J, Labelle H, Le May S, Lewis L, Arnold K, Oitment C, Jentzsch T, Lewis S, Rienmuller A, Jentzsch T, Yashuv HS, Martin A, Nielsen C, Berven S, Ludwig T, Coyle M, Asmussen M, Edwards B, Nicholls F, Bigney E, Fleury C, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, Lebel K, LaRue B, Investigators CSORN, Gal R, Verlaan JJ, Charest-Morin R, Fisher CG, Wessels H, Verkooijen L, Ng T, Gokaslan Z, Fisher C, Dea N, Charest-Morin R, Urquhart J, Glennie A, Fisher C, Bailey C, Mcintosh G, Fisher C, Paquet J, Abraham E, Bailey C, Weber M, Johnson M, Nataraj A, Glennie A, Attabib N, Kelly A, Hall H, Rampersaud R, Manson N, Phan P, Thomas K, Dea N, Thomé C, Kögl N, Vo AK, Kramer JLK, Petr O, Visva S, Phan K, Nguyen-Luu T, Stratton A, Kingwell S, Wai E, Phan P, Puskas D, Pahuta M, Marion T, Greene R, Kehler S, Rockwood K, Urquhart J, Thornley P, Rasoulinejad P, Glennie A, Rampersaud R, Manson N, Abraham E, Fisher C, Charest-Morin R, Paquette S, Gélinas-Phaneuf N, Thomas K, Dea N, Dvorak M, Kwon B, Street J, Ailon T, Christie S, Bailey C, McIntosh G, Dea N, Charest-Morin R, Adams T, Bigney E, Cunningham E, Richardson E, Vandewint A, Attabib N, Abraham E, Manson N, Small C, LeRoux A, Kolyvas G, Investigators CSORN, Hebert J, Jiang E, Fisk F, Taliaferro K, Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dvorak MF, Wellington C, Kwon BK, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau É, Mac-Thiong JM, Moghaddamjou A, Fehlings MG, Nadeau M, Fisher C, Toor J, Larouche J, Finkelstein J, Whyne C, Yee A, Toor J, Du JT, Versteeg A, Yee N, Finkelstein J, Abouali J, Nousiainen MT, Kreder H, Whyne C, Larouche J, Toor J, Lewis S, Finkelstein J, Larouche J, Yee A, Whyne C, Dhaliwal P, Hasan M, Berrington N, Johnson M, Burger L, Nicholls F, Evaniew N, Cobetto N, Aubin CE, Larson AN, Cheng Y, Fourney D, Hakimjavadi R, Michalowski W, Viktor H, Baddour N, Wai E, Stratton A, Kingwell S, Phan P, Dandurand C, Mawhinney G, Reynolds J, Orosz L, Thomson A, Bhatt F, Guth M, Allen B, Boyd D, Grigorian J, Schuler T, Jazini E, Haines C, Orosz L, Bhatt F, Allen B, Sabet A, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Namian S, Bharara N, Jazini E, Good C, Schuler T, Haines C, Orosz L, Tewari A, Roy R, Good C, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Bhatt F, Grigorian J, Schuler T, Haines C, Merril J, Roy R, Jazini E, Wang M, Orosz L, Haines C, Jazini E, Bhatt F, Sabet A, Roy R, Schuler T, Good C, Greene R, Schmidt M, Christie S, Richard-Denis A, Le MT, Lim V, Mac-Thiong JM, Gallagher M, Cheung A, Brown J, Chaudhry H, Yee C, McIntosh G, Christie S, Fisher C, Jarzem P, Roy JF, Bouchard J, Yee A, Eseonu K, Ahn H, Cherry A, Rampersaud R, Davidson B, Rabinovitch L, Nielsen C, Jiang F, Vaisman A, Lewis S, Canizares M, Rampersaud R, Investigators CSORN, Avila M, Burket A, Aguilar-Salinas P, Mongrain R, Ouellet J, Driscoll M, Schmidt-Braekling T, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaule P, Grammatopoulos G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Wilson J, Hall H, Bailey CS, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, Mcintosh G, Rasoulinejad P, Charest-Morin R, Hindi M, Farimani PL, Mashayekhi MS, Ailon T, Boyd M, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Urquhart J, Ailon T, Bailey C, Boyd M, Charest-Morin R, Dea N, Dvorak M, Glennie A, Kwon B, Paquette S, Rampersaud R, Street J, Fisher C, Vandewint A, Bigney E, El-Mughayyar D, Richardson E, Edward A, Manson N, Attabib N, Kolyvas G, Small C, Investigators CSORN, Mac-Thiong JM, Barthélémy D, Lim V, Richard-Denis A, Driscoll M, Aubin CE, Cobetto N, Roy-Beaudry M, Bellefleur C, Turgeon I, Labelle H, Barchi S, Parent S, Joncas J, Parent S, Labelle H, Barchi S, Mac-Thiong JM, Lee W, Phan P, Bigney E, Richardson E, El-Mughayyar D, Vandewint A, Abraham E, Manson N, Small C, Alugo T, Leroux A, Kolyvas G, Investigators CSORN, Attabib N, McIntosh G, Oxner W, Dunning PC, Glennie A, Wang D, Humphreys S, Noonan V, Urquhart J, Siddiqi F, Rasoulinejad P, Bailey C, Urquhart J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Fisher C, Bailey C, Investigators CSORN, Bigney E, Dumas E, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, LaRue B, Investigators CSORN, Macthiong JM, Bourassa-Moreau E, Ogden C, Gallagher M, Cheung A, Huong VT, Tarabay B, Al-Shakfa F, Yuh SJ, Shedid D, Boubez G, Wang Z, Gueziri HE, Santaguida C, Collins DL, Hall A, Alant J, Barry S, Weise L, Glennie A, Oxner B, Etchegary H, Christie S, Carreon L, Glassman S, Brown M, Daniels C, Polly D, Gum J, Gum J, Glassman S, Brown M, Daniels C, Carreon L, Hong HA, Fallah N, Humphreys S, Walden K, Noonan VK, Phan P, Basiratzadeh S, Wai EK, Phan P, Salo P, Krawetz R, Hart D, Bains I, Swamy G, Yang Q, Godoy A, Smith S, Lin C, Nataraj A, Puskas D, Pahuta M, Marion T, Dea N, Waheed Z, Thorogood N, Nightingale T, Noonan V, Touchette C, Duda T, Almojuela A, Bergeron D, Aljoghaiman M, Sader N, Kameda-Smith M, Alant J, Christie S, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Labelle H, Pereira P, Charles YP, Krutko A, Santos C, Park Y, Arzoglou V, Park SW, Franke J, Fuentes S, He S, Hosszu T, Varanda P, Mlyavykh S, Vanhauwaert D, Senker W, Franke J, Park Y, Charles YP, Santos C, Arzoglou V, Song Y, He S, Bhagat S, Hong JY, Vanhauwaert D, Senker W, Pereira P, Senker W, Charles YP, Pereira P, Santos C, Park Y, Arzoglou V, Park SW, Bordon G, Fuentes S, Song Y, Vialle E, Bhagat S, Krutko A, Franke J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Abraham E, Ailon T, Charest-Morin R, Dea N, Dvorak M, Gélinas-Phaneuf N, Kwon B, Manson N, Paquette S, Street J, Thomas K, Fisher C, Bailey C, Mishreky A, Hurry J, El-Hawary R, Jiang E, Fisk F, Taliaferro K, Dea N, Investigators CSORN, Al Anazi M, El-Hawary R, Kindrachuk M, Noyes E, Wu A, Fourney D, Pratt M, Wai E, Stratton A, Kingwell S, Wang Z, Phan P, Robarts S, Razmjou H, Yee A, Larouche J, Finkelstein J, Persad A, Huschi Z, Cheng Y, Fourney D, Rossong H, Zhang H, Johnson M, Goytan M, Zarrabian M, Berrington N, Zeiler F, Charles A, Roy-Beaudy, Parent S, Duong L, Marion T, Guha D, Pahuta M, Hache P, Oitment C, Guha D, Pahuta M, Sarraj M, Oitment C, Guha D, Pahuta M, Miyanji F, McAnany S, Cheung A, Dewitt D, Street J, Jurisica I, Perruccio AV, Rampersaud YR, Niu Y, Perruccio AV, Jurisica I, Rampersaud YR, Glennie A, Alahmari A, Al-Jahdali F, Fisher C, Rampersaud R, Urquhart J, Bailey C, Urquhart J, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Harback K, Akpinar I, Adjetey C, Tindall D, Chernesky J, Noonan V, Fernandes RJR, Bailey C, Siddiqi F, Rasoulinejad P, Toor J, Abbas A, Brooks H, Larouche J, Abbas A, Bhatia A, Selimovic D, Larouche J, Yee A, Lewis S, Finkelstein J, Toor J, Abbas A, Toor J, Versteeg A, Finkelstein J, Toor J, Abbas A, Ahn H, Larouche J, Finkelstein J, Whyne C, Yee A, Slomp F, Thiessen E, Lastivnyak N, Maclean LS, Ritchie V, Hockley A, Osborn J, Paquette S, Sahjpaul R, Gal R, Charest-Morin R, Verlaan JJ, Wessels H, Fisher CG, Verkooijen L, Pastrak M, Truong VT, Liberman M, Al-Shakfa F, Yuh SJ, Soder SA, Wu J, Sunna T, Renaud-Charest É, Boubez G, Shedid D, Balasuberamaniam P, Shrikumar M, Chen T, Anthony T, Phillips A, Nathens A, Chapman M, Crawford E, Stark R, Schwartz C, Finkelstein J, Small C, Rampersaud R. Canadian Spine SocietyAbstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments?Abstract 74. How useful is prereferral spine imaging? A quality improvement projectAbstract 82. Early recovery after surgery, predictors of shorter length of stayAbstract 68. Gliding screws on early-onset scoliosis: a 5-year experienceAbstract 66. Reliability of radiographic assessment of growth modulation from anterior vertebral body tethering surgery in pediatric scoliosisAbstract 16. A dangerous curve: impact of the COVID-19 pandemic on brace treatment in adolescent idiopathic scoliosisAbstract 24. Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosisAbstract 94. Recognizing the importance of self-image in adult spinal deformity: results from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS)Abstract 25. Assessing pain as a primary factor in the surgical treatment of adult spinal deformity surgery in patients over 60 years of ageAbstract 72. Application of the Ames-International Spine Study Group (AMES) radiographic modifiers to an asymptomatic population. Are the thresholds for “normal” appropriate?Abstract 109. Exploring the relationship between cannabis and narcotic use on preoperative health considerations in Canadian thoracolumbar patients: a CSORN studyAbstract 36. Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyAbstract 91. What do patients expect of palliative treatment for symptomatic spinal metastases? A qualitative studyAbstract 44. Denosumab for giant cell tumours of the spine: molecular predictors of clinical response — a pilot studyAbstract 89. Surgical management and outcomes from “stable” degenerative spondylolisthesis (DS) from the CSORN prospective DS study: What the @#$ % are we doing?Abstract 33. Economic consequences of waiting for lumbar disc herniation surgeryAbstract 108. Motor recovery depends on timing of surgery in patients with lumbar disc herniationAbstract 106. Outcomes following revision decompression for lumbar spinal stenosis when compared to primary decompression: a matched cohort analysis using the Canadian Spine Outcomes and Research Network registryAbstract 64. Patient engagement, remote monitoring and virtual care — a pilot project in rural and remote patients undergoing elective lumbar surgeryAbstract 84. Development of a frailty index from the Canadian Spine Outcomes and Research Network (CSORN) to predict long-term success of surgery for patients with degenerative pathologies of the spineAbstract 102. Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis: analysis from the CSORN prospective LDS propensity score matched studyAbstract 31. Impact on patient-reported outcomes of ending the posterior construct proximally at C2 versus C3 in degenerative cervical myelopathy patientsAbstract 42. Perioperative factors predict 2-year trajectories of pain and disability following anterior cervical discectomy and fusionAbstract 61. Calculating utilities from the modified Japanese Orthopaedic Association score: a prerequisite for quantifying the value of care for cervical myelopathyAbstract 119. Serum neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP) biomarkers and their association with MRI findings in human acute traumatic spinal cord injuryAbstract 95. The Montreal Acute Classification of Spinal Cord Injury (MAC-SCI): a new tool to detect and characterize spinal cord injury in the trauma patientAbstract 118. Mechanism of injury is associated with neurologic outcomes after cervical sensorimotor complete acute traumatic spinal cord injuryAbstract 13. Patient perspective: diagnosis and prognosis of acute spinal cord injuriesAbstract 136. Predictive analytics to improve dedicated spine trauma operating room resource allocationAbstract 138. Machine learning models to predict surgical resident workload at a level 1 trauma centreAbstract 139. Machine learning to predict duration of surgery and length of stay for single-level discectomy proceduresAbstract 9. Outpatient spinal surgery in ManitobaAbstract 131. Unexpected positive culture in presumed aseptic revision spine surgery: a systematic review and meta-analysisAbstract 50. Lumbar anterior vertebral body tethering: biomechanical assessment of the surgical decision factors influencing the immediate and 2 years postoperative correctionAbstract 145. Does prolonged symptom duration influence surgical outcomes for cervical radiculopathy?Abstract 147. A data-driven cluster analysis approach to create homogenous subgroups for traumatic spine injury: toward improving traditional classificationAbstract 41. The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spineAbstract 5. Complications, revision rates and accuracy of robotic-guided S2 alar-iliac screw placementAbstract 6. Opioid use after spine surgery: How much are we over-prescribing?Abstract 7. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at 1 yearAbstract 8. Augmented reality–assisted spine surgery: an early experience demonstrating safety and accuracy with 218 screwsAbstract 22. Comparison of complications, revision rates and fluoroscopy time using the latest technology in robotic-guided surgery with historical fluoroscopic-guided controlsAbstract 23. Robotic-guided thoracolumbar fusion experience: a multi-surgeon, single-centre study of 628 patients and 3874 robotic-guided screws from 2012 to 2020Abstract 86. A province-wide assessment of the appropriateness of lumbar spine MRIAbstract 134. Concomitant traumatic spinal cord injury and brain injury diagnoses are more frequent and impactful than expectedAbstract 45. Spatial and depth mapping of nascent mineralization on Ti6Al4V surfaces demonstrating hierarchical macro-micro-nanoscale surface featuresAbstract 111. Propensity-matched outcomes comparing lumbar interbody fusion and total disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyAbstract 30. A Canadian-based pilot study of current surgical practice and implant preferences in lumbar fusion surgeryAbstract 32. Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusionsAbstract 99. Comparing patient preoperative expectations and postoperative expectation fulfillment between minimally invasive versus open fusion surgeryAbstract 146. Outpatient robotic-assisted lumbar spinal fusion using the Mazor X Stealth EditionAbstract 149. Lessons learned from my first 100 robotic-assisted lumbar fusions using the Mazor X Stealth Edition: surgical synergy with MIS, surgical navigation and roboticsAbstract 151. Freehand biomechanical testing for use in lumbar discectomy trainingAbstract 48. Spinal pathology and outcome post-THA: Does segment of arthrodesis matter?Abstract 27. Patient, surgical and institutional factors associated with length of stay in degenerative lumbar spine surgery: national multicentre cohort analysis from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 28. The impact of the increasing proportion of degenerative spine emergency admissionsAbstract 51. Patient’s expectations of surgery for degenerative spondylolisthesis: analysis by site and type of surgery from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 60. The impact of sex on thoracolumbar surgery outcomes in patients with diabetes — a CSORN studyAbstract 81. The impact of older age on rehabilitation outcomes following functional motor-incomplete traumatic spinal cord injuryAbstract 47. Devise and investigate a novel, intramuscular pressure based, muscle activation strategy in a spine stability modelAbstract 17. 3D radiologic outcomes for patients with moderate idiopathic scoliosis curves treated with internal (anterior vertebral growth modulation) versus external bracing: a 2-year observational studyAbstract 18. Is quality of life affected by concomitant isthmic spondylolisthesis when undergoing surgery for adolescent idiopathic scoliosis and nonsurgical management of the spondylolisthesis?Abstract 128. Toward macrostructural and microstructural investigation of the cervical spinal cord through quantitative analysis of T2-weighted and diffusion-weighted imagingAbstract 26. Minimally invasive versus open thoracolumbar spine surgery for patients who have lumbar spinal stenosis and an ASA score of 3 or above: a CSORN studyAbstract 101. Association between surgeon age and outcomes of spine surgery: a population-based retrospective cohort studyAbstract 77. Utilizing machine learning methodology to create a short form of the Multi-Morbidity Index in spinal cord injuryAbstract 70. Ten-year reoperation rate and clinical outcome in patients treated surgically for lumbar spinal stenosisAbstract 105. Assessing the importance of radiographic and clinical parameters when choosing decompression without fusion for LDS: results from the CSORN prospective DS studyAbstract 104. Preoperative cannabis use in Canadian thoracolumbar spine surgery patients: a CSORN studyAbstract 142. Post-traumatic ascending myelitis, about 2 cases, etiologic analysis and treatmentAbstract 55. NanoLOCK surfaces enhance osteoblast activities at the cellular levelAbstract 76. Which scoring system is the most accurate for predicting survival in patients undergoing surgery for spinal metastases from lung cancer?Abstract 11. Pedicle screw insertion using ultrasound-based navigation without intraoperative radiation: feasibility study on porcine cadaversAbstract 85. What barriers prevent patients being discharged from hospital following elective spine surgery?Abstract 15. Propensity-matched comparison of 90-day complications in robotic-assisted versus non-robotic-assisted lumbar fusionAbstract 56. No-tap (2-step) robotic-assisted cortical bone trajectory (RA-CBT) screw insertion is safe and efficient: comparative analysis of 179 patients and 924 RA-CBT screwsAbstract 124. Developing a Web-based application to promote the adoption of a clinical prediction model for independent walking in people with traumatic spinal cord injury — a protocolAbstract 125. Multivariable prediction models for prognostication after traumatic spinal cord injury — a systematic reviewAbstract 148. Expression of blood serum cytokines in the presentation of acute sciaticaAbstract 150. Do patient-reported outcome scores (PROs) correlate with bundled payment plan performance for elective spine surgeries?Abstract 46. Effects of delayed neurosurgery on anxiety, depression and economic burdenAbstract 69. Care close to home — a retrospective analysis of patients undergoing elective lumbar surgery in a rural satellite hospitalAbstract 110. Surgical adverse events for primary tumours of the spine and their impact on prognosis and outcomes: a PTRON studyAbstract 80. Spinal cord stimulation research in the restoration of function for individuals living with spinal cord injuries: a scoping reviewAbstract 132. Workup and management of asymptomatic extracranial traumatic vertebral artery injury: a Canadian Neurosurgery Resident Research Collaborative studyAbstract 12. A surgical treatment algorithm for restoring pelvic balance and health-related quality of life in high-grade lumbosacral spondylolisthesisAbstract 38. Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre studyAbstract 39. Clinical outcomes and fusion success in patients with degenerative lumbar disease without spondylolisthesis: comparing anterolateral to posterior MIS approaches from a global multicentre studyAbstract 40. Anterolateral versus posterior approaches to minimally invasive interbody fusion for patients with spondylolisthesis: results at 1-year follow-up from a global multicentre studyAbstract 73. Benefit of minimally invasive lumbar interbody fusion versus traditional interbody fusion versus posterolateral spinal fusion in lumbar degenerative spondylolisthesis: a propensity-matched analysis from the CSORN prospective LDS studyAbstract 67. The effect of fusionless pediatric scoliosis surgery on 3D radiographic spinopelvic alignmentAbstract 62. Calculating utilities from the Neck Disability Index: a prerequisite for quantifying the value of cervical spine careAbstract 63. The psychometric properties of the mJOA for quality-of-life assessments in cervical myelopathyAbstract 59. Low radius of curvature growth friendly implants increases the risk of developing clinically significant proximal junctional kyphosisAbstract 144. Very long–term outcome of single-level minimally invasive lumbar microdiscectomy with a tubular retractorAbstract 112. Metal implant hypersensitivity in patients undergoing spinal surgery: a literature review and case reportAbstract 43. Diagnostic value of the lumbar spinal stenosis (SSHQ) survey in virtual care provided at a tertiary spine programAbstract 54. Is the Calgary Postoperative Pain After Spine Surgery (CAPPS) score correlated with long-term outcomes after lumbar fusion?Abstract 4. Development of a single-entry referral pathway for patients with spinal conditions in Manitoba: a cross-sectional review of impact and potential way forward for Canadian spine programsAbstract 113. Automatization of bone age calculationAbstract 123. An effectiveness and quality-of-life analysis of conservative care versus surgery for moderate and severe cervical myelopathyAbstract 133. Long-term survivorship of cervical spine procedures: a survivorship meta-analysis and meta-regressionAbstract 137. Natural history of degenerative cervical myelopathy: a meta-analysis and neurologic deterioration survival curve synthesisAbstract 14. Does intraoperative vancomycin powder affect postoperative infections in adolescent idiopathic scoliosis?Abstract 37. The clinical impact of nano-surface technology on postoperative opioid consumption in patients undergoing anterior lumbar interbody fusionAbstract 130. Design and implementation of a comprehensive perioperative complex spine communication toolAbstract 87. Stratifying low back pain patients in an inter-professional education and self-management model of care: results of a latent class analysisAbstract 88. Cohort accuracy versus confidence at the patient level: clinical challenges for AI-based prediction of low back pain outcomesAbstract 96. Preoperative disc angle is an important predictor of segmental lordosis after degenerative spondylolisthesis fusionAbstract 97. Preoperative depression, functional and radiographic outcomes after surgery for degenerative lumbar spondylolisthesisAbstract 116. A CSORN study of functional outcomes after surgery for lumbar degenerative spondylolisthesisAbstract 121. A CSORN study of the effect on radiographic alignment outcomes with different surgery type for degenerative lumbar spondylolisthesisAbstract 79. Spinal cord stimulation to restore neurological function: a costing analysisAbstract 107. Biomechanical properties of a novel morselized bone graft cageAbstract 93. Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating roomAbstract 103. Machine learning models can predict subsequent publication of North American Spine Society Annual General Meeting abstractsAbstract 117. The use of primary sacroiliac joint fusion for lower back pain due to sacroiliac joint pathology: a systematic review and meta-analysisAbstract 141. How to make the most of your operative time by optimizing surgical schedulingAbstract 126. Altering physician referral practices remains a challenge: a spine assessment clinic quality improvement studyAbstract 152. Outcomes of workers’ compensation patients undergoing neuromodulation for persistent neuropathic pain conditionsAbstract 90. Expectations of treatment outcomes in patients with spinal metastases: What do we tell our patients? A qualitative studyAbstract 52. Fluoroscopically guided radiofrequency ablation of the superior cluneal nerve: preliminary outcomes data for a minimally invasive approach for treating superior cluneal neuralgiaAbstract 21. Single-stage posterior approach for en bloc resection and spinal reconstruction of T4 Pancoast tumour invading spineAbstract 34. Predictors of sacral ulcers in patients with complete spinal cord injuryAbstract 135. Targeting geographic wait time disparities in Canada: a rapid review of domestic and international strategies to reduce orthopedic wait times in the MaritimesAbstract 143. The influence of coronal plane parameters on patient-reported outcome measures in patients undergoing decompression for lumbar spinal stenosis. Can J Surg 2022. [DOI: 10.1503/cjs.011622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Badley EM, Zahid S, Wilfong JM, Perruccio AV. Relationship Between Body Mass Index and Osteoarthritis for Single and Multisite Osteoarthritis of the Hand, Hip, or Knee: Findings From a Canadian Longitudinal Study on Aging. Arthritis Care Res (Hoboken) 2022; 74:1879-1887. [PMID: 34121361 DOI: 10.1002/acr.24729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/10/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether an apparent association between hand osteoarthritis (OA) and adiposity is explained by the presence of OA at other joint sites. METHODS Data from the Canadian Longitudinal Study on Aging, first cycle, comprehensive cohort, were used. Respondents age 45-85 years (n = 18,279) were asked separate questions about doctor-diagnosed OA in the hand, hip, or knee. Multinomial logistic regression was used to investigate the relationship between all combinations of hand, hip, and knee OA and body mass index (BMI) and waist-to-height ratio (WHtR). RESULTS OA was reported by 34.6% of respondents, 28.0% with OA at >1 joint site. Hand OA was not significantly associated with BMI after accounting for OA at other joint sites, with similar findings for WHtR. All joint site combinations containing the knee were strongly associated with BMI, with odds ratios (ORs) ranging from OR 2.92 (95% confidence interval [95% CI] 2.53-3.37) for knee OA only with obesity class I to OR 9.98 (95% CI 7.12-13.88) for multi-joint knee, hip, hand OA with obesity class II/III. BMI distributions including knee OA were broader and shifted to higher BMI levels than those for hand or hip OA. CONCLUSION Apparent associations between hand OA and BMI may be explained by concurrent OA at other joint sites. Recognizing that OA is a multi-joint disease is crucial for studies of the associations of adiposity with OA in a particular joint, especially the hand. The association between knee OA and BMI appears to be distinct from those for OA at other joint sites.
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Affiliation(s)
- Elizabeth M Badley
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shatabdy Zahid
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Jessica M Wilfong
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Costello CA, Rockel JS, Liu M, Gandhi R, Perruccio AV, Rampersaud YR, Mahomed NN, Rahman P, Randell EW, Furey A, Kapoor M, Zhai G. Individual participant data meta-analysis of metabolomics on sustained knee pain in primary osteoarthritis patients. Rheumatology (Oxford) 2022; 62:1964-1971. [PMID: 36124971 PMCID: PMC10152299 DOI: 10.1093/rheumatology/keac545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Knee pain is the major driver for osteoarthritis (OA) patients to seek healthcare; but after pursuing both conservative and surgical pain interventions, approximately 20% of patients continue to report long-term pain following total knee arthroplasty (TKA). The study aimed to identify a metabolomic signature for sustained knee pain after TKA to elucidate possible underlying mechanisms. METHODS Two independent cohorts from St. John's, NL, Canada (n = 430), and Toronto, ON, Canada (n = 495) were included in the study. Sustained knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (five questions) at least one year after TKA for primary OA. Those reporting any pain on all five questions were considered to have sustained knee pain. Metabolomic profiling was performed on fasted pre-operative plasma samples using the Biocrates Absolute IDQ p180 kit. Associations between metabolites and pair-wise metabolite ratios with sustained knee pain in each individual cohort were assessed using logistic regression with adjustment for age, sex, and BMI. Random-effects meta-analysis using inverse variance as weights was performed on summary statistics from both cohorts. RESULTS One metabolite, phosphatidylcholine (PC) diacyl (aa) C28:1 (OR = 0.66, p = 0.00026), and three metabolite ratios, PC aa C32:0 to PC aa C28:1, PC aa C28:1 to PC aa C32:0, and tetradecadienylcarnitine (C14:2) to sphingomyelin C20:2 (ORs=1.59, 0.60, and 1.59, respectively; all p < 2 × 10-5), were significantly associated with sustained knee pain. CONCLUSIONS Though further investigations are needed, our results provide potential predictive biomarkers and drug targets that could serve as a marker for poor response and be modified pre-operatively to improve knee pain and surgical response to TKA.
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Affiliation(s)
- Christie A Costello
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jason S Rockel
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Ming Liu
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Rajiv Gandhi
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute for Health Policy, Management & Evaluation, Dalla Lana School of Public Health.,Department of Surgery, Faculty of Medicine, University of Toronto
| | - Y Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nizar N Mahomed
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Proton Rahman
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Edward W Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrew Furey
- Division of Orthopaedics, Faculty of Medicine, Memorial University of Newfoundland; Office of the Premier, Province of Newfoundland & Labrador, St. John's, NL, Canada
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Guangju Zhai
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Rampersaud YR, Canizares M, Perruccio AV, Abraham E, Bailey CS, Christie SD, Evaniew N, Finkelstein JA, Glennie RA, Johnson MG, Nataraj A, Paquet J, Phan P, Weber MH, Thomas K, Manson N, Hall H, Fisher CG. Fulfillment of Patient Expectations After Spine Surgery is Critical to Patient Satisfaction: A Cohort Study of Spine Surgery Patients. Neurosurgery 2022; 91:173-181. [PMID: 35442936 PMCID: PMC9165646 DOI: 10.1227/neu.0000000000001981] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient satisfaction is an important indicator used to monitor quality of care and outcomes after spine surgery. OBJECTIVE To examine the complex relationship between preoperative expectations, fulfillment of expectations, postsurgical outcomes, and satisfaction after spine surgery. METHODS In this national study of patients undergoing elective surgery for degenerative spinal conditions from the Canadian Spine Outcomes and Research Network Registry, we used logistic regression to examine the relationships between patient satisfaction with surgery (1-5 scale), preoperative expectation score (0 = none to 100 = highest), fulfillment of expectations, and disability and pain improvement. RESULTS Fifty-eight percent of patients were extremely satisfied, and 3% were extremely dissatisfied. Expectations were variable and generally high (mean 79.5 of 100) while 17.3% reported that none of their expectations were met, 49.8% reported that their most important expectation was met, and 32.9% reported that their most important expectation was not met but others were. The results from the fully adjusted ordinal logistic model for satisfaction indicate that satisfaction was higher among patients with higher preoperative expectations (odds ratio [OR] [95% CI]: 1.11, [1.04-1.19]), reporting important improvements in disability (OR [95% CI]: 2.52 [1.96-3.25]) and pain (OR [95% CI]: 1.64 [1.25-2.15]) and reporting that expectations were fulfilled (OR = 80.15, for all expectations were met). The results were similar for lumbar and cervical patients. CONCLUSION Given the dominant impact of expectation fulfillment on satisfaction level, there is an opportunity for improving overall patient satisfaction by specifically assessing and mitigating the potential discrepancies between patients' preoperative expectations and likely surgical outcomes. The findings are likely relevant across elective surgical populations.
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Affiliation(s)
- Y. Raja Rampersaud
- Schroeder Arthritis Institute & Division of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V. Perruccio
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Edward Abraham
- Department of Orthopaedic Surgery, Horizon Health Network, Saint John Orthopedics, Saint John, New Brunswick, Canada
| | - Christopher S. Bailey
- London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Sean D. Christie
- Department of Surgery (Neurosurgery) Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nathan Evaniew
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Michael G. Johnson
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Nataraj
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Paquet
- Centre de Recherche CHU de Quebec-Universite Laval, Québec City, Québec, Canada
| | - Philippe Phan
- Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, Ontario, Canada
| | - Michael H. Weber
- Department of Surgery, McGill University and Montreal General Hospital, Montreal, Quebec, Canada
| | - Kenneth Thomas
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Neil Manson
- Department of Orthopaedic Surgery, Horizon Health Network, Saint John Orthopedics, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Vancouver General Hospital and the University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia, Canada
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Badley EM, Wilfong JM, Chan CH, Canizares M, Perruccio AV. I don’t know what type of arthritis I have: A population-based comparison of people with arthritis who knew their specific type and those who didn’t. PLoS One 2022; 17:e0270029. [PMID: 35727744 PMCID: PMC9212124 DOI: 10.1371/journal.pone.0270029] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To understand differences between people with arthritis who do not know their type (DK) compared to those reporting osteoarthritis (OA) or inflammatory and autoimmune types of arthritis (IAA), including the receipt of appropriate health care, information, and services. Methods Analysis of the Survey on Living with Chronic Disease in Canada–Arthritis Component. Respondents aged ≥20 years with health professional-diagnosed arthritis (n = 4,385) were characterized as reporting DK, OA or IAA. Variables: arthritis characteristics (duration, number and site of joints affected), arthritis impact (current pain and fatigue, difficulty in sleeping and daily activities, impact on life), health (self-rated general and mental health, life stress), arthritis management strategies (seeing health professionals, medication use, assistive devices, receipt of arthritis information, self-management activities). Multinomial logistic and log-Poisson regressions were used, as appropriate, to compare the DK to the OA and IAA groups. Results In this arthritis sample, 44.2% were in the DK group, 38.3% reported OA and 17.5% reported IAA. Those in the DK group were more likely to be younger, have low income, low education, and be of non-white cultural background compared to those with OA. There were no significant differences in arthritis impact, but the DK group was less likely to have received information on, or have used, arthritis management strategies. Conclusions The sociodemographic characteristics of the DK group suggest they likely have lower health literacy. They were less likely to have accessed health care and other support services, indicating this is an important group for health education, both for individuals with arthritis and health care providers.
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Affiliation(s)
- Elizabeth M. Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Canada
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jessica M. Wilfong
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Canada
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- * E-mail:
| | - Christina H. Chan
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Anthony V. Perruccio
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Canada
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Lively S, Milliot M, Potla P, Espin-Garcia O, Layeghifard M, Sundararajan K, Endisha H, Nakamura A, Perruccio AV, Veillette C, Kapoor M, Rampersaud YR. Association of presurgical circulating MicroRNAs with 1-year postsurgical pain reduction in spine facet osteoarthritis patients with lumbar spinal stenosis. Osteoarthritis and Cartilage Open 2022; 4:100283. [DOI: 10.1016/j.ocarto.2022.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 04/13/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
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Perruccio AV, Roos EM, Skou ST, Grønne DT, Davis AM. Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:1140-1146. [PMID: 35587461 DOI: 10.1002/acr.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. METHODS Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8-week education and exercise program. The following factors were recorded at program entry: age; education; mental well-being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program-specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post-program) on a 0-100-mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post-program. Logistic regression was used and conducted separately in male and female subjects. RESULTS The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4-48.1) and male subjects had a score of 41.7 (95% CI 40.3-43.1). By post-program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program-specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well-being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program-specific factors were not associated with response, while better mental well-being and fewer comorbidities were associated with being a responder. CONCLUSION Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.
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Affiliation(s)
- Anthony V Perruccio
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | | | - Aileen M Davis
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Liu M, Huang Y, Zhang H, Aitken D, Nevitt MC, Rockel JS, Pelletier JP, Lewis CE, Torner J, Rampersaud YR, Perruccio AV, Mahomed NN, Furey A, Randell EW, Rahman P, Sun G, Martel-Pelletier J, Kapoor M, Jones G, Felson D, Qi D, Zhai G. Restricting Branched-Chain Amino Acids within a High-Fat Diet Prevents Obesity. Metabolites 2022; 12:334. [PMID: 35448521 PMCID: PMC9030079 DOI: 10.3390/metabo12040334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity is a global pandemic, but there is yet no effective measure to control it. Recent metabolomics studies have identified a signature of altered amino acid profiles to be associated with obesity, but it is unclear whether these findings have actionable clinical potential. The aims of this study were to reveal the metabolic alterations of obesity and to explore potential strategies to mitigate obesity. We performed targeted metabolomic profiling of the plasma/serum samples collected from six independent cohorts and conducted an individual data meta-analysis of metabolomics for body mass index (BMI) and obesity. Based on the findings, we hypothesized that restriction of branched-chain amino acids (BCAAs), phenylalanine, or tryptophan may prevent obesity and tested our hypothesis in a dietary restriction trial with eight groups of 4-week-old male C57BL/6J mice (n = 5/group) on eight different types of diets, respectively, for 16 weeks. A total of 3397 individuals were included in the meta-analysis. The mean BMI was 30.7 ± 6.1 kg/m2, and 49% of participants were obese. Fifty-eight metabolites were associated with BMI and obesity (all p ≤ 2.58 × 10-4), linked to alterations of the BCAA, phenylalanine, tryptophan, and phospholipid metabolic pathways. The restriction of BCAAs within a high-fat diet (HFD) maintained the mice's weight, fat and lean volume, subcutaneous and visceral adipose tissue weight, and serum glucose and insulin at levels similar to those in the standard chow group, and prevented obesity, adipocyte hypertrophy, adipose inflammation, and insulin resistance induced by HFD. Our data suggest that four metabolic pathways, BCAA, phenylalanine, tryptophan, and phospholipid metabolic pathways, are altered in obesity and restriction of BCAAs within a HFD can prevent the development of obesity and insulin resistance in mice, providing a promising strategy to potentially mitigate diet-induced obesity.
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Affiliation(s)
- Ming Liu
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Yiheng Huang
- College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (Y.H.); (D.Q.)
| | - Hongwei Zhang
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (H.Z.); (P.R.); (G.S.)
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (D.A.); (G.J.)
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA;
| | - Jason S. Rockel
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON M5T 2S8, Canada; (J.S.R.); (Y.R.R.); (A.V.P.); (N.N.M.); (M.K.)
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X 0A9, Canada; (J.-P.P.); (J.M.-P.)
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama, Birmingham, AL 35233, USA;
| | - James Torner
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA;
| | - Yoga Raja Rampersaud
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON M5T 2S8, Canada; (J.S.R.); (Y.R.R.); (A.V.P.); (N.N.M.); (M.K.)
| | - Anthony V. Perruccio
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON M5T 2S8, Canada; (J.S.R.); (Y.R.R.); (A.V.P.); (N.N.M.); (M.K.)
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Nizar N. Mahomed
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON M5T 2S8, Canada; (J.S.R.); (Y.R.R.); (A.V.P.); (N.N.M.); (M.K.)
- Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andrew Furey
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
- Office of the Premier, Government of Newfoundland and Labrador, St. John’s, NL A1B 4J6, Canada
| | - Edward W. Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Proton Rahman
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (H.Z.); (P.R.); (G.S.)
| | - Guang Sun
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (H.Z.); (P.R.); (G.S.)
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X 0A9, Canada; (J.-P.P.); (J.M.-P.)
| | - Mohit Kapoor
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, ON M5T 2S8, Canada; (J.S.R.); (Y.R.R.); (A.V.P.); (N.N.M.); (M.K.)
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (D.A.); (G.J.)
| | - David Felson
- Department of Rheumatology, Boston University School of Medicine, Boston, MA 02118, USA;
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Dake Qi
- College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (Y.H.); (D.Q.)
| | - Guangju Zhai
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
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Rockel JS, Layeghifard M, Rampersaud YR, Perruccio AV, Mahomed NN, Davey JR, Syed K, Gandhi R, Kapoor M. Identification of a differential metabolite-based signature in patients with late-stage knee osteoarthritis. Osteoarthritis and Cartilage Open 2022; 4:100258. [DOI: 10.1016/j.ocarto.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 01/11/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
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Power JD, Perruccio AV, Paterson JM, Canizares M, Veillette C, Coyte PC, Badley EM, Mahomed NN, Rampersaud YR. Healthcare utilization and costs for musculoskeletal disorders in Ontario, Canada. J Rheumatol Suppl 2022; 49:740-747. [PMID: 35365584 DOI: 10.3899/jrheum.210938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the magnitude and costs of ambulatory primary and specialist physician care and hospital service use for musculoskeletal disorders (MSDs) in Canada's largest province, Ontario. METHODS Administrative health databases were analyzed for fiscal year 2013-2014 for adults 18+ years, including data on physician services, emergency department (ED) visits and hospitalizations. ICD diagnostic codes were used to identify MSD services. A validated algorithm was used to estimate direct medical costs. Person visit rates and numbers of persons and visits were tabulated by care setting, age and sex, and physician specialty. Data were examined for all MSDs combined as well as specific diagnostic groupings. RESULTS Overall, 3.1 million adult Ontarians (28.5%) made 8 million outpatient physician visits associated with MSDs. These included 5.6 million primary care visits. MSDs accounted for 560,000, 12.3%, of all adult ED visits. Total costs for MSD-related care were $1.6 billion, with 12.6% of costs attributed to primary care, 9.2% to specialist care, 8.6% to ED care, 8.5% to day surgery and 61.2% of total costs associated with inpatient hospitalizations. Costs due to arthritis accounted for 40% of total MSD care costs ($639 million). MSD-related imaging costs were $169 million. Including these costs yields a total estimate of $1.8 billion for all MSDs combined. CONCLUSION MSDs place a significant and costly burden on the health care system. Health system planning needs to consider the large and escalating demand for care to reduce both the individual and population burden.
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Affiliation(s)
- J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - J Michael Paterson
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Peter C Coyte
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
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Perruccio AV, Wong JT, Badley EM, Power JD, Yip C, Rampersaud YR. Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location. North American Spine Society Journal (NASSJ) 2021; 8:100092. [PMID: 35141656 PMCID: PMC8820018 DOI: 10.1016/j.xnsj.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Arthritis Community Research and Evaluation Unit, University Health Network; Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto; Toronto, ON, Canada
- Corresponding author at: Krembil Research Institute, 399 Bathurst St. - MP10-302, Toronto, ON M5T 2S8, Canada
| | - Jessica T.Y. Wong
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - Elizabeth M. Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Arthritis Community Research and Evaluation Unit, University Health Network; Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - J. Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
| | - Calvin Yip
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - Y. Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto; Toronto, ON, Canada
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Perruccio AV, Zahid S, Yip C, Power JD, Canizares M, Heckman GA, Badley EM. Cardiovascular risk profile and osteoarthritis - considering sex and multisite joint involvement: a CLSA population-based study. Arthritis Care Res (Hoboken) 2021; 75:893-901. [PMID: 34825501 DOI: 10.1002/acr.24826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without OA, and considering single and multisite joint OA. METHODS Data source: Cycle-1, Comprehensive-Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals aged 45-85. Systemic inflammatory/metabolic CVD risk factors collected: C-reactive protein (hsCRP), high density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips and/or hands, and were characterized as yes/no and single/multisite. Individuals with OA were age-sex matched to non-OA controls. Covariates: age, sex, education, income, physical activity, timed-up-and-go, comorbidities. A latent CVD risk variable was derived in females and males; standardized scores were categorized: lowest/mid-low/mid-high/highest risk. Associations with OA were quantified using ordinal logistic regressions. RESULTS 6098 respondents (3049 with OA) had a median age of 63 years, 55.8% female. One-third of OA respondents were in the highest risk category, versus one-fifth of non-OA. Apart from BMI (the largest contributor in both sexes), hsCRP (an inflammation marker) was predominant in females, and metabolic factors and smoking in males. Overall, OA was associated with worse CVD risk quartiles compared to non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among females with multisite OA but not males. CONCLUSIONS Findings suggest unique CVD risks by sex/multisite subgroups, and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.
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Affiliation(s)
- Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research & Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Dept. of Surgery, Medicine, University of Toronto, Toronto, Canada
| | - Shatabdy Zahid
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research & Evaluation Unit, Toronto, Canada
| | - Calvin Yip
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research & Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - George A Heckman
- Research Institute for Aging, and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research & Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Sundararajan K, Ajrawat P, Canizares M, Power JD, Perruccio AV, Sarro A, Montoya L, Rampersaud YR. The potential for diversion of prescribed opioids among orthopaedic patients: Results of an anonymous patient survey. PLoS One 2021; 16:e0256741. [PMID: 34437639 PMCID: PMC8389484 DOI: 10.1371/journal.pone.0256741] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Diversion of prescription opioid medication is a contributor to the opioid epidemic. Safe handling practices can reduce the risk of diversion. We aimed to understand: 1) if orthopaedic patients received instructions on how to safely handle opioids, 2) their typical storage/disposal practices, and 3) their willingness to participate in an opioid disposal program (ODP). METHODS Cross-sectional study of adult orthopaedic patients who completed an anonymous survey on current or past prescription opioid use, instruction on handling, storage and disposal practices, presence of children in the household, and willingness to participate in an ODP. Frequencies and percentages of responses were computed, both overall and stratified by possession of unused opioids. RESULTS 569 respondents who reported either current or past prescription opioid use were analyzed. 44% reported receiving storage instructions and 56% reported receiving disposal instructions from a health care provider. Many respondents indicated unsafe handling practices: possessing unused opioids (34%), using unsafe storage methods (90%), and using unsafe disposal methods (34%). Respondents with unused opioids were less likely to report receiving handling instructions or using safe handling methods, and 47% of this group reported having minors or young adults in the household. Respondents who received storage and disposal instructions were more likely to report safe storage and disposal methods. Seventy-four percent of respondents reported that they would participate in an ODP. CONCLUSION While many orthopaedic patients report inadequate education on safe opioid handling and using unsafe handling practices, findings suggest targeted education is associated with better behaviours. However, patients are willing to safely dispose of unused medication if provided a convenient option. These findings suggest a need to address patient knowledge and behavior regarding opioid handling to reduce the risk of opioid diversion.
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Affiliation(s)
- Kala Sundararajan
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Prabjit Ajrawat
- Department of Surgery, Division of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Mayilee Canizares
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J Denise Power
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Sarro
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Luis Montoya
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
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Power JD, Glennie A, Rogers S, Aziz M, Singh S, Dandurand C, Tauh S, Richard-Denis A, Morris S, Richard-Denis A, Lim V, Mputu PM, Soroceanu A, Sadiq I, Daly C, Dandurand C, Larouche J, Correale M, Sharma A, Charest-Morin R, Lee J, Ajoku U, Moskven E, Asif H, Al-attar ENM, Mishreky A, Rocos B, Rocos B, Rocos B, Srivastava SK, Patgaonkar P, Cummins D, Bednar D, Chan V, Bowker R, Evaniew N, Hathi K, Hall H, Ludwig T, Ludwig T, Truong VT, Passalent L, Wang S, Shaikh N, Pelletier-Roy R, Shen J, Wang Z, Singh S, Machida M, Machida M, Fernandes R, Fernandes R, Marathe N, Kerr J, Magnan MC, Visva S, Jarvis J, Jarvis J, Jentzsch T, Cherry A, Cherry A, Cherry A, Dandurand C, Rampersaud R, Sundararajan K, Levasseur A, Fernandes R, Fernandes R, Fullerton K, Malone H, Daly C, Peloza J, Peloza J, Walden K, Elsemin O, MacLean MA, Rose J, Oppermann M, Ferguson D, Hindi M, Dermott JA, DeVries Z, Lebel D, Ayling O, Singh V, Craig M, Lasswell T, Perruccio AV, Canizares M, McIntosh G, Rampersaud YR, Urquhart J, Koto P, Rasoulinejad P, Sequeira K, Miller T, Watson J, Rosedale R, Gurr K, Siddiqi F, Bailey C, Manson N, Bigney E, Vandewint A, Richardson E, El-Mughayyar D, McPhee R, Abraham E, Weber M, McIntosh G, Kelly A, Santaguida C, Ouellet J, Reindl R, Jarzem P, Lasry O, Dea N, Fisher C, Street J, Boyd M, Charest-Morin R, Rhines L, Boriani S, Charest-Morin R, Gokaslan Z, Gasbarrini A, Saghal A, Laufer II, Lazary A, Bettegowda C, Kawahara N, Clarke M, Rampersaud YR, Reynolds J, Disch A, Chou D, Shin JH, Wei F, Hornicek FJ, Barzilai O, Fisher C, Dea N, Nickel D, Thorpe L, Brown J, Weiler R, Linassi G, Fourney D, Dionne A, Bégin J, Mac-Thiong JM, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore GW, Laule C, Kwon B, Gravel LF, Dionne A, Bourassa-Moreau E, Maurais G, Khoueir P, Mac-Thiong JM, Richard-Denis A, Dionne A, Bourassa-Moreau É, Bégin J, Mac-Thiong JM, Beausejour M, Richard-Denis A, Begin J, Dionne A, Mac-Thiong JM, Scheer J, Protopsaltis T, Gupta M, Passias P, Gum J, Smith J, Bess S, Lafage V, Ames C, Klineberg E, Frederick A, Nicholls F, Lewkonia P, Thomas K, Jacobs B, Swamy G, Miller N, Tanguay R, Soroceanu A, Nevin J, Bourassa-Moreau E, Dvorak M, Fisher C, Paquette S, Kwon B, Dea N, Ailon T, Charest-Morin R, Street J, Hindi M, Kwon B, Dvorak M, Ailon T, Paquette S, Fisher C, Charest-Morin R, Dea N, Street J, Finkelstein J, Bowes J, Ford M, Yee A, Soever L, Rachevitz M, Bigness A, Robertson S, Wilson R, Wong W, Nugent J, Frantzeskos S, Duffy M, Rampersaud R, Marathe N, Agarwal R, Bailey CS, Paquet J, Dea N, Goytan M, McIntosh G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Hall H, Bailey C, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, McIntosh G, Abraham E, Glennie A, Jarzem P, Ahn H, Blanchard J, Hogan G, Kelly A, Charest-Morin R, Tohidi M, Hopman W, Yen D, Parent S, Miyanji F, Murphy J, El-Hawary R, Lebel D, Zeller R, Reda L, Dodds M, Lebel D, Zeller R, Zeller R, Marathe N, Bhosale S, Raj A, Marathe N, Goyal V, Theologis A, Witiw C, Fehlings M, Morash K, Yaszay B, Andras L, Sturm P, Sponseller P, El-Hawary R, Swamy G, Jacobs WB, Bouchard J, Cho R, Manson NA, Rampersaud YR, Paquet J, Bailey CS, Johnson M, Attabib N, Fisher CG, McIntosh G, Thomas KC, Bigney E, Richardson E, Alugo T, El-Mughayyar D, Vandewint A, Manson N, Abraham E, Attabib N, Prostko R, Cheng B, Haring K, Fischer M, Bourget-Murray J, Sridharan S, Frederick A, Johnston K, Edwards B, Nicholls F, Soroceanu A, Bouchard J, Shedid D, Al-Shakfa F, Shen J, Boubez G, Yuh SJ, Wang Z, Sundararajan K, Perruccio A, Coyte P, Bombardier C, Bloom J, Hawke C, Haroon N, Inman R, Rampersaud YR, Hebert J, Abraham E, Vandewint A, Bigney E, Richardson E, El-Mughayyar D, Attabib N, Small C, Manson N, Zhang H, Beresford-Cleary N, Street J, Wilson D, Oxland T, Richard-Denis A, Jean S, Bourassa-Moreau É, Fleury J, Beauchamp-Vien G, Bégin J, Mac-Thiong JM, Boudier-Revéret M, Majdalani C, Truong VT, Wang Z, Shedid D, Najjar A, Yuh SJ, Boubez G, Sebaaly A, McIntosh G, Ailon T, Dea N, Fisher C, Charest-Morin R, Lebel D, Rocos B, Zabjek K, Zeller R, Zabjek K, Rocos B, Lebel D, Zeller R, Gee A, Schneider N, Kanawati A, Schemitsch E, Bailey C, Rasoulinejad P, Zdero R, Schneider N, Gee A, Kanawati A, Zdero R, Bailey C, Rasoulinejad P, Lohkamp LN, Fehlings M, Abraham E, Vandewint A, Bigney E, Hebert J, Richardson E, El-Mughayyar D, Chorney J, El-Hawary R, Manson N, Wai E, Phan P, Kingwell S, Tierney S, Stratton A, AlDuwaisan A, Moravek D, Wai E, Kingwell S, Stratton A, Phan P, Devries Z, Barrowman N, Smit K, Tice A, Devries Z, Barrowman N, Smit K, Tice A, Sundararajan K, Rampersaud YR, Oitment C, Wunder J, Ferguson P, Rampersaud R, Rampersaud R, Rampersaud R, Ailon T, Dvorak M, Kwon B, Paquette S, Charest-Morin R, Dea N, Fisher C, Street J, Bailey C, Casha S, Glennie A, Fox R, McIntosh G, Yee A, Fisher C, Perruccio A, Perruccio A, Rampersaud YR, Mac-Thiong JM, Richard-Denis A, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Klein G, Emmenegger U, Finkelstein J, Lyons F, Whyne C, Hardisty M, Millgram M, Guyer R, Harel R, Ashkenazi E, Dvorak M, Fisher C, Paquette S, Street J, Dea N, Ailon T, Charest-Morin R, Kwon B, Millgram M, Guyer R, Le Huec JC, Ashkenazi E, Millgram M, Guyer R, Harel R, Kutz S, Ashkenazi E, Parsons J, Bailey CS, Dhaliwal P, Fourney DR, Noonan V, Mac-Thiong JM, Beausejour M, Sassine S, Joncas J, Barchi S, Le May S, Cobetto N, Fortin C, Carl-Éric A, Parent S, Labelle H, Bailey C, Fisher C, Rampersaud R, Glennie A, Manson N, Bigney E, Vandewint A, Hebert J, El-Mughayyar D, Richardson E, Ghallab N, Flood M, Attabib N, Abraham E, Swamy G, Nicholls F, Thomas K, Jacobs WB, Soroceanu A, Evaniew N, Stevens M, Dunning C, Oxner W, Glennie A, Dandurand C, Paquette S, Kwon B, Ailon T, Dvorak M, Dea N, Charest-Morin R, Fisher C, Street J, Kim D, Lebel DE, Jarvis J, Tice A, Smit K, Campbell F, Mashida M, Isaac L, Bath N, Stocki D, Levin D, Koyle M, Ruskin D, Stinson J, Ailon T, Dea N, Fisher C, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Cho R, Lewkonia P, Swamy G, Lasry O, Ailon T, Zamani N, Rampersaud R, Rasoulinejad P. 2021 Canadian Spine Society Abstracts. Can J Surg 2021; 64:S1-S36. [PMID: 34296831 PMCID: PMC8410468 DOI: 10.1503/cjs.012621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
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Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Glennie RA, Canizares M, Perruccio AV, Abraham E, Nicholls F, Nataraj A, Phan P, Attabib N, Johnson MG, Richardson E, McIntosh G, Ahn H, Fisher CG, Manson N, Thomas K, Rampersaud YR. The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study. J Neurosurg Spine 2021:1-8. [PMID: 34020418 DOI: 10.3171/2020.11.spine201490] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients. METHODS Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected. RESULTS There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34-0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not. CONCLUSIONS Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.
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Affiliation(s)
- R Andrew Glennie
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia
| | - Mayilee Canizares
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Anthony V Perruccio
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Edward Abraham
- 3Department of Surgery, Dalhousie University.,11Canada East Spine Centre; and
| | - Fred Nicholls
- 4Department of Surgery, University of Calgary, Alberta
| | - Andrew Nataraj
- 5Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta
| | | | - Najmedden Attabib
- 3Department of Surgery, Dalhousie University.,12Department of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick
| | - Michael G Johnson
- 7Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba
| | - Eden Richardson
- 8Canadian Spine Outcomes and Research Network.,11Canada East Spine Centre; and
| | | | - Henry Ahn
- 9Department of Surgery, University of Toronto, Toronto, Ontario; and
| | - Charles G Fisher
- 10Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Manson
- 3Department of Surgery, Dalhousie University.,11Canada East Spine Centre; and
| | | | - Y Raja Rampersaud
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia.,9Department of Surgery, University of Toronto, Toronto, Ontario; and
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Badley EM, Wilfong JM, Yip C, Millstone DB, Perruccio AV. The contribution of age and obesity to the number of painful joint sites in individuals reporting osteoarthritis: a population-based study. Rheumatology (Oxford) 2021; 59:3350-3357. [PMID: 32306046 PMCID: PMC7590415 DOI: 10.1093/rheumatology/keaa138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/28/2019] [Revised: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To investigate the association of OA risk factors with number of painful joint sites in a representative population sample. Methods Analysis of the 2009 Survey on Living with Chronic Diseases in Canada – Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample. Results The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample. Conclusion The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.
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Affiliation(s)
- Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jessica M Wilfong
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto
| | - Calvin Yip
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dov B Millstone
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto
| | - Anthony V Perruccio
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Perruccio AV, Power JD, Yip C, Badley EM, Canizares M, Rampersaud YR. The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis. Spine J 2021; 21:80-89. [PMID: 32805432 DOI: 10.1016/j.spinee.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. PURPOSE Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. DESIGN Prospective study of consecutive patients followed to 12-month postsurgery. PATIENT SAMPLE Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. OUTCOMES MEASURES Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and "pain/stiffness/swelling most days of the month" indicated on a homunculus (a joint site count was derived). ASSESSMENTS Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. METHODS Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. RESULTS In all, 165 patients were included. The mean age was 67 years (range: 44-90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). CONCLUSIONS Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.
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Affiliation(s)
- Anthony V Perruccio
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Calvin Yip
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elizabeth M Badley
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Y Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Ali SA, Gandhi R, Potla P, Keshavarzi S, Espin-Garcia O, Shestopaloff K, Pastrello C, Bethune-Waddell D, Lively S, Perruccio AV, Rampersaud YR, Veillette C, Rockel JS, Jurisica I, Appleton CT, Kapoor M. Sequencing identifies a distinct signature of circulating microRNAs in early radiographic knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1471-1481. [PMID: 32738291 DOI: 10.1016/j.joca.2020.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE MicroRNAs act locally and systemically to impact osteoarthritis (OA) pathophysiology, but comprehensive profiling of the circulating miRNome in early vs late stages of OA has yet to be conducted. Sequencing has emerged as the preferred method for microRNA profiling since it offers high sensitivity and specificity. Our objective was to sequence the miRNome in plasma from 91 patients with early [Kellgren-Lawrence (KL) grade 0 or 1 (n = 41)] or late [KL grade 3 or 4 (n = 50)] symptomatic radiographic knee OA to identify unique microRNA signatures in each disease state. DESIGN MicroRNA libraries were prepared using the QIAseq miRNA Library Kit and sequenced on the Illumina NextSeq 550. Counts were produced for microRNAs captured in miRBase and for novel microRNAs. Statistical, bioinformatics, and computational biology approaches were used to refine and interpret the final list of microRNAs. RESULTS From 215 differentially expressed microRNAs (FDR < 0.01), 97 microRNAs showed an increase or decrease in expression in ≥85% of samples in the early OA group as compared to the median expression in the late OA group. Increasing this threshold to ≥95%, seven microRNAs were identified: hsa-miR-335-3p, hsa-miR-199a-5p, hsa-miR-671-3p, hsa-miR-1260b, hsa-miR-191-3p, hsa-miR-335-5p, and hsa-miR-543. Four novel microRNAs were present in ≥50% of early OA samples and had 27 predicted gene targets in common with the prioritized set of predicted gene targets from the 97 microRNAs, suggesting common underlying mechanisms. CONCLUSION Sequencing of well-characterized patient cohorts produced unbiased profiling of the circulating miRNome and identified a unique panel of 11 microRNAs in early radiographic knee OA.
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Affiliation(s)
- S A Ali
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Bone & Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA.
| | - R Gandhi
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada.
| | - P Potla
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - S Keshavarzi
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - O Espin-Garcia
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - K Shestopaloff
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - C Pastrello
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - D Bethune-Waddell
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - S Lively
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - A V Perruccio
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
| | - Y R Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada.
| | - C Veillette
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada.
| | - J S Rockel
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
| | - I Jurisica
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Departments of Medical Biophysics and Computer Science, University of Toronto, Toronto, ON, Canada.
| | - C T Appleton
- Department of Medicine and Department of Physiology and Pharmacology, Western Bone and Joint Institute, The University of Western Ontario, London, ON, Canada(a).
| | - M Kapoor
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Matthies N, Keshen S, Lewis S, Webster F, Perruccio AV, Rampersaud YR. An Exploratory Analysis of Spine Patients' Preoperative Concerns and Decision-making Process: Does What Surgeons Say Matter? Spine (Phila Pa 1976) 2020; 45:1067-1072. [PMID: 32675614 DOI: 10.1097/brs.0000000000003456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, pre-post patient survey. OBJECTIVE The aim of this study was to determine what factors affect a patient's decision to undergo elective surgery following a surgical consultation. SUMMARY OF BACKGROUND DATA The surgical consultation is an important step in selecting and preparing patients for elective surgery. Despite the proven effectiveness and low risk of complications, many spine procedure candidates may still choose to forgo surgery after an appropriate discussion and clear surgical indications. METHODS Survey and open-response questions regarding pre- and post-consultation surgical concerns and overall willingness to undergo surgery were collected and analyzed from 124 patients deemed surgical candidates. Demographics, surgical willingness, and patient concerns were analyzed. Open-ended response data were tallied for surgical concerns and responses were analyzed line-by-line to assess for main themes. Sub-analysis was included on patients who reconsidered their willingness post-consultation. RESULTS Qualitative thematic analysis of patient's concerns regarding surgery uncovered six major themes: Interference on quality of life (QOL), fear, physical concerns, success, risk, and concerns regarding the surgeon (CS). Success and risk were most commonly mentioned pre-consultation (27%, 26%); risk and QOL were most commonly mentioned post-consultation (22%, 21%). Of 124 patients, 103 were willing to have surgery before consultation and remained willing post-consultation; six patients became unwilling. Twenty-one patients were unwilling to consider surgery before consultation; only five remained unwilling. No differences were found between degenerative and deformity patients regarding initial willingness or changes thereafter. CONCLUSION The decision to undergo surgery is a multifactorial and complex process with a variety of patient concerns. We grouped these concerns into six categories to aid in future discussion with patients. 87% of patients have made up their mind before attending their surgical consultation. Appropriate understanding of patient-specific willingness and concerns should help facilitate necessary discussion and aid in a more efficient and useful shared decision-making process. LEVEL OF EVIDENCE 4.
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Perruccio AV, Fitzpatrick J, Power JD, Gandhi R, Rampersaud YR, Mahomed NN, Davey JR, Syed K, Veillette C, Badley EM. Sex-Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:1074-1080. [PMID: 31199582 DOI: 10.1002/acr.24002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/11/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The influence of sex on post-total knee arthroplasty (TKA) outcomes has been variable in the literature. Though sex is often reported as an averaged effect, we undertook this study to investigate whether sex modified the influence of presurgery characteristics on post-TKA knee pain. METHODS This was a prospective study with data derived from 477 TKA osteoarthritis patients (279 women, 198 men). Questionnaires were completed presurgery and at 3 months postsurgery. The association between 3-month post-TKA knee pain and presurgery covariates (body mass index, comorbidity count, symptomatic joint count, low back pain, knee pain, and depressive symptoms) was assessed by linear regression. Sex-specific effects were evaluated using interactions. RESULTS Women had significantly worse presurgery knee pain, joint count, and depressive symptoms, and worse postsurgery knee pain, than men. With simple covariate adjustment, no sex effect on pain was found. However, sex was found to moderate the effects of comorbidities (worse for women [P = 0.013]), presence of low back pain (worse for men [P = 0.003]), and depressive symptoms (worse for men [P < 0.001]) on postsurgery pain. Worse presurgery pain was associated with worse postsurgery pain similarly for women and men. CONCLUSION The influence of some patient factors on early post-TKA pain cannot be assumed to be the same for women and men; average effects may mask underlying associations. Results suggest a need to consider sex differences in understanding TKA outcomes, which may have important implications for prognostic tool development in TKA.
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Affiliation(s)
- Anthony V Perruccio
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | | | - J Denise Power
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J Roderick Davey
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Khalid Syed
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Christian Veillette
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- University of Toronto and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Perruccio AV, Yip C, Power JD, Canizares M, Gignac MA, Badley EM. Understanding the association between osteoarthritis and social participation: a CLSA population-based study. Arthritis Care Res (Hoboken) 2020; 73:1638-1647. [PMID: 32598513 DOI: 10.1002/acr.24366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The focus on disability in osteoarthritis (OA) has largely been on performing specific activities, neglecting wider implications for social participation (SP). We investigated the association between OA and SP considering activity limitations (AL) and instrumental supports (IS) as intervening variables in the association. METHODS Data were from 21,214 respondents aged 45-85 from cycle 1, Canadian Longitudinal Study on Aging. The questionnaire elicited: self-reported doctor-diagnosed OA; difficulty with 14 activities; perceived availability and receipt of IS; and 17 SP activities. Structural equation modeling was used. PRIMARY OUTCOME SP; Primary predictor: OA; Intervening variables: AL, received IS, perceived IS. Latent variables were developed for intervening and SP variables. Covariates: age, sex, body mass index, income, education, smoking, comorbidity count. RESULTS Mean age was 63 years, 51% were female, and 26.5% reported OA. Two distinct SP indicators were identified, SP-Diversity and SP-Intensity. Without considering intervening variables, minimal/no association was found between OA and SP. When considered, unique pathways linking OA and SP were found. The overall negative association between AL and SP was, in part, direct and, in part, buffered by both receipt and perceived availability of IS. Absent AL, OA was associated with greater SP. CONCLUSIONS Enhanced SP in people with OA without AL may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with AL, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available IS in maintaining SP.
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Affiliation(s)
- Anthony V Perruccio
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health.,Department of Surgery, University of Toronto, Toronto, Canada, Ontario
| | - Calvin Yip
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Ontario
| | - J Denise Power
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Mayilee Canizares
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Monique Am Gignac
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Ontario.,Institute for Work and Health, Toronto, Canada, Ontario
| | - Elizabeth M Badley
- Healthcare & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Ontario
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Wilfong JM, Perruccio AV, Millstone DB, Badley EM. Participation in Informal Caregiving Among People With Arthritis: Findings From a Canadian Longitudinal Study on Aging. Arthritis Care Res (Hoboken) 2020; 73:1528-1536. [PMID: 32475060 DOI: 10.1002/acr.24329] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Despite the joint pain and significant dysfunction that characterizes arthritis, many people with arthritis continue to carry out everyday duties and responsibilities. The objective of the present study was to describe participation in informal caregiving (unpaid assistance to someone with a health issue or limitation) among people with arthritis. METHODS Analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative sample of people ages 45-85 years (n = 21,241), was performed. A questionnaire covering sociodemographic, health, and caregiving variables was completed by each study participant. Caregiving variables examined characteristics of the person who received the most care from the questionnaire respondent, as well as the types of caregiving (e.g., hands-on versus hands-off tasks) and amount of care provided (e.g., hours per week). RESULTS There was no difference in the proportion of people with and without arthritis who provided informal care (46%). Individuals with arthritis reported worse health, but this did not affect the likelihood of providing care, nor the types or amount of care provided. Caregivers with and without arthritis were most likely to provide fewer than 7 hours per week of care, and the most common type of care was characterized as hands-off, particularly transportation assistance. Men were just as likely to provide care as women but were less likely to provide high intensity care or perform hands-on tasks. CONCLUSION Despite reporting worse health on average, people with arthritis were just as likely as people without arthritis to provide informal care. The need to provide informal care among people with arthritis may impact their ability to engage in self-management activities for their arthritis.
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Affiliation(s)
- Jessica M Wilfong
- Krembil Research Institute, University Health Network, and Arthritis Community Research and Evaluation Unit, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Krembil Research Institute, University Health Network, and Arthritis Community Research and Evaluation Unit, and University of Toronto, Toronto, Ontario, Canada
| | - Dov B Millstone
- Arthritis Community Research and Evaluation Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Krembil Research Institute, University Health Network, and Arthritis Community Research and Evaluation Unit, and University of Toronto, Toronto, Ontario, Canada
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Fei JZ, Perruccio AV, Ye JY, Gladman DD, Chandran V. The relationship between patient acceptable symptom state and disease activity in patients with psoriatic arthritis. Rheumatology (Oxford) 2020; 59:69-76. [PMID: 31199486 DOI: 10.1093/rheumatology/kez202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The Psoriatic Arthritis Disease Activity Score (PASDAS) and Disease Activity Index for Psoriatic Arthritis (DAPSA) are composite PsA disease activity measures. We sought to identify the PASDAS and DAPSA cut-off points consistent with patient acceptable symptom state (PASS), the threshold of symptoms beyond which patients consider themselves well, and examine PASS across published PASDAS and DAPSA thresholds for low, moderate and high disease activity. METHODS We used a standard protocol including physician assessment and patient-reported outcomes to prospectively record measures required to calculate PASDAS and DAPSA. We identified PASS thresholds for the PASDAS and DAPSA using receiver operating characteristics curve analyses. We assessed the frequency of reporting acceptable symptom state across disease activity thresholds for PASDAS and DAPSA scores. RESULTS A total of 229 patients (58.5% male, mean age 55.5 years, mean disease duration 17.1 years) were recruited. The PASS threshold for the PASDAS was 3.79 [area under the curve (AUC) 0.86, sensitivity 0.75, specificity 0.82] and for the DAPSA was 11.10 (AUC 0.91, sensitivity 0.89, specificity 0.82). With the PASDAS, 90% of patients defined as having low disease activity considered their symptom state acceptable, compared with 55% and 17% among those with moderate and high disease activity, respectively. With the DAPSA, 98% of patients in disease remission considered their symptom state acceptable compared with 85, 22 and 18% among those with low, moderate and high disease activity, respectively. CONCLUSION We have defined PASS thresholds for PASDAS and DAPSA. The PASDAS target for low disease activity and DAPSA targets of low disease activity or remission align well with PASS.
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Affiliation(s)
- Jeanie Z Fei
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, Western University, London, Ontario, Canada
| | - Anthony V Perruccio
- Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justine Y Ye
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Vinod Chandran
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Canizares M, Glennie RA, Perruccio AV, Abraham E, Ahn H, Attabib N, Christie S, Johnson MG, Nataraj A, Nicholls F, Paquet J, Phan P, Rasoulinejad P, Manson N, Hall H, Thomas K, Fisher CG, Rampersaud YR. Erratum to 'Patients' expectations of spine surgery for degenerative conditions: results from the Canadian Spine Outcomes and Research Network (CSORN)'. [Spine J. 2020;20(3):399-408]. Spine J 2020; 20:674. [PMID: 32081566 DOI: 10.1016/j.spinee.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Canizares
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - R A Glennie
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - A V Perruccio
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - E Abraham
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - H Ahn
- Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
| | - N Attabib
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - S Christie
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - M G Johnson
- Canadian Spine Outcomes and Research Network, Canada; University of Manitoba, Winnipeg, Manitoba, Canada
| | - A Nataraj
- Canadian Spine Outcomes and Research Network, Canada; University of Alberta, Edmonton, Alberta, Canada
| | - F Nicholls
- Canadian Spine Outcomes and Research Network, Canada; University of Calgary, Calgary, Alberta, Canada
| | - J Paquet
- Canadian Spine Outcomes and Research Network, Canada; Universite Laval, Quebec City, Quebec, Canada
| | - P Phan
- Canadian Spine Outcomes and Research Network, Canada; The Ottawa Hospital - Civic Campus, Ottawa, Ontario, Canada
| | - P Rasoulinejad
- Canadian Spine Outcomes and Research Network, Canada; Western University, London Health Sciences, London, Ontario, Canada
| | - N Manson
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - H Hall
- Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
| | - K Thomas
- Canadian Spine Outcomes and Research Network, Canada; University of Calgary, Calgary, Alberta, Canada
| | - C G Fisher
- Canadian Spine Outcomes and Research Network, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Y R Rampersaud
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
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Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Development of a Modified Psoriatic Arthritis Disease Activity Score Using the Medical Outcomes Study Short Form 12 as a Measure of Quality of Life. Arthritis Care Res (Hoboken) 2020; 72:577-582. [PMID: 30875460 DOI: 10.1002/acr.23876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite measure of psoriatic arthritis (PsA) disease activity. The length of its patient-reported components raises concern about questionnaire burden. The PASDAS includes the Medical Outcomes Study Short Form 36 (SF-36) health survey. We undertook this study to investigate the agreement between the PASDAS and a modified PASDAS (mPASDAS), which substituted the SF-36 with the shortened SF-12. METHODS A total of 100 patients who fulfilled the criteria of the Classification of Psoriatic Arthritis Study Group for PsA were consecutively recruited. All of the PASDAS-required variables were collected. The 12 item responses for SF-12 were extracted from the SF-36 questionnaire. The PASDAS and the mPASDAS were calculated using the SF-36 and SF-12 scores, respectively. A Bland-Altman plot of the mean differences in PASDAS and mPASDAS scores was generated to evaluate agreement. Construct validity was assessed by examining correlations of the PASDAS and the mPASDAS with the Health Assessment Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue subscale, the EuroQol 5-domain instrument (health-related quality of life), and pain scores (range 0-10, visual analog scale). The kappa statistic was used to measure agreement between disease activity states as determined by the PASDAS and mPASDAS. RESULTS The mean ± SD PASDAS and mPASDAS was 3.29 ± 1.39 and 3.24 ± 1.27, respectively. The correlation between the 2 scores was 0.998 (P < 0.0001), and the mean difference was -0.05 (95% confidence interval [95% CI] -0.07, -0.03). Construct validity was found, with nearly identical correlations of the PASDAS and mPASDAS with each of the external health measures. The misclassification rate with the mPASDAS was only 6%. The weighted κ = 0.90 (95% CI 0.82, 0.97). CONCLUSION The mPASDAS may replace the PASDAS in disease activity assessment given the excellent agreement, validity, and low misclassification rate.
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Affiliation(s)
- Anthony V Perruccio
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Matthew Got
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Suzanne Li
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Yang Ye
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vinod Chandran
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
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Yip C, Badley EM, Canizares M, Power JD, Perruccio AV. Risk Factor Profiles for Individuals With Diagnosed OA and With Symptoms Indicative of OA: Findings From the Canadian Longitudinal Study on Aging. ACR Open Rheumatol 2020; 2:174-179. [PMID: 32114717 PMCID: PMC7077769 DOI: 10.1002/acr2.11120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The vast majority of published estimates of osteoarthritis (OA) burden are based on an OA diagnosis. These data are limited, as individuals often do not visit a physician until their symptoms are moderate to severe. This study compared individuals with an OA diagnosis to those with OA joint symptoms but without a diagnosis considering a number of sociodemographic and health characteristics. A further distinction was made between individuals with symptoms in one joint site and those with symptoms in multiple joint sites. METHODS Data are from 23 186 respondents aged 45 to 85 years from the first cycle of the Canadian Longitudinal Study on Aging. A multinomial logistic regression model examined the relationship between sociodemographic- and health-related characteristics and OA status (diagnosed OA, joint symptoms without OA, no OA or joint symptoms). In addition, logistic regression models assessed the relationship between OA status and usually experiencing pain and having some degree of functional limitation. RESULTS Twenty-one percent of respondents reported a diagnosis of OA, and 25% reported symptoms typical of OA but without an OA diagnosis. Other than being slightly younger, the characteristic profile of individuals with symptoms in two or more joint sites was indistinguishable from that of those with diagnosed OA. CONCLUSION It may be warranted to consider OA-like multiple joint symptoms when deriving estimates of OA-attributed population health and cost burden.
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Affiliation(s)
- Calvin Yip
- Healthcare & Outcomes Research, Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth M Badley
- Healthcare & Outcomes Research, Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, ON, Canada
| | - Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Healthcare & Outcomes Research, Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Arthritis Community Research and Evaluation Unit, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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Perruccio AV, Badley EM, Power JD, Canizares M, Kapoor M, Rockel J, Chandran V, Gandhi R, Mahomed NM, Davey JR, Syed K, Veillette C, Rampersaud YR. Sex differences in the relationship between individual systemic markers of inflammation and pain in knee osteoarthritis. Osteoarthritis and Cartilage Open 2019; 1:100004. [DOI: 10.1016/j.ocarto.2019.100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023] Open
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Power JD, Perruccio AV, Gandhi R, Veillette C, Davey JR, Lewis SJ, Syed K, Mahomed NN, Rampersaud YR. Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients. Arthritis Care Res (Hoboken) 2019; 71:1178-1185. [DOI: 10.1002/acr.23831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023]
Affiliation(s)
- J. Denise Power
- Arthritis Program and Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Anthony V. Perruccio
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Rajiv Gandhi
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Christian Veillette
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - J. Roderick Davey
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Stephen J. Lewis
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Khalid Syed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Nizar N. Mahomed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Y. Raja Rampersaud
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
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Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Treating Psoriatic Arthritis to Target: Defining the Psoriatic Arthritis Disease Activity Score That Reflects a State of Minimal Disease Activity. J Rheumatol 2019; 47:362-368. [PMID: 31203221 DOI: 10.3899/jrheum.181472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite disease activity measure (range 0-10) for psoriatic arthritis (PsA). We aimed to validate a cutoff value of PASDAS that defines minimal disease activity (MDA) state, as well as to validate previously defined PASDAS cutoffs for low and high disease activity. METHODS Patients were prospectively recruited from the University of Toronto PsA clinic according to a standard protocol, and variables necessary to complete the PASDAS and the MDA were collected. Receiver-operating characteristic (ROC) curve analysis determined the optimal PASDAS cutoff discriminating patients in MDA state from those not in MDA. Previously proposed PASDAS disease activity cutoff scores were validated by determining the proportion of patients requiring treatment escalation, a surrogate of active disease, in each of low, moderate, and high disease activity groups. RESULTS One hundred seventy-eight patients [53.9% male, mean PASDAS 3.29 (SD 1.29), 47.8% in MDA] were recruited. ROC curve analysis identified a PASDAS score of 3.2 as the point that maximized the sensitivity and specificity for MDA based on 5 of 7 criteria (sensitivity 88%, specificity 92%, area under the curve 0.96). For MDA based on meeting 6 of 7 and 7 of 7 criteria, PASDAS scores of 2.6 and 2.1 maximized sensitivity and specificity, respectively. An increasing proportion of patients from low to moderate to high disease activity groups required treatment escalation, increasing from 8.1% to 42% to 67%, respectively. CONCLUSION A PASDAS score < 3.2 reflects MDA. This study has externally validated PASDAS cutoff scores previously proposed to differentiate between low, moderate, and high disease activity.
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Affiliation(s)
- Anthony V Perruccio
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Matthew Got
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Suzanne Li
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Yang Ye
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Dafna D Gladman
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Vinod Chandran
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network.
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Power JD, Kudesia P, Nadeem A, Perruccio AV, Sundararajan K, Mahomed NN, Rampersaud YR, Gandhi R. Patterns of Depressive Symptoms Before and After Surgery for Osteoarthritis: A Descriptive Study. ACR Open Rheumatol 2019; 1:203-212. [PMID: 31777796 PMCID: PMC6857983 DOI: 10.1002/acr2.1031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To examine patterns of depressive symptoms before and over the year following osteoarthritis (OA) surgery, stratified by joint and postsurgical outcome. Methods Participants were hip (n = 287), knee (n = 360), and lumbar spine (n = 100) OA patients scheduled for joint replacement or decompression surgery with or without fusion. One pre‐ and 4 postsurgery questionnaires were completed. Depressive symptoms were quantified using the Hospital Anxiety and Depression Scale (HADS). One‐year outcomes were based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores for hip and knee patients and Oswestry Disability Index (ODI) scores for spine patients and were categorized as “worse” (top score tertile) vs. “better” outcomes (first, second tertiles). Plots over time were generated by joint and outcome: 1) mean pain/disability and depression scores and 2) percentage of patients meeting HADS cut‐off for depression “caseness,” reporting depression diagnosis and treatment. Results There were notable decreases in depression scores for patients with better outcomes. For those with worse outcomes, decreases were smaller for hip patients and were not significant for knee and spine patients. Among those with poorer outcomes, 25% of spine and knee patients were depression “cases” pre‐ and postsurgery; an additional 16% of spine and 10% of knee patients developed new “caseness” postsurgery. The proportion of these patients deemed depression cases by score was much higher than the proportion reporting diagnosis/treatment. Conclusion Although depressive symptoms decrease overall in OA patients postsurgery, degrees of change vary by joint and surgical outcome. Greater attention to mental health postsurgery is warranted and may lead to improved surgical outcomes, particularly among knee and spine patients.
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Affiliation(s)
- J Denise Power
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Prtha Kudesia
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Alina Nadeem
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Anthony V Perruccio
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Kala Sundararajan
- Arthritis Program and Krembil Research Institute University Health Network Toronto Ontario Canada
| | - Nizar N Mahomed
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Y Raja Rampersaud
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
| | - Rajiv Gandhi
- Arthritis Program and Krembil Research Institute University Health Network, Toronto, Ontario, Canada and University of Toronto Toronto Ontario Canada
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Chandran V, Abji F, Perruccio AV, Gandhi R, Li S, Cook RJ, Gladman DD. Serum-based soluble markers differentiate psoriatic arthritis from osteoarthritis. Ann Rheum Dis 2019; 78:796-801. [DOI: 10.1136/annrheumdis-2018-214737] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/10/2023]
Abstract
ObjectivesWe aimed to identify soluble biomarkers that differentiate psoriatic arthritis (PsA) from osteoarthritis (OA).MethodsMarkers of cartilage metabolism (cartilage oligomeric matrix protein [COMP], hyaluronan), metabolic syndrome (adiponectin, adipsin, resistin, hepatocyte growth factor [HGF], insulin, leptin) and inflammation (C-reactive protein [CRP], interleukin-1β [IL-1β], IL-6, IL-8, tumour necrosis factor alpha [TNFα], monocyte chemoattractant protein-1 [MCP-1], nerve growth factor [NGF]) were compared in serum samples from 201 patients with OA, 77 patients with PsA and 76 controls. Levels across the groups were compared using the Kruskal-Wallis test. Pairwise comparisons were made with Wilcoxon rank-sum test. Multivariate logistic regression analyses were performed to identify markers that differentiate PsA from OA. Receiver operating characteristic (ROC) curves were constructed based on multivariate models. The final model was further validated in an independent set of 73 PsA and 75 OA samples using predicted probabilities calculated with coefficients of age, sex and biomarkers.ResultsLevels of the following markers were significantly different across the three groups (p<0.001)—COMP, hyaluronan, resistin, HGF, insulin, leptin, CRP, IL-6, IL-8, TNFα, MCP-1, NGF. In multivariate analysis, COMP (OR 1.24, 95% CI 1.06 to 1.46), resistin (OR 1.26, 95% CI 1.07 to 1.48), MCP-1 (OR 1.10, 95% CI 0.07 to 1.48) and NGF (OR<0.001, 95% CI <0.001 to 0.25) were found to be independently associated with PsA versus OA. The area under the ROC curve (AUROC) for this model was 0.99 compared with model with only age and sex (AUROC 0.87, p<0.001). Similar results were obtained using the validation sample.ConclusionA panel of four biomarkers may distinguish PsA from OA. These results need further validation in prospective studies.
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Badley EM, Goulart CM, Millstone DB, Perruccio AV. An Update on Arthritis in Canada - National and Provincial Data Regarding the Past, Present, and Future. J Rheumatol 2019; 46:579-586. [PMID: 30770501 DOI: 10.3899/jrheum.180147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide updated arthritis estimates for Canada given a change in wording in the 2015 Canadian Community Health Survey (CCHS) arthritis question. METHODS Prevalence data from the 2000 to 2016 CCHS were used to document trends in the prevalence of arthritis over time. Projections of arthritis prevalence were also calculated using data from CCHS 2015 in conjunction with Statistics Canada's published population projections. Data for 2015 were also used to provide summary data on the effect of arthritis. RESULTS Between 2000 and 2014 there were some fluctuations in the prevalence of arthritis (age ≥ 15 yrs), with the range of prevalence varying between 15.4% and 17.6%. There was a significant increase in overall prevalence to over 20% with the 2015 and 2016 surveys (6 million Canadians), coinciding with a revised wording of the arthritis question. This increase was observed in all age and sex groups, except for men aged 85+. The overall characteristics of the 2015 arthritis population were similar to those in 2007/08. Using the updated 2015 CCHS arthritis data, projection estimates suggest the population prevalence of arthritis will increase to just over 24% by 2040, with the number of Canadians living with arthritis projected to increase by about 50% from 2015 to 2040. CONCLUSION The revised question likely increased ascertainment of arthritis owing to inclusion of examples of arthritis diagnoses in the CCHS question and more explicit wording in the French version, resulting in a large increase in the estimated prevalence and numbers of people with arthritis in Canada.
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Affiliation(s)
- Elizabeth M Badley
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto.
| | - Céline M Goulart
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
| | - Dov B Millstone
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
| | - Anthony V Perruccio
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
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Perruccio AV, Yip C, Power JD, Canizares M, Badley EM. Discordance Between Population Impact of Musculoskeletal Disorders and Scientific Representation: A Bibliometric Study. Arthritis Care Res (Hoboken) 2018; 71:56-60. [DOI: 10.1002/acr.23583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/10/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Anthony V. Perruccio
- Krembil Research InstituteUniversity Health NetworkArthritis Community Research and Evaluation Unitand Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
| | - Calvin Yip
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - J. Denise Power
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Mayilee Canizares
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Elizabeth M. Badley
- Krembil Research InstituteUniversity Health NetworkArthritis Community Research and Evaluation Unitand Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
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