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Kumara MT, Cleveland RJ, Kostic AM, Weisner SE, Allen KD, Golightly YM, Welch H, Dale M, Messier SP, Hunter DJ, Katz JN, Callahan LF, Losina E. Budget impact of the Walk With Ease program for knee osteoarthritis. Osteoarthr Cartil Open 2024; 6:100463. [PMID: 38562164 PMCID: PMC10982564 DOI: 10.1016/j.ocarto.2024.100463] [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: 06/22/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Walk With Ease (WWE) is an effective low-cost walking program. We estimated the budget impact of implementing WWE in persons with knee osteoarthritis (OA) as a measure of affordability that can inform payers' funding decisions. Methods We estimated changes in two-year healthcare costs with and without WWE. We used the Osteoarthritis Policy (OAPol) Model to estimate per-person medical expenditures. We estimated total and per-member-per-month (PMPM) costs of funding WWE for a hypothetical insurance plan with 75,000 members under two conditions: 1) all individuals aged 45+ with knee OA eligible for WWE, and 2) inactive and insufficiently active individuals aged 45+ with knee OA eligible. In sensitivity analyses, we varied WWE cost and efficacy and considered productivity costs. Results With eligibility unrestricted by activity level, implementing WWE results in an additional $1,002,408 to the insurance plan over two years ($0.56 PMPM). With eligibility restricted to inactive and insufficiently active individuals, funding WWE results in an additional $571,931 over two years ($0.32 PMPM). In sensitivity analyses, when per-person costs of $10 to $1000 were added with 10-50% decreases in failure rate (enhanced sustainability of WWE benefits), two-year budget impact varied from $242,684 to $6,985,674 with unrestricted eligibility and from -$43,194 (cost-saving) to $4,484,122 with restricted eligibility. Conclusion Along with the cost-effectiveness of WWE at widely accepted willingness-to-pay thresholds, these results can inform payers in deciding to fund WWE. In the absence of accepted thresholds to define affordability, these results can assist in comparing the affordability of WWE with other behavioral interventions.
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Affiliation(s)
- Mahima T. Kumara
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Serena E. Weisner
- Thurston Arthritis Research Center, Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Kelli D. Allen
- Durham VA Health Care System, Durham, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
- Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Heather Welch
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Melissa Dale
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Ambrose KR, Huffman KF, Odom EL, Foster AL, Turkas N, Callahan LF. A public health approach to osteoarthritis in the United States. Osteoarthritis Cartilage 2024; 32:406-410. [PMID: 38135269 PMCID: PMC10984765 DOI: 10.1016/j.joca.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Kirsten R Ambrose
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Katie F Huffman
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Erica L Odom
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anika L Foster
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Leigh F Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Messier SP, Gill ME, Mihalko SL, Beavers DP, Queen K, Miller GD, Losina E, Katz JN, Loeser RF, DeVita P, Hunter DJ, Quandt SA, Lyles MF, Hudson D, Callahan LF. Clinical, Health-Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2024; 76:503-510. [PMID: 37885103 PMCID: PMC10963163 DOI: 10.1002/acr.25265] [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: 04/30/2023] [Revised: 08/28/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether clinical, health-related quality of life (HRQL), and gait characteristics in adults with knee osteoarthritis (OA) differed by obesity category. METHODS This cross-sectional analysis of 823 older adults (mean age 64.6 years, SD 7.8 years) with knee OA and overweight or obesity compared clinical, HRQL, and gait outcomes among obesity classifications (overweight or class I, body mass index [BMI] 27.0-34.9; class II, BMI 35.0-39.9; class III BMI ≥40.0). RESULTS Patients with class III obesity had worse Western Ontario McMasters Universities Arthritis Index knee pain (0-20) than the overweight or class I (mean 8.6 vs 7.0; difference 1.5; 95% confidence interval [CI] 1.0-2.1; P < 0.0001) and class II (mean 8.6 vs 7.4; difference 1.1; 95% CI 0.6-1.7; P = 0.0002) obesity groups. The Short Form 36 physical HRQL measure was lower in the class III obesity group compared to the overweight or class I (mean 31.0 vs 37.3; difference -6.2; 95% CI -7.8 to -4.7; P < 0.0001) and class II (mean 31.0 vs 35.0; difference -3.9; 95% CI -5.6 to -2.2; P < 0.0001) obesity groups. The class III obesity group had a base of support (cm) during gait that was wider than that for the overweight or class I (mean 14.0 vs 11.6; difference 3.3; 95% CI 2.6-4.0; P < 0.0001) and class II (mean 14.0 vs 11.6; difference 2.4; 95% CI 1.6-3.2; P < 0.0001) obesity groups. CONCLUSION Among adults with knee OA, those with class III obesity had significantly higher pain levels and worse physical HRQL and gait characteristics compared to adults with overweight or class I or class II obesity.
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Affiliation(s)
- Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Rheumatology and Immunology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Malia E. Gill
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Shannon L. Mihalko
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | | | - Gary D. Miller
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard F. Loeser
- Division of Rheumatology, Allergy and Immunology Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mary F. Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David Hudson
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC 28723, USA
| | - Leigh F. Callahan
- Division of Rheumatology, Allergy and Immunology Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kopp PT, Yang C, Yang H, Katz JN, Paltiel AD, Hunter DJ, Callahan LF, Mihalko SL, Newman JJ, DeVita P, Loeser RF, Miller GD, Messier SP, Losina E. Cost-Effectiveness of Community-Based Diet and Exercise for Patients with Knee Osteoarthritis and Obesity or Overweight. Arthritis Care Res (Hoboken) 2024. [PMID: 38450873 DOI: 10.1002/acr.25323] [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: 08/27/2023] [Revised: 01/19/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN) study, a community-based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/m2 relative to a group-based health education (HE) intervention. We sought to determine the incremental cost-effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the "next-best" strategy ranked by increasing lifetime cost. METHODS We used the Osteoarthritis Policy Model to project long-term clinical and economic benefits of the WE-CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE-CAN trial. Our outcomes included quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs). RESULTS In a cohort with mean age 65 years, BMI 37 kg/m2, and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0-100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY. CONCLUSION The community-based D + E program for persons with knee OA and BMI >27kg/m2 could be cost-effective for willingness-to-pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community-based D + E programs into OA care may be beneficial for public health.
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Affiliation(s)
- Paul T Kopp
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Heidi Yang
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - David J Hunter
- University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Paul DeVita
- East Carolina University, Greenville, North Carolina
| | | | - Gary D Miller
- Wake Forest University, Winston-Salem, North Carolina
| | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Messier SP, Callahan LF, Losina E, Mihalko SL, Guermazi A, Ip E, Miller GD, Katz JN, Loeser RF, Pietrosimone BG, Soto S, Cook JL, Newman JJ, DeVita P, Spindler KP, Runhaar J, Armitano-Lago C, Duong V, Selzer F, Hill R, Love M, Beavers DP, Saldana S, Stoker AM, Rice PE, Hunter DJ. The osteoarthritis prevention study (TOPS) - A randomized controlled trial of diet and exercise to prevent Knee Osteoarthritis: Design and rationale. Osteoarthr Cartil Open 2024; 6:100418. [PMID: 38144515 PMCID: PMC10746515 DOI: 10.1016/j.ocarto.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/19/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background Osteoarthritis (OA), the leading cause of disability among adults, has no cure and is associated with significant comorbidities. The premise of this randomized clinical trial is that, in a population at risk, a 48-month program of dietary weight loss and exercise will result in less incident structural knee OA compared to control. Methods/design The Osteoarthritis Prevention Study (TOPS) is a Phase III, assessor-blinded, 48-month, parallel 2 arm, multicenter randomized clinical trial designed to reduce the incidence of structural knee OA. The study objective is to assess the effects of a dietary weight loss, exercise, and weight-loss maintenance program in preventing the development of structural knee OA in females at risk for the disease. TOPS will recruit 1230 ambulatory, community dwelling females with obesity (Body Mass Index (BMI) ≥ 30 kg/m2) and aged ≥50 years with no radiographic (Kellgren-Lawrence grade ≤1) and no magnetic resonance imaging (MRI) evidence of OA in the eligible knee, with no or infrequent knee pain. Incident structural knee OA (defined as tibiofemoral and/or patellofemoral OA on MRI) assessed at 48-months from intervention initiation using the MRI Osteoarthritis Knee Score (MOAKS) is the primary outcome. Secondary outcomes include knee pain, 6-min walk distance, health-related quality of life, knee joint loading during gait, inflammatory biomarkers, and self-efficacy. Cost effectiveness and budgetary impact analyses will determine the value and affordability of this intervention. Discussion This study will assess the efficacy and cost effectiveness of a dietary weight loss, exercise, and weight-loss maintenance program designed to reduce incident knee OA. Trial registration ClinicalTrials.gov Identifier: NCT05946044.
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Affiliation(s)
- Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shannon L. Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Ali Guermazi
- Boston University School of Medicine, Boston, MA, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary D. Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian G. Pietrosimone
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Soto
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James L. Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jovita J. Newman
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Kurt P. Spindler
- Clinical Research and Outcomes, Cleveland Clinic Florida, Weston, FL, USA
| | - Jos Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands
| | - Cortney Armitano-Lago
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vicky Duong
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ryan Hill
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Monica Love
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Aaron M. Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Paige E. Rice
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia
- Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
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Huffman KF, Ambrose KR, Nelson AE, Allen KD, Golightly YM, Callahan LF. The Critical Role of Physical Activity and Weight Management in Knee and Hip Osteoarthritis: A Narrative Review. J Rheumatol 2024; 51:224-233. [PMID: 38101914 PMCID: PMC10922233 DOI: 10.3899/jrheum.2023-0819] [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] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
Physical activity (PA) and weight management are critical components of an effective knee and hip osteoarthritis (OA) management plan, yet most people with OA remain insufficiently active and/or overweight. Clinicians and their care teams play an important role in educating patients with OA about PA and weight management, eliciting patient motivation to engage in these strategies, and referring patients to appropriate self-management interventions. The purpose of this review is to educate clinicians about the current public health and clinical OA guidelines for PA and weight management and highlight a variety of evidence-based self-management interventions available in community and clinical settings and online.
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Affiliation(s)
- Katie F Huffman
- K.F. Huffman, MA, K.R. Ambrose, MS, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
| | - Kirsten R Ambrose
- K.F. Huffman, MA, K.R. Ambrose, MS, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda E Nelson
- A.E. Nelson, MD, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelli D Allen
- K.D. Allen, PhD, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, and Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina
| | - Yvonne M Golightly
- Y.M. Golightly, PhD, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leigh F Callahan
- L.F. Callahan, PhD, Osteoarthritis Action Alliance, Thurston Arthritis Research Center, and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Department of Orthopaedics, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Callahan LF, Samsell B, DiBenedetti D, Frangiosa T, Slota C, Biggar V, Paulsen R, Lappin D, Herring WL, Romano C. Evaluating Elements of the Care Partner Experience in Individuals Who Care for People with Alzheimer's Disease Across the Severity Spectrum. Neurol Ther 2024; 13:53-67. [PMID: 37889399 PMCID: PMC10787717 DOI: 10.1007/s40120-023-00558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Non-professional care partners play an important and often evolving role in the care of persons living with Alzheimer's disease (PLWAD). We investigated two elements of the care partner experience, namely time and strain incurred by care partners providing care to PLWAD across the severity spectrum. METHODS Data gathered from the Alzheimer's Disease Patient and Caregiver Engagement (AD PACE) What Matters Most (WMM) study series were analyzed to determine how much time care partners spent providing care to PLWAD based on where the care recipients lived. Additionally, quantitative assessments of weekly hours providing care and the strain experienced by care partners were conducted using the UsAgainstAlzheimer's A-LIST Insights Series survey, which included the Modified Caregiver Strain Index (MCSI). Finally, a targeted literature review was conducted to contextualize findings and characterize the existing literature landscape. RESULTS Care partners in the AD PACE WMM studies (n = 139) spent significantly more hours providing care for recipients who lived with someone (mean ± standard deviation [SD], 57.3 ± 44.3 h/week) than for recipients who lived alone (26.0 ± 12.0 h/week) (P = 0.0096) or lived in assisted living/nursing home (23.6 ± 14.4 h/week) (P = 0.0002). In the A-LIST Insights Series survey, care partners provided an overall mean (± SD) 58.1 ± 53.0 h of direct care each week, with caregiving hours increasing with increasing severity of AD/AD-related dementias (AD/ADRD). Additionally, care partners for recipients with mild (n = 14), moderate (n = 111), and severe AD/ADRD (n = 91) had overall mean MCSI scores of 9.0 ± 3.8 (range 2-14), 13.3 ± 4.8 (range 4-23), and 17.5 ± 5.3 (range 4-26), respectively, with higher scores suggesting greater care partner strain. CONCLUSIONS Persons living with AD require increasing levels of care along the spectrum of disease, and even individuals with early disease need care from partners. Early interventions that slow progression of AD and programs that improve family function may have beneficial impact on the experiences of care partners for recipients with mild, moderate, or severe AD.
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Affiliation(s)
| | - Brian Samsell
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | | | | | | | - William L Herring
- RTI Health Solutions, Research Triangle Park, NC, USA
- Karolinska Institute, Stockholm, Sweden
| | - Carla Romano
- RTI Health Solutions, Research Triangle Park, NC, USA.
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Fallon EA, Brown DR, Callahan LF, Foster AL, Kim JS, Lo GH, Piercy KL. Stepping Up Counseling and Referral to Effective Physical Activity Interventions for Adults With Osteoarthritis. J Rheumatol 2024; 51:209-212. [PMID: 37967909 DOI: 10.3899/jrheum.2023-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Elizabeth A Fallon
- Centers for Disease Control and Prevention, Division of Population Health, Atlanta, Georgia;
| | - David R Brown
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Leigh F Callahan
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, North Carolina
| | - Anika L Foster
- Centers for Disease Control and Prevention, Division of Population Health, Atlanta, Georgia
| | | | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Veterans Affairs Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katrina L Piercy
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Washington, DC, USA
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Kim S, Kosorok MR, Arbeeva L, Schwartz TA, Callahan LF, Golightly YM, Nelson AE, Allen KD. Precision Medicine-Based Machine Learning Analyses to Explore Optimal Exercise Therapies for Individuals With Knee Osteoarthritis: Random Forest-Informed Tree-Based Learning. J Rheumatol 2023; 50:1341-1345. [PMID: 37527856 PMCID: PMC10543458 DOI: 10.3899/jrheum.2022-1039] [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] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE We applied a precision medicine-based machine learning approach to discover underlying patient characteristics associated with differential improvement in knee osteoarthritis symptoms following standard physical therapy (PT), internet-based exercise training (IBET), and a usual care/wait list control condition. METHODS Participants (n = 303) were from the Physical Therapy vs Internet-Based Training for Patients with Knee Osteoarthritis trial. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12-month follow-up. Random forest-informed tree-based learning was applied to identify patient characteristics that were critical to improving outcomes, and patients with those features were grouped. RESULTS Age, BMI, and Brief Fear of Movement (BFOM) score, all at baseline, were identified as characteristics that effectively divided participants, creating 6 subgroups. Assigning treatments according to these models, compared to assigning a single best treatment to all patients, resulted in greater improvements of the average WOMAC at 12 months (P = 0.01). Key patterns were that IBET was the optimal treatment for patients of younger age and low BFOM, whereas PT was the optimal treatment for patients of older age, high BFOM, and BMI (kg/m2) between 26.3 and 37.2. CONCLUSION These results suggest that easily assessed patient characteristics including age, fear of movement, and BMI could be used to guide patients toward either home-based exercise or PT, though additional studies are needed to confirm these findings. (ClinicalTrials.gov: NCT02312713).
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Affiliation(s)
- Siyeon Kim
- S. Kim, MA, M.R. Kosorok, PhD, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael R Kosorok
- S. Kim, MA, M.R. Kosorok, PhD, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Liubov Arbeeva
- L. Arbeeva, MS, L.F. Callahan, PhD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Todd A Schwartz
- T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leigh F Callahan
- L. Arbeeva, MS, L.F. Callahan, PhD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne M Golightly
- Y.M. Golightly, PT, MS, PhD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, and Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda E Nelson
- A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelli D Allen
- K.D. Allen, PhD, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina, USA.
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10
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Zimmerman ZE, Cleveland RJ, Kostic AM, Leifer VP, Weisner SE, Allen KD, Golightly YM, Welch H, Dale M, Messier SP, Hunter DJ, Katz JN, Callahan LF, Losina E. Walk with ease for knee osteoarthritis: A cost-effectiveness analysis. Osteoarthr Cartil Open 2023; 5:100368. [PMID: 37234863 PMCID: PMC10206185 DOI: 10.1016/j.ocarto.2023.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Objective The Walk With Ease (WWE) program was developed by the Arthritis Foundation to help people with arthritis learn to exercise safely and improve arthritis symptoms. We sought to establish the value of the WWE program. Methods We used the Osteoarthritis Policy (OAPol) Model, a widely published and validated computer simulation of knee osteoarthritis (OA), to assess the cost-effectiveness of WWE in knee OA. We derived model inputs using data from a workplace wellness initiative in Montana that offered WWE to state employees. Our primary outcomes were quality-adjusted life years (QALYs) and costs over a 2-year period, which we used to calculate the incremental cost-effectiveness ratio (ICER). The base case analysis was restricted to subjects who were inactive or insufficiently active (<180 min/week of PA) at baseline. We performed scenario and probabilistic sensitivity analyses to determine the impact of uncertainty in model parameters on our results. Results In the base case analysis, adding WWE to usual care resulted in an ICER of $47,900/QALY. When the program was offered without preselection by baseline activity level, the ICER for WWE + usual care was estimated at $83,400/QALY. Results of the probabilistic sensitivity analysis indicated that WWE offered to inactive or insufficiently active individuals has a 52% chance of having an ICER <$50,000/QALY. Conclusion The WWE program offers good value for inactive/insufficiently active individuals. Payers may consider including such a program to increase physical activity in individuals with knee OA.
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Affiliation(s)
- Zoe E. Zimmerman
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aleksandra M. Kostic
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Serena E. Weisner
- Thurston Arthritis Research Center; Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Kelli D. Allen
- Durham VA Health Care System, Durham, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
- Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Heather Welch
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Melissa Dale
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Jeffrey N. Katz
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Dept. of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Elena Losina
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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11
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Buck AN, Vincent HK, Newman CB, Batsis JA, Abbate LM, Huffman KF, Bodley J, Vos N, Callahan LF, Shultz SP. Evidence-Based Dietary Practices to Improve Osteoarthritis Symptoms: An Umbrella Review. Nutrients 2023; 15:3050. [PMID: 37447376 PMCID: PMC10347206 DOI: 10.3390/nu15133050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
While there is some research investigating whole foods or diets that are easily understood and accessible to patients with osteoarthritis, specific nutrients or nutraceuticals are more commonly identified. Unfortunately, guidelines and evidence surrounding individual nutrients, extracts, and nutraceuticals are conflicting and are more difficult to interpret and implement for patients with osteoarthritis. The purpose of this umbrella review is to provide a comprehensive understanding of the existing evidence of whole foods and dietary patterns effects on osteoarthritis-related outcomes to inform evidence-based recommendations for healthcare professionals and identify areas where more research is warranted. A literature search identified relevant systematic reviews/meta-analyses using five databases from inception to May 2022. Five systematic reviews/meta-analyses were included in the current umbrella review. Most evidence supported the Mediterranean diet improving osteoarthritis-related outcomes (e.g., pain, stiffness, inflammation, biomarkers of cartilage degeneration). There was little to no evidence supporting the effects of fruits and herbs on osteoarthritis-related outcomes; however, there was some suggestion that specific foods could potentiate symptom improvement through antioxidative mechanisms. The overall lack of homogeneity between the studies limits the conclusions that can be made and highlights the need for quality research that can identify consumer-accessible foods to improve osteoarthritis-related symptoms.
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Affiliation(s)
- Ashley N. Buck
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC 27402, USA
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
| | - Heather K. Vincent
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 33865, USA
| | - Connie B. Newman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - John A. Batsis
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Geriatric Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27402, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27402, USA
| | - Lauren M. Abbate
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- VA Eastern Colorado Geriatric Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
| | - Katie F. Huffman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jennifer Bodley
- Lemieux Library, Seattle University, Seattle, WA 98122, USA;
| | - Natasha Vos
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- North Carolina Center for Health and Wellness, University of North Carolina, Asheville, NC 28804, USA
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Sarah P. Shultz
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- School of Nursing and Health Studies, Monmouth University, West Long Branch, NJ 07764, USA
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12
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Harmon S, Alvarez C, Hannan MT, Callahan LF, Gates LS, Bowen CJ, Menz HB, Nelson AE, Golightly YM. Association of Foot Symptoms With Decreased Time to All-Cause Mortality: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25186. [PMID: 37386686 PMCID: PMC10755075 DOI: 10.1002/acr.25186] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Adults with foot symptoms (ie, pain, aching, or stiffness) may be at increased risk of reduced time to all-cause mortality. The purpose of this study was to evaluate whether foot symptoms are independently associated with all-cause mortality in older adults. METHODS We analyzed longitudinal data from 2613 participants from the Johnston County Osteoarthritis Project, a longitudinal population-based cohort of adults 45 years of age and older. Participants completed questionnaires at baseline to determine presence of foot symptoms and covariable status. Baseline walking speed was measured via an 8-foot walk test. To examine the association of foot symptoms with time to mortality, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models, adjusted for potential confounders. RESULTS We observed 813 deaths over 4 to 14.5 years of follow-up. At baseline, 37% of participants had foot symptoms, mean age was 63 years, mean body mass index was approximately 31 kg/m2 , 65% were women, and 33% were Black. Moderate to severe foot symptoms were associated with reduced time to mortality after adjustment for demographics, comorbidities, physical activity, and knee and hip symptoms (HR = 1.30, 95% CI 1.09-1.54). Importantly, this association was not modified by walking speed or diabetes. CONCLUSION Individuals with foot symptoms had an increased hazard of all-cause mortality compared with those with no foot symptoms. These effects were independent of key confounders and were not moderated by walking speed. Effective interventions to identify and manage at least moderate foot symptoms may reduce the risk of decreased time to mortality.
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Affiliation(s)
- Skylar Harmon
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Nova Southeastern University- Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Marian T. Hannan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA
- Hinda and Arthur Marcus Institute of Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Lucy S. Gates
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Catherine J. Bowen
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hylton B. Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, AUS
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE USA
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13
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt LC, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:193-197. [PMID: 37130278 PMCID: PMC10176846 DOI: 10.4085/1062-6050-0255.22] [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] [Indexed: 05/04/2023]
Abstract
After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury.
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Affiliation(s)
- Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Kirsten R. Ambrose
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Shelby Baez
- Department of Kinesiology, Michigan State University, East Lansing
| | - Nicholas Beresic
- Department of Orthopaedics, University of North Carolina, Chapel Hill
| | | | - Leigh F. Callahan
- Department of Orthopaedics, University of North Carolina, Chapel Hill
| | | | - Madison Franek
- Wellness Center at Meadowmont, Department of Therapy Services, University of North Carolina, Chapel Hill
| | | | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Department of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Adam Naylor
- Telos SPC, Boston, MA
- Deloitte US, Boston, MA
| | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, New York University
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Brian Pietrosimone
- Department of Orthopaedics, University of North Carolina, Chapel Hill
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Matthew Salzler
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, Tufts Medical Center, Boston, MA
| | - Laura C. Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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14
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
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Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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Hauber B, Paulsen R, Krasa HB, Vradenburg G, Comer M, Callahan LF, Winfield J, Potashman M, Hartry A, Lee D, Wilson H, Hoffman DL, Wieberg D, Kremer IN, Taylor GA, Taylor JM, Lappin D, Martin AD, Frangiosa T, Biggar V, Slota C, Romano C, DiBenedetti DB. Assessing What Matters to People Affected by Alzheimer's Disease: A Quantitative Analysis. Neurol Ther 2023; 12:505-527. [PMID: 36763306 PMCID: PMC10043143 DOI: 10.1007/s40120-023-00445-0] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION In this phase of the ongoing What Matters Most study series, designed to evaluate concepts that are meaningful to people affected by Alzheimer's disease (AD), we quantified the importance of symptoms, impacts, and outcomes of AD to people at risk for or with AD and care partners of people with AD. METHODS We administered a web-based survey to individuals at risk for or with AD (Group 1: unimpaired cognition with evidence of AD pathology; Group 2: AD risk factors and subjective cognitive complaints/mild cognitive impairment; Group 3: mild AD) and to care partners of individuals with moderate AD (Group 4) or severe AD (Group 5). Respondents rated the importance of 42 symptoms, impacts, and outcomes on a scale ranging from 1 ("not at all important") to 5 ("extremely important"). RESULTS Among the 274 respondents (70.4% female; 63.1% white), over half of patient respondents rated all 42 items as "very important" or "extremely important," while care partners rated fewer items as "very important" or "extremely important." Among the three patient groups, the minimum (maximum) mean importance rating for any item was 3.4 (4.6), indicating that all items were at least moderately to very important. Among care partners of people with moderate or severe AD, the minimum (maximum) mean importance rating was 2.1 (4.4), indicating that most items were rated as at least moderately important. Overall, taking medications correctly, not feeling down or depressed, and staying safe had the highest importance ratings among both patients and care partners, regardless of AD phase. CONCLUSION Concepts of importance to individuals affected by AD go beyond the common understanding of "cognition" or "function" alone, reflecting a desire to maintain independence, overall physical and mental health, emotional well-being, and safety. Preservation of these attributes may be key to understanding whether interventions deliver clinically meaningful outcomes.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Russ Paulsen
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | - Holly B Krasa
- Blue Persimmon Group LLC, Washington, DC, 20016, USA
| | | | - Meryl Comer
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | | | - John Winfield
- University of North Carolina, Chapel Hill, NC, 27599, USA
| | | | | | - Daniel Lee
- Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ, 08540, USA
| | - Hilary Wilson
- Boehringer Ingelheim, Burlington, ON, L7L 5H4, Canada
| | | | | | - Ian N Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer's Disease), Washington, DC, 20043, USA
| | | | | | - Debra Lappin
- Faegre Drinker Consulting, Washington, DC, 20001, USA
| | | | | | | | - Christina Slota
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Carla Romano
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Dana B DiBenedetti
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
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Astrike-Davis EM, Cleveland RJ, Louis Bridges S, Jonas BL, Callahan LF. Associations of Socioeconomic Status With Disease Progression in African Americans With Early Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:85-91. [PMID: 35468261 PMCID: PMC9592673 DOI: 10.1002/acr.24896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/25/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In prior cross-sectional analyses of African American patients with rheumatoid arthritis (RA), measures of socioeconomic status (SES) were associated with clinical joint damage and poorer patient-reported outcome scores. The purpose of this study was to determine whether SES measures are associated with disease progression in a cohort of African American patients with early RA (<2 years duration). METHODS We analyzed baseline SES and change in 60-month clinical radiographs and patient-reported outcomes data (n = 101 and 177, respectively) in individuals with early RA. SES measures were educational attainment, occupation, homeownership, household income, and block group poverty. Outcomes were based on radiographs (total erosion and joint space narrowing [JSN] scores on hands and feet) and patient-reported outcomes (pain, fatigue, disability, and learned helplessness). We used logistic regression with mixed effects accounting for study site to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Both low education and occupation status were associated with worsening pain (adjusted OR 5.86 [95% CI 3.05-11.3] and adjusted OR 2.55 [95% CI 1.54-4.21], respectively). Patients without a high-school diploma were more likely to have worsened reports of learned helplessness (OR 1.92 [95% CI 1.37-2.67]). Community measures of SES were also significantly associated with patient-reported outcomes score changes. Patients living in areas of block group poverty ≥20% were twice as likely to experience increased disability scores over 60 months of disease duration (OR 1.95 [95% CI 1.17-3.25]). We found no association between SES measures and erosion or JSN score progression. CONCLUSION Low educational attainment and nonprofessional occupation status were associated with increased worsening of patient-reported outcomes. However, there were no corresponding increases in radiographically assessed erosion or JSN score progression.
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Affiliation(s)
| | | | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medical College, New York, New York
| | - Beth L Jonas
- University of North Carolina at Chapel Hill School of Medicine
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17
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Messier SP, Beavers DP, Queen K, Mihalko SL, Miller GD, Losina E, Katz JN, Loeser RF, DeVita P, Hunter DJ, Newman JJ, Quandt SA, Lyles MF, Jordan JM, Callahan LF. Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial. JAMA 2022; 328:2242-2251. [PMID: 36511925 PMCID: PMC9856237 DOI: 10.1001/jama.2022.21893] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Some weight loss and exercise programs that have been successful in academic center-based trials have not been evaluated in community settings. OBJECTIVE To determine whether adaptation of a diet and exercise intervention to community settings resulted in a statistically significant reduction in pain, compared with an attention control group, at 18-month follow-up. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded randomized clinical trial conducted in community settings in urban and rural counties in North Carolina. Patients were men and women aged 50 years or older with knee osteoarthritis and overweight or obesity (body mass index ≥27). Enrollment (N = 823) occurred between May 2016 and August 2019, with follow-up ending in April 2021. INTERVENTIONS Patients were randomly assigned to either a diet and exercise intervention (n = 414) or an attention control (n = 409) group for 18 months. MAIN OUTCOMES AND MEASURES The primary outcome was the between-group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score (range, 0 [none] to 20 [severe]; minimum clinically important difference, 1.6) over 18 months, tested using a repeated-measures mixed linear model with adjustments for covariates. There were 7 secondary outcomes including body weight. RESULTS Among the 823 randomized patients (mean age, 64.6 years; 637 [77%] women), 658 (80%) completed the trial. At 18-month follow-up, the adjusted mean WOMAC pain score was 5.0 in the diet and exercise group (n = 329) compared with 5.5 in the attention control group (n = 316) (adjusted difference, -0.6; 95% CI, -1.0 to -0.1; P = .02). Of 7 secondary outcomes, 5 were significantly better in the intervention group compared with control. The mean change in unadjusted 18-month body weight for patients with available data was -7.7 kg (8%) in the diet and exercise group (n = 289) and -1.7 kg (2%) in the attention control group (n = 273) (mean difference, -6.0 kg; 95% CI, -7.3 kg to -4.7 kg). There were 169 serious adverse events; none were definitely related to the study. There were 729 adverse events; 32 (4%) were definitely related to the study, including 10 body injuries (9 in diet and exercise; 1 in attention control), 7 muscle strains (6 in diet and exercise; 1 in attention control), and 6 trip/fall events (all 6 in diet and exercise). CONCLUSIONS AND RELEVANCE Among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to a statistically significant but small difference in knee pain over 18 months. The magnitude of the difference in pain between groups is of uncertain clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02577549.
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Affiliation(s)
- Stephen P. Messier
- J. B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Rheumatology and Immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kate Queen
- Haywood Regional Medical Center, Clyde, North Carolina
| | - Shannon L. Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Gary D. Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard F. Loeser
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jovita J. Newman
- J. B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mary F. Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joanne M. Jordan
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Leigh F. Callahan
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
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Kuhn KA, Stahly A, Konig MF, Carandang K, Herndon C, Backman C, Callahan LF, Schulert G, Fraenkel L, Ogdie A. Impact of the COVID-19 Pandemic on Early Career Investigators in Rheumatology: Recommendations to Address Challenges to Early Research Careers. Arthritis Care Res (Hoboken) 2022; 75:947-955. [PMID: 36342380 PMCID: PMC9877547 DOI: 10.1002/acr.25055] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has impacted the careers of trainees and early career investigators (ECIs). We sought to assess how the American College of Rheumatology (ACR) and the Rheumatology Research Foundation (RRF) can address the needs of those pursuing research careers. METHODS The Committee on Research created a survey to assess the impact of COVID-19 and identify topics for the ACR and the RRF to address. In fall of 2020, we surveyed postdoctoral trainees and ECIs within 9 years of terminal training. Responses were analyzed using descriptive statistics and qualitative content analysis. RESULTS Twenty-one percent of invitees responded to the survey (n = 365); of these, 60% were pursuing careers in academic research. Seventy-five percent of respondents in academic research career paths placed their primary projects on hold during the pandemic. The number of individuals pursuing a research career from 2020 to 2021 decreased by 5%. Respondents reported funding, caregiving, and lack of preliminary data as significant challenges. Suggested impactful interventions included increased funding, funding process reform, and expanding mentoring and networking resources. CONCLUSION Major stressors identified during the pandemic included increased caregiving responsibilities and difficulty obtaining data and funding, for which respondents suggested increases and changes in funding programs as well as more mentoring and networking opportunities. Based on these, the Committee on Research proposes 3 priorities: 1) flexible funding mechanisms for ECIs and additional support for those impacted by caregiving; 2) virtual and in-person programs for career development and networking; and 3) curated content relevant to building a research career available on demand.
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Affiliation(s)
| | - Andrew Stahly
- University of Colorado Anschutz Medical CampusAurora
| | | | - Kristine Carandang
- Young Patients' Autoimmune Research & Empowerment Alliance and University of Wisconsin‐River FallsRiver Falls
| | | | - Catherine Backman
- The University of British Columbia and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | | | - Grant Schulert
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of MedicineCincinnatiOhio
| | - Liana Fraenkel
- Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of MedicineNew HavenConnecticut
| | - Alexis Ogdie
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia
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19
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Kelley GA, Kelley KS, Callahan LF. Clinical Relevance Of Tai Chi On Pain, Stiffness, And Function In Knee Osteoarthritis: A Meta-analysis. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879020.29167.f0] [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: 11/21/2022]
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20
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Kelley GA, Kelley KS, Callahan LF. Are There Interindividual Differences in Anxiety as a Result of Aerobic Exercise Training in Adults With Fibromyalgia? An Ancillary Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2022; 103:1858-1865. [PMID: 35051402 PMCID: PMC9288562 DOI: 10.1016/j.apmr.2021.12.019] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/12/2021] [Accepted: 12/23/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine whether true interindividual response differences (IIRD) exist with respect to changes in anxiety because of aerobic exercise training in adults with fibromyalgia (FM). DATA SOURCES Data from a previous meta-analytical database of randomized controlled trials of exercise in adults with arthritis and other rheumatic diseases. STUDY SELECTION Randomized controlled trials limited to aerobic exercise training on anxiety in adults 18 years or older with FM were included. DATA EXTRACTION Change outcome SDs treated as point estimates for anxiety were used to calculate true IIRD from each study. In addition, treatment effect data were extracted. DATA SYNTHESIS The inverse variance heterogeneity model was used to pool all results. For the 5 studies and 321 participants in which results were pooled, statistically significant treatment effect reductions in anxiety were observed (mean, -0.77 points, 95% CI, -1.25 to -0.77). However, no significant IIRD were found (mean, 0.6 points, 95% CI, -1.2 to 1.5). The 95% prediction interval for true IIRD in a future study was -1.7 to 0.8. The percent chance, ie, probability, of a clinically meaningful difference in variability, was 61.5% (only possibly clinically important). CONCLUSIONS The results of the current study suggest that aerobic exercise is associated with reductions in anxiety among adults with fibromyalgia. However, there is currently a lack of convincing evidence to support the notion that true IIRD exist. Therefore, a search for potential mediators and moderators associated with aerobic exercise and changes in anxiety among adults with FM may not be warranted. However, additional research is needed before any true level of certainty can be established. This includes (1) the assessment of IIRD in future randomized controlled trials, (2) randomized controlled trials of longer duration, and (3) an increase in the proportion of men included in randomized controlled trials.
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Affiliation(s)
- George A Kelley
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV.
| | - Kristi S Kelley
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV
| | - Leigh F Callahan
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC; Department of Orthopedics, University of North Carolina, Chapel Hill, NC; Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
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21
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Kelley GA, Kelley KS, Callahan LF. Inter-individual Differences In Anxiety As A Result Of Aerobic Exercise In Adults With Fibromyalgia: Meta-analysis. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877872.40464.54] [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: 11/21/2022]
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22
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Sun EY, Alvarez C, Callahan LF, Sheikh SZ. The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study. J Med Internet Res 2022; 24:e38802. [PMID: 36001872 PMCID: PMC9439379 DOI: 10.2196/38802] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. OBJECTIVE Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. METHODS In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. RESULTS We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or "other" race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of <US $25,000 (P=.01) were associated with lower odds of MyChart activation. Following COVID-19, younger age (P<.001), commercial insurance (P=.03), state insurance (P=.02), and median income of US $50,000-75,000 (P=.01) were associated with significantly higher odds of MyChart use. However, being of Black or African American (P<.001) or "other" race (P=.01), Spanish as a primary language (P=.002), male sex (P=.004), rural residence (P=.005), and having no insurance (P<.001) or Medicaid (P=.008) were associated with lower odds of MyChart use. CONCLUSIONS Residence in a rural area, being of minority race/ethnicity, older age, male sex, lower median income, Medicaid, being uninsured, and non-English primary language are associated with lower odds of patient portal activation and use. Future health policy and clinical practice measures should focus on reducing barriers to health technology adoption among these groups.
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Affiliation(s)
- Enid Y Sun
- Section of Rheumatology, Department of Medicine, Temple Lewis Katz School of Medicine, Philadelphia, PA, United States
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Saira Z Sheikh
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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23
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Gebauer SC, Chrusciel T, Salas J, Neme J, Callahan LF, Scherrer J. Construction of an Administrative Osteoarthritis Severity Index. ACR Open Rheumatol 2022; 4:942-947. [PMID: 35975355 PMCID: PMC9661818 DOI: 10.1002/acr2.11490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Electronic health record (EHR) databases are a powerful resource to investigate clinical trajectories of osteoarthritis (OA). There are no existing EHR tools to evaluate risk for knee arthroplasty (KA). We developed an OA severity index (OASI) using EHR data and demonstrate the index's association with time to KA. METHODS This retrospective cohort study used 2010-2018 nationally distributed Optum EHR data. Eligible patients were 45 to 80 years old with a new diagnosis of knee OA in 2011-2012 and no prior KA. The OASI was a sum of first instance of x-ray imaging, advanced imaging, intra-articular injection, nonsteroidal anti-inflammatory drugs, and opioids. Principal components analysis index (PCI) score was also explored. Extended Cox proportional hazard models assessed time-dependent OASI and time to KA. RESULTS Among 16,675 eligible patients, 12.7% underwent KA. Median follow-up time was 72 months. Adjusted OASI models showed each additional event almost doubled the risk for KA (adjusted hazard ratio = 1.80, 95% confidence interval: 1.75-1.86). Similar results were observed for PCI. CONCLUSION The sum OASI performs well identifying patients who would undergo KA and offers simplicity versus the PCI. Although replication in other cohorts is recommended, the OASI appears to be a novel and valid means to measure clinical OA severity in research studies using large EHR-based cohorts.
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Affiliation(s)
| | | | - Joanne Salas
- Saint Louis University School of Medicine St. LouisMissouri
| | - Jamil Neme
- Saint Louis University School of Medicine St. LouisMissouri
| | - Leigh F. Callahan
- Thurston Arthritis Research CenterUniversity of North Carolina at Chapel Hill
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24
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Buck AN, Shultz SP, Huffman KF, Vincent HK, Batsis JA, Newman CB, Beresic N, Abbate LM, Callahan LF. Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis. Curr Dev Nutr 2022; 6:nzac084. [PMID: 35702382 PMCID: PMC9188467 DOI: 10.1093/cdn/nzac084] [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: 02/07/2022] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management. Objectives The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine whether there is a disconnect between what patients want to know about nutrition and OA management and what information health-care professionals (HCPs) are providing to patients. Methods The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in 4 domains: 1) strategies for weight management and a healthy lifestyle; 2) vitamins, minerals, and other supplements; 3) foods or nutrients that may reduce inflammation; and 4) diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources. Results Survey responses from 338 individuals with OA and 104 HCPs were included. The highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods and nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices and herbs (65%), fruits and vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%), and fasting or intermittent fasting (15%). There was greater than 20% discrepancy between interests reported by individuals with OA and discussions reported by HCPs on: weight loss strategies, general information on vitamins and minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion sizes, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging. Conclusions There is disparity between the nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats. This study explored the information gap between what individuals with OA want to know and what HCPs believe they need to know.
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Affiliation(s)
- Ashley N Buck
- Kinesiology Department, Seattle University, Seattle, WA, USA
| | - Sarah P Shultz
- Kinesiology Department, Seattle University, Seattle, WA, USA
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
| | | | - Heather K Vincent
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - John A Batsis
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connie B Newman
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Lauren M Abbate
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
- Department of Emergency Medicine University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh F Callahan
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Division of Rheumatology, Allergy and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Nelson AE, Keefe TH, Schwartz TA, Callahan LF, Loeser RF, Golightly YM, Arbeeva L, Marron JS. Biclustering reveals potential knee OA phenotypes in exploratory analyses: Data from the Osteoarthritis Initiative. PLoS One 2022; 17:e0266964. [PMID: 35609053 PMCID: PMC9129051 DOI: 10.1371/journal.pone.0266964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 11/19/2021] [Accepted: 03/30/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To apply biclustering, a methodology originally developed for analysis of gene expression data, to simultaneously cluster observations and clinical features to explore candidate phenotypes of knee osteoarthritis (KOA) for the first time. Methods Data from the baseline Osteoarthritis Initiative (OAI) visit were cleaned, transformed, and standardized as indicated (leaving 6461 knees with 86 features). Biclustering produced submatrices of the overall data matrix, representing similar observations across a subset of variables. Statistical validation was determined using the novel SigClust procedure. After identifying biclusters, relationships with key outcome measures were assessed, including progression of radiographic KOA, total knee arthroplasty, loss of joint space width, and worsening Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, over 96 months of follow-up. Results The final analytic set included 6461 knees from 3330 individuals (mean age 61 years, mean body mass index 28 kg/m2, 57% women and 86% White). We identified 6 mutually exclusive biclusters characterized by different feature profiles at baseline, particularly related to symptoms and function. Biclusters represented overall better (#1), similar (#2, 3, 6), and poorer (#4, 5) prognosis compared to the overall cohort of knees, respectively. In general, knees in biclusters #4 and 5 had more structural progression (based on Kellgren-Lawrence grade, total knee arthroplasty, and loss of joint space width) but tended to have an improvement in WOMAC pain scores over time. In contrast, knees in bicluster #1 had less incident and progressive KOA, fewer total knee arthroplasties, less loss of joint space width, and stable pain scores compared with the overall cohort. Significance We identified six biclusters within the baseline OAI dataset which have varying relationships with key outcomes in KOA. Such biclusters represent potential phenotypes within the larger cohort and may suggest subgroups at greater or lesser risk of progression over time.
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Affiliation(s)
- Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Thomas H Keefe
- Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Richard F Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - J S Marron
- Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Bowden JL, Callahan LF, Eyles JP, Kent JL, Briggs AM. Realizing Health and Well-being Outcomes for People with Osteoarthritis Beyond Health Service Delivery. Clin Geriatr Med 2022; 38:433-448. [DOI: 10.1016/j.cger.2021.11.011] [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: 11/03/2022]
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Traore Y, Epstein J, Spitz E, March L, Maillefert JF, Rutherford C, Ricatte C, Alleyrat C, Cross M, King LK, Callahan LF, Fautrel B, Buttel T, Hawker G, Hunter DJ, Guillemin F. Development and validation of the Flare-OA questionnaire for measuring flare in knee and hip osteoarthritis. Osteoarthritis Cartilage 2022; 30:689-696. [PMID: 35066175 DOI: 10.1016/j.joca.2021.12.011] [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: 05/31/2021] [Revised: 11/15/2021] [Accepted: 12/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties. METHODS We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity. RESULTS Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was >0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2). CONCLUSION Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.
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Affiliation(s)
- Y Traore
- Inserm, CHRUNancy, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France
| | - J Epstein
- Inserm, CHRUNancy, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France; Université de Lorraine, APEMAC - MICS, Nancy, France.
| | - E Spitz
- Université de Lorraine, APEMAC - EPSAM, Metz, France
| | - L March
- University of Sydney, Institute of Bone and Joint Research, Kolling Institute, And Royal North Shore Hospital, Rheumatology Department, Australia
| | - J-F Maillefert
- University Hospital, Department of Rheumatology, Dijon, France
| | - C Rutherford
- University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney Nursing School, Sydney, Australia
| | - C Ricatte
- Université de Lorraine, APEMAC - EPSAM, Metz, France
| | - C Alleyrat
- Inserm, CHRUNancy, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France
| | - M Cross
- University of Sydney, Institute of Bone and Joint Research, Kolling Institute, And Royal North Shore Hospital, Rheumatology Department, Australia
| | - L K King
- University of Toronto, Department of Medicine, Canada
| | - L F Callahan
- University of North Carolina, Thurston Arthritis Research Center, Chapel Hill, USA
| | - B Fautrel
- Sorbonne Université - Assistance Publique Hôpitaux de Paris, Rheumatology Dept, Pitié-Salpêtrière Hospital, Paris, France; Institut Pierre Louis d'Epidémiologie et Santé Publique, Inserm UMR-S 1136, Paris, France
| | - T Buttel
- University of Sydney, Institute of Bone and Joint Research, Kolling Institute, And Royal North Shore Hospital, Rheumatology Department, Australia; Inner West Psychology, Sydney, Australia
| | - G Hawker
- University of Toronto, Department of Medicine, Canada
| | - D J Hunter
- University of Sydney, Institute of Bone and Joint Research, Kolling Institute, And Royal North Shore Hospital, Rheumatology Department, Australia
| | - F Guillemin
- Inserm, CHRUNancy, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France; Université de Lorraine, APEMAC - MICS, Nancy, France
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Kelley GA, Kelley KS, Callahan LF. Clinical relevance of Tai Chi on pain and physical function in adults with knee osteoarthritis: An ancillary meta-analysis of randomized controlled trials. Sci Prog 2022; 105:368504221088375. [PMID: 35379041 PMCID: PMC10450487 DOI: 10.1177/00368504221088375] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The clinical relevance of Tai Chi on pain, stiffness, and physical function in adults with knee osteoarthritis (KOA) has not been established. Therefore, the purpose of the current study was to address this gap. Eight randomized controlled trials from a recent meta-analysis representing 407 participants (216 Tai Chi, 191 control) in adults ≥18 years of age with KOA and included the assessment of pain, stiffness, and physical function using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed. The inverse variance heterogeneity model (IVhet) was first used to pool standardized mean difference effect sizes (ES) for each outcome. Clinical relevance, i.e., number-needed-to treat (NNT) ≤10 and relative risk reduction (RRR) ≥25% was calculated across assumed controlled risks (ACR) ranging from 0.01 to 0.99. Statistically significant improvements were found for pain (ES, -0.75, 95% CI, -0.99, -0.51; Q = 8.9, p = 0.26; I2 = 21%), stiffness (ES, -0.70, 95% CI, -0.95, -0.46; Q = 9.6, p = 0.21; I2 = 27%), and physical function (ES, -0.91, 95% CI, -1.12, -0.70; Q = 7.2, p = 0.40; I2 = 3%). The intersection of results for a NNT ≤10 and RRR ≥25% yielded high evidence and clinically relevant improvements across a wide range of ACR for pain (0.15 to 0.88), stiffness (0.15 to 0.87), and physical function (0.13 to 0.97). These findings suggest that Tai Chi results in statistically significant as well as clinically important improvements in pain, stiffness, and physical function across a wide range of ACR in adults with KOA.
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Affiliation(s)
- George A Kelley
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Kristi S Kelley
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Leigh F Callahan
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Gates LS, Perry TA, Golightly YM, Nelson AE, Callahan LF, Felson D, Nevitt M, Jones G, Cooper C, Batt ME, Sanchez-Santos MT, Arden NK. Recreational Physical Activity and Risk of Incident Knee Osteoarthritis: An International Meta-Analysis of Individual Participant-Level Data. Arthritis Rheumatol 2022; 74:612-622. [PMID: 34730279 PMCID: PMC9450021 DOI: 10.1002/art.42001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/21/2021] [Revised: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The effect of physical activity on the risk of developing knee osteoarthritis (OA) is unclear. We undertook this study to examine the relationship between recreational physical activity and incident knee OA outcomes using comparable physical activity and OA definitions. METHODS Data were acquired from 6 global, community-based cohorts of participants with and those without knee OA. Eligible participants had no evidence of knee OA or rheumatoid arthritis at baseline. Participants were followed up for 5-12 years for incident outcomes including the following: 1) radiographic knee OA (Kellgren-Lawrence [K/L] grade ≥2), 2) painful radiographic knee OA (radiographic OA with knee pain), and 3) OA-related knee pain. Self-reported recreational physical activity included sports and walking/cycling activities and was quantified at baseline as metabolic equivalents of task (METs) in days per week. Risk ratios (RRs) were calculated and pooled using individual participant data meta-analysis. Secondary analysis assessed the association between physical activity, defined as time (hours per week) spent in recreational physical activity and incident knee OA outcomes. RESULTS Based on a total of 5,065 participants, pooled RR estimates for the association of MET days per week with painful radiographic OA (RR 1.02 [95% confidence interval (95% CI) 0.93-1.12]), radiographic OA (RR 1.00 [95% CI 0.94-1.07]), and OA-related knee pain (RR 1.00 [95% CI 0.96-1.04]) were not significant. Similarly, the analysis of hours per week spent in physical activity also showed no significant associations with all outcomes. CONCLUSION Our findings suggest that whole-body, physiologic energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes.
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Affiliation(s)
| | | | | | | | | | - David Felson
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Graeme Jones
- University of Tasmania, Hobart, Tasmania, Australia
| | - Cyrus Cooper
- Southampton General Hospital and University of Southampton, Southampton, UK
| | - Mark E Batt
- Nottingham University Hospitals, Nottingham, UK
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30
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Nelson AE, Hu D, Arbeeva L, Alvarez C, Cleveland RJ, Schwartz TA, Murphy LB, Helmick CG, Callahan LF, Renner JB, Jordan JM, Golightly YM. Point prevalence of hip symptoms, radiographic, and symptomatic OA at five time points: The Johnston County Osteoarthritis Project, 1991–2018. Osteoarthritis and Cartilage Open 2022; 4. [DOI: 10.1016/j.ocarto.2022.100251] [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: 11/26/2022] Open
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31
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Soto SH, Berry DC, Callahan LF. Qualitative Exploration of Dyadic Influence on Physical Activity Between Latina Patients With Osteoarthritis and a Supporter of Their Physical Activity. Arthritis Care Res (Hoboken) 2022; 74:281-290. [PMID: 32976699 PMCID: PMC7990739 DOI: 10.1002/acr.24460] [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: 02/19/2020] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Research indicates that social support may promote physical activity; however, most Latina individuals with osteoarthritis (OA) are not sufficiently active. The purpose of this qualitative dyadic study was to explore how Latina patients with OA and a self-selected physical activity "supporter" motivate each other to be more active. Furthermore, perceptions of how OA symptoms impact support and physical activity were examined. METHODS Semistructured dyadic interviews were conducted with Latina patients with OA and a member of their social network age ≥16 years who supports their physical activity (n = 14 dyads). We used framework analysis to reduce qualitative data to themes and subthemes. RESULTS Daughters (n = 5), spouses (n = 4), sons (n = 2), a granddaughter (n = 1), a nephew (n = 1), and a friend (n = 1) provided support for the target behavior. In many cases, members of dyads said the motivation to engage in physical activity was reciprocated rather than focused solely on Latina patients with OA. Support was often reciprocated by engaging in physical activity together, using pressure, talking about being active, modeling physical activity, and helping with household responsibilities. Although participants agreed that physical activity was beneficial and Latina patients desired additional support when experiencing OA symptoms, there was concern about the safety of activity in the presence of symptoms. Several adult daughters indicated that their mothers' OA symptoms motivated their own physical activity. CONCLUSION Dyadic strategies for promoting physical activity among Latina patients with OA and how support may be reciprocated were identified.
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Affiliation(s)
- Sandra H. Soto
- UNC, Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460,Thurston Arthritis Research Center, 3300 Thurston Bldg., Campus Box 7280, Chapel Hill, NC 27599
| | - Diane C. Berry
- UNC, Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, 3300 Thurston Bldg., Campus Box 7280, Chapel Hill, NC 27599,UNC, Division of Rheumatology, Allergy and Immunology, Department of Medicine, 125 MacNider Hall, Campus Box #7005, Chapel Hill, NC 27599-7280
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32
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Thoma LM, Cleveland RJ, Jonas BL, Bridges SL, Callahan LF. Association of Disease Activity and Disability With Rehabilitation Utilization in African American Adults With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2022; 74:16-21. [PMID: 34586720 PMCID: PMC8720062 DOI: 10.1002/acr.24797] [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: 03/24/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association of disease activity and disability with rehabilitation utilization in African American adults with rheumatoid arthritis (RA). METHODS We analyzed cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with RA (CLEAR) I and CLEAR II registry. Disease activity was quantified with the Disease Activity Score in 28 joints using the C-reactive protein level. Disability was measured with the Health Assessment Questionnaire. Rehabilitation utilization was determined by self-reported recall of physical therapy or occupational therapy visits in the prior 6 months or ever. We examined the association of disease activity and disability with rehabilitation utilization using separate binary logistic regression models to estimate odds ratios and 95% confidence intervals and adjusted for potential confounders. We repeated the analyses with the sample stratified by disease duration (early RA and established RA). RESULTS Of 1,067 participants, 14% reported utilizing rehabilitation in the prior 6 months, and 41% reported ever utilizing rehabilitation. Rehabilitation utilization in the prior 6 months was similar among those with early and established RA (12% versus 16%). A greater proportion of those with established RA reported any past rehabilitation utilization (28% versus 50%). Among those with established RA but not early RA, worse disability was associated with rehabilitation utilization in the prior 6 months. Disease activity was not associated with either outcome. CONCLUSION Among African American adults with RA, rehabilitation utilization in the 6 months prior to assessment was low and associated with disability but not disease activity. Factors driving rehabilitation utilization are unclear.
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Affiliation(s)
| | | | | | - S. Louis Bridges
- Hospital for Special Surgery and Weill Cornell College of Medicine
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33
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Griesemer I, Vu MB, Callahan LF, Cleveland R, Golightly YM, Grimm K, Huffman K, Nelson AE, Rees J, Allen K. Developing a Primary Care-Focused Intervention to Engage Patients With Osteoarthritis in Physical Activity: A Stakeholder Engagement Qualitative Study. Health Promot Pract 2022; 23:64-73. [PMID: 32783476 PMCID: PMC10565837 DOI: 10.1177/1524839920947690] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Physical activity (PA) is important for managing osteoarthritis (OA), but many patients are inactive. Research is needed on strategies to leverage clinical encounters to engage patients in PA. Guided by the socioecological model of health behavior, this study aimed to engage stakeholders in the process of refining an Osteoarthritis Physical Activity Care Pathway (OA-PCP). Six focus groups and seven individual interviews were conducted with key stakeholders. Focus groups were specific to stakeholder roles and included patients with OA, support partners, and clinic personnel (n = 6 focus groups). Interview participants were local and national PA program representatives (n = 7 interviews). Data were analyzed by thematic analysis. Themes identified in the data included ways the OA-PCP can help patients with OA address challenges to PA engagement, strategies for connecting patients with PA resources, methods for implementing OA-PCP into clinical settings and potential use of PA trackers in the OA-PCP program. Stakeholders' comments were summarized into key recommendations for OA-PCP. Some recommendations reinforced and led to refinements in planned aspects of OA-PCP, including tailoring to individual patients, involvement of a support partner, and addressing pain with PA. Other recommendations resulted in larger changes for OA-PCP, including the addition of three email- or mail-based contacts and not requiring use of a PA tracker. The refined OA-PCP program is being evaluated in an exploratory trial, with the ultimate goal of establishing a PA program for OA that can be successfully implemented in clinical settings.
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Affiliation(s)
- Ida Griesemer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan B. Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Kimberlea Grimm
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie Huffman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda E. Nelson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Rees
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelli Allen
- Durham VA Healthcare System, Durham, NC, USA
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Guerrina R, Borisch B, Callahan LF, Howick J, Reginster JY, Mobasheri A. Health and Gender Inequalities of the COVID-19 Pandemic: Adverse Impacts on Women's Health, Wealth and Social Welfare. Front Glob Womens Health 2021; 2:670310. [PMID: 34816222 PMCID: PMC8593989 DOI: 10.3389/fgwh.2021.670310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/21/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
In this paper we discuss the nexus of health and gender inequalities associated with the COVID-19 pandemic and highlight its adverse impacts on women's health, welfare and social standing. The COVID-19 pandemic has exposed the link between socio-economic inequalities and health outcomes, especially in the area of rheumatic and musculoskeletal (RMDs) diseases. Women are more adversely affected by RMDs diseases compared to men. Epidemiological research carried out over several decades has demonstrated the presence of clear gender patterns in the manifestation of musculoskeletal diseases, including osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SS) and osteoporosis (OP). The public health measures that have been adopted to curb the spread of Sars-COV-2 are expected to have a particularly detrimental impact on women in the long term precisely because of the nexus between health outcomes and socio-economic structures. Moreover, the prioritization of urgent care will further compound this effect. COVID-19 has created a condition of ontological insecurity that is becoming increasingly manifested through various chronic diseases and associated comorbidities. RMDs and their impact on mobility and the ability of individuals to be independent, happy and mobile is a key public health challenge in the post-COVID-19 reality and a key part of the ongoing pandemic. There is an urgent need to engage with policymakers to publicize and prioritize this problem and develop viable solutions to address it.
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Affiliation(s)
- Roberta Guerrina
- School of Sociology, Politics and International Studies, University of Bristol, Bristol, United Kingdom
| | - Bettina Borisch
- Policies and Governance Research Group, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Leigh F Callahan
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States.,Departments of Orthopedics and Social Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Jean-Yves Reginster
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - Ali Mobasheri
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.,Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Griesemer I, Phillips A, Khan C, Bahorski S, Altpeter M, Callahan LF, Porter LS, Rini C. Developing a couple typology: A qualitative study of couple dynamics around physical activity. Transl Behav Med 2021; 10:751-759. [PMID: 31220320 DOI: 10.1093/tbm/ibz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Partner-based social support can motivate engagement in physical activity (PA); however, couples approach exchanging support in different ways. This study aimed to elucidate the role of relationship dynamics in couple-based support for PA, with the goal of informing intervention strategies that will effectively leverage couple characteristics to increase support for PA. We conducted a qualitative study of couples who completed a longitudinal study of social support for PA. Participants were people with osteoarthritis who were not meeting PA recommendations and their cohabitating partners (n = 19 couples). We conducted in-depth, semistructured interviews and analyzed transcripts using narrative analysis. Participants were 76% non-Hispanic White and, on average, 62 years old. Themes in the data included (a) attitudes about working together to be more active (ranging from positive to negative) and (b) couples' narrative concordance (high to low shared reality). We developed a couple typology with four categories: "Working together works" (positive attitudes/high shared reality; n = 4 couples), "Doing our own thing" (range of attitudes with practical/preferential barriers to working together/high shared reality; n = 5 couples), "Conscious conflict" (discrepant attitudes/high shared reality; n = 5 couples), and "Different realities" (discrepant attitudes/low shared reality; n = 5 couples). We describe examples of each type. In a sample of 19 couples, there were observable differences in participants' attitudes about working together to be more active and in couples' shared reality around those attitudes. Future research should investigate implications for the efficacy of interventions and, if warranted, develop methods to identify couple types and offer appropriate intervention strategies.
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Affiliation(s)
- Ida Griesemer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Phillips
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Stephanie Bahorski
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Mary Altpeter
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Christine Rini
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.,Georgetown University School of Medicine, Washington, DC, USA
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Nelson AE, Hu D, Arbeeva L, Alvarez C, Cleveland RJ, Schwartz TA, Murphy LB, Helmick CG, Callahan LF, Renner JB, Jordan JM, Golightly YM. The Prevalence of Knee Symptoms, Radiographic, and Symptomatic Osteoarthritis at Four Time Points: The Johnston County Osteoarthritis Project, 1999-2018. ACR Open Rheumatol 2021; 3:558-565. [PMID: 34245232 PMCID: PMC8363850 DOI: 10.1002/acr2.11295] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To describe point prevalence of knee symptoms, radiographic knee osteoarthritis (rKOA), severe rKOA, and symptomatic rKOA at four time points in the longitudinal, population‐based Johnston County Osteoarthritis Project (JoCo OA). Methods Data were from 2573 JoCo OA participants with up to 18 years of follow‐up (1999‐2018) and standardized fixed‐flexion knee radiographs read by a single, reliable expert musculoskeletal radiologist. The four outcomes were 1) self‐reported knee symptoms, defined by “On most days, do you have pain, aching, or stiffness in your right/left knee?”; 2) rKOA, defined as a Kellgren‐Lawrence grade (KLG) of 2 to 4); 3) severe rKOA, defined as a KLG of 3 or 4; and 4) symptomatic rKOA, defined as both symptoms and rKOA in the same joint. Weighted prevalence estimates and 95% confidence intervals (CIs) were generated overall and by age group, sex, race, and body mass index (BMI). Results Most recently (2017‐2018, T4), the overall prevalence (percentage) of knee symptoms, rKOA, severe rKOA, and symptomatic rKOA was 41% (95% CI: 35‐47%), 61% (95% CI: 56‐67%), 35% (95% CI: 30‐40%), and 30% (95% CI: 24‐35%), respectively. From time point T1 to T4, prevalence increased for rKOA, severe rKOA, and symptomatic rKOA but not for knee symptoms. The prevalence of both severe rKOA (17‐39%) and symptomatic rKOA (23‐30%) was consistently higher among women. The prevalence of all outcomes was higher among those with higher BMI and among Black participants at all time points, particularly rKOA (35‐69%) and severe rKOA (22‐46%). Conclusion These updated estimates demonstrate a large and increasing burden of knee OA, particularly among women and Black individuals.
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Affiliation(s)
| | - David Hu
- University of North Carolina at Chapel Hill
| | | | | | | | | | - Louise B. Murphy
- Centers for Disease Control and PreventionAtlantaGeorgiaUnited States
- Optum Life SciencesEden PrairieMinnesotaUnited States
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Soto SH, Hales DP, Callahan LF, Rini C. Partner and Relationship Predictors of Longitudinal Physical Activity Trajectories Among Individuals with Osteoarthritis Using Latent Class Growth Analysis. Ann Behav Med 2021; 56:685-697. [PMID: 34223870 PMCID: PMC9274998 DOI: 10.1093/abm/kaab054] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physical activity reduces osteoarthritis symptoms, yet many individuals with the disease are insufficiently active. PURPOSE We identified physical activity trajectories over 12 months of individuals with osteoarthritis and examined how their cohabiting spouses'/partners' baseline physical activity and relationship factors affected trajectory membership. METHODS In this longitudinal observational study, we collected data from 168 adults with knee/hip osteoarthritis. We used latent class growth curve analysis to identify physical activity trajectories and logistic regression to predict trajectory membership using partners' physical activity, relationship satisfaction, and communal coping (belief that both partners are responsible for osteoarthritis management). Measures, including objectively assessed physical activity, were collected at baseline from the couple, who then received an educational class on physical activity and social support. Objectively assessed physical activity was also collected from individuals with osteoarthritis at 1 week, 3 months, 6 months, and 12 months post-baseline. RESULTS Three trajectories were identified: stable active, increaser, and stable sedentary (24%, 40%, 37% of participants, respectively). Individuals with osteoarthritis with partners who were more active and who believed they alone were responsible for their osteoarthritis were more likely to follow the stable active (versus stable sedentary) trajectory. Those with partners who were less active and had higher relationship satisfaction were more likely to follow the increaser (vs. stable active) trajectory. CONCLUSIONS Findings demonstrate the importance of considering partner and relationship factors in physical activity interventions for couples.
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Affiliation(s)
- Sandra H Soto
- School of Nursing, University of North Carolina, Carrington Hall, Chapel Hill, NC, USA.,Thurston Arthritis Research Center, CB# 7280, Chapel Hill, NC, USA
| | - Derek P Hales
- Department of Nutrition, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, CB# 7280, Chapel Hill, NC, USA.,Department of Medicine, UNC, Chapel Hill, NC, USA
| | - Christine Rini
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Golightly YM, Alvarez C, Arbeeva LS, Cleveland RJ, Schwartz TA, Renner JB, Murphy LB, Callahan LF, Jordan JM, Nelson AE. Associations of Comorbid Conditions and Transitions Across States of Knee Osteoarthritis in a Community-Based Cohort. ACR Open Rheumatol 2021; 3:512-521. [PMID: 34196495 PMCID: PMC8363852 DOI: 10.1002/acr2.11287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine relationships between knee osteoarthritis (KOA) and obesity, diabetes mellitus (DM), and cardiovascular disease (CVD). METHODS Associations of time-dependent obesity, DM, and CVD with KOA transition states over approximately 18 years were examined among 4093 participants from a community-based cohort. Transition states were 1) no knee symptoms and no radiographic KOA (rKOA; Kellgren-Lawrence grade ≥2 in at least one knee), 2) asymptomatic rKOA, 3) knee symptoms only, 4) symptomatic rKOA (sxKOA; rKOA and symptoms in same knee). Markov multistate models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for associations between comorbid conditions and transitions across states, adjusting for baseline age, sex, race, education, enrollment cohort, birth year, and time-dependent knee injury history. RESULTS At baseline, 40% of participants had obesity, 13% had DM, and 22% had CVD (mean age = 61 years; 34% Black; 37% male). Compared with those without obesity, those with obesity had a higher hazard of worsening from no rKOA/no symptoms to asymptomatic rKOA (aHR = 1.7; 95% CI = 1.3-2.2) and from knee symptoms to sxKOA (aHR = 1.7; 95% CI = 1.3-2.3), as well as a lower hazard of symptom resolution from sxKOA to asymptomatic rKOA (aHR = 0.5 [95% = CI 0.4-0.7]). Compared with those without CVD, those with CVD had a higher hazard of worsening from no rKOA/symptoms to knee symptoms (aHR = 1.5; 95% CI = 1.1-2.1). DM was not associated with transitions of rKOA. CONCLUSION Prevention of obesity and CVD may limit the development or worsening of rKOA and symptoms.
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Jiang X, Nelson AE, Cleveland RJ, Beavers DP, Schwartz TA, Arbeeva L, Alvarez C, Callahan LF, Messier S, Loeser R, Kosorok MR. Precision Medicine Approach to Develop and Internally Validate Optimal Exercise and Weight-Loss Treatments for Overweight and Obese Adults With Knee Osteoarthritis: Data From a Single-Center Randomized Trial. Arthritis Care Res (Hoboken) 2021; 73:693-701. [PMID: 32144896 PMCID: PMC7483572 DOI: 10.1002/acr.24179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/07/2019] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To apply a precision medicine approach to determine the optimal treatment regime for participants in an exercise (E), dietary weight loss (D), and D + E trial for knee osteoarthritis that would maximize their expected outcomes. METHODS Using data from 343 participants of the Intensive Diet and Exercise for Arthritis (IDEA) trial, we applied 24 machine-learning models to develop individualized treatment rules on 7 outcomes: Short Form 36 physical component score, weight loss, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/function/stiffness scores, compressive force, and interleukin-6 level. The optimal model was selected based on jackknife value function estimates that indicate improvement in the outcomes if future participants follow the estimated decision rule compared to the optimal single, fixed treatment model. RESULTS Multiple outcome random forest was the optimal model for the WOMAC outcomes. For the other outcomes, list-based models were optimal. For example, the estimated optimal decision rule for weight loss indicated assigning the D + E intervention to participants with baseline weight not exceeding 109.35 kg and waist circumference above 90.25 cm, and assigning D to all other participants except those with a history of a heart attack. If applied to future participants, the optimal rule for weight loss is estimated to increase average weight loss to 11.2 kg at 18 months, contrasted with 9.8 kg if all participants received D + E (P = 0.01). CONCLUSION The precision medicine models supported the overall findings from IDEA that the D + E intervention was optimal for most participants, but there was evidence that a subgroup of participants would likely benefit more from diet alone for 2 outcomes.
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Affiliation(s)
- Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Amanda E. Nelson
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Rebecca J. Cleveland
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Todd A. Schwartz
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Liubov Arbeeva
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Carolina Alvarez
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Leigh F. Callahan
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Stephen Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Richard Loeser
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
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Vilen LH, Altpeter M, Callahan LF. Overcoming Barriers to Walk With Ease Implementation in Community Organizations. Health Promot Pract 2021; 23:708-717. [PMID: 33797292 PMCID: PMC9393651 DOI: 10.1177/15248399211002851] [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] [Indexed: 11/15/2022]
Abstract
Introduction The Arthritis Foundation’s Walk With Ease (WWE) program has been shown to
reduce arthritis symptoms and increase physical performance for up to 1
year. However, research on community-based WWE implementation is limited.
The purpose of this study was to examine early implementation at community
organizations that received 1-year WWE implementation grants from the
Osteoarthritis Action Alliance. Method Program managers at five Osteoarthritis Action Alliance grantee organizations
participated in 45-minute telephone interviews. Interviewees represented
organizations with the highest WWE enrollment at 6 months
(n = 3, >30% of goal enrollment) and no enrollment
at 6 months (n = 2). The Planning for Sustainability
framework guided qualitative analysis of factors affecting early
implementation. Results All grantees were confident in WWE’s evidence base, thought it a beneficial
supplement to other programming, stressed the importance of senior
leadership support for WWE, and engaged community partners for marketing
support and as walking sites. Implementation experiences unique to low
enrollment grantees were (1) recent major structural changes within their
organization, (2) difficulties in communicating logistics internally, and
(3) difficulties in balancing WWE with other responsibilities. All
organizations experienced barriers that required altering their original
implementation plans; however, practical solutions like adapting the program
to improve flexibility, training organizational staff as leaders, and
utilizing community partnerships served to address multiple barriers
simultaneously. Discussion Building organizational capacity by overcoming early barriers is a key
element of early implementation. Our findings offer concrete solutions to
early WWE implementation barriers and suggest the need for further research
on adaptations to improve WWE’s flexibility in community organizations.
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Affiliation(s)
- Leigha H Vilen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,University of Wisconsin, Madison, WI, USA
| | - Mary Altpeter
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh F Callahan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kowitt SD, Aiello AE, Callahan LF, Fisher EB, Gottfredson NC, Jordan JM, Muessig KE. How Are Neighborhood Characteristics Associated With Mental and Physical Functioning Among Older Adults With Radiographic Knee Osteoarthritis? Arthritis Care Res (Hoboken) 2021; 73:308-317. [PMID: 31841258 DOI: 10.1002/acr.24125] [Citation(s) in RCA: 3] [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: 04/04/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine how neighborhood characteristics are associated with health outcomes among older adults with osteoarthritis. METHODS In multilevel, cross-sectional, and longitudinal analyses we examined whether 4 neighborhood characteristics were associated with depressive symptoms and reported knee impact scores, and whether the neighborhood characteristics interacted with race/ethnicity among older adults with radiographic knee osteoarthritis (n = 656 for cross-sectional analyses and n = 434 for longitudinal analyses). The data came from the Johnston County Osteoarthritis Project, a prospective cohort study in North Carolina designed to examine risk factors for osteoarthritis. RESULTS Although few longitudinal associations were found, cross-sectional results suggested that greater perceived neighborhood social cohesion (B = -0.04, P < 0.001) and perceived neighborhood resources for physical activity and walking (B = -0.03, P < 0.001) were associated with fewer depressive symptoms, and that greater perceived neighborhood resources for physical activity and walking were associated with higher (better) knee impact scores (B = 0.48, P = 0.008). We also observed 2 significant interactions among neighborhood characteristics and race/ethnicity related to depressive symptoms (P < 0.01); for African American adults, greater perceived neighborhood resources for physical activity and walking were associated with fewer depressive symptoms (B = -0.03, P < 0.001), but for White adults, greater perceived neighborhood safety was associated with fewer depressive symptoms (B = -0.04, P = 0.003). CONCLUSION In a sample of older adults with radiographic knee osteoarthritis, neighborhood context mattered, but in nuanced ways. Interventions aiming to improve mental and physical functioning of older adults with knee osteoarthritis can look to this study as evidence for the importance of neighborhood characteristics.
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Affiliation(s)
- Sarah D Kowitt
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Allison E Aiello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Leigh F Callahan
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Nisha C Gottfredson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Joanne M Jordan
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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Leyland KM, Gates LS, Sanchez-Santos MT, Nevitt MC, Felson D, Jones G, Jordan JM, Judge A, Prieto-Alhambra D, Yoshimura N, Newton JL, Callahan LF, Cooper C, Batt ME, Lin J, Liu Q, Cleveland RJ, Collins GS, Arden NK. Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data. Aging Clin Exp Res 2021; 33:529-545. [PMID: 33590469 PMCID: PMC7943431 DOI: 10.1007/s40520-020-01762-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population. METHODS Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung-Knapp modification for random-effects meta-analysis. FINDINGS 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA. DISCUSSION Participants with POA or PROA had a 35-37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality. FUNDING Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.
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Affiliation(s)
- Kirsten M Leyland
- MRC Integrated Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lucy S Gates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
| | - Maria T Sanchez-Santos
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - David Felson
- Boston University School of Medicine, Boston, MA, USA
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Joanne M Jordan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dani Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Julia L Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Leigh F Callahan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mark E Batt
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham University Hospitals, Nottingham, UK
| | - Jianhao Lin
- Peking University People's Hospital, Arthritis Clinic and Research Centre, Beijing, China
| | - Qiang Liu
- Peking University People's Hospital, Arthritis Clinic and Research Centre, Beijing, China
| | - Rebecca J Cleveland
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
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Coffman CJ, Arbeeva L, Schwartz TA, Callahan LF, Golightly YM, Goode AP, Huffman KM, Allen KD. Application of Heterogeneity of Treatment Effect Methods: Exploratory Analyses of a Trial of Exercise-Based Interventions for Knee OA. Arthritis Care Res (Hoboken) 2021; 74:1359-1368. [PMID: 33463020 PMCID: PMC8286274 DOI: 10.1002/acr.24564] [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: 05/15/2020] [Revised: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate heterogeneity of treatment effects (HTE) in a trial of exercise-based interventions for knee osteoarthritis (OA). METHODS Participants (n=350) were randomized to standard physical therapy (PT; n=140), Internet-Based Exercise Training (IBET; n=142), or wait list control (WL; n=68). We applied QUalitative INteraction Trees (QUINT), a sequential partitioning method, and Generalized Unbiased Interaction Detection and Estimation (GUIDE), a regression tree approach, to identify subgroups with greater improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score over 4-months. Predictors included 24 demographic, clinical and psychosocial characteristics. We conducted internal validation to estimate optimism (bias) in the range of mean outcome differences among arms. RESULTS Both QUINT and GUIDE indicated that for participants with lower body mass index (BMI), IBET was better than PT (improvements of WOMAC ranged from 6.3 to 9.1 points lower) and for those with higher BMI and longer duration of knee OA, PT was better than IBET (WOMAC improvement was 6.3 points). In GUIDE analyses comparing PT or IBET to WL, participants not employed had improvements in WOMAC ranging from 1.8 to 6.8 points lower with PT or IBT vs. WL. From internal validation, there were large corrections to the mean outcome differences among arms; however, after correction some differences remained in the clinically meaningful range. CONCLUSION Results suggest there may be subgroups who experience greater improvement in symptoms from PT or IBET, and this could guide referrals and future trials. However, uncertainty persists for specific treatment effect size estimates and how they apply beyond this study sample.
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Affiliation(s)
- Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, HSRD (152), 508 Fulton Street, Durham, NC, 27705, United States.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Departments of Orthopaedics and Social Medicine, United States
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Adam P Goode
- Duke Clinical Research Institute, Duke University School of Medicine, United States.,Department of Orthopedic Surgery, Duke University Medical Center, Durham, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, United States
| | - Kim M Huffman
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, United States
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, HSRD (152), 508 Fulton Street, Durham, NC, 27705, United States.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Parsons CM, Gates LS, Perry T, Nevitt M, Felson D, Sanchez-Santos MT, Jones G, Golightly YM, Allen KD, Callahan LF, White DK, Walker-Bone K, Cooper C, Arden NK. Predominant lifetime occupation and associations with painful and structural knee osteoarthritis: An international participant-level cohort collaboration. Osteoarthr Cartil Open 2020; 2:100085. [PMID: 36474872 PMCID: PMC9718216 DOI: 10.1016/j.ocarto.2020.100085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
Objective With adults working to older ages, occupation is an important, yet less modifiable domain of physical activity to consider in the risk of knee osteoarthritis (OA). This study aimed to investigate the association between predominant lifetime occupation and prevalent knee OA. Design Participant-level data were used from five international community-based cohorts: Johnston County Osteoarthritis Project, the Hertfordshire Cohort Study, the Multicenter Osteoarthritis Study, the Tasmanian Cohort Study and Framingham Osteoarthritis Study. Self-reported predominant occupation was categorized into sedentary, light, light manual and heavy manual levels. Cross-sectional associations between predominant lifetime occupation and knee OA outcomes including prevalence of radiographic knee OA (RKOA), symptomatic RKOA and knee pain, were assessed using logistic regression, accounting for cohort clustering. Results Data for 7391 participants were included. 24.7% reported sedentary lifetime occupation, 30.0% light, 35.9% light manual and 9.4% heavy manual. 43.3% presented with RKOA, 52.1% with knee pain and 29.0% with symptomatic RKOA. There was over a two-fold increase in the odds of having RKOA, knee pain and symptomatic RKOA in those whose with heavy manual compared to sedentary occupations ((odds ratio (OR): 2.14; 95% confidence interval (CI): 1.79, 2.58), (OR: 2.19; 95% CI: 1.78, 2.70), (OR: 2.41; 95% CI: 1.94, 2.99) respectively). Conclusion This large international multi-cohort study demonstrated an association of heavy manual work with RKOA, symptomatic RKOA and knee pain. Measures that protect workers and are designed to reduce heavy manual related activities remain a priority to reduce the risk of knee OA.
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Affiliation(s)
- Camille M. Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Lucy S. Gates
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Thomas Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Michael Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - David Felson
- Arthritis Research UK Epidemiology Unit and National Institute for Health Research Biomedical Research Centre, University of Manchester, Manchester, UK
- Boston University School of Medicine, Boston, MA, USA
| | - Maria T. Sanchez-Santos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
- Injury Prevention Research Centre, University of North Carolina at Chapel Hill, USA
- Division of Physical Therapy, University of North Carolina at Chapel Hill; USA
| | - Kelli D. Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Centre of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs Health Care System, Durham, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
- Department of Medicine, Orthopaedics, and Social Medicine, School of Medicine, University of North Carolina at Chapel Hill; USA
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, Southampton, UK
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nigel K. Arden
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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46
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Hartry A, Menne H, Wronski SL, Paulsen R, Callahan LF, Potashman M, Lee D, Wunderlich G, Hoffman D, Wieberg D, Kremer IN, Hauber B, DiBenedetti DB. Evaluation of what matters most in existing clinical outcomes assessments in Alzheimer's disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.040100] [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: 11/07/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease) Washington DC USA
| | - Brett Hauber
- University of Washington School of Pharmacy Seattle WA USA
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47
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Majid T, Paulsen R, Callahan LF, Potashman M, Lee D, Hartry A, Wunderlich G, Hoffman D, Wieberg D, Kremer IN, DiBenedetti DB. The importance of care partner input in Alzheimer’s disease (AD) drug development. Alzheimers Dement 2020. [DOI: 10.1002/alz.040099] [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: 11/06/2022]
Affiliation(s)
- Tabassum Majid
- University of Maryland Baltimore County Baltimore MD USA
| | | | | | | | | | | | | | | | | | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease) Washington DC USA
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48
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Hauber B, Paulsen R, Callahan LF, Potashman M, Lee D, Hartry A, Wunderlich G, Hoffman D, Wieberg D, Kremer IN, DiBenedetti DB. Quantifying what matters most to patients and care partners in Alzheimer's disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.040095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Brett Hauber
- RTI Health Solutions Research Triangle Park NC USA
- University of Washington School of Pharmacy Seattle WA USA
| | | | | | | | | | | | | | | | | | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease) Washington DC USA
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49
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Callahan LF, Cleveland RJ, Allen KD, Golightly Y. Racial/Ethnic, Socioeconomic, and Geographic Disparities in the Epidemiology of Knee and Hip Osteoarthritis. Rheum Dis Clin North Am 2020; 47:1-20. [PMID: 34042049 DOI: 10.1016/j.rdc.2020.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
It is estimated that 32.5 million US adults have clinical osteoarthritis (OA), with the most common sites being knee and hip. OA is associated with substantial individual and societal costs. Race/ethnicity, socioeconomic status (SES), and geographic variations in the prevalence of knee and hip OA are well established around the world. In addition, clinical outcomes associated with hip and knee OA differ according to race/ethnicity, SES, and geography. This variation is likely multifactorial and may also reflect country-specific differences in health care systems. The interplay between different factors, such as geography, SES, and race/ethnicity, is difficult to study.
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Affiliation(s)
- Leigh F Callahan
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA.
| | - Rebecca J Cleveland
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA
| | - Kelli D Allen
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, VA Healthcare System, Durham, NC, USA
| | - Yvonne Golightly
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599-7280, USA
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50
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Cleveland RJ, Alvarez C, Nelson AE, Schwartz TA, Renner JB, Jordan JM, Callahan LF. Hip symptoms are associated with premature mortality: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2020; 28:1330-1340. [PMID: 32777267 PMCID: PMC7530042 DOI: 10.1016/j.joca.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/12/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality. DESIGN We analyzed data from 3,919 individuals in a community-based prospective cohort of African Americans and Caucasians age ≥45 years. Women ≥50 years of age and all men underwent supine anteroposterior pelvic radiography at baseline, with the participant's feet in 15 degrees of internal rotation. Hip radiographic (rOA) was defined as a Kellgren-Lawrence grade of ≥2 in at least one hip. Participants completed questionnaires at baseline to determine presence of hip symptoms and covariate status. Participants with symptomatic hip rOA (SxOA) are a subset of individuals with hip rOA and symptoms in the same hip. Multiple imputation was used to impute missing values of covariates. Mortality was determined through 2015 and follow-up time was calculated from baseline assessment until death or censoring which took place when a participant was lost to follow-up or reached the end of study period. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). We carried out additional analyses stratified by sex, race, age and obesity. RESULTS Mean follow-up time was 14.2 years during which 1762 deaths occurred. There were 29.9% participants in our population with hip rOA at baseline. Compared to those with neither hip rOA nor hip symptoms, we observed an increased risk of all-cause mortality in participants with hip symptoms alone (HR = 1.28, 95% CI = 1.13-1.46), but no association for hip rOA either with or without symptoms. In stratified analyses we observed increased associations for hip symptoms alone and hip sxOA in those <65 years (43% and 39% increase, respectively) and in Caucasians (34% and 21% increase, respectively). CONCLUSIONS Individuals who had hip symptoms without hip rOA had an increased risk of mortality. These effects were particularly strong for those who were <65 years of age and Caucasians. Effective interventions to identify those with hip pain in order to lessen it could reduce premature mortality.
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Affiliation(s)
- Rebecca J. Cleveland
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA,School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Jordan B. Renner
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Departments of Orthopaedics and Social Medicine, University of North Carolina, Chapel Hill, NC, USA
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