1
|
Hurwitz E, Butzin-Dozier Z, Master H, O'Neil ST, Walden A, Holko M, Patel RC, Haendel MA. Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study. JMIR Mhealth Uhealth 2024; 12:e54622. [PMID: 38696234 PMCID: PMC11099816 DOI: 10.2196/54622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. OBJECTIVE The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. METHODS Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. RESULTS Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method's specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. CONCLUSIONS This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies.
Collapse
Affiliation(s)
- Eric Hurwitz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zachary Butzin-Dozier
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Shawn T O'Neil
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anita Walden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Holko
- International Computer Science Institute, Berkeley, CA, United States
| | - Rena C Patel
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melissa A Haendel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
2
|
Coronado RA, Pennings JS, Master H, Brintz CE, Cole KR, Helmy J, Oleisky ER, Davidson C, Abtahi AM, Stephens BF, Archer KR. The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes after Lumbar Spine Surgery. Spine (Phila Pa 1976) 2024:00007632-990000000-00641. [PMID: 38605675 DOI: 10.1097/brs.0000000000005000] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS). SUMMARY OF BACKGROUND DATA Psychological and behavioral factors are considered major risk factors of poor outcome after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment. METHODS Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other, and in combination as a 4-level variable: 1) moderate/severe sleep disturbance alone, 2) moderate/severe depression alone, 3) both moderate/severe sleep disturbance and depression, 4) no moderate/severe sleep disturbance or depression. RESULTS Preoperative sleep disturbance and depression were associated with 12-month disability and pain (P<0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes (P<0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared to patients without moderate/severe sleep disturbance or depression. CONCLUSION The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies.
Collapse
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carrie E Brintz
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith R Cole
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph Helmy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily R Oleisky
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
3
|
Wise A, Boring MA, Odom EL, Foster AL, Guglielmo D, Master H, Croft JB. Racial and Ethnic Differences in the Prevalence of Patients With Arthritis and Severe Joint Pain and Who Received Provider Counseling About Physical Activity for Arthritis Among Adults Aged 18 Years or Older-United States, 2019. Arthritis Care Res (Hoboken) 2024. [PMID: 38383988 DOI: 10.1002/acr.25316] [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: 08/31/2023] [Revised: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study examined the racial and ethnic differences in individuals with self-reported and doctor-diagnosed arthritis, severe joint pain, and provider counseling for physical activity among US adults with arthritis. METHODS We estimated prevalence by race and ethnicity among 31,997 adults aged ≥18 years in the 2019 National Health Interview Survey. We used multiple logistic regression models to investigate associations between outcomes and race and ethnicity. RESULTS Compared with non-Hispanic White adults (22.9%), we found a significantly higher age-adjusted prevalence of arthritis among American Indian/Alaska Native adults (30.3%). Among adults with arthritis, higher age-adjusted prevalence of severe joint pain among American Indian/Alaska Native (39.1%), non-Hispanic Black (36.4%), and Hispanic adults (35.7% vs 22.5% [White]) and higher provider counseling for physical activity among non-Hispanic Black adults (58.9% vs 52.1% [White]) were observed and could not be fully explained by differences in socioeconomic factors, body mass index, depression history, and comorbid conditions. Additional models also containing inability to pay medical bills and food insecurity did not explain racial and ethnic differences. CONCLUSION Our findings highlight a need for multilevel interventions to mitigate social and environmental barriers to physical activity and eliminate disparities in individuals with arthritis and severe joint pain.
Collapse
Affiliation(s)
| | | | - Erica L Odom
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anika L Foster
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Guglielmo
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janet B Croft
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
4
|
Master H, Coronado RA, Whitaker S, Block S, Vanston SW, Pennings JS, Gupta R, Robinette P, Stephens B, Abtahi A, Schwarz J, Archer KR. Combining Wearable Technology and Telehealth Counseling for Rehabilitation After Lumbar Spine Surgery: Feasibility and Acceptability of a Physical Activity Intervention. Phys Ther 2024; 104:pzad096. [PMID: 37478463 PMCID: PMC10851843 DOI: 10.1093/ptj/pzad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/24/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the feasibility and acceptability of a wearable device and telehealth counseling physical activity intervention early after lumbar spine surgery. METHODS Sixteen patients were randomized to an 8-session physical activity intervention or to usual postoperative care after surgery. The intervention included a wearable device (ie, Fitbit) and telehealth counseling by a licensed physical therapist. The feasibility of study procedures was assessed through recruitment, randomization, retention, and participation rates. Acceptability was assessed through a satisfaction survey and median within-participant change in objective physical activity (steps per day and time spent in moderate-to-vigorous physical activity [MVPA]) and patient-reported outcomes. RESULTS Of 64 participants who were eligible, recruitment and randomization rates were 41 and 62%, respectively. Retention for objective physical activity and patient-reported outcomes was 94 and 100%, respectively, at 6-month follow-up. Seven (88%) participants in the intervention group completed all telehealth sessions, and 6 (75%) met step goals over the 8 sessions. All participants in the intervention group found the wearable device and telehealth counseling to be helpful and reported it much or somewhat more important than other postoperative services. Median within-participant change for steps per day improved from baseline (preoperative) to 6 months after surgery for both the intervention (1070) and usual care (679) groups, while MVPA only improved for the intervention group (2.2. minutes per day). Improvements in back and leg pain and disability were noted for both groups. No adverse events were reported in the study. CONCLUSION Combining wearable technology and telehealth counseling is a feasible approach to promote the physical activity during the early postoperative period after spine surgery. Future randomized controlled trials are needed to investigate the efficacy of leveraging wearables and telehealth during postoperative rehabilitation. IMPACT This study has implications for the clinical dissemination of physical activity strategies in the rehabilitation setting.
Collapse
Affiliation(s)
- Hiral Master
- Vanderbilt Institute of Clinical & Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah Whitaker
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon Block
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rishabh Gupta
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Payton Robinette
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron Stephens
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir Abtahi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob Schwarz
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
5
|
Pennings JS, Oleisky ER, Master H, Davidson C, Coronado RA, Brintz CE, Archer KR. Impact of Racial/Ethnic Disparities on Patient Reported Outcomes Following Cervical Spine Surgery: QOD Analysis. Spine (Phila Pa 1976) 2024:00007632-990000000-00570. [PMID: 38270397 DOI: 10.1097/brs.0000000000004935] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
STUDY DESIGN Retrospective analysis of data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). OBJECTIVE To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at 1 year after cervical spine surgery. SUMMARY OF BACKGROUND DATA Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and prolonged length of stay after cervical spine surgery compared to Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic and other non-Hispanic groups (i.e., Asian) remains unclear. METHODS PROMs were used to assess disability (NDI) and neck/arm pain preoperatively and 1-year postoperative. Primary outcomes were disability and pain, and not being satisfied from pre-operative to 12-months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups (Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)) with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving MCID 1-year postoperatively. RESULTS Of the 14,429 participants, all had significant reductions in pain and disability, and 87% were satisfied at 1-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30% to 70%) compared to NHW. NHB had 50% higher odds of worse disability scores compared to NHW. NHA reported similar disability and neck pain outcomes compared to NHW. CONCLUSIONS Hispanic and non-Hispanic Black patients had worse patient-reported outcomes 1-year after cervical spine surgery compared to non-Hispanic White individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for non-Hispanic Asian patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Emily R Oleisky
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Carrie E Brintz
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
6
|
Hughes AM, Annis J, Master H, Perry AS, Stevenson LW, Shah R, Brittain EL. Physical Activity Trajectories Preceding Incident Heart Failure: A Proof-of-Concept Study. JACC Heart Fail 2024; 12:232-234. [PMID: 37897460 DOI: 10.1016/j.jchf.2023.09.006] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Andrew M Hughes
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey Annis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew S Perry
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ravi Shah
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Evan L Brittain
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
7
|
Wei WQ, Guardo C, Gandireddy S, Yan C, Ong H, Kerchberger V, Dickson A, Pfaff E, Master H, Basford M, Tran N, Mancuso S, Syed T, Zhao Z, Feng Q, Haendel M, Lunt C, Ginsburg G, Chute C, Denny J, Roden D. Genetic and Survey Data Improves Performance of Machine Learning Model for Long COVID. Res Sq 2023:rs.3.rs-3749510. [PMID: 38196610 PMCID: PMC10775401 DOI: 10.21203/rs.3.rs-3749510/v1] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Over 200 million SARS-CoV-2 patients have or will develop persistent symptoms (long COVID). Given this pressing research priority, the National COVID Cohort Collaborative (N3C) developed a machine learning model using only electronic health record data to identify potential patients with long COVID. We hypothesized that additional data from health surveys, mobile devices, and genotypes could improve prediction ability. In a cohort of SARS-CoV-2 infected individuals (n=17,755) in the All of Us program, we applied and expanded upon the N3C long COVID prediction model, testing machine learning infrastructures, assessing model performance, and identifying factors that contributed most to the prediction models. For the survey/mobile device information and genetic data, extreme gradient boosting and a convolutional neural network delivered the best performance for predicting long COVID, respectively. Combined survey, genetic, and mobile data increased specificity and the Area Under Curve the Receiver Operating Characteristic score versus the original N3C model.
Collapse
Affiliation(s)
| | | | | | - Chao Yan
- Vanderbilt University Medical Center
| | - Henry Ong
- Vanderbilt University Medical Center
| | | | | | | | | | - Melissa Basford
- Vanderbilt Institute of Clinical and Translational Research/Vanderbilt University Medical Center
| | | | | | | | | | - QiPing Feng
- Department of Medicine, Vanderbilt University Medical Center
| | | | | | | | | | - Joshua Denny
- All of Us Research Program, National Institutes of Health
| | - Dan Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
8
|
Voinier D, Neogi T, Master H, Thoma LM, Brunette M, Jakiela J, Stefanik JJ, White DK. Sitting may increase risk for radiographic incidence and progression of knee osteoarthritis over 2 years: Data from a large cohort study. Musculoskeletal Care 2023; 21:1075-1084. [PMID: 37253682 PMCID: PMC10687316 DOI: 10.1002/msc.1786] [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: 05/04/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To examine the association of leisure-time sitting with radiographic incidence and progression of knee osteoarthritis (OA) over 2 years, and to determine whether worktime sitting modifies this association. METHODS We included adults with or at high risk for knee OA who enroled in the Osteoarthritis Initiative (OAI). Participants reported leisure-time sitting (≤4 vs. >4 h/day) and worktime sitting (frequent vs. infrequent) at enrolment, and had bilateral knee radiographs at enrolment and 2 years later. Our outcome, radiographic knee OA incidence/progression (yes/no), was defined as any increase in Kellgren-Lawrence grade over 2 years. We examined the association of leisure-time sitting (≤4 vs. >4 h/day) with risk of radiographic knee OA incidence/progression using binary linear regression, adjusting for potential confounders. We stratified by worktime sitting (frequent vs. infrequent) and repeated our analysis. RESULTS We included 4254 adults (mean age 61 years; 58% women; mean body mass index 29 kg/m2 ) who contributed a total of 8127 knees. Adults with >4 h/day of leisure-time sitting had 25% higher risk (adjusted risk ratio [RR] 1.25, 95% confidence interval [95% CI] 1.08-1.50) for radiographic knee OA incidence/progression compared with adults with ≤4 h/day of leisure-time sitting (referent group). Importantly, this association was intensified (RR 1.60, 95% CI 1.19-2.33) among adults with frequent worktime sitting, but was attenuated (RR 1.11, 95% CI 0.89-1.39) among adults with infrequent worktime sitting. CONCLUSIONS Higher leisure-time sitting (>4 h/day) may be associated with greater risk for radiographic knee OA incidence/progression over 2 years. Furthermore, this association was intensified among adults who also reported frequent worktime sitting.
Collapse
Affiliation(s)
- Dana Voinier
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise M. Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jason Jakiela
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| |
Collapse
|
9
|
Master H, Annis J, Huang S, Beckman JA, Ratsimbazafy F, Marginean K, Carroll R, Natarajan K, Harrell FE, Roden DM, Harris P, Brittain EL. Author Correction: Association of step counts over time with the risk of chronic disease in the All of Us Research Program. Nat Med 2023; 29:3270. [PMID: 37046000 PMCID: PMC10719085 DOI: 10.1038/s41591-023-02313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Annis
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua A Beckman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francis Ratsimbazafy
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kayla Marginean
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karthik Natarajan
- Department Biomedical Informatics, Columbia University, New York, NY, USA
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Department of Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul Harris
- Department of Biomedical Informatics, Biomedical Engineering and Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
10
|
Lederer L, Breton A, Jeong H, Master H, Roghanizad AR, Dunn J. The Importance of Data Quality Control in Using Fitbit Device Data From the Research Program. JMIR Mhealth Uhealth 2023; 11:e45103. [PMID: 37962944 PMCID: PMC10662681 DOI: 10.2196/45103] [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] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 11/15/2023] Open
Abstract
Wearable digital health technologies (DHTs) have become increasingly popular in recent years, enabling more capabilities to assess behaviors and physiology in free-living conditions. The All of Us Research Program (AoURP), a National Institutes of Health initiative that collects health-related information from participants in the United States, has expanded its data collection to include DHT data from Fitbit devices. This offers researchers an unprecedented opportunity to examine a large cohort of DHT data alongside biospecimens and electronic health records. However, there are existing challenges and sources of error that need to be considered before using Fitbit device data from the AoURP. In this viewpoint, we examine the reliability of and potential error sources associated with the Fitbit device data available through the AoURP Researcher Workbench and outline actionable strategies to mitigate data missingness and noise. We begin by discussing sources of noise, including (1) inherent measurement inaccuracies, (2) skin tone–related challenges, and (3) movement and motion artifacts, and proceed to discuss potential sources of data missingness in Fitbit device data. We then outline methods to mitigate such missingness and noise in the data. We end by considering how future enhancements to the AoURP’s Fitbit device data collection methods and the inclusion of new Fitbit data types would impact the usability of the data. Although the reliability considerations and suggested literature are tailored toward Fitbit device data in the AoURP, the considerations and recommendations are broadly applicable to data from wearable DHTs in free-living conditions.
Collapse
Affiliation(s)
- Lauren Lederer
- Department of Biomedical Engineering, Duke University, DurhamNC, United States
| | - Amanda Breton
- Department of Electrical and Computer Engineering, Duke University, DurhamNC, United States
| | - Hayoung Jeong
- Department of Biomedical Engineering, Duke University, DurhamNC, United States
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Ali R Roghanizad
- Department of Biomedical Engineering, Duke University, DurhamNC, United States
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, DurhamNC, United States
| |
Collapse
|
11
|
Hurwitz E, Butzin-Dozier Z, Master H, O’Neil ST, Walden A, Holko M, Patel RC, Haendel MA. Harnessing consumer wearable digital biomarkers for individualized recognition of postpartum depression using the All of Us Research Program dataset. medRxiv 2023:2023.10.13.23296965. [PMID: 37873471 PMCID: PMC10593061 DOI: 10.1101/2023.10.13.23296965] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Postpartum depression (PPD), afflicting one in seven women, poses a major challenge in maternal health. Existing approaches to detect PPD heavily depend on in-person postpartum visits, leading to cases of the condition being overlooked and untreated. We explored the potential of consumer wearable-derived digital biomarkers for PPD recognition to address this gap. Our study demonstrated that intra-individual machine learning (ML) models developed using these digital biomarkers can discern between pre-pregnancy, pregnancy, postpartum without depression, and postpartum with depression time periods (i.e., PPD diagnosis). When evaluating variable importance, calories burned from the basal metabolic rate (calories BMR) emerged as the digital biomarker most predictive of PPD. To confirm the specificity of our method, we demonstrated that models developed in women without PPD could not accurately classify the PPD-equivalent phase. Prior depression history did not alter model efficacy for PPD recognition. Furthermore, the individualized models demonstrated superior performance compared to a conventional cohort-based model for the detection of PPD, underscoring the effectiveness of our individualized ML approach. This work establishes consumer wearables as a promising avenue for PPD identification. More importantly, it also emphasizes the utility of individualized ML model methodology, potentially transforming early disease detection strategies.
Collapse
Affiliation(s)
- Eric Hurwitz
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Wright Center for Clinical and Translational Research, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shawn T. O’Neil
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anita Walden
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle Holko
- International Computer Science Institute, Berkeley, CA, USA
| | - Rena C. Patel
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa A. Haendel
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
12
|
Bergner JL, Farrar JQ, Master H, Coronado RA. Clinical measurement of functional dart thrower's motion in patients with unilateral wrist conditions undergoing nonoperative or postoperative hand therapy. J Hand Ther 2023; 36:923-931. [PMID: 36918307 DOI: 10.1016/j.jht.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Cross-sectional and descriptive study BACKGROUND: Functional dart thrower's motion (F-DTM) is an obliquely oriented wrist motion that occurs in activities such as throwing and drinking from a cup. There is limited data on clinical measurement of F-DTM. PURPOSE OF THE STUDY The purpose of this study was to 1) describe and establish reference scores for F-DTM measurement for nonoperative and postoperative wrist patients 2) compare F-DTM between the affected and nonaffected sides and 3) determine F-DTM score agreement across three consecutive trials. METHODS Two certified hand therapists evaluated F-DTM in consecutive adult patients with a unilateral wrist condition undergoing nonoperative or postoperative therapy. Three trials of goniometer measurements for radial extension (RE) and ulnar flexion (UF) were assessed on the nonaffected and affected wrists. A total arc F-DTM was computed. Mean, 95% confidence intervals (CI), and Cohen's d effect size described side-to-side differences in RE, UF, and total arc F-DTM. Agreement in scores across trials was assessed with an intraclass correlation coefficient (ICC). RESULTS Thirty-one nonoperative (mean ± SD age = 40.0 ± 13.9 years, 74% female, 94% right hand dominant) and 44 postoperative patients (mean ± SD age = 44.9 ± 14.9 years, 66% female, 84% right hand dominant) were enrolled. The average side-to-side difference, in degrees, in the nonoperative group was -6.4 (95% CI: -9.4 to -3.4, Cohen's d = 0.8) for RE, -10.4 (-16.7 to -4.0, d = 0.6) for UF, and -16.8 (-24.3 to -9.2, d = 0.8) for total arc F-DTM. The average side-to-side difference in the postoperative group was -33.6 (-38.8 to -28.3, d = 1.9) for RE, -34.7 (-40.6 to -28.7, d = 1.8) for UF, and -68.2 (-77.9 to -58.5, d = 2.1) for total arc F-DTM. The range of ICCs for F-DTM measurements was 0.82-0.96. CONCLUSIONS Goniometer measurement of F-DTM is a clinically feasible method to quantify functional motion loss in an injured wrist population, particularly patients with postoperatively managed wrist conditions.
Collapse
Affiliation(s)
- Jamie L Bergner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Master of Science Occupational Therapy Program, Cox College, Springfield, MO, USA.
| | - Jennifer Q Farrar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
13
|
Mayo KR, Basford MA, Carroll RJ, Dillon M, Fullen H, Leung J, Master H, Rura S, Sulieman L, Kennedy N, Banks E, Bernick D, Gauchan A, Lichtenstein L, Mapes BM, Marginean K, Nyemba SL, Ramirez A, Rotundo C, Wolfe K, Xia W, Azuine RE, Cronin RM, Denny JC, Kho A, Lunt C, Malin B, Natarajan K, Wilkins CH, Xu H, Hripcsak G, Roden DM, Philippakis AA, Glazer D, Harris PA. The All of Us Data and Research Center: Creating a Secure, Scalable, and Sustainable Ecosystem for Biomedical Research. Annu Rev Biomed Data Sci 2023; 6:443-464. [PMID: 37561600 DOI: 10.1146/annurev-biodatasci-122120-104825] [Citation(s) in RCA: 1] [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: 08/12/2023]
Abstract
The All of Us Research Program's Data and Research Center (DRC) was established to help acquire, curate, and provide access to one of the world's largest and most diverse datasets for precision medicine research. Already, over 500,000 participants are enrolled in All of Us, 80% of whom are underrepresented in biomedical research, and data are being analyzed by a community of over 2,300 researchers. The DRC created this thriving data ecosystem by collaborating with engaged participants, innovative program partners, and empowered researchers. In this review, we first describe how the DRC is organized to meet the needs of this broad group of stakeholders. We then outline guiding principles, common challenges, and innovative approaches used to build the All of Us data ecosystem. Finally, we share lessons learned to help others navigate important decisions and trade-offs in building a modern biomedical data platform.
Collapse
Affiliation(s)
- Kelsey R Mayo
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa A Basford
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Carroll
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Moira Dillon
- Verily Life Sciences, South San Francisco, California, USA
| | - Heather Fullen
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesse Leung
- Verily Life Sciences, South San Francisco, California, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shimon Rura
- Verily Life Sciences, South San Francisco, California, USA
| | - Lina Sulieman
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Nan Kennedy
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Banks
- Data Sciences Platform, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - David Bernick
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Asmita Gauchan
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lee Lichtenstein
- Data Sciences Platform, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Brandy M Mapes
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kayla Marginean
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steve L Nyemba
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Andrea Ramirez
- The All of Us Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Charissa Rotundo
- Vanderbilt University Medical Center Enterprise Cybersecurity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keri Wolfe
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Weiyi Xia
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Romuladus E Azuine
- The All of Us Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua C Denny
- The All of Us Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Abel Kho
- Department of Medicine and Institute for Augmented Intelligence in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christopher Lunt
- The All of Us Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradley Malin
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hua Xu
- Section of Biomedical Informatics and Data Science, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Dan M Roden
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - David Glazer
- Verily Life Sciences, South San Francisco, California, USA
| | - Paul A Harris
- Deparment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| |
Collapse
|
14
|
Voinier D, Neogi T, Arbeeva L, Voinier S, Master H, Thoma LM, Brunette M, Jakiela JT, White DK. Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2023; 31:1091-1100. [PMID: 36822497 PMCID: PMC10523474 DOI: 10.1016/j.joca.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. METHODS We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2 years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2 years, adjusting for potential confounders. RESULTS We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8 kg/m2). Mean PA composition was: MVPA 9.1 min/day, LPA 278 min/day, SED 690 min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β = -0.0005, P = 0.97), nor was LPA (β = 0.06, P = 0.27) or SED (β = -0.06, P = 0.21). CONCLUSION Using CoDA, PA composition was not associated with medial JSW loss over 2 years.
Collapse
Affiliation(s)
- D Voinier
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Arbeeva
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - S Voinier
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - H Master
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA.
| | - L M Thoma
- University of North Carolina at Chapel Hill, Division of Physical Therapy, Chapel Hill, NC, USA.
| | - M Brunette
- Evidation Health Inc, San Mateo, CA, USA.
| | - J T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - D K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| |
Collapse
|
15
|
England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Constien D, Chan KK, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips L“R, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:1299-1311. [PMID: 37227071 PMCID: PMC10947582 DOI: 10.1002/art.42507] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
Collapse
Affiliation(s)
- Bryant R. England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | | | - Jennifer L. Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | - Carole V. Dodge
- University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY
| | | | | | | | | | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Chris Y. Lane
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, TN
| | | | | | | | | | - Louise Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | |
Collapse
|
16
|
Pfaff ER, Girvin AT, Crosskey M, Gangireddy S, Master H, Wei WQ, Kerchberger VE, Weiner M, Harris PA, Basford M, Lunt C, Chute CG, Moffitt RA, Haendel M. De-black-boxing health AI: demonstrating reproducible machine learning computable phenotypes using the N3C-RECOVER Long COVID model in the All of Us data repository. J Am Med Inform Assoc 2023; 30:1305-1312. [PMID: 37218289 PMCID: PMC10280348 DOI: 10.1093/jamia/ocad077] [Citation(s) in RCA: 1] [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: 01/18/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Machine learning (ML)-driven computable phenotypes are among the most challenging to share and reproduce. Despite this difficulty, the urgent public health considerations around Long COVID make it especially important to ensure the rigor and reproducibility of Long COVID phenotyping algorithms such that they can be made available to a broad audience of researchers. As part of the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, researchers with the National COVID Cohort Collaborative (N3C) devised and trained an ML-based phenotype to identify patients highly probable to have Long COVID. Supported by RECOVER, N3C and NIH's All of Us study partnered to reproduce the output of N3C's trained model in the All of Us data enclave, demonstrating model extensibility in multiple environments. This case study in ML-based phenotype reuse illustrates how open-source software best practices and cross-site collaboration can de-black-box phenotyping algorithms, prevent unnecessary rework, and promote open science in informatics.
Collapse
Affiliation(s)
- Emily R Pfaff
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | | | - Srushti Gangireddy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - V Eric Kerchberger
- Department of Medicine, Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Weiner
- Department of Medicine, Weill Cornell Medicine, New York, USA
| | - Paul A Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa Basford
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris Lunt
- National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Chute
- Johns Hopkins Schools of Medicine, Public Health, and Nursing. Baltimore, Maryland, USA
| | - Richard A Moffitt
- Departments of Hematology and Medical Oncology and Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Melissa Haendel
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | | |
Collapse
|
17
|
Abstract
Despite improvements in cardiovascular care in recent decades, cardiovascular disease (CVD) remains a leading cause of death worldwide. At its core, CVD is a largely preventable disease with diligent risk factor management and early detection. As highlighted in the American Heart Association's Life's Essential 8, physical activity plays a central role in CVD prevention at an individual and population level. Despite pervasive knowledge of the numerous cardiovascular and noncardiovascular health benefits of physical activity, physical activity has steadily decreased over time and unfavorable changes in physical activity occur throughout people's lives. Here, we use a lifecourse framework to examine the evidence reporting on the association of physical activity with CVD. From in utero to older adults, we review and discuss the evidence detailing how physical activity may prevent incident CVD and mitigate CVD-related morbidity and death across all life stages.
Collapse
Affiliation(s)
- Andrew S. Perry
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Erin E. Dooley
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nicole L. Spartano
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Evan L. Brittain
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
18
|
Han L, Annis J, Master H, Hughes A, Roden D, Harris P, Ruderfer D, Brittain E. Quantifying physical activity needed to mitigate genetic risk for obesity. Res Sq 2023:rs.3.rs-2986582. [PMID: 37333237 PMCID: PMC10275053 DOI: 10.21203/rs.3.rs-2986582/v1] [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] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Despite consistent public health recommendations, obesity rates continue to increase. Physical activity (e.g. daily steps) is a well-established modifier of body weight. Genetic background is an important, but typically uncaptured, contributor to obesity risk. Leveraging physical activity, clinical, and genetic data from the All of Us Research Program, we measured the impact of genetic risk of obesity on the level of physical activity needed to reduce incident obesity. For example, we show that an additional 3,310 steps per day (11,910 steps total) would be needed to mitigate a 25% higher than average genetic risk of obesity. We quantify the number of daily steps needed to mitigate obesity risk across the spectrum of genetic risk. This work quantifies the relationship between physical activity and genetic risk showing significant independent effects and provides a first step towards personalized activity recommendations that incorporate genetic information to reduce incident obesity risk.
Collapse
Affiliation(s)
- Lide Han
- VANDERBILT UNIVERSITY MEDICAL CENTER
| | | | | | | | - Dan Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | |
Collapse
|
19
|
England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Chan KK, Constien D, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips LR, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023. [PMID: 37227116 DOI: 10.1002/acr.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
Collapse
Affiliation(s)
- Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | | | | | | | - Carole V Dodge
- University of Michigan Hospital and Health System, Ann Arbor
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | | | | | | | - Janet Lewis
- University of Virginia, Charlottesville, Virginia
| | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, California
| | | | - Neha Shah
- Stanford Health Care, Palo Alto, California
| | | | | | - Rawan AlHeresh
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Linda C Li
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, Tennesee
| | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
20
|
Perry AS, Annis JS, Master H, Nayor M, Hughes A, Kouame A, Natarajan K, Marginean K, Murthy V, Roden DM, Harris PA, Shah R, Brittain EL. Association of Longitudinal Activity Measures and Diabetes Risk: An Analysis From the National Institutes of Health All of Us Research Program. J Clin Endocrinol Metab 2023; 108:1101-1109. [PMID: 36458881 PMCID: PMC10306083 DOI: 10.1210/clinem/dgac695] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
CONTEXT Prior studies of the relationship between physical activity and incident type 2 diabetes mellitus (T2DM) relied primarily on questionnaires at a single time point. OBJECTIVE We sought to investigate the relationship between physical activity and incident T2DM with an innovative approach using data from commercial wearable devices linked to electronic health records in a real-world population. METHODS Using All of Us participants' accelerometer data from their personal Fitbit devices, we used a time-varying Cox proportional hazards models with repeated measures of physical activity for the outcome of incident T2DM. We evaluated for effect modification with age, sex, body mass index (BMI), and sedentary time using multiplicative interaction terms. RESULTS From 5677 participants in the All of Us Research Program (median age 51 years; 74% female; 89% White), there were 97 (2%) cases of incident T2DM over a median follow-up period of 3.8 years between 2010 to 2021. In models adjusted for age, sex, and race, the hazard of incident diabetes was reduced by 44% (95% CI, 15%-63%; P = 0.01) when comparing those with an average daily step count of 10 700 to those with 6000. Similar benefits were seen comparing groups based on average duration of various intensities of activity (eg, lightly active, fairly active, very active). There was no evidence for effect modification by age, sex, BMI, or sedentary time. CONCLUSION Greater time in any type of physical activity intensity was associated with lower risk of T2DM irrespective of age, sex, BMI, or sedentary time.
Collapse
Affiliation(s)
- Andrew S Perry
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Jeffrey S Annis
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Matthew Nayor
- Sections of Cardiovascular Medicine and Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Andrew Hughes
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Aymone Kouame
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
| | - Kayla Marginean
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Venkatesh Murthy
- Department of Medicine and Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Paul A Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Ravi Shah
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Evan L Brittain
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| |
Collapse
|
21
|
Abstract
Wearable devices, such as smartwatches and activity trackers, are commonly used by patients in their everyday lives to manage their health and well-being. These devices collect and analyze long-term continuous data on measures of behavioral or physiologic function, which may provide clinicians with a more comprehensive view of a patients' health compared with the traditional sporadic measures captured by office visits and hospitalizations. Wearable devices have a wide range of potential clinical applications ranging from arrhythmia screening of high-risk individuals to remote management of chronic conditions such as heart failure or peripheral artery disease. As the use of wearable devices continues to grow, we must adopt a multifaceted approach with collaboration among all key stakeholders to effectively and safely integrate these technologies into routine clinical practice. In this Review, we summarize the features of wearable devices and associated machine learning techniques. We describe key research studies that illustrate the role of wearable devices in the screening and management of cardiovascular conditions and identify directions for future research. Last, we highlight the challenges that are currently hindering the widespread use of wearable devices in cardiovascular medicine and provide short- and long-term solutions to promote increased use of wearable devices in clinical care.
Collapse
Affiliation(s)
- Andrew Hughes
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Evan Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
22
|
Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
Collapse
Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| |
Collapse
|
23
|
Desine S, Master H, Annis J, Hughes A, Roden DM, Harris PA, Brittain EL. Daily Step Counts Before and After the COVID-19 Pandemic Among All of Us Research Participants. JAMA Netw Open 2023; 6:e233526. [PMID: 36939705 PMCID: PMC10028484 DOI: 10.1001/jamanetworkopen.2023.3526] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 11/21/2022] [Accepted: 01/31/2023] [Indexed: 03/21/2023] Open
Abstract
This cohort study of US adults examines changes in physical activity following the onset of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Stacy Desine
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Annis
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dan M. Roden
- Department of Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A. Harris
- Departments of Biomedical Informatics, Biomedical Engineering and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan L. Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
24
|
Lawford BJ, Master H, Larsen JB, Bartholdy C, Corrigan P, Ginnerup-Nielsen E, Le C, Teoli A, Bennell KL, Metcalf B, Hinman RS, Button K, Collins NJ, Cottrell E, Henrotin Y, Skou ST, Thoma LM, Wellsandt E, White DK, Holden MA. What should a toolkit to aid the delivery of therapeutic exercise for hip and knee osteoarthritis look like? Qualitative analysis of an international survey of 318 researchers, clinicians, and consumers by the OARSI Rehabilitation Discussion Group. Musculoskeletal Care 2023. [PMID: 36631968 DOI: 10.1002/msc.1732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to identify important components of, and practical resources relevant for inclusion in, a toolkit to aid exercise delivery for people with hip/knee osteoarthritis. METHOD An online international multi-disciplinary survey was conducted across 43 countries (139 clinicians, 44 people with hip/knee osteoarthritis and 135 osteoarthritis researchers). Participants were presented with the seeding statement 'Practical resources to aid the implementation of exercise for people with hip/knee osteoarthritis should…' and asked to provide up to 10 open text responses. Responses underwent refinement and qualitative content analysis to create domains and categories. RESULTS Refinement of 551 open text responses yielded 72 unique statements relevant for analysis. Statements were organised into nine broad domains, suggesting that resources to aid exercise delivery should: (1) be easily accessible; (2) be of high quality; (3) be developed by, and for, stakeholders; (4) include different ways of delivering information; (5) include different types of resources to support exercise and non-exercise components of self-management; (6) include resources on recommended exercises and how to perform/progress them; (7) include tools to support motivation and track progress; (8) include resources to enable tailoring of the programme to the individual and; (9) facilitate access to professional and peer support. CONCLUSION Our findings identified important components of, and practical resources to include within, a toolkit to aid delivery of exercise for people with hip/knee osteoarthritis. These findings have implications for exercise providers and lay the foundation for the development of a toolkit to help ensure exercise provision aligns with current international recommendations.
Collapse
Affiliation(s)
- Belinda J Lawford
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesper B Larsen
- Department of Health Science and Technology, Musculoskeletal Health and Implementation, Aalborg University, Aalborg, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | | | - Christina Le
- University of Alberta in Edmonton, Edmonton, Alberta, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Ben Metcalf
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Kate Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
| | - Yves Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium.,Motricity Sciences Department, musculoSKeletal Innovative Research Lab (mSKIL), Institute of Pathology, University of Liège, Liège, Belgium.,Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Liège, Belgium.,The Osteoarthritis Foundation, Boncelles, Belgium
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Louise M Thoma
- Division of Physical Therapy, Department of Health Sciences, School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
| |
Collapse
|
25
|
Master H, Kouame A, Marginean K, Basford M, Harris P, Holko M. How Fitbit data are being made available to registered researchers in All of Us Research Program. Pac Symp Biocomput 2023; 28:19-30. [PMID: 36540961 PMCID: PMC9811842] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The National Institutes of Health's (NIH) All of Us Research Program aims to enroll at least one million US participants from diverse backgrounds; collect electronic health record (EHR) data, survey data, physical measurements, biospecimens for genomics and other assays, and digital health data; and create a researcher database and tools to enable precision medicine research [1]. Since inception, digital health technologies (DHT) have been envisioned as essential to achieving the goals of the program [2]. A "bring your own device" (BYOD) study for collecting Fitbit data from participants' devices was developed with integration of additional DHTs planned in the future [3]. Here we describe how participants can consent to share their digital health technology data, how the data are collected, how the data set is parsed, and how researchers can access the data.
Collapse
Affiliation(s)
- Hiral Master
- Vanderbilt University Medical Center, Nashville TN, USA,
| | | | | | | | | | | |
Collapse
|
26
|
Coronado RA, Master H, Bley JA, Robinette PE, Sterling EK, O'Brien MT, Henry AL, Pennings JS, Vanston SW, Myczkowski B, Skolasky RL, Wegener ST, Archer KR. Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial. Phys Ther 2022; 102:6623302. [PMID: 35778941 PMCID: PMC10071580 DOI: 10.1093/ptj/pzac091] [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: 09/30/2021] [Revised: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery. METHODS In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score ≥ 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. RESULTS Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. CONCLUSIONS Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. IMPACT This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery.
Collapse
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopedic Surgery, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Bley
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Payton E Robinette
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emma K Sterling
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael T O'Brien
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Abigail L Henry
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan W Vanston
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brittany Myczkowski
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard L Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin R Archer
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
27
|
Bley JA, Master H, Huston LJ, Block S, Pennings JS, Coronado RA, Cox CL, Sullivan JP, Dale KM, Saluan PM, Spindler KP, Archer KR. Return to Sports After Anterior Cruciate Ligament Reconstruction: Validity and Reliability of the SPORTS Score at 6 and 12 Months. Orthop J Sports Med 2022; 10:23259671221098436. [PMID: 35693459 PMCID: PMC9185013 DOI: 10.1177/23259671221098436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The Subjective Patient Outcome for Return to Sports (SPORTS) score is a
single-item scale that measures athletes' ability to return to their
preinjury sport based on effort and performance. Purpose/Hypothesis: The purpose of this study was to examine the psychometric properties of the
SPORTS score and a modified score within the first year after anterior
cruciate ligament reconstruction (ACLR). The modified version replaced “same
sport” with “any sport” in the answer choices. It was hypothesized that both
versions of the SPORTS score would have acceptable floor and ceiling effects
and internal responsiveness, moderate convergent validity, and excellent
test-retest reliability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients were recruited preoperatively from 2 academic medical centers. The
authors collected responses to the 1-item SPORTS scores at 6 and 12 months
after ACLR and the Tegner activity scale, Lysholm knee score, Knee injury
and Osteoarthritis Outcome Score (KOOS)–sport/recreation subscale, and Marx
activity rating scale preoperatively and 6 and 12 months after ACLR. Ceiling
and floor effects and responsiveness were assessed using descriptive
statistics and cross-tabulations, respectively, at both follow-up time
points. Spearman correlations and intraclass correlation coefficients were
used to examine convergent validity and test-retest reliability,
respectively. Results: Follow-up rates at 6 and 12 months were 100% and 99%, respectively.
Test-retest follow-up was 77%. Floor effects for the SPORTS scores were not
observed, while ceiling effects at 12 months ranged from 38% to 40%.
Cross-tabulation of the SPORTS scores showed that 64% to 66% of patients
reported a change in their score from 6 to 12 months, with significant
differences noted between the proportions that improved versus worsened for
return to any sport. Convergent validity was observed at 6 and 12 months via
moderate correlations with the Tegner, Lysholm, KOOS–sport/recreation, and
Marx scores (r = 0.31 to 0.47). Fair to good test-retest
reliability (intraclass correlation coefficient, 0.58 and 0.60) was found at
12 months after ACLR. Conclusion: The SPORTS score appears to be a reliable, responsive, and valid 1-item scale
that can be used during the first year after ACLR. No differences in
psychometric properties were found between the SPORTS score and the modified
version.
Collapse
Affiliation(s)
- Jordan A Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon Block
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jaron P Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin M Dale
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul M Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, Weston, Florida, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
28
|
Master H, Castillo R, Wegener ST, Pennings JS, Coronado RA, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Archer KR. Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery. BMC Musculoskelet Disord 2021; 22:883. [PMID: 34663295 PMCID: PMC8522146 DOI: 10.1186/s12891-021-04622-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Methods We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes. Results The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator. Conclusions The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04622-w.
Collapse
Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renan Castillo
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine M Haug
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
29
|
Master H, Thoma LM, Neogi T, Dunlop DD, LaValley M, Christiansen MB, Voinier D, White DK. Daily Walking and the Risk of Knee Replacement Over 5 Years Among Adults With Advanced Knee Osteoarthritis in the United States. Arch Phys Med Rehabil 2021; 102:1888-1894. [PMID: 34175271 PMCID: PMC8487939 DOI: 10.1016/j.apmr.2021.05.014] [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: 01/10/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the association of the volume and intensity of daily walking at baseline with the risk of knee replacement (KR) over 5 years in adults with advanced structural knee osteoarthritis. DESIGN Prospective, longitudinal, and multicenter observational study. SETTING Osteoarthritis Initiative study with follow-up from 2008-2015. PARTICIPANTS Community-dwelling adults with or at risk of knee osteoarthritis were recruited from 4 sites in the United States (N=516; mean age, 67.7±8.6y; body mass index, 29.3±4.7 kg/m2; 52% female). We included participants with advanced structural disease, without KR and had valid daily walking data (quantified using Actigraph GT1M), at baseline. INTERVENTIONS Not applicable. MAIN OUTCOMES KR. Walking volume was measured as steps/day and intensity as minutes/day spent not walking (0 steps/min) and walking at very light (1-49 steps/min), light (50-100 steps/min), or moderate (>100 steps/min) intensities. To examine the relationship of walking volume and intensity with the risk of KR, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for covariates. RESULTS Of 516 adults with advanced structural disease, 88 received a KR over 5 years (17%). Walking an additional 1000 steps/d was not associated with the risk of KR (adjusted HR=0.95; 95% CI, 0.84-1.04). Statistically, replacing 10 min/d of very light and light walking with 10 min/d of moderate walking reduced the risk of KR incidence by 35% and 37%, respectively (adjusted HR=0.65, 95% CI, 0.45-0.94, for very light and adjusted HR=0.63; 95% CI, 0.40-1.00, for light). CONCLUSIONS Daily walking volume and intensity did not increase KR risk over 5 years and may be protective in some cases in adults with advanced structural knee osteoarthritis.
Collapse
Affiliation(s)
- Hiral Master
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Louise M Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Dorothy D Dunlop
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL; Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Meredith B Christiansen
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE
| | - Dana Voinier
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE.
| |
Collapse
|
30
|
Master H, Thoma LM, Dunlop DD, Christiansen MB, Voinier D, White DK. Joint Association of Moderate-to-vigorous Intensity Physical Activity and Sedentary Behavior With Incident Functional Limitation: Data From the Osteoarthritis Initiative. J Rheumatol 2021; 48:1458-1464. [PMID: 33526619 PMCID: PMC8325705 DOI: 10.3899/jrheum.201250] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the joint association of moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior with the risk of developing functional limitation 4 years later in adults with knee osteoarthritis (OA). METHODS Using 48-month (baseline) accelerometry data from the Osteoarthritis Initiative, we classified participants as Active-Low Sedentary (≥ 1 10-min bout/week of MVPA, lowest tertile for standardized sedentary time), Active-High Sedentary (≥ 1 10-min bout/week of MVPA, top 2 tertiles for standardized sedentary time), Inactive-Low Sedentary (zero 10-min bouts/week of MVPA, lowest tertile for standardized sedentary time), and Inactive-High Sedentary (zero 10-minute bouts/week of MVPA, top 2 tertiles for standardized sedentary time) groups. Functional limitation was defined as > 12 seconds for the 5-repetition sit-to-stand test (5XSST) and < 1.22 m/s gait speed during the 20-meter walk test. To investigate the association of exposure groups with risk of developing functional limitation 4 years later, we calculated adjusted risk ratios (aRR; adjusted for potential confounders). RESULTS Of 1091 and 1133 participants without baseline functional limitation, based on the 5XSST and 20-meter walk test, respectively, 15% and 21% developed functional limitation 4 years later. The Inactive-Low Sedentary and Inactive-High Sedentary groups had increased risk of developing functional limitations compared to the Active-Low Sedentary and Active-High Sedentary groups. The Inactive-Low Sedentary group had 72% (aRR 1.72, 95% CI 1.00-2.94) and 52% (aRR 1.52, 95% CI 1.03-2.25) more risk of developing functional limitation based on the 5XSST and 20-meter walk test, respectively, compared to the Active-Low Sedentary group. CONCLUSION Regardless of sedentary category, being inactive (zero 10-min bouts/week in MVPA) may increase the risk of developing functional limitation in adults with knee OA.
Collapse
Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, and Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Louise M Thoma
- L.M. Thoma, PT, DPT, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dorothy D Dunlop
- D.D. Dunlop, PhD, Department of Medicine, and Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Dana Voinier
- D. Voinier, PT, DPT, D.K. White, PT, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- D. Voinier, PT, DPT, D.K. White, PT, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
| |
Collapse
|
31
|
Master H, Pennings JS, Coronado RA, Bley J, Robinette PE, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Wegener ST, Archer KR. How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery? Arch Phys Med Rehabil 2021; 102:1873-1879. [PMID: 34175276 DOI: 10.1016/j.apmr.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether early postoperative walking is associated with "best outcome" and no opioid use at 1 year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice. DESIGN Secondary analysis from randomized controlled trial. SETTING Two academic medical centers in the United States. PARTICIPANTS We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition (N=248). A total of 212 participants (mean age, 62.8±11.4y, 53.3% female) had valid walking data at baseline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Disability (Oswestry Disability Index), back and leg pain (Brief Pain Inventory), and opioid use (yes vs no) were assessed at baseline and 1 year after surgery. "Best outcome" was defined as Oswestry Disability Index ≤20, back pain ≤2, and leg pain ≤2. Steps/day (walking) was assessed with an accelerometer worn for at least 3 days and 10 h/d at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and "best outcome" and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes. RESULTS Each additional 1000 steps/d at 6 weeks after spine surgery was associated with 41% higher odds of achieving "best outcome" (95% confidence interval [CI], 1.15-1.74) and 38% higher odds of no opioid use (95% CI, 1.09-1.76) at 1 year. Walking ≥3500 steps/d was associated with 3.75 times the odds (95% CI, 1.56-9.02) of achieving "best outcome" and 2.37 times the odds (95% CI, 1.07-5.24) of not using opioids. CONCLUSIONS Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/d threshold may serve as an initial recommendation during early postoperative counseling.
Collapse
Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jordan Bley
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Payton E Robinette
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Christine M Haug
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
32
|
Coronado RA, Bley JA, Huston LJ, Pennings JS, Master H, Reinke EK, Bird ML, Scaramuzza EA, Haug CM, Mathis SL, Vanston SW, Cox CL, Spindler KP, Archer KR. Composite psychosocial risk based on the fear avoidance model in patients undergoing anterior cruciate ligament reconstruction: Cluster-based analysis. Phys Ther Sport 2021; 50:217-225. [PMID: 34116406 DOI: 10.1016/j.ptsp.2021.05.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine associations between preoperative fear-avoidance model (FAM) risk subgroup status and patient expectation of surgical success with postoperative outcomes at 6 and 12 months after anterior cruciate ligament reconstruction (ACLR). DESIGN Cohort study. SETTING Academic medical center. PARTICIPANTS 54 patients (25 females) undergoing unilateral ACLR. MAIN OUTCOME MEASURES Cluster analysis distinguished FAM risk subgroups based on preoperative fear of movement/reinjury, self-efficacy, and pain catastrophizing. Preoperative expectation for surgical success was assessed with a numeric rating scale. Six and 12-month outcomes included Subjective Patient Outcomes for Return to Sport, Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life, and International Knee Documentation Committee (IKDC) Subjective Knee Form. RESULTS Thirteen (24%) patients were "moderate-to-high FAM risk." Moderate-to-high FAM risk patients had lower odds of return to sport at 12 months (OR = 0.3, p = .05) and lower KOOS sports/recreation at 6 months (st. beta = -0.27, p = .05), KOOS quality of life at 12 months (st. beta = -0.42, p = .007), and IKDC at 6 (st. beta = -0.29, p = .04) and 12 months (st. beta = -0.47, p = .001). Higher expectation was associated with lower 6-month IKDC (st. beta = -0.36, p = .008) and 12-month KOOS quality of life (st. beta = -0.29, p = .05). CONCLUSIONS Preoperative FAM risk influences patient-reported outcomes and return to sport at 6 and 12 months.
Collapse
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan A Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mackenzie L Bird
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erica A Scaramuzza
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine M Haug
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shannon L Mathis
- Department of Kinesiology, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
33
|
Master H, Neogi T, LaValley M, Thoma LM, Zhang Y, Voinier D, Christiansen MB, White DK. Does the 1-year Decline in Walking Speed Predict Mortality Risk Beyond Current Walking Speed in Adults With Knee Osteoarthritis? J Rheumatol 2020; 48:279-285. [PMID: 33259329 DOI: 10.3899/jrheum.200259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA). METHODS Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders. RESULTS Of 4229 participants in the analytic sample (58% female, age 62 ± 9 yrs, BMI 29 ± 5 kg/m2), 6% (n = 270) died over 11 years. Slow sustainers and slow decliners had 2-times increased mortality risk compared to adequate sustainers (HR 1.96, 95% CI 1.44-2.66 for slow sustainers, and HR 2.08, 95% CI 1.46-2.96 for slow decliners). Adequate decliners had 0.43 times the mortality risk compared with adequate sustainers (HR 0.57, 95% CI 0.32-1.01). CONCLUSION In adults with, or at risk of, knee OA, walking slower than 1.22 m/s in the present increased mortality risk, regardless of decline over the previous year.
Collapse
Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Physical Therapy, College of Health Sciences, University of Delaware, Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, and Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael LaValley
- M. LaValley, PhD, School of Public Health, Boston University, Boston, Massachusetts
| | - Louise M Thoma
- L.M. Thoma, PT, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yuqing Zhang
- Y. Zhang, PhD, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dana Voinier
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Meredith B Christiansen
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
| |
Collapse
|
34
|
Christiansen MB, Dix C, Master H, Jakiela JT, Habermann B, Silbernagel KG, White DK. "I've been to physical therapy before, but not for the knees." A qualitative study exploring barriers and facilitators to physical therapy utilization for knee osteoarthritis. Musculoskeletal Care 2020; 18:477-486. [PMID: 32588487 PMCID: PMC7749817 DOI: 10.1002/msc.1491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physical therapy (PT) is recommended to reduce pain and improve function. However, only 10%-15% of adults with knee osteoarthritis (OA) use PT in the United States. The purpose of this study was to explore patient-reported barriers and facilitators to PT utilization for knee OA, to understand why PT is underutilized. METHODS Qualitative descriptive study using semi-structured interviews was conducted, that is, one-on-one phone interviews with adults from local community centers. Participants were eligible if they were fluent in English and self-reported knee OA (1) over 45 years of age, (2) have activity-related knee pain, and (3) have no morning stiffness or morning stiffness in the knee(s) for ≤30 min. Interviews were audio-recorded and transcribed. To identify barriers and facilitators to PT utilization for knee OA, a coding framework, thematic analysis, and a constant comparative approach were used. RESULTS Of 22 participants with health insurance and who participated, 59% were considering PT, 23% refused PT, and 18% used PT for knee OA. Themes identified as either barriers or facilitators for participants were (1) previous experience with PT, (2) physician referral, (3) beliefs about treatment efficacy before and after knee replacement surgery, (4) insurance coverage, and (5) preference to avoid surgery. CONCLUSION A previous positive encounter with PT and a physician referral may facilitate PT utilization for adults with knee OA. Knowledge about and access to PT services were not identified as barriers related to PT utilization. Further research is necessary to confirm findings in a broader group of adults with knee OA.
Collapse
Affiliation(s)
- Meredith B Christiansen
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Celeste Dix
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Hiral Master
- Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason T Jakiela
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | | | - Karin G Silbernagel
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| |
Collapse
|
35
|
Coronado RA, Master H, White DK, Pennings JS, Bird ML, Devin CJ, Buchowski MS, Mathis SL, McGirt MJ, Cheng JS, Aaronson OS, Wegener ST, Archer KR. Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery. BMC Musculoskelet Disord 2020; 21:783. [PMID: 33246446 PMCID: PMC7697379 DOI: 10.1186/s12891-020-03816-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery. METHODS Fifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months. RESULTS After surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p < 0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively. CONCLUSION Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.
Collapse
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA
| | - Daniel K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA
| | - Mackenzie L Bird
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shannon L Mathis
- Department of Kinesiology, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
36
|
Master H, Coleman G, Dobson F, Bennell K, Hinman RS, Jakiela JT, White DK. A Narrative Review on Measurement Properties of Fixed-distance Walk Tests Up to 40 Meters for Adults With Knee Osteoarthritis. J Rheumatol 2020; 48:638-647. [PMID: 33060316 DOI: 10.3899/jrheum.200771] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
Knee osteoarthritis (OA) is a serious disease and has no cure to date. Knee OA is a leading cause of functional limitation (e.g., difficulty walking). Walking speed is 1 method of quantifying difficulty with walking and should be assessed in clinical practice for adults with knee OA because it has prognostic value and is modifiable. Specifically, slow walking speed is associated with increased risk of adverse health outcomes, including all-cause mortality in adults with knee OA and can be modified by engaging in physical activity or exercise. However, at present, there is little consensus on the distance and instructions used to conduct the walk test. Distance is often selected based on space availability, and instruction varies, from asking the participants to walk at a comfortable pace versus as fast as possible. Therefore, the purpose of this narrative review is to summarize the measurement properties, strengths, and limitations of a fixed-distance walk test ≤ 40 meters in adults with knee OA. Good measurement properties in terms of reliability and validity were observed across the different testing protocols for fixed-distance walk test (i.e., any distance ≤ 40 m and fast- or self-paced). Therefore, clinicians and researchers can select a testing protocol that can safely and consistently be performed over time, as well as provide a practice trial to acclimatize the patients to the fixed-distance walk test.
Collapse
Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Grace Coleman
- G. Coleman, BS, SPT, Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Fiona Dobson
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Kim Bennell
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Jason T Jakiela
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
| |
Collapse
|
37
|
Christiansen MB, Thoma LM, Master H, Voinier D, White DK. The Association of an Increasing Waist Circumference and Risk of Incident Low Physical Function in Adults with Knee Osteoarthritis. J Rheumatol 2020; 47:1550-1556. [PMID: 32173659 DOI: 10.3899/jrheum.190876] [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] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate an 8-year change in waist circumference (WC) with the risk of incident low physical function over 1 year in adults with, or at risk of, knee osteoarthritis (OA). METHODS Data from the Osteoarthritis Initiative were used. Change in WC was measured from study enrollment (0 month) to the 96-month visit and classified as Increase (≥ 5cm gain) or Maintain (< 5cm gain). We identified World Health Organization (WHO) risk category based on WC at study enrollment as Large WC (males ≥ 102 cm, females ≥ 88 cm) or Small WC (males < 102 cm, females < 88 cm). The outcome was incident low physical function (≥ 28 Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at the 108-month visit. To investigate the association of the 8-year change in WC with the risk of low physical function, we calculated risk ratios (95% CI) and adjusted for potential confounders. We repeated the analyses stratified by the WHO disease risk category. RESULTS The Increase WC group had 1.43 (95% CI 1.04-1.96) times the risk of incident low physical function compared to adults in the Maintain WC group. Adults with a Large WC at baseline who increased WC had 1.55 (95% CI 1.00-2.37) times the risk of incident low physical function compared to those who maintained WC. Adults with a Small WC at baseline who increased WC had 1.97 (95% CI 0.84-4.63) times the risk compared to those who maintained WC. CONCLUSION Increasing WC increases the risk of incident low physical function in the following year. Maintaining WC may mitigate developing low physical function.
Collapse
Affiliation(s)
- Meredith B Christiansen
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware;
| | - Louise M Thoma
- L.M. Thoma, Assistant Professor, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hiral Master
- H. Master, Postdoctoral Research Fellow, PhD, Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dana Voinier
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware
| | - Daniel K White
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware
| |
Collapse
|
38
|
Coleman G, White DK, Thoma LM, Mathews D, Christiansen MB, Schmitt LA, Jakiela JT, Master H. Does a physical therapist-administered physical activity intervention reduce sedentary time after total knee replacement: An exploratory study? Musculoskeletal Care 2020; 19:142-145. [PMID: 32975020 DOI: 10.1002/msc.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Grace Coleman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Louise M Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Mathews
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Meredith B Christiansen
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Laura A Schmitt
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Jason T Jakiela
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Hiral Master
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.,Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
39
|
Holden MA, Button K, Collins NJ, Henrotin Y, Hinman RS, Larsen JB, Metcalf B, Master H, Skou ST, Thoma LM, Wellsandt E, White DK, Bennell K. Guidance for implementing best practice therapeutic exercise for people with knee and hip osteoarthritis: what does the current evidence base tell us? Arthritis Care Res (Hoboken) 2020; 73:1746-1753. [PMID: 32860729 DOI: 10.1002/acr.24434] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Therapeutic exercise is a recommended first-line treatment for people with knee and hip osteoarthritis. However, there is little specific advice or practical resources to guide clinicians in its implementation. As the first in a series of projects by the Osteoarthritis Research Society International Rehabilitation Discussion Group to address this gap, we aim to synthesize current literature informing the implementation of therapeutic exercise for people with knee and hip osteoarthritis. METHODS Narrative review focusing on evidence from systematic reviews and randomized controlled trials. RESULTS Therapeutic exercise is safe for people with knee and hip osteoarthritis. Numerous types of therapeutic exercise (including aerobic, strengthening, neuromuscular, mind-body exercise) may be utilised at varying doses and in different settings to improve pain and function. Benefits from therapeutic exercise appear greater when dosage recommendations from general exercise guidelines for healthy adults are met. However, interim therapeutic exercise goals may also be useful, given that many barriers to achieving these dosages exist among this patient group. Theoretically-informed strategies to improve adherence to therapeutic exercise, such as patient education, goal setting, monitoring and feedback, may help maintain participation and optimise clinical benefits over the longer-term. Sedentary behaviour is also a risk factor for disability and lower quality of life in people with knee and hip osteoarthritis, although limited evidence exists regarding how best to reduce this behaviour. CONCLUSION Current evidence can be used to inform how to implement best practice therapeutic exercise, at a sufficient and appropriate dose, for people with knee and hip osteoarthritis.
Collapse
Affiliation(s)
- Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Kate Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University
| | - Natalie J Collins
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
| | - Yves Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium.,Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Liège, Belgium.,Bone and Cartilage Research Unit, Institute of Pathology, University of Liège, Liège, Belgium
| | - Rana S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Jesper B Larsen
- Translational Pain Biomarker & Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ben Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Hiral Master
- Department of Orthopedic Surgery and Rehab, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Naestved, Denmark
| | - Louise M Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| |
Collapse
|
40
|
Voinier D, Neogi T, Stefanik JJ, Guermazi A, Roemer FW, Thoma LM, Master H, Nevitt MC, Lewis CE, Torner J, White DK. Using Cumulative Load to Explain How Body Mass Index and Daily Walking Relate to Worsening Knee Cartilage Damage Over Two Years: The MOST Study. Arthritis Rheumatol 2020; 72:957-965. [PMID: 31785075 DOI: 10.1002/art.41181] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knee cartilage damage is often linked to mechanical overloading. However, cartilage requires mechanical load to remain healthy, suggesting that underloading may be detrimental. This study was undertaken to examine knee overloading and underloading by defining cumulative load as the joint effects of body mass index (BMI) and daily walking, and examine the relationship between cumulative load and worsening cartilage damage over 2 years. METHODS We used data from the Multicenter Osteoarthritis Study. Steps/day, measured by accelerometry, and BMI were calculated at the 60-month visit. Cartilage damage on magnetic resonance imaging was semiquantitatively scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) at the 60-month and 84-month visits; worsening damage was defined as increased WORMS between visits. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated using binomial regression, with adjustment for potential confounders. RESULTS Our study included 964 participants, 62% of whom were female, with a mean ± SD age of 66.9 ± 7.5 years. Participants had a mean ± SD BMI of 29.7 ± 4.8 kg/m2 and walked a mean ± SD of 7,153 ± 2,591 steps/day. Participants who walked a moderate number of steps/day (6,000-7,900) or a high number of steps/day (>7,900) and had a high BMI (>31 kg/m2 ) had a greater risk of worsening medial tibiofemoral (TF) damage (RR 2.83 [95% CI 1.46-5.48] and RR 2.61 [95% CI 1.50-4.54], respectively) compared with those who walked similar steps/day and had a low BMI (18-27 kg/m2 ). Participants with a low number of steps/day (<6,000) and a low BMI had a greater risk of worsening medial TF and lateral patellofemoral (PF) damage (RR 2.03 [95% CI 1.06-3.92] and RR 2.28 [95% CI 1.06-4.85], respectively) compared with those who walked a high number of steps/day and had a low BMI. Effect estimates for other compartments of the knee did not reach statistical significance. CONCLUSION This study provides preliminary evidence that both overloading and underloading may be detrimental to medial TF cartilage, and underloading may be detrimental to lateral PF cartilage.
Collapse
Affiliation(s)
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - Frank W Roemer
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
41
|
Christiansen MB, Thoma LM, Master H, Voinier D, Schmitt LA, Ziegler ML, LaValley MP, White DK. Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement. Arthritis Care Res (Hoboken) 2020; 72:661-668. [PMID: 30908867 DOI: 10.1002/acr.23882] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/20/2018] [Accepted: 03/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR). METHODS People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. RESULTS Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group. CONCLUSION A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.
Collapse
|
42
|
Thoma LM, Dunlop D, Song J, Lee J, Tudor-Locke C, Aguiar EJ, Master H, Christiansen MB, White DK. Are Older Adults With Symptomatic Knee Osteoarthritis Less Active Than the General Population? Analysis From the Osteoarthritis Initiative and the National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2019; 70:1448-1454. [PMID: 29468844 DOI: 10.1002/acr.23511] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/02/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare objectively measured physical activity in older adults with symptomatic knee osteoarthritis (OA) with similarly aged adults without osteoarthritis (OA) or knee symptoms from the general population. METHODS We included people ages 50-85 years with symptomatic knee OA from the Osteoarthritis Initiative (OAI, n = 491), and ages 50-85 years from the general population using National Health and Nutrition Examination Survey (NHANES, n = 449) data. A uniaxial accelerometer was worn for ≥10 hours/day for ≥4 days in the NHANES group in 2003-2004 and in the OAI group in 2008-2010. We calculated time spent in moderate-to-vigorous physical activity (MVPA in minutes/day) and described differences in MVPA and demographic variables between the samples. We conducted matched-pairs sensitivity analyses to further evaluate the role of potential confounders. RESULTS Both cohorts had similarly low levels of physical activity in age- and sex-specific strata. Time in MVPA ranged from a median of 1-22 minutes/day in people with symptomatic knee OA, and from 1-24 minutes/day in the general population without OA or knee pain. These results were similar in sensitivity analyses. CONCLUSION Time spent in MVPA was similarly low in those with symptomatic knee OA as in older adults without knee pain or OA.
Collapse
Affiliation(s)
| | | | - Jing Song
- Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | |
Collapse
|
43
|
Christiansen MB, Thoma LM, Master H, Schmitt LA, Pohlig R, White DK. A Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement: Protocol for a Randomized Controlled Trial. Phys Ther 2018; 98:578-584. [PMID: 29608733 PMCID: PMC6692704 DOI: 10.1093/ptj/pzy037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The definitive treatment for knee osteoarthritis is a total knee replacement, which results in a clinically meaningful improvement in pain and physical function. However, evidence suggests that physical activity (PA) remains unchanged after total knee replacement (TKR). OBJECTIVE The objective of this study is to investigate the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR. DESIGN This study will be a randomized controlled trial. SETTING The setting is an outpatient physical therapy clinic. PARTICIPANTS The participants are 125 individuals who are over the age of 45 and are seeking outpatient physical therapy following a unilateral TKR. INTERVENTION In addition to standardized physical therapy after TKR, the intervention group will receive, during physical therapy, a weekly PA intervention that includes a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist. CONTROL The control group will receive standardized physical therapy alone after TKR. MEASUREMENTS The efficacy of the intervention will be measured as minutes per week spent in moderate to vigorous PA at enrollment, at discharge, and at 6 months and 12 months after discharge from physical therapy. The fidelity and safety of the intervention will be assessed throughout the study. LIMITATIONS Participants will not be masked, PA data will be collected after randomization, and the trial will be conducted at a single site. CONCLUSIONS The goal of this randomized controlled trial is to increase PA after TKR. A protocol for investigating the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR is presented. The findings will be used to support a large multisite clinical trial to test the effectiveness, implementation, and cost of this intervention.
Collapse
Affiliation(s)
- Meredith B Christiansen
- Department of Physical Therapy and Department of Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | | | - Hiral Master
- Department of Physical Therapy and Department of Biomechanics and Movement Science, University of Delaware
| | | | - Ryan Pohlig
- College of Health Sciences, University of Delaware
| | - Daniel K White
- Department of Physical Therapy and the Department of Biomechanics and Movement Science, University of Delaware, STAR Health Sciences Complex, 540 South College Avenue, Newark, DE 19713,Address all correspondence to Dr. White at:
| |
Collapse
|
44
|
Master H, Thoma LM, Christiansen MB, Polakowski E, Schmitt LA, White DK. Minimum Performance on Clinical Tests of Physical Function to Predict Walking 6,000 Steps/Day in Knee Osteoarthritis: An Observational Study. Arthritis Care Res (Hoboken) 2018; 70:1005-1011. [PMID: 29045051 DOI: 10.1002/acr.23448] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not. METHODS Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance-based clinical tests: 5 times sit-to-stand test, walking speed (tested over 20 meters), and 400-meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80-95%) to predict walking ≥6,000 steps/day. RESULTS Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m2 , and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4-14.0 seconds on the 5 times sit-to-stand test, 1.13-1.26 meters/second for walking speed, or 315-349 seconds on the 400-meter walk test. CONCLUSION Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.
Collapse
|
45
|
Master H, White DK. Letter to the Editor on "Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty". J Arthroplasty 2017; 32:3258-3259. [PMID: 28669570 DOI: 10.1016/j.arth.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/06/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Hiral Master
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Daniel K White
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| |
Collapse
|
46
|
White DK, Li Z, Zhang Y, Marmon AR, Master H, Zeni J, Niu J, Jiang L, Zhang S, Lin J. Physical Function After Total Knee Replacement: An Observational Study Describing Outcomes in a Small Group of Women From China and the United States. Arch Phys Med Rehabil 2017; 99:194-197. [PMID: 28760574 DOI: 10.1016/j.apmr.2017.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States. DESIGN Observational. SETTING Community environment. OUTCOMES Both groups adhered to the Osteoarthritis Research Society International (OARSI) protocols for the 6-minute walk and 30-second chair stand. We compared physical function prior to TKR and 6 months after using linear regression adjusted for covariates. PARTICIPANTS Women (N=60) after TKR. INTERVENTIONS Not applicable. RESULTS Age and body mass index in the China group (n=30; 66y and 27.0kg/m2) were similar to those in the U.S. group (n=30; 65y and 29.6kg/m2). Before surgery, the China group walked 263 (95% confidence interval [CI], -309 to -219) less meters and had 10.2 (95% CI, -11.8 to -8.5) fewer chair stands than the U.S. group. At 6 months when compared with the U.S. group, the China group walked 38 more meters, but this difference did not reach statistical significance (95% CI, -1.6 to 77.4), and had 3.1 (95% CI, -4.4 to -1.7) fewer chair stands. The China group had greater improvement in the 6-minute walk test than did the U.S. group (P<.001). CONCLUSIONS Despite having worse physical function before TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands than did the U.S. group after surgery.
Collapse
Affiliation(s)
- Daniel K White
- Department of Physical Therapy, University of Delaware, Newark, DE.
| | - Zhichang Li
- Peking University People's Hospital, Peking University, Beijing, China
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, MA
| | - Adam R Marmon
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Hiral Master
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Joseph Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jingbo Niu
- Boston University School of Medicine, Boston, MA
| | - Long Jiang
- Peking University People's Hospital, Peking University, Beijing, China
| | - Shu Zhang
- First People's Hospital of Dongcheng District, Beijing, China
| | - Jianhao Lin
- Peking University People's Hospital, Peking University, Beijing, China
| |
Collapse
|
47
|
Abstract
Knee osteoarthritis is a common cause of an array of functional limitations in older adults, and the accurate assessment of such limitations is critical for practicing clinicians and scientists. Patient-reported measures are a valuable resource to track the type and severity of limitation, although the psychometric performance of each instrument should be thoroughly evaluated before adoption. This article reviews the validity, reliability, sensitivity to change, and responsiveness of 3 patient-reported measures of physical function: the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score, and the Patient Reported Outcomes Measurement Information System Physical Function scale.
Collapse
Affiliation(s)
- Daniel K White
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, 210L, Newark, DE 19713, USA.
| | - Hiral Master
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, 210L, Newark, DE 19713, USA
| |
Collapse
|
48
|
Yavuz M, Master H, Garrett A, Lavery LA, Adams LS. Peak Plantar Shear and Pressure and Foot Ulcer Locations: A Call to Revisit Ulceration Pathomechanics. Diabetes Care 2015; 38:e184-5. [PMID: 26370381 PMCID: PMC4613917 DOI: 10.2337/dc15-1596] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/04/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Metin Yavuz
- University of North Texas Health Science Center, Fort Worth, TX
| | - Hiral Master
- University of North Texas Health Science Center, Fort Worth, TX
| | - Alan Garrett
- University of North Texas Health Science Center, Fort Worth, TX John Peter Smith Hospital, Fort Worth, TX
| | | | - Linda S Adams
- University of North Texas Health Science Center, Fort Worth, TX
| |
Collapse
|
49
|
Zhao Y, Salem Y, Li M, Master H, Liu H(H. Comparison of Surface Landmarks for Measuring the Individualized Height of Rolling Walker. Physical & Occupational Therapy In Geriatrics 2015. [DOI: 10.3109/02703181.2015.1009228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
50
|
Bucay M, Zacca NM, Trakhtenbroit AD, Asimacopoulos PJ, Master H, Raizner AE. Rotablator induced "shave" of intraluminal cap exposing intramural plaque crater. Cathet Cardiovasc Diagn 1992; 25:209-12. [PMID: 1571976 DOI: 10.1002/ccd.1810250307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient with recent onset of unstable angina was found to have a severe, eccentric stenosis of the proximal left anterior descending coronary artery. Rotational atherectomy was performed. After the first passage of the burr across the stenosis, an intraplaque crater was angiographically visualized. It is hypothesized that the patient's clinical presentation may be attributed to plaque rupture and formation of an intraplaque crater which was sealed by a fibrous cap. This cap was "shaved" by the rotating burr, exposing the crater. Adjunctive balloon dilatation expanded the true lumen and compressed the crater.
Collapse
Affiliation(s)
- M Bucay
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | |
Collapse
|