Development of a clinical prediction rule to identify physical activity after total hip arthroplasty

OBJECTIVE

To develop clinical prediction rule (CPR) of physical activity at 1-year after total hip arthroplasty (THA).

DESIGN

Retrospective cohort study.

SETTING

University hospital with orthopedic surgery.

PARTICIPANTS

The study group included 321 patients (56 men) who underwent primary THA.

INTERVENTION

Not applicable.

MAIN OUTCOMES MEASURES

The data collected included age, body mass index, clinical score from the questionnaires, hip pain, range of motion, muscle strength, and Physical functions (10-Meter Walk Test, Timed Up and Go test and Sit-to-stand). Patients were classified into sufficient and insufficient activity groups based on their University of California, Los Angeles (UCLA) activity score 1 year after THA. Variables measured preoperatively and at 3 weeks postoperatively were analyzed using univariate and multivariate methods to derive CPR for physical activity.

RESULTS

A CPR was developed using the following five factors and cut-offs: age, ≤70.5 years; preoperative UCLA activity score, ≥3.5; preoperative hip abduction strength, ≥0.54 Nm/kg; preoperative knee extension strength, ≥1.04 Nm/kg; and 10-Meter Walk Test, ≤8.49 s at 3 weeks after surgery. The presence of four of the five factors predicted a sufficient physical activity level at 1-year, with a positive likelihood ratio of 5.94 and probability of 85.4%. The presence of five predictor variables increased the probability of sufficient physical activity after THA to 94.7%.

CONCLUSION

This study developed a CPR for physical activity at 1-year after THA. Having four or more of the five measurements were useful indicators for predicting of physical activity at 1 year postoperatively.

Evaluating Factors of Greater Patient Satisfaction with Outpatient Cardiology Telehealth Visits During the COVID-19 Pandemic

Background

The impact of telehealth on cardiovascular care during the COVID-19 pandemic on patient satisfaction and factors associated with satisfaction are not well characterized.

Methods

We conducted a nonrandomized, prospective cross-sectional survey study for outpatient telehealth cardiovascular visits over a 169-day period utilizing a validated telehealth usability questionnaire. For each variable, patients were divided into 2 groups—1 with scores above the median, labeled “greater satisfaction,” and the other with scores below the median, labeled “less satisfaction.”

Results

A total of 13,913 outpatient telehealth encounters were successfully completed during the study period. A total of 7327 unique patients were identified and received a survey invitation; 5993 (81.8%) patients opened the invitation, and 1034 (14.1%) patients consented and completed the survey. Overall mean and median scores were 3.15 (standard deviation 0.74) and 3.37 (interquartile range 2.73–3.68) (maximum score 4.00). Greater satisfaction was noted among younger patients (mean age 63.3 ± 14.0 years, P = .005), female gender (46.3%, P = .007), non-White ethnicity (24.2% P = .006), self-identified early adopters and innovators of new technology (49.8%, P < .001), 1-way travel time greater than 1 hour (22.3%, P < .001), 1-way travel distance greater than 10 miles (49.0%, P < .001), patients needing child care arrangement (16.4%, P < .001), and history of orthotopic heart transplant (OHT) (5.1%, P = .04).

Conclusion

Patients reported overall satisfaction with telehealth during the COVID-19 pandemic. Factors associated with patient convenience, along with female gender, younger age, and non-White ethnicity, correlated with greater satisfaction. Cardiovascular comorbidities did not correlate with greater satisfaction except for OHT. Further research into the impact of telehealth on patient satisfaction, safety, and clinical outcomes is needed.

Blue light therapy improves circadian dysfunction as well as motor symptoms in two mouse models of Huntington's disease

Patients with Huntington's disease (HD) exhibit movement disorders, psychiatric disturbance and cognitive impairments as the disease progresses. Abnormal sleep/wake cycles are common among HD patients with reports of delayed sleep onset, fatigue during the day, and a delayed pattern of melatonin secretion all of which suggest circadian dysfunction. Mouse models of HD confirm disrupted circadian rhythms with pathophysiology found in the central circadian clock (suprachiasmatic nucleus). Importantly, circadian dysfunction manifests early in disease, even before the classic motor symptoms, in both patients and mouse models. Therefore, we hypothesize that the circadian dysfunction may interact with the disease pathology and exacerbate the HD symptoms. If correct, early intervention may benefit patients and delay disease progression. One test of this hypothesis is to determine whether light therapy designed to strengthen this intrinsic timing system can delay the disease progression in mouse models. Therefore, we determined the impact of blue wavelength-enriched light on two HD models: the BACHD and Q175 mice. Both models received 6 h of blue-light at the beginning of their daily light cycle for 3 months. After treatment, both genotypes showed improvements in their locomotor activity rhythm without significant change to their sleep behavior. Critically, treated mice of both lines exhibited improved motor performance compared to untreated controls. Focusing on the Q175 genotype, we sought to determine whether the treatment altered signaling pathways in brain regions known to be impacted by HD using NanoString gene expression assays. We found that the expression of several HD relevant markers was altered in the striatum and cortex of the treated mice. Our study demonstrates that strengthening the circadian system can delay the progression of HD in pre-clinical models. This work suggests that lighting conditions should be considered when managing treatment of HD and other neurodegenerative disorders.