Because individuals with osteoarthritis (OA) avoid physical activities that exacerbate symptoms, potentially increasing risk for cardiovascular disease (CVD) and death, we assessed the relationship ...between OA disability and these outcomes.
In a population cohort aged 55+ years with at least moderately severe symptomatic hip and/or knee OA, OA disability (Western Ontario McMaster Universities (WOMAC) OA scores; Health Assessment Questionnaire (HAQ) walking score; use of walking aids) and other covariates were assessed by questionnaire. Survey data were linked to health administrative data to determine the relationship between baseline OA symptom severity to all-cause mortality and occurrence of a composite CVD outcome (acute myocardial infarction, coronary revascularization, heart failure, stroke or transient ischemic attack) over a median follow-up of 13.2 and 9.2 years, respectively.
Of 2156 participants, 1,236 (57.3%) died and 822 (38.1%) experienced a CVD outcome during follow-up. Higher (worse) baseline WOMAC function scores and walking disability were independently associated with a higher all-cause mortality (adjusted hazard ratio, aHR, per 10-point increase in WOMAC function score 1.04, 95% confidence interval, CI 1.01-1.07, p = 0.004; aHR per unit increase in HAQ walking score 1.30, 95% CI 1.22-1.39, p<0.001; and aHR for those using versus not using a walking aid 1.51, 95% CI 1.34-1.70, p<0.001). In survival analysis, censoring on death, risk of our composite CVD outcome was also significantly and independently associated with greater baseline walking disability ((aHR for use of a walking aid = 1.27, 95% CI 1.10-1.47, p = 0.001; aHR per unit increase in HAQ walking score = 1.17, 95% CI 1.08-1.27, p<0.001).
Among individuals with hip and/or knee OA, severity of OA disability was associated with a significant increase in all-cause mortality and serious CVD events after controlling for multiple confounders. Research is needed to elucidate modifiable mechanisms.
Obesity is an important topic for the osteoarthritis (OA) scientific community. However, the predominant use of body mass index (BMI) to define obesity in OA research is associated with uncertainties ...and limitations. These include an inability to discern fat and muscle mass, account for sex-differences in fat distribution, or identify adiposity-related health impairments. A focus on BMI in OA research may influence weight bias in clinical practice and impact disparities in access to effective OA treatments. To ensure that our understanding and approaches to improve health outcomes for individuals with or at risk for OA continues to advance in the next decade, future research will need to consider alternative measures beyond BMI for obesity identification and align with evolving obesity science. OA researchers must be aware of issues associated with weight stigma and work to minimize negative generalizations based on BMI.
The assessment of musculoskeletal pain Hawker, Gillian A
Clinical and experimental rheumatology,
2017 Sep-Oct, Letnik:
35 Suppl 107, Številka:
5
Journal Article
Recenzirano
Musculoskeletal (MSK) pain has a major impact on people's quality of life. Chronic MSK pain causes sleep interruption, fatigue, depressed mood, activity limitations and participation restrictions. ...The impact of MSK pain is influenced by contextual factors, including comorbidity, arthritis coping efficacy and access to MSK care. Thus, MSK pain assessment warrants a bio-psychosocial perspective that includes pain, its downstream effects and contextual factors. Such an approach should incorporate elicitation of symptoms using patient-report questionnaires and physical examination to help localize the pain and assess for signs of inflammation, tenderness on palpation, pain on motion, joint instability and malalignment. Using such an approach to the assess chronic pain in MSK conditions has potential to improve our ability to target the right treatment to the right patient, resulting in improved outcomes.
Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the next generation of physicians. Despite this, the number of physicians ...experience symptoms of burnout is rising. To assess the impact of organizational culture on physicians' professional fulfillment and burnout, we surveyed full-time Department of Medicine members at the University of Toronto. A cross-sectional survey assessed: physician factors (age, gender, minority status, disability, desire to reduce clinical workload); workplace culture (efforts to create a collegial environment, respectful/civil interactions, confidence to address unprofessionalism without reprisal, witnessed and/or personally experienced unprofessionalism); professional fulfillment and burnout using the Stanford Professional Fulfillment Index. We used multivariable linear regression to examine the relationship of measures of workplace culture on professional fulfillment and burnout (scores 0-10), controlling for physician factors. Of 419 respondents (52.0% response rate), we included 400 with complete professional fulfillment and burnout data in analyses (60% less than or equal to age 50, 45% female). Mean scores for professional fulfillment and burnout were 6.7±1.9 and 2.8±1.9, respectively. Controlling for physician factors, professional fulfillment was associated with satisfaction with efforts to create a collegial environment (adjusted beta 0.45, 95% CI 0.21 to 0.70) and agreement that colleagues were respectful/civil (adjusted beta 0.85, 95% CI 0.53 to 1.17). Lower professional fulfillment was associated with higher burnout scores. Controlling for professional fulfillment and physician factors, lower confidence in taking action to address unprofessionalism (adjusted beta -0.22, 95% CI -0.40 to -0.03) was associated with burnout. Organizational culture and physician factors had an impact on professional fulfillment and burnout. Professional fulfillment partially mediated the relationship between organizational culture and burnout. Strategies that promote inclusion, respect and civility, and safe ways to report workplace unprofessionalism are needed in academic medicine.
Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability among older people. One in 3 people over age 65, and disproportionately more women than men, are living with ...OA. The prevalence of OA is rising related to an increasing prevalence of OA risk factors, including aging and obesity. In older adults, OA frequently exists alongside other common chronic conditions and may increase the risk for worse outcomes from these conditions. Given the growing burden and impact of OA, enhanced effort is required to deliver effective and safe treatments to those living with the disease.
To update the 1997 OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) core domain set for clinical trials in hip and/or knee osteoarthritis (OA).
An ...initial review of the COMET database of core outcome sets (COS) was undertaken to identify all domains reported in previous COS including individuals with hip and/or knee OA. These were presented during 5 patient and health professionals/researcher meetings in 3 continents (Europe, Australasia, North America). A 3-round international Delphi survey was then undertaken among patients, healthcare professionals, researchers, and industry representatives to gain consensus on key domains to be included in a core domain set for hip and/or knee OA. Findings were presented and discussed in small groups at OMERACT 2018, where consensus was obtained in the final plenary.
Four previous COS were identified. Using these, and the patient and health professionals/researcher meetings, 50 potential domains formed the Delphi survey. There were 426 individuals from 25 different countries who contributed to the Delphi exercise. OMERACT 2018 delegates (n = 129) voted on candidate domains. Six domains gained agreement as mandatory to be measured and reported in all hip and/or knee OA clinical trials: pain, physical function, quality of life, and patient's global assessment of the target joint, in addition to the mandated core domain of adverse events including mortality. Joint structure was agreed as mandatory in specific circumstances, i.e., depending on the intervention.
The updated core domain set for hip and/or knee OA has been agreed upon. Work will commence to determine which outcome measurement instrument should be recommended to cover each core domain.
A challenge to the use of observational data to study treatment effects is the issue of confounding. Noncomparability of exposed and nonexposed subjects can lead to biased estimation of the treatment ...effect. The propensity score is a balancing score that can be used to form matched groups, or pairs, that are not systematically different and enable nonbiased comparisons between groups. This article reviews propensity score methods with an illustrative example of the application of propensity score matching in an observational study of an uncommon disease (systemic sclerosis).
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