24-hour activity and sleep profiles in arthritis

Objectives: Identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership. Methods: Cross-sectional cohort, using baseline data from two randomized trials studying activity counselling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or knee osteoarthritis (OA). Participants wore activity monitors for 1-week and completed surveys for demographics, mood (Patient Health Questionnaire-9) and sitting and walking habits (Self-Reported Habit Index). 1440 minutes / day stratified into minutes off-body, sleeping, resting, non-ambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership. Results: 172 people (RA: 51%, OA:30%, SLE: 19%). Clusters: High Sitters: 6.9 hours sleep, 1.6 hours rest, 13.2 hours non-ambulatory, 1.6 hours intermittent and 0.3 hours purposeful walking. Low Sleepers: 6.5 hours sleep, 1.2 hours rest, 12.2 hours non-ambulatory, 3.3 hours intermittent and 0.6 hours purposeful walking. High Sleepers: 8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory, 2.5 hours intermittent and 0.3 hours purposeful walking. Balanced Activity: 7.4 hours sleep, 1.5 hours sleep, 9.4 hours non-ambulatory, 4.4 hours intermittent and 0.8 hours purposeful walking. Younger age [OR: 0.95 (95% CI: 0.91-0.99)], weaker occupational sitting habit [OR: 0.55 (95% CI: 0.41-0.76)] and stronger walking outside habit [OR: 1.43 (95% CI: (1.06-1.91)] were each associated with Balanced Activity relative to High Sitters. Conclusions: Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Suggesting tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyPostdoctora

Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy

Background: We used High Resolution – peripheral Quantitative CT (HR-pQCT) imaging to examine peri-articular bone quality in early rheumatoid arthritis (RA) and explore whether bone quality improved over 12-months in individuals receiving care consistent with practice guidelines. Methods: A 1-year longitudinal cohort study (Baseline and 12-months) evaluating individuals with early RA compared to age/sex-matched peers. Personal demographic and health and lifestyle information were collected for all. Whereas, active joint count (AJC28), functional limitation, and RA medications were also collected for RA participants. HR-pQCT imaging analyses quantified bone density and microstructure in the Metacarpal Head (MH) and Ultra-Ultra-Distal (UUD) radius at baseline and 12-months. Analyses included a General Linear Modelling repeated measures analyses examined main effects for disease, time, and interaction on bone quality. Results: Participants (n = 60, 30 RA/30 NRA); 80% female, mean age 53 (varying from 21 to 74 years). At baseline, RA participants were on average 7.7 months since diagnosis, presenting with few active joints (AJC28: 30% none, remaining 70% Median 4 active joints) and minimal self-reported functional limitation (mHAQ-DI0–3: 0.56). At baseline, 29 of 30 RA participants had received one or more non-biologic disease-modifying anti-rheumatic drugs (DMARD);13 in combination with glucocorticoid and 1 in combination with a biologic medication. One participant only received glucocorticoid medication. Four RA participants withdrew leaving 26 pairs (n = 52) at 12-months; 23 pairs (n = 46) with UUD and 22 pairs (n = 44) with MH baseline and 12-month images to compare. Notable RA/NRA differences (p < 0.05) in bone quality at all three sites included lower trabecular bone density and volume, more rod-like trabeculae, and larger and more variable spaces between trabeculae; fewer trabeculae at the UUD and MH2 sites; and lower cortical bone density and volume in the MH sites. Rate of change over 12-months did not differ between RA/NRA participants which meant there was also no improvement over the year in RA bone quality. Conclusions: Early changes in peri-articular bone density and microstructure seen in RA are consistent with changes more commonly seen in aging bone and are slow or resistant to recover despite well controlled inflammatory joint symptoms with early DMARD therapy.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study

Background: High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites. Methods: 12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%95). Results: Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH2 trabecular number) to .99 (MS3 polar moment of inertia); CV% varied from  3 on 5 point scale. Conclusion: In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.Family Practice, Department ofMedicine, Faculty ofOrthopaedics, Department ofPhysical Therapy, Department ofOther UBCNon UBCReviewedFacult

The Impact of 51 Risk Factors on Life Expectancy in Canada: Findings from a New Risk Prediction Model Based on Data from the Global Burden of Disease Study

The aims of this study were (1) to develop a comprehensive risk-of-death and life expectancy (LE) model and (2) to provide data on the effects of multiple risk factors on LE. We used data for Canada from the Global Burden of Disease (GBD) Study. To create period life tables for males and females, we obtained age/sex-specific deaths rates for 270 diseases, population distributions for 51 risk factors, and relative risk functions for all disease-exposure pairs. We computed LE gains from eliminating each factor, LE values for different levels of exposure to each factor, and LE gains from simultaneous reductions in multiple risk factors at various ages. If all risk factors were eliminated, LE in Canada would increase by 6.26 years for males and 5.05 for females. The greatest benefit would come from eliminating smoking in males (2.45 years) and high blood pressure in females (1.42 years). For most risk factors, their dose-response relationships with LE were non-linear and depended on the presence of other factors. In individuals with high levels of risk, eliminating or reducing exposure to multiple factors could improve LE by several years, even at a relatively advanced age.Medicine, Faculty ofNon UBCMedicine, Department ofPhysical Therapy, Department ofReviewedFacultyResearche

Can we improve cognitive function among adults with osteoarthritis by increasing moderate-to-vigorous physical activity and reducing sedentary behaviour? Secondary analysis of the MONITOR-OA study

Background: Preliminary evidence suggests osteoarthritis is a risk factor for cognitive decline. One potential reason is 87% of adults with osteoarthritis are inactive, and low moderate-to-vigorous physical activity and high sedentary behaviour are each risk factors for cognitive decline. Thus, we investigated whether a community-based intervention to increase moderate-to-vigorous physical activity and reduce sedentary behaviour could improve cognitive function among adults with osteoarthritis. Methods: This was a secondary analysis of a six month, proof-of-concept randomized controlled trial of a community-based, technology-enabled counselling program to increase moderate-to-vigorous physical activity and reduce sedentary behaviour among adults with knee osteoarthritis. The Immediate Intervention (n = 30) received a Fitbit® Flex™ and four bi-weekly activity counselling sessions; the Delayed Intervention (n = 31) received the same intervention two months later. We assessed episodic memory and working memory using the National Institutes of Health Toolbox Cognition Battery. Between-group differences (Immediate Intervention vs. Delayed Intervention) in cognitive performance were evaluated following the primary intervention (i.e., Baseline – 2 Months) using intention-to-treat. Results: The intervention did not significantly improve cognitive function; however, we estimated small average improvements in episodic memory for the Immediate Intervention vs. Delayed Intervention (estimated mean difference: 1.27; 95% CI [− 9.27, 11.81]; d = 0.10). Conclusion: This small study did not show that a short activity promotion intervention improved cognitive health among adults with osteoarthritis. However, the effects of increased moderate-to-vigorous physical activity and reduced sedentary behaviour are likely to be small and thus we recommend subsequent studies use larger sample sizes and measure changes in cognitive function over longer intervals. Trial registration number: ClinicalTrials.gov Protocol Registration System: NCT02315664 ; registered 12 December, 2014; https://clinicaltrials.gov/ct2/show/NCT02315664?cond=NCT02315664&rank=1Medicine, Faculty ofOther UBCPhysical Therapy, Department ofReviewedFacult

A technology-enabled Counselling program versus a delayed treatment control to support physical activity participation in people with inflammatory arthritis: study protocol for the OPAM-IA randomized controlled trial

Background: Being physically active is an essential component of successful self-management for people with inflammatory arthritis; however, the vast majority of patients are inactive. This study aims to determine whether a technology-enabled counselling intervention can improve physical activity participation and patient outcomes. Methods: The Effectiveness of Online Physical Activity Monitoring in Inflammatory Arthritis (OPAM-IA) project is a community-based randomized controlled trial with a delayed control design. We will recruit 130 people with rheumatoid arthritis or systemic lupus erythematosus, who can be physically active without health professional supervision. Randomization will be stratified by diagnosis. In Weeks 1–8, participants in the Immediate Group will: 1) receive education and counselling by a physical therapist (PT), 2) use a Fitbit and a new web-based application, FitViz, to track and obtain feedback about their physical activity, 3) receive 4 biweekly follow-up calls from the PT. Those in the Delayed Group will receive the same program in Week 10. We will interview a sample of participants about their experiences with the intervention. Participants will be assessed at baseline, and Weeks 9, 18 and 27. The primary outcome measure is time spent in moderate/vigorous physical activity in bouts of ≥ 10 min, measured with a portable multi-sensor device in the free-living environment. Secondary outcomes include step count, time in sedentary behaviour, pain, fatigue, mood, self-management capacity, and habitual behaviour. Discussion: A limitation of this study is that participants, who also administer the outcome measures, will not be blinded. Nonetheless, by customizing existing self-monitoring technologies in a patient-centred manner, individuals can be coached to engage in an active lifestyle and monitor their performance. The results will determine if this intervention improves physical activity participation. The qualitative interviews will also provide insight into a paradigm to integrate this program to support self-management. Trial registration Date of last update in ClinicalTrials.gov: September 18, 2015. ClinicalTrials.gov Identifier: NCT02554474 .Medicine, Faculty ofNon UBCMedicine, Department ofOccupational Science and Occupational Therapy, Department ofPhysical Therapy, Department ofReviewedFacult

Efficacy of a Physical Activity Counselling Program with Use of Wearable Tracker in People with Inflammatory Arthritis : A Randomized Controlled Trial

Objectives. To assess the efficacy of a multi-faceted counselling intervention at improving physical activity participation and patient outcomes. Methods. We recruited people with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). In Weeks 1-8, the Immediate Group received education and counselling by a physiotherapist (PT), used a Fitbit and a web-application to obtain feedback about their physical activity, and received 4 follow-up calls from the PT. The Delay Group received the same intervention in Weeks 10-17. Participants were assessed at baseline, Week 9, 18 and 27. Primary outcome was time spent in moderate/vigorous physical activity (MVPA; in bouts of >10 mins) measured with a SenseWear. Secondary outcomes included step count, time in sedentary behaviour, pain, fatigue, mood, self management capacity, and habitual behaviours. Results. 118 participants enrolled. The adjusted mean difference in MVPA was 9.4 mins/day (95% CI: -0.5, 19.3, P=0.06). A significant effect was found in pain (-2.45; 95% CI: -4.78, -0.13, P=0.04), and perceived walking habit (0.54; 95% CI: 0.08, 0.99, P=0.02). The remaining secondary outcomes improved, but were not statistically significant. Post-hoc analysis revealed a significant effect in MVPA (14.3 mins/day; 95% CI: 2.3, 26.3) and pain (-4.05; 95% CI: -6.73, -1.36) in participants with RA, but not those with SLE. Conclusion. Counselling by a PT has potential to improve physical activity in people with inflammatory arthritis, but further study is needed to understand the intervention effect on different diseases. We found a significant improvement in pain, suggesting the intervention might have a positive effect on symptom management.Medicine, Faculty ofNon UBCMedicine, Department ofOccupational Science and Occupational Therapy, Department ofPhysical Therapy, Department ofReviewedFacultyResearcherPostdoctora