Level of Pain and Disability at Time of TKR across the Past 10 Years: Results from Two National Cohorts

Introduction: A recent analysis reported a growing numbers of younger US adults with knee pain consistent with osteoarthritis (OA), although parallel analyses of knee x-rays found no increase in the classic radiographic signs of OA. The accompanying editorial evoked the need to understand if surgeons are performing surgery at an earlier stage in the condition.1 We compared pre-operative demographic and symptom profiles of a national US cohort of OA patients undergoing primary total knee replacement (TKR) in 2011-2012 with a national US cohort of patients from 2000-2004 to evaluate change, if any, in the timing of surgery as measured by patient pain and function. Methods: Following informed consent, the 2011-2012 national research study collected comprehensive data including demographic, comorbidity, and patient-reported pain and physical function, from a national sample of TKR patients. Comparable data from a national sample collected by one implant manufacturer between 2000-2004 were analyzed. Descriptive statistics compared the demographic and symptom profiles of the two cohorts. Results: There were fewer females in the 2011-2012 cohort (n=2363) compared to the 2000-2004 cohort (n=7144) (61.62%, vs. 66.72%). The 2011-2012 cohort was younger than the 2000-2004 cohort (66.7 years, vs. 68.12 years) and had a lower mean BMI (31.5 vs 32.3). Pre-operative physical function scores (SF36/PCS) were 3 points higher in 2011-2012 than 2000-2004 (33.2 vs. 30.41). When compared to the national PCS norm of 50 (SD=10), TKR patients from both time periods reported pre-operative function levels almost 2 standard deviations below the national norm. There was no significant difference in terms of emotional health (SF36/MCS scores: 51.85 for the 2011-2012 cohort vs. 51.83 for the 2000-2004 cohort). Conclusion: Despite the significant growth in the use of primary TKR in the last decade, especially among younger patients, TKR patients continue to report significant disability at the time of surgery

Differential Burden of Musculoskeletal Pain in Blacks and Whites at the Time of Total Joint Replacement Surgery

Introduction: The existence of racial disparities in total knee (TKR) and hip (THR) replacement outcomes is well established. The role of musculoskeletal co-morbidities among black and white TKR patients at the time of surgery were investigated in a prospective cohort enrolled in the FORCE-TJR consortium of 131 surgeons in 22 US states. Materials & methods: Descriptive analyses were performed on 3,306 TKR and 2,439 THR patients. Data included sociodemographic factors (age, sex, race), BMI, comorbid conditions using the modified Charlson comorbidity scores, burden of musculoskeletal disease using the Knee/Hip injury and Osteoarthritis Outcome Score (KOOS/HOOS) in both knees and hips, emotional health based on the Short Form 36 (SF-36) Mental Component Score (MCS) and physical function based on the Physical Component Score (SF-36 PCS). Factors associated with pre-operative surgical joint pain and function were examined using multivariate stepwise linear regression models. Results: Compared to Whites, Blacks (143 hips and 201 knees) reported worse surgical joint pain (mean pain: 39.3 vs. 49.2 (hip); 43.4 vs. 53.2 (knee)), poorer surgical joint function (mean function: 38.9 vs. 45.7 (hip); 45.9 vs. 53.4 (knee)), poorer global function (mean PCS: 30.0 vs. 31.6 (hip); 31.3 vs. 33.1 (knee)), and more non-operative joints pain. (All p\u3c0.03). In adjusted multivariable models, differences at the time of surgery in surgical joint symptoms and global function were explained by differences in musculoskeletal pain in the hips, knees, and low back. Conclusion: Greater burden of musculoskeletal pain explains differences in pre-operative pain and function between Blacks and Whites and likely impacts rehabilitation and subsequent TJR outcomes

Differential burden of musculoskeletal pain in African Americans and whites patients at the time of total joint replacement surgery

Objective: African Americans patients have greater operative joint pain and functional limitation at the time of total joint replacement (TJR) compared to white patients. We examined the factors associated with this apparent disparity. Methods: A consecutive sample of 5745 patients with advanced knee and hip osteoarthritis [who elected to undergo TJR in 2011-201] reported, preoperatively, medical comorbidities, operative and non-operative hip/ knee pain using Hip and Knee Disability and Osteoarthritis Outcome Scores (HOOS/KOOS), function using Short Form 36 Physical Component Score (PCS). Total burden of musculoskeletal pain was quantified as moderate/severe pain in non-operative hip and knee joints and lumbar back pain using Oswestry Disability Index (ODI). Associations among race, medical co-morbidites (modified Charlson), total musculoskeletal pain burden, operative joint pain, and functional limitations were examined using multivariable regression models. Results:Compared to Whites, African Americans (143 hips and 201 knees) reported worse surgical joint pain (mean pain: 39.3 vs. 49.2 [hip]; 43.4 vs. 53.2 [knee]), poorer surgical joint function (mean function: 38.9 vs. 45.7 [hip]; 45.9 vs. 53.4 [knee]), poorer global function (mean PCS: 30.0 vs. 31.6 [hip]; 31.3 vs. 33.1 [knee]), and more non-operative joints pain (p Conclusions: Greater burden of musculoskeletal pain explains differences in pre-operative pain and function between African American and white patients and likely impacts rehabilitation and subsequent TJR outcomes

Greater Co-morbidity Burden is Associated with Greater Pain and Disability at Time of Total Knee Replacement Among African American Patients

Introduction: The existence of racial disparities in total joint replacement (TJR) care is well established based on Medicare and VA data.1,3 As compared to white patients, African American TJR patients have lower utilization rates, more pain, poorer function at the time of surgery, and higher post-operative complication rates.2,3 We analyzed a national prospective total knee replacement (TKR) cohort to further investigate patterns of medical and musculoskeletal co-morbidities among African American and white TKR patients. Methods: Descriptive analyses were performed on a national database (FORCE-TJR) of 3,313 TKR patients from 107 orthopedic surgeons. Data collected include patient sociodemographics (age, gender, race, education, insurance, household income, smoking status), modified Charlson co-morbidity scores, and pre-operative and post-operative pain and function scores (SF-36 PCS and MCS, WOMAC, KOOS/HOOS ADL score). To assess the total musculoskeletal pain burden, WOMAC pain scores were recorded for non-operative weight bearing joints as well as Oswestry low back pain scores. Multivariate models are in progress. Results: Preliminary descriptive analyses demonstrate a higher medical co-morbidity burden in African American TKR patients as compared to whites (COPD, DM, smoking), as well as worse baseline pain (mean WOMAC pain score = 43.46 vs. 52.92, p Conclusion: Preliminary results demonstrate significant differences in medical and musculoskeletal co-morbidities that correlate with poorer pain and function scores in African American patients at the time of TKR

Location of All-cause 30-day Readmission Following Total Joint Replacement: Surgical Hospital Versus Outside Hospital

Background: Evaluating posthospital complications and hospital readmissions in the United States is limited under the current system. This is due to an inability to quantify posthospital care delivered to patients at locations other than the surgical hospital. In order to circumvent this issue, information can be sought directly from patients about posthospital health care utilization. This approach provides a more complete record in comparison with methods that evaluate complications treated only at the surgical hospital. Methods: Participants undergoing total joint replacement (TJR) between 5/10/11 and 5/17/11 were identified from the Function and Outcomes Research in Comparative Effectiveness Registry (FORCE-TJR) cohort. The cohort is a nationally representative sample of TJR patients undergoing total knee replacement and total hip replacement. Patients are asked to self-report complications on the six-month follow-up questionnaire. The questionnaire specifically inquires about any emergency department visit, outpatient surgery, or hospital admission that occurred within six months of the total joint replacement surgery. For each positive report of postoperative complication, the pertinent medical records are retrieved and reviewed and discharge diagnoses are used to identify whether the complication is a surgical site symptom or a medical complication. The location of the care is identified as the surgical hospital or an outside hospital. We report on the location of all readmissions within 30 days of discharge from the initial TJR surgery. Results: In total, our sample yielded 112 validated patient-reported readmissions following TJR. Of these readmissions, 75% were treated at the surgical hospital and 25% were treated at an outside hospital. Patients receiving care at the surgical hospital were similar in terms of demographics compared with those seeking care at an outside hospital in terms of mean age (66.7 years vs. 66.9 years, p=0.92), and gender (67.9% male vs. 63.1% male, p=0.65). Additionally, the mean number of days since discharge was similar (16.7 days vs. 15.1 days, p = 0.45) among patients treated at the surgical hospital compared with those treated at an outside hospital. Discharge diagnoses varied by the location of care. At the surgical hospital, discharge diagnoses identified surgical site symptoms as the cause of 36.9% of admissions and medical conditions as the cause of 63.1% of admissions. When compared with discharge diagnoses at outside hospitals, surgical site symptoms accounted for 17.9% of admissions and medical conditions for 82.1% (p=0.067). Conclusion: Public reporting of all post-TJR discharge complications is currently used to compare quality of care between hospitals. However, our study demonstrates that hospitals and surgeons may underestimate their complication rates by 25%. This suggests that novel approaches, such as direct to patient contact, are needed to minimize missing post-hospital event data

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women\u27s healthy eating.

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = 225) between the ages of 50-69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women\u27s healthy eating

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N ¼ 225) between the ages of 50e69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women

The VAPB-PTPIP51 endoplasmic reticulum-mitochondria tethering proteins are present in neuronal synapses and regulate synaptic activity

Signaling between the endoplasmic reticulum (ER) and mitochondria regulates a number of key neuronal functions. This signaling involves close physical contacts between the two organelles that are mediated by “tethering proteins” that function to recruit regions of ER to the mitochondrial surface. The ER protein, vesicle-associated membrane protein-associated protein B (VAPB) and the mitochondrial membrane protein, protein tyrosine phosphatase interacting protein-51 (PTPIP51), interact to form one such tether. Recently, damage to ER-mitochondria signaling involving disruption of the VAPB-PTPIP51 tethers has been linked to the pathogenic process in Parkinson’s disease, fronto-temporal dementia (FTD) and related amyotrophic lateral sclerosis (ALS). Loss of neuronal synaptic function is a key feature of Parkinson’s disease and FTD/ALS but the roles that ER-mitochondria signaling and the VAPB-PTPIP51 tethers play in synaptic function are not known. Here, we demonstrate that the VAPB-PTPIP51 tethers regulate synaptic activity. VAPB and PTPIP51 localise and form contacts at synapses, and stimulating neuronal activity increases ER-mitochondria contacts and the VAPB-PTPIP51 interaction. Moreover, siRNA loss of VAPB or PTPIP51 perturbs synaptic function and dendritic spine morphology. Our results reveal a new role for the VAPB-PTPIP51 tethers in neurons and suggest that damage to ER-mitochondria signaling contributes to synaptic dysfunction in Parkinson’s disease and FTD/ALS

Limitations in odour simulation may originate from differential sensory embodiment

Across diverse lineages, animals communicate using chemosignals, but only humans communicate about chemical signals. Many studies have observed that compared with other sensory modalities, communication about smells is relatively rare and not always reliable. Recent cross-cultural studies, on the other hand, suggest some communities are more olfactorily oriented than previously supposed. Nevertheless, across the globe a general trend emerges where olfactory communication is relatively hard. We suggest here that this is in part because olfactory representations are different in kind: they have a low degree of embodiment, and are not easily expressed as primitives, thereby limiting the mental manipulations that can be performed with them. New exploratory data from Dutch children (9-12 year-olds) and adults support that mental imagery from olfaction is weak in comparison with vision and audition, and critically this is not affected by language development. Specifically, while visual and auditory imagery becomes more vivid with age, olfactory imagery shows no such development. This is consistent with the idea that olfactory representations are different in kind from representations from the other senses. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'

Designing a physical activity parenting course : parental views on recruitment, content and delivery

Background Many children do not engage in sufficient levels of physical activity (PA) and spend too much time screen-viewing (SV). High levels of SV (e.g. watching TV, playing video games and surfing the internet) and low levels of PA have been associated with adverse health outcomes. Parenting courses may hold promise as an intervention medium to change children’s PA and SV. The current study was formative work conducted to design a new parenting programme to increase children’s PA and reduce their SV. Specifically, we focussed on interest in a course, desired content and delivery style, barriers and facilitators to participation and opinions on control group provision. Methods In-depth telephone interviews were conducted with thirty two parents (29 female) of 6–8 year olds. Data were analysed thematically. An anonymous online survey was also completed by 750 parents of 6–8 year old children and descriptive statistics calculated. Results Interview participants were interested in a parenting course because they wanted general parenting advice and ideas to help their children be physically active. Parents indicated that they would benefit from knowing how to quantify their child’s PA and SV levels. Parents wanted practical ideas of alternatives to SV. Most parents would be unable to attend unless childcare was provided. Schools were perceived to be a trusted source of information about parenting courses and the optimal recruitment location. In terms of delivery style, the majority of parents stated they would prefer a group-based approach that provided opportunities for peer learning and support with professional input. Survey participants reported the timing of classes and the provision of childcare were essential factors that would affect participation. In terms of designing an intervention, the most preferred control group option was the opportunity to attend the same course at a later date. Conclusions Parents are interested in PA/SV parenting courses but the provision of child care is essential for attendance. Recruitment is likely to be facilitated via trusted sources. Parents want practical advice on how to overcome barriers and suggest advice is provided in a mutually supportive group experience with expert input