Current Clinical Measures Research Articles

Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting.

BackgroundCellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory.ObjectiveThe objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs.MethodsA total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment.ResultsWe identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH.ConclusionsContinuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain.

Long-Range Temporal Correlations Reflect Treatment Response in the Electroencephalogram of Patients with Infantile Spasms.

Infantile spasms syndrome is an epileptic encephalopathy in which prompt diagnosis and treatment initiation are critical to therapeutic response. Diagnosis of the disease heavily depends on the identification of characteristic electroencephalographic (EEG) patterns, including hypsarrhythmia. However, visual assessment of the presence and characteristics of hypsarrhythmia is challenging because multiple variants of the pattern exist, leading to poor inter-rater reliability. We investigated whether a quantitative measurement of the control of neural synchrony in the EEGs of infantile spasms patients could be used to reliably distinguish the presence of hypsarrhythmia and indicate successful treatment outcomes. We used autocorrelation and Detrended Fluctuation Analysis (DFA) to measure the strength of long-range temporal correlations in 21 infantile spasms patients before and after treatment and 21 control subjects. The strength of long-range temporal correlations was significantly lower in patients with hypsarrhythmia than control patients, indicating decreased control of neural synchrony. There was no difference between patients without hypsarrhythmia and control patients. Further, the presence of hypsarrhythmia could be classified based on the DFA exponent and intercept with 92% accuracy using a support vector machine. Successful treatment was marked by a larger increase in the DFA exponent compared to those in which spasms persisted. These results suggest that the strength of long-range temporal correlations is a marker of pathological cortical activity that correlates with treatment response. Combined with current clinical measures, this quantitative tool has the potential to aid objective identification of hypsarrhythmia and assessment of treatment efficacy to inform clinical decision-making.

Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL. Twenty-five postlingually deafened adults with CIs were assessed. Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL. Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics. Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population. 4. Laryngoscope, 128:959-966, 2018.

Systematic assessment of clinical methods to diagnose and monitor diabetic retinal neuropathy

PurposeBackground and Purpose: Diabetic retinal neuropathy refers to retinal neural tissue damage occurring before diabetic retinopathy and fulfils many of the criteria for causality for the subsequent vasculopathy. Developing reliable means of measuring neuronal damage in diabetes may be important in efforts to prevent retinopathy. This study aimed to systematically assess current clinical measurements of diabetic retinal neuropathy.MethodsA systematic search of the medical literature since 1984 was performed on PUBMED and EMBASE and the evidence supporting each identified method as an indicator for clinically important diabetic retinal neuropathy was graded relatively as strong, medium or weak according to criteria assessing its relationship to subsequent diabetic retinopathy, quality of supporting studies and published reproducibility.ResultsThe systematic search yielded 6,421 results. Subsequent assessment by two independent investigators identified 601 multiple subject studies in humans assessing clinical aspects of retinal structure, function or psychophysics in the pre‐diabetic retina. Clinical methods assessed as being supported by relatively ‘strong’ evidence included FM‐100 hue colour vision changes, flash ERG b‐wave latency, flash multifocal b‐wave latency, scotopic flash ERG oscillatory potential amplitude and contrast sensitivity.ConclusionsConclusions/Discussions: The results showed moderately poor quality of extant evidence and indicate the best clinical methods for assessing diabetic retinal neuropathy remain to be confirmed. This is the first systematic assessment of the medical literature aiming to assess the breadth and validity of these methods and represents an early step in identifying and developing endpoints for use in trials designed to identify at risk patients or prevent diabetic retinopathy.

Regional variation exists in patient selection and treatment of abdominal aortic aneurysms

Significant regional variation in surgical rates has been identified following multiple surgical procedures. However, limited data have examined the regional variability in patient selection and treatment of abdominal aortic aneurysms (AAAs). This study aimed to evaluate regional variation in patient selection, perioperative management, and operative approach for the repair of AAAs. All patients undergoing open repair or endovascular aneurysm repair (EVAR) of an AAA in the Vascular Quality Initiative from 2009 to 2014 were identified. All regional groups were deidentified, and those with fewer than 100 open repairs were combined into a single region. We identified 17,269 elective repairs (EVAR, 13,759; open, 3510) and 1462 ruptured AAAs (EVAR, 749; open, 713). There was significant regional variation in the use of EVAR for elective repair (range, 66%-88%; P< .01) andruptured AAA repair (40%-80%; P< .01). The median diameter for elective repair was similar among regions (EVAR,5.4cm; open, 5.7cm). There was wide variation in the treatment of small aneurysms in male patients (<5.5cm) for EVAR (34%-49%; P< .01) and open repair (17%-38%; P< .01) and variation in the treatment of small aneurysms in female patients (<5cm) for EVAR (14%-32%; P< .01) but not significant for open repair (6%-24%). For elective cases, preoperative aspirin (EVAR, 50%-75% [P< .01]; open, 49%-78% [P< .01]) and statin use (EVAR, 61%-75% [P< .01]; open, 56%-80% [P< .01]) varied widely. Among elective cardiac patients, preoperative management varied significantly, including beta-blocker use (EVAR, 66%-78% [P< .01]; open, 69%-88% [P= .01]) and the frequency of stress tests (EVAR, 33%-64% [P< .01]; open, 31%-73% [P< .01]). Among open repairs for aneurysms extending at or beyond the juxtarenal segment, there was wide variation in the use of retroperitoneal exposures (7%-70%; P< .01) and adjunctive renal protective measures (cold renal perfusion, 2%-43% [P< .01]; mannitol, 47%-92% [P< .01]). Significant regional variation exists in patient selection, perioperative management, and operative approach for the repair of AAA. Definitive evidence is lacking in many aspects of operative care, including the use of the retroperitoneal approach and renal protective strategies. However, this variation emphasizes the importance of research to determine best practice in the areas of greatest variation. Furthermore, where current clinical process measures exist and data are clear, such as the use of statin and antiplatelet agents, the high degree of variation should serve as an impetus for regional quality improvement projects.

Can clinical foot and ankle assessments improve the prediction of patient reported outcomes in knee arthroplasty?

Knee arthroplasty (KA) has been considered to be a successful and cost-effective intervention for individuals with severe end stage Osteoarthritis (OA). A number of clinically important predictors of outcomes following KA have been established, however there are still other factors to be identified to improve our ability to recognise patients at risk of poor KA outcomes. Although the relationship between foot, ankle and knee kinematics has become widely accepted, it is not known whether foot and ankle status affect KA outcomes. This thesis therefore aims to determine whether clinical foot and ankle measures are useful in predicting patient reported outcomes following KA. A formal literature review was firstly undertaken to identify current methods of assessing musculoskeletal foot and ankle status. Findings of the review revealed an absence of a standardised assessment protocol and a lack of agreement and validity for many current clinical measures. In response to this an international expert consensus study was undertaken to produce an agreed set of objective clinical musculoskeletal foot and ankle assessment measures to form a new protocol. Two measures identified from the review, and agreed via expert consensus, as the most robust assessment methods- the Foot Posture Index (FPI) and ankle dorsiflexion, were introduced to a large prospective cohort of patients awaiting knee arthroplasty, in addition to foot pain questions. Results show that ankle dorsiflexion and foot posture were not associated with one year knee outcomes, however pre-operative foot pain was associated to outcome; the presence of foot pain increased the risk of a poor post-operative clinical outcome. Findings suggest that it would be beneficial to address foot pain prior to surgery to reduce the risks associated with a poor outcome. Further work would be beneficial to establish the sequential link between foot pain and knee OA in order to inform the most appropriate method of the conservative management.

Delineating ADHD and bipolar disorder: A comparison of clinical profiles in adult women

ObjectiveOverlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms. MethodsSixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment. ResultsADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted. ConclusionsUsing measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.

Ultrasound and Clinical Measures for Lymphedema.

Treatment for breast cancer has increased patient survivorship exponentially over the past few decades. With increased survivorship, more women are living with the longstanding effects of breast cancer treatment, such as lymphedema. Patients, health care providers, and payers depend on practical and efficient clinical measures to accurately diagnose and monitor disease progression or regression. However, current clinical measures do not include objective measures that assess lymphedetamous tissue accurately. This study compared current measures to a novel use of ultrasound (US) imaging to quantify tissue texture. Seventeen women diagnosed with lymphedema completed self-report questionnaires and then were tested twice by two lymphedema physical therapists who measured edema, fibrosis, and limb volume differences. One therapist measured subjects' limbs using US imaging and derived measures of entropy and average pixel intensity. Volume measures were consistent between therapists (p < 0.01) but palpation was not (0.01 < p < 0.72). Therapists' measures correlated better to subjects' self-report of edema (0.01 < p > 0.32) as compared to fibrosis (0.23 < p > 0.90). US measures were reliable (Cronbachs's α = 0.7 and 0.91 for entropy and API, respectively). Entropy measures demonstrated significant differences between subjects' involved versus uninvolved forearms (p = 0.03). Therapists were not consistent with each other when rating edema or fibrosis; however, they were consistent when measuring limb volume differences. US measures (entropy) demonstrated a significant difference between involved and uninvolved. US imaging, as a tool to quantify subcutaneous tissues, holds promise to be a safe, mobile, and effective method to measure lymphedema tissue texture.

Does quality of life depend on speech recognition performance for adult cochlear implant users?

Current postoperative clinical outcome measures for adults receiving cochlear implants (CIs) consist of testing speech recognition, primarily under quiet conditions. However, it is strongly suspected that results on these measures may not adequately reflect patients' quality of life (QOL) using their implants. This study aimed to evaluate whether QOL for CI users depends on speech recognition performance. Twenty-three postlingually deafened adults with CIs were assessed. Participants were tested for speech recognition (Central Institute for the Deaf word and AzBio sentence recognition in quiet) and completed three QOL measures-the Nijmegen Cochlear Implant Questionnaire; either the Hearing Handicap Inventory for Adults or the Hearing Handicap Inventory for the Elderly; and the Speech, Spatial and Qualities of Hearing Scale questionnaires-to assess a variety of QOL factors. Correlations were sought between speech recognition and QOL scores. Demographics, audiologic history, language, and cognitive skills were also examined as potential predictors of QOL. Only a few QOL scores significantly correlated with postoperative sentence or word recognition in quiet, and correlations were primarily isolated to speech-related subscales on QOL measures. Poorer pre- and postoperative unaided hearing predicted better QOL. Socioeconomic status, duration of deafness, age at implantation, duration of CI use, reading ability, vocabulary size, and cognitive status did not consistently predict QOL scores. For adult, postlingually deafened CI users, clinical speech recognition measures in quiet do not correlate broadly with QOL. Results suggest the need for additional outcome measures of the benefits and limitations of cochlear implantation. 4. Laryngoscope, 126:699-706, 2016.

Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?

ObjectiveTo determine the extent of alignment between clinical outcome measures and patient-derived goals for the management of chronic low back pain (cLBP). MethodsA customised, patient-led goal setting intervention was implemented facilitated by a physiotherapist, in which participants identified problem areas and developed strategies to address them. Patient goals were compared to the most commonly used outcome measures in cLBP as well as research outcomes recommended by the IMMPACT consortium. ResultsFrom 20 participants, a total of 27 unique goals were identified, the most common goal related to physical activity (49%). Comparison of participant goals to the most common measures used by physiotherapists found none of the goals could be aligned. Comparison of goals and domains with IMPACCT outcome domains found 76% of the goals were aligned with physical functioning and 16% with emotional functioning. ConclusionThis study has identified goals important to patients in cLBP, these were varied, and most did not correspond with current clinical measures. Practice implicationsClinical outcome measures may not be providing accurate information about the success of treatments that are meaningful to the patient. Clinicians should consider a collaborative approach with cLBP patients to determine treatment interventions that are driven by patient preference.

Measuring Spasticity and Fine Motor Control (Pinch) Change in the Hand After Botulinum Toxin-A Injection Using Dynamic Computerized Hand Dynamometry

ObjectivesTo evaluate change in fine motor hand performance and to investigate the relationship between existing clinical measures and dynamic computerized dynamometry (DCD) after botulinum toxin-A (BTX-A) injections for adults with upper limb spasticity. DesignPretest/posttest clinical intervention study. SettingHospital outpatient spasticity clinics. ParticipantsA convenience sample of adults (N=28; mean age, 51y) with upper limb spasticity after acquired brain injury. InterventionsBTX-A injections for upper limb spasticity management. Main Outcome MeasuresDCD protocol using a piezoelectric pinch meter (termed DCD[pinch]); current clinical upper limb measures: Modified Ashworth Scale, Tardieu Scale, Action Research Arm Test, Michigan Hand Outcomes Questionnaire, and Goal Attainment Scale. ResultsBTX-A produced a significant change on DCD(pinch) and some current clinical measures, with correlations observed between DCD(pinch) and current clinical measures. ConclusionsDCD(pinch) sensitively and objectively assessed the effects of BTX-A on upper limb spasticity during a simulated functionally based pinch and release task.

Atypical cortical language organization in epilepsy patients: evidence for divergent hemispheric dominance for receptive and expressive language function.

The central goal of presurgical language mapping is to identify brain regions that subserve cortical language function to minimize postsurgical language deficits. Presurgical language mapping in patients with epilepsy presents a key challenge because of the atypical pattern of hemispheric language dominance found in this population, with higher incidences of bilateral and right-biased language dominance than typical. In this prospective study, we combine magnetoencephalography with a panel of tasks designed to separately assess receptive and expressive function to provide a sensitive measure of language function in 15 candidates for resective surgery. We report the following: 4 of 15 patients (27%) showed left hemisphere dominance across all tasks, 4 of 15 patients (27%) showed right hemisphere dominance across all tasks, and 7 of 15 (46%) showed discordant language dominance, with right-dominant receptive and left-dominant expressive language. All patients with discordant language dominance showed this right-receptive and left-expressive pattern. Results provide further evidence supporting the importance of using a panel of tasks to assess separable aspects of language function. The clinical relevance of the findings is discussed, especially about current clinical operative measures for assessing language dominance, which use single hemisphere procedure (intracarotid amobarbital procedure and awake intraoperative stimulation) for determining language laterality.

Dynamic computerised hand dynamometry: Measuring outcomes following upper limb botulinum toxin-A injections in adults with acquired brain injury

Evaluate upper limb performance in adults receiving botulinum toxin-A injections for upper limb spasticity using Dynamic Computerised Hand Dynamometry and current clinical measures. Pre-test/post-test clinical intervention study. Twenty-eight participants with spasticity following acquired brain injury. Botulinum toxin-A effects were measured 4 weeks post-injection using Dynamic Computerised Dynamometry. Current clinical upper limb performance measures spanning the International Classification of Functioning, Disability and Health domains were also conducted at the Body Function and Structure (Modified Ashworth Scale; Tardieu Scale) and Activity (Action Research Arm Test; Goal Attainment Scaling; patient disability and carer burden scales) domains. Dynamic Computerised Dynamometry hand performance measures were correlated with performance on current clinical measures. Significant post botulinum toxin-A changes were identified on current clinical measures and the Dynamic Computerised Dynamometry. Dynamic Computerised Dynamometry results correlated with current clinical measures demonstrating functional upper limb change across the Body Function and Structure and Activity domains. Dynamic Computerised Dynamometry sensitively assesses the effects of botulinum toxin-A on upper limb spasticity during a simple, functionally based, grasp and release task. Unlike current measures, the Dynamic Computerised Dynamometry provides information across the Body Function and Structure and Activity domains of the International Classification of Function.

Objective Quantification of Wrist and Finger Spasticity: An Alternative to Current Clinical Measurements: A Commentary

Contractures and spasticity are two commonly occurring phenomena following neurological lesions. These require different medical management but are often difficult to separate using the current clinical methods. This commentary outlines a newly available device (the Neuroflexor™) used to quantify the elastic, viscous and reflex components of wrist/finger stiffness. The device and algorithm used to quantify stiffness is described. In addition, positive and negative aspects of the device and considerations for use are provided.

Robotic Identification of Kinesthetic Deficits After Stroke

Kinesthesia, the sense of body motion, is essential to proper control and execution of movement. Despite its importance for activities of daily living, no current clinical measures can objectively measure kinesthetic deficits. The goal of this study was to use robotic technology to quantify prevalence and severity of kinesthetic deficits of the upper limb poststroke. Seventy-four neurologically intact subjects and 113 subjects with stroke (62 left-affected, 51 right-affected) performed a robot-based kinesthetic matching task with vision occluded. The robot moved the most affected arm at a preset speed, direction, and magnitude. Subjects were instructed to mirror-match the movement with their opposite arm (active arm). A large number of subjects with stroke were significantly impaired on measures of kinesthesia. We observed impairments in ability to match movement direction (69% and 49% impaired for left- and right-affected subjects, respectively) and movement magnitude (42% and 31%). We observed impairments to match movement speed (32% and 27%) and increased response latencies (48% and 20%). Movement direction errors and response latencies were related to clinical measures of function, motor recovery, and dexterity. Using a robotic approach, we found that 61% of acute stroke survivors (n=69) had kinesthetic deficits. Additionally, these deficits were highly related to existing clinical measures, suggesting the importance of kinesthesia in day-to-day function. Our methods allow for more sensitive, accurate, and objective identification of kinesthetic deficits after stroke. With this information, we can better inform clinical treatment strategies to improve poststroke rehabilitative care and outcomes.

OP0231-HPR Predictors of no Improvement in Subjective Health Perception in Newly Diagnosed RA Patients with a Good DAS28 Response at 12 Months in the Dream Tight Control Cohort

BackgroundModern treatment strategies are highly successful in reducing disease activity in rheumatoid arthritis (RA). However, changes in clinical measures of disease activity may not always correspond with a patient’s own...

Correction of Ocular Shape in Retinal Optical Coherence Tomography and Effect on Current Clinical Measures

To address the misrepresentation of the eye in retinal optical coherence tomography (OCT) images and to examine the effect of this misrepresentation on retinal thickness measurements. Prospective case series. Five subjects with recent orbital magnetic resonance imaging (MRI) scans and normal eye examinations were consented from the clinics of the Duke Eye Center. Each subject had both eyes imaged using a retinal spectral-domain OCT system and ocular biometry measured. Two types of individualized optical models of the subject eyes-numerical and analytical-were used to determine the spatial paths of the OCT A-scans. These paths were used to reorient the A-scans in the associated retinal OCT images and generate corrected images. Using curvature as a general measure of shape, the radii of curvature of the retinal pigment epithelium in the original and corrected OCT images were compared to the ocular radii of curvature in the MRI images. Differences between the retinal thickness maps derived from the original and corrected OCT images were then determined. The retinal curvatures were substantially flatter in the original OCT than in the MRI images (mean paired difference: 52.8 ± 41.8 mm, P < .001). Correcting the OCT images decreased the paired differences between OCT and MRI (numerical: 1.6 ± 2.3 mm, P = .091; analytical: 1.9 ± 4.3 mm, P = .278). Retinal thickness measurements between the corrected and uncorrected images differed, with a root mean square difference of 5.61 μm over the entire 6-mm extent of the image; this difference was greater peripherally (6.02 μm) than centrally (2.54 μm). Optically based algorithms can be used to correct the shape of the retina as represented in OCT; this correction makes OCT more consistent with other clinical imaging techniques. Resultant retinal thickness maps were minimally affected by the change in shape. Ocular shape correction should be considered in future development of posterior segment OCT-based morphologic measurements.

Metabolomics as a tool for personalizing medicine: 2012 update.

Numerous factors in conjunction with an individual's genetic make up will determine predisposition to disease, adverse or beneficial effects of drug treatment or therapy, and disease progression. A major limitation of current clinical measures is that the disease phenotype, which is comprised of the genotype and other environmental factors, is underestimated. Rather, each disease is treated similarly even though the disease process is highly complex. Methods that evaluate the interaction of genotype and environmental factors would likely be a better indicator of patients' response to medical treatments. The omics technologies, specifically metabolomics, will play a major role in the movement towards personalized medicine. Metabolomics is phenotype driven and should provide better clinical biomarkers. Furthermore, recent studies have shown that associations between genetic variants and downstream metabolite changes can provide a unique description of an individual's genotype and phenotype, which will further enhance the movement towards personalized medicine.

Does the Modified Harris Hip Score Reflect Patient Satisfaction After Hip Arthroscopy?

Background: No published studies have explored the relationship between commonly reported clinical outcomes and patient satisfaction after hip arthroscopy. Purpose: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period. Study Design: Case series; Level of evidence, 4. Methods: We reviewed our institutional database for prospectively collected mHHS and patient satisfaction data from 697 patients. Patients were evaluated preoperatively and at 1 and 2 years after surgery. Results: The mHHS correlated with patient satisfaction at 1 year (P < .001, Pearson R = 0.451) and at 2 years (P < .001, Pearson R = .454). Considering scores from excellent to good as positive results and from fair to poor as negative results, sensitivity was 73% at 1 year and 77% at 2 years. Respectively, the specificity was 64% and 73%, positive predictive value 86% and 91%, negative predictive value 45% and 46%, and accuracy 71% and 76%. At 1- and 2-year follow-up, a respective 55% and 54% of patients with fair to poor mHHS were satisfied with the outcome of hip arthroscopy. In contrast, for those patients with an excellent to good mHHS at 1 and 2 years after surgery, 14% and 9%, respectively, were dissatisfied with their outcome. Conclusion: Our results show a correlation between patient satisfaction and the mHHS but also demonstrate a limitation of the mHHS as an outcome measure in the prediction of patient satisfaction. Further investigation is required to assess factors beyond current standard orthopaedic clinical outcome measures that may influence patient satisfaction after hip arthroscopy.

Trends in Prevalence, Awareness, Management, and Control of Hypertension Among United States Adults, 1999 to 2010

The purpose of this study was to quantify the trends in blood pressure (BP), and the prevalence, awareness, management, and control of hypertension in U.S. adults (≥20 years of age) from 1999 to 2010, and to assess the efficacy of current clinical measures in diagnosing and adequately treating hypertensive patients. Hypertension is a major independent risk factor for cardiovascular disease and stroke. Recent data indicate a decreasing trend in hypertension prevalence, along with improvements in hypertension awareness, management, and control. The study used regression models to assess the trends in hypertension prevalence, awareness, management, and control from 1999 to 2010 among 28,995 male and female adults with BP measurements from a nationally representative sample of the noninstitutionalized U.S. population (National Health and Nutrition Examination Survey [NHANES] 1999 to 2010), with special attention given to 5,764 participants in NHANES 2009 to 2010. In 2009 to 2010, the prevalence of hypertension was 30.5% among men and 28.5% among women. The hypertension awareness rate was 69.7% (95% confidence interval [CI]: 62.0% to 77.4%) among men and 80.7% (95% CI: 74.5% to 86.8%) among women. The hypertension control rate was 40.3% (95% CI: 33.7% to 46.9%) for men and 56.3% (95% CI: 49.2% to 63.3%) for women. From 1999 to 2010, the prevalence of hypertension remained stable. Although hypertension awareness, management, and control improved, the overall rates remained poor (74.0% for awareness, 71.6% for management, 46.5% for control, and 64.4% for control in management); worse still, no improvement was shown from 2007 to 2010. From 1999 to 2010, prevalence of hypertension remained stable. Hypertension awareness, management, and control were improved, but remained poor; nevertheless, there has been no improvement since 2007.