Global Physical Health Research Articles

Religiosity and Physical Health of Middle-Old Aged African Americans: The Linking Role of Self-Control.

Objective: This study examined a psychological process (i.e., sense of control) that links religiosity to self-reported physical health in older African Americans. Methods: Two waves of data from 231 middle-old aged African Americans (AAs) were used to test two specific hypotheses: (a) religiosity influences changes in sense of control middle-old aged AAs, and (b) sense of control influences changes in global physical health in middle-old aged AAs. The analysis used two modeling approaches: (a) an autoregressive cross-lagged modeland (b) a parallel growth/change model. Results: The results of both types of models showed that religiosity positively influenced changes in sense of control and that sense of control positively influenced changes in physical health in middle-old aged AAs over time. Discussion: These findings provide evidence that sense of control links religiosity to physical health in older African Americans. The theoretical and practical implications of the findings are discussed.

PASC in Solid Organ Transplant Recipients With Self-reported SARS-CoV-2 Infection.

Postacute sequelae of SARS-CoV-2 infection (PASC) is an increasingly recognized phenomenon and manifested by long-lasting cognitive, mental, and physical symptoms beyond the acute infection period. We aimed to estimate the frequency of PASC symptoms in solid organ transplant (SOT) recipients and compared their frequency between those with SARS-CoV-2 infection requiring hospitalization and those who did not require hospitalization. A survey consisting of 7 standardized questionnaires was administered to 111 SOT recipients with history of SARS-CoV-2 infection diagnosed >4 wk before survey administration. Median (interquartile range) time from SARS-CoV-2 diagnosis was 167 d (138-221). Hospitalization for SARS-CoV-2 infection was reported in 33 (30%) participants. Symptoms after the COVID episode were perceived as following: significant trauma (53%), cognitive decline (50%), fatigue (41%), depression (36%), breathing problems (35%), anxiety (23%), dysgeusia (22%), dysosmia (21%), and pain (19%). Hospitalized patients had poorer median scores in cognition (Quick Dementia Rating System survey score: 2.0 versus 0.5, P = 0.02), quality of life (Health-related Quality of Life survey: 2.0 versus 1.0, P = 0.015), physical health (Global physical health scale: 10.0 versus 11.0, P = 0.005), respiratory status (Breathlessness, Cough and Sputum Scale: 1.0 versus 0.0, P = 0.035), and pain (Pain score: 3 versus 0 out of 10, P = 0.003). Among patients with infection >6 mo prior, some symptoms were still present as following: abnormal breathing (42%), cough (40%), dysosmia (29%), and dysgeusia (34%). SOT recipients reported a high frequency of PASC symptoms. Multidisciplinary approach is needed to care for these patients beyond the acute phase.

Concurrent Validity Between Potential Screening Tests for Early Mobility Decline in Independent Community Dwellers.

Standardized screening tests that detect early mobility decline, regardless of etiology, are needed for healthy aging. The locomotive syndrome (LS) tests are designed to identify stages of mobility decline and inform appropriate levels of intervention. The long-term goal of this research is to develop standardized mobility screening tests that can be used across health care settings and throughout a patient's lifespan to guide appropriate medical care. As the first step in this process, this study examines the concurrent validity between the reference and the LS tests. This cross-sectional study examined correlations between the LS functional tests and a set of reference tests and the ability to differentiate the 3 stages of mobility decline. The reference tests included the stair-climbing test, the 30-second chair rise test, the 6-minute walk test, the Global Physical Health (GPH) portion of the PROMIS, and the Lower Extremity Functional Scale (LEFS). The LS tests included the Stand-Up Test, the 2-Step Test, and the 25-question Geriatric Locomotive Function Scale (25-GLFS). A total of 115 community dwellers of 61.2 years old on average (±10.0 years), with n = 71 (61%) older than 60 years, voluntary participated in this prospective study. Nonparametric analyses of variance and correlations were used to examine the concurrent validity. Performance-based tests were significantly correlated (| r | = 0.38-0.61, P < .001) with LS tests. The LEFS was correlated with all LS tests, but the GPH was only correlated with the 25-GLFS. Also, significant differences were found in reference test scores between the 3 LS stages ( P < .05). The LS tests and reference tests demonstrated significant correlations, and participants performed significantly worse on reference tests as LS severity increased. Given these results, it is possible that the LS standardized tests may play an important role in mobility screening. Future research should investigate feasibility, sensitivity, and specificity of these tests.

Should patients with lumbar stenosis and grade I spondylolisthesis be treated differently based on spinopelvic alignment? A retrospective, two-year, propensity matched, comparison of patient-reported outcome measures and clinical outcomes from multiple sites within a single health system

BACKGROUNDDegenerative lumbar spondylolisthesis is one of the most common pathologies addressed by surgeons. Recently, data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. However, given not all degenerative spondylolistheses are clinically comparable, the best treatment option may depend on multiple parameters. Specifically, the impact of spinopelvic alignment on patient reported and clinical outcomes following fusion versus decompression for grade I spondylolisthesis has yet to be explored. PURPOSEThis study assessed two-year clinical outcomes and one-year patient reported outcomes following laminectomy with concomitant fusion versus laminectomy alone for management of grade I degenerative spondylolisthesis and stenosis. The present study is the first to examine the effect of spinopelvic alignment on patient-reported and clinical outcomes following decompression alone versus decompression with fusion. STUDY DESIGN/SETTINGRetrospective sub-group analysis of observational, prospectively collected cohort study. PATIENT SAMPLE679 patients treated with laminectomy with fusion or laminectomy alone for grade I degenerative spondylolisthesis and comorbid spinal stenosis performed by orthopaedic and neurosurgeons at three medical centers affiliated with a single, tertiary care center. OUTCOME MEASURESThe primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and post-operatively at 4-6 and 10-12 months postoperatively. Secondary outcomes included operative parameters (estimated blood loss and operative time), and two-year clinical outcomes including reoperations, duration of postoperative physical therapy, and discharge disposition. METHODSRadiographs/MRIs assessed stenosis, spondylolisthesis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt; from this data, two cohorts were created based on pelvic incidence minus lumbar lordosis (PILL), denoted as “high” and “low” mismatch. Patients underwent either decompression or decompression with fusion; propensity score matching (PSM) and coarsened exact matching (CEM) were used to create matched cohorts of “cases” (fusion) and “controls” (decompression). Binary comparisons used McNemar test; continuous outcomes used Wilcoxon rank-sum test. Between-group comparisons of changes in PROMIS GPH and GMH scores were analyzed using mixed-effects models; analyses were conducted separately for patients with high and low pelvic incidence-lumbar lordosis (PILL) mismatch. RESULTS49.9% of patients (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. In the high PLL mismatch cohort at 10-12 months postoperatively, fusion-treated patients reported improved PROs, including GMH (26.61 vs. 20.75, p<0.0001) and GPH (23.61 vs. 18.13, p<0.0001). They also required fewer months of outpatient physical therapy (1.61 vs. 3.65, p<0.0001) and had lower 2-year reoperation rates (12.63% vs. 17.89%, p=0.0442) compared to decompression-only patients. In contrast, in the low PLL mismatch cohort, fusion-treated patients demonstrated worse endpoint PROs (GMH: 18.67 vs. 21.52, p<0.0001; GPH: 16.08 vs. 20.74, p<0.0001). They were also more likely to require skilled nursing/rehabilitation centers (6.86% vs. 0.98%, p=0.0412) and extended outpatient physical therapy (2.47 vs. 1.34 months, p<0.0001) and had higher 2-year reoperation rates (25.49% vs. 14.71%,p=0.0152). CONCLUSIONSLumbar laminectomy with fusion was superior to laminectomy in health–related quality of life and reoperation rate at two years postoperatively only for patients with sagittal malalignment, represented by high PILL mismatch. In contrast, the addition of fusion for patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony (low PILL mismatch) resulted in worse quality of life outcomes and reoperation rates.

Preoperative Patient-Reported Data Indicate the Risk of Prolonged Opioid Use After Hand and Upper Extremity Surgeries

Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. We included 2,114 patients. In our final model on the 2018-2019 electronic health records and PRD data (n= 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. Prognostic II.

Patients With Advanced Cancer and Minor Children: An Exploratory Study of Health-Related Quality of Life and Satisfaction With Care.

Patients with advanced cancer and minor children experience high rates of depression and anxiety. However, associations between parental status and other aspects of the patient experience are not well understood. This study compared patient-reported outcomes of patients with and without minor children. This was a retrospective analysis of 448 adults with stage III or IV solid tumors from a public research registry. Multiple linear regression models or modified Poisson regression models were fitted to evaluate differences in health-related quality of life, global health, and patient satisfaction scores between patients living with and without minors. One in five patients lived with minor children. They reported significantly worse health-related quality of life, global physical health, and global mental health. They also expressed lower satisfaction with time spent with their provider, communication, and financial aspects. Patients with minor children may benefit from earlier identification and support for their psychosocial needs and concerns.

213. Patient reported outcomes comparing lumbar laminectomy and fusion versus laminectomy alone in patients with radiographic spinopelvic malalignment in the setting of concomitant lumbar stenosis and spondylolisthesis: a nonrandomized, prospective cohort study

<h3>BACKGROUND CONTEXT</h3> The importance of spinopelvic harmony (pelvic incidence [PI] = lumbar lordosis [LL] ±10°) is well established. PI-LL discordance correlates with increased degenerative lumbar spondylolisthesis. Recent evidence favors concomitant fusion and decompression for management of lumbar spondylolisthesis. <h3>PURPOSE</h3> This study assessed whether the addition of fusion to decompression is superior to decompression alone by examining clinical outcomes and patient-reported outcomes (PROs) in patients with pelvic incidence-lumbar lordosis (PILL) mismatch, single-level, degenerative Grade 1 spondylolisthesis and canal stenosis. <h3>STUDY DESIGN/SETTING</h3> Observational prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 352 patients with spinopelvic mismatch, spinal canal stenosis and single-level, degenerative Grade 1 spondylolisthesis undergoing laminectomy alone or laminectomy with fusion at a tertiary care center. <h3>OUTCOME MEASURES</h3> Postoperative Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH) and Global Mental Health (GMH) scores were primary outcomes. Secondary outcomes included operative complications, PROs at 6 and 12 months postoperatively, and reoperation. <h3>METHODS</h3> Patients underwent decompression by laminectomy alone or laminectomy and fusion. Radiographs/MRIs assessed stenosis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt. Propensity score matching (PSM) and coarsened exact matching (CEM) created matched cohorts of "cases" (fusion) and "controls" (decompression). Binary comparisons used McNemar test, continuous outcomes used Wilcoxon rank-sum test. <h3>RESULTS</h3> A total of 190 (54.0%) of 352 patients with high PILL mismatch were treated with decompression and fusion. Those undergoing fusion experienced greater operative blood loss (308.9 vs 203.2 mL, p=0.0005), operative time (233 vs 149 min, p=0.0006) and length of stay (4.75 vs 2.83 months, p < 0.0001) and fewer months of outpatient physical therapy (1.61 vs 3.65 months, p < 0.0001) compared to decompression-only patients. Additionally, postoperative PILL mismatch at 3 months was lower in the fusion group due to increased lumbar lordosis (48.78 vs 39.8°, p < 0.0001). Postoperative PROs demonstrated significant differences with improved GMH and GPH at 5-7 months (GMH:17.61 vs 14.48, p < 0.0001; GPH: 16.24 vs 14.21, p=0.007) and 10-12 months postoperative (GMH: 26.61 vs 20.75, p < 0.0001; GPH: 23.61 vs 18.13, p < 0.0001) and a decreased 2-year readmission rate (12.63% vs 17.89%, p=0.0442). <h3>CONCLUSIONS</h3> Patients with spinopelvic mismatch were more likely to benefit from fusion and decompression for treatment of single-level, Grade 1 spondylolisthesis with comorbid spinal canal stenosis. Improvement is associated with significantly increased lumbar lordosis from preoperative measures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

208. Should patients with lumbar stenosis and Grade I spondylolisthesis be treated differently based on spinopelvic alignment? A comparison of clinical and patient reported outcomes within a single health system

<h3>BACKGROUND CONTEXT</h3> Degenerative spondylolisthesis of the lumbar spine is one of the most common pathologies addressed by surgeons. Recently, high-level data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. <h3>PURPOSE</h3> The present study is the first analysis to examine the effect of spinopelvic alignment on patient-reported outcomes following decompression alone versus decompression with fusion. <h3>STUDY DESIGN/SETTING</h3> Subgroup analysis of observational prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 679 patients with degenerative Grade I spondylolisthesis and stenosis treated with laminectomy alone or laminectomy with fusion at a tertiary care insitution. <h3>OUTCOME MEASURES</h3> Primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and postoperatively at 6 and 12 months. <h3>METHODS</h3> Patients underwent laminectomy alone or laminectomy with instrumented fusion for degenerative Grade I lumbar spondylolisthesis and stenosis. Four cohorts were created based on pelvic incidence minus lumbar lordosis (PILL): (1) fusion with PILL>10°, (2) fusion with PILL10°, and (4) decompression alone with PILL <10°. The between-group comparisons of PROMIS GPH/GMH score changes were analyzed using mixed-effects models. Analyses were conducted independently for the following: (1) unmatched cohort, (2) 1:1 propensity score matched patients (PSM), (3) coarsened exact matched (CEM) patients. <h3>RESULTS</h3> A total of 49.9% (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. When comparing low spinopelvic mismatch (PILL 10) patients, fusion-treated patients had improved postoperative PROs (GMH: 26.61 vs 20.75, p < 0.0001; GPH: 23.61 vs 18.13, p < 0.0001) at 10-12 months. Mixed effect modeling confirmed GPH score improvement was 5.11 (2.08 - 8.13) points higher at 10-12 months in the fusion group. <h3>CONCLUSIONS</h3> Among Grade I spondylolisthesis patients with PILL>10°, laminectomy with fusion was associated with greater improvement in physical health-related quality of life than laminectomy alone. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Clinical Outcomes of Revision Surgery Using a Dorsal Approach After Failed Primary Interdigital Neuroma Excision.

Revision neurectomy may be approached with either a dorsal or a plantar incision. Although a plantar approach is more commonly described, few studies have investigated outcomes following a dorsal revision neuroma excision. In this study, we performed a case series on a group of patients who underwent revision neuroma excision through a dorsal approach and reported complications and outcomes using validated patient-reported outcome measures (PROMs). This retrospective case series included 10 patients who underwent a dorsal-approach revision neuroma excision and had preoperative and minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Complications including neuroma recurrence and continued unresolved pain were obtained from the electronic medical record. Preoperative and postoperative PROMIS scores were compared to assess improvement in PROMs. There were significant improvements in the PROMIS pain interference (P = .026), pain intensity (P = .008), and global physical health (P = .017) domains. One patient experienced recurrence of their neuroma 4 years after surgery. This case series provides preliminary data indicating that revision neurectomy using a dorsal approach leads to satisfactory outcomes in pain-related PROMs. Further research with comparative study designs is necessary to determine if one approach is superior to the other. Level IV: Retrospective.

Long-term functional, psychological, emotional, and social outcomes in pediatric victims of violence

BackgroundTo evaluate the long-term functional, psychological, and emotional outcomes in individuals who survived violence-related injuries as children. MethodsWe retrospectively identified all pediatric patients (age <18y at time of injury) treated for a violent traumatic injury (gun-shot wound, stab, or assault) at our institution (1/2011–12/2020). We then prospectively attempted to contact and survey, via telephone, all patients that had reached adulthood (age ≥18y at time of study) using 7 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Primary Care Post Traumatic Stress Disorder (PTSD) screen. ResultsOf the 270 patients identified, we attempted to contact 218, successfully contacted 68, and 24 participated in the study. Of participants, 15 (62.5%) sustained gunshot wounds, 8 (33.3%) were stabbed, and 1 (4.2%) was assaulted with a median time from injury of 6.7(3.4) years. Based on PROMIS metrics, Global Physical Health (55.0 vs. 50.0, p = 0.013) and Emotional Support (55.4 vs. 50.0, p = 0.004) were better in participants compared to reference populations. However, a disproportionate number of participants reported substance use in the past 30 days (45.8 vs 13.0%; p < 0.001), 41.7% screened positive for PTSD, and 62.5% requested resources and/or referral for medical care. ConclusionsMany individuals who survive violent injuries as children continued to experience negative physical and mental outcomes extending into adulthood that required ongoing medical and psychological support. Further resources are needed to better understand the long-term effects of violent injury and to care for the complex needs of this population.

Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses.

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September–November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19–81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10508-022-02353-0.

Improving health-related quality of life in women with breast, blood, and gynaecological Cancer with an eHealth-enabled 12-week lifestyle intervention: the women’s wellness after Cancer program randomised controlled trial

BackgroundThe residual effects of cancer and its treatment can profoundly affect women’s quality of life. This paper presents results from a multisite randomized controlled trial that evaluated the clinical benefits of an e-health enabled health promotion intervention (the Women’s Wellness after Cancer Program or WWACP) on the health-related quality of life of women recovering from cancer treatment.MethodsOverall, 351 women previously treated for breast, blood or gynaecological cancers were randomly allocated to the intervention (WWACP) or usual care arms. The WWACP comprised a structured 12-week program that included online coaching and an interactive iBook that targeted physical activity, healthy diet, stress and menopause management, sexual wellbeing, smoking cessation, alcohol intake and sleep hygiene. Data were collected via a self-completed electronic survey at baseline (t0), 12 weeks (post-intervention, t1) and 24 weeks (to assess sustained behaviour change, t2). The primary outcome, health-related quality of life (HRQoL), was measured using the Short Form Health Survey (SF-36).ResultsFollowing the 12-week lifestyle program, intervention group participants reported statistically significant improvements in general health, bodily pain, vitality, and global physical and mental health scores. Improvements were also noted in the control group across several HRQoL domains, though the magnitude of change was less.ConclusionsThe WWACP was associated with improved HRQoL in women previously treated for blood, breast, and gynaecological cancers. Given how the synergy of different lifestyle factors influence health behaviour, interventions accounting for the reciprocity of multiple health behaviours like the WWACP, have real potential for immediate and sustainable change.Trial registrationThe protocol for this randomised controlled trial was submitted to the Australian and New Zealand Clinical Trials Registry on 15/07/2014 and approved on 28/07/2014 (ACTRN12614000800628).

Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes.

This study investigates the effect of gender-affirming facial feminization surgery (FFS) on psychosocial outcomes in patients with gender dysphoria. Comprehensive analyses of psychosocial outcomes after gender-affirming FFS are absent in the literature resulting in a paucity of information on the impact of FFS on quality of life as well as ramifications in health insurance coverage of FFS. Scores from 11 validated, quantitative instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) assessing anxiety, anger, depression, global mental health, global physical health, satisfaction with sex life, positive affect, emotional support, social isolation, companionship, and meaning and purpose. Patients within the preoperative group (pre-FFS) were evaluated >30 days before surgery and patients within the postoperative group (post-FFS) were evaluated ≥10 weeks after surgery. A total of 169 patients [mean (SD) age, 33.5 (10.8) years] were included. Compared with the pre-FFS group (n=107), the post-FFS group (n=62) reported improved scores anxiety (56.8±8.8 vs 60.1±7.9, P =0.01), anger (47.4±7.6 vs 51.2±9.6, P =0.01), depression (52.2±9.2 vs 57.0±8.9, P =0.001), positive affect (46.6±8.9 vs 42.9±8.7, P =0.01), meaning and purpose (49.9±10.7 vs 46.2±10.5, P =0.03), global mental health (46.7±7.6 vs 43.1±9.2, P =0.01), and social isolation (52.2±7.5 vs 55.4±7.4, P =0.01). Multivariable analysis to account for the effects of other gender-affirming surgeries, hormone therapy duration, preexisting mental health diagnoses, socioeconomic disparities, and patient-reported quality of social relationships on psychosocial functioning demonstrated that completion of FFS was independently predictive of improved scores. Gender-affirming FFS improves the quality of life by multiple psychosocial domains in transfeminine patients.

Effect of Prior Cheilectomy on Outcomes of First Metatarsophalangeal Joint Fusion for Treatment of Hallux Rigidus.

Background:Patients with hallux rigidus who do not experience significant pain relief after cheilectomy often require a conversion to metatarsophalangeal (MTP) fusion. However, it is unclear whether the previous cheilectomy affects outcomes of the subsequent fusion. The aim of this study was to compare patient-reported outcomes and complications in patients undergoing MTP fusion for hallux rigidus between patients with a history of cheilectomy and those undergoing a fusion as a primary procedure.Methods:This retrospective cohort study included patients who underwent MTP fusion who had preoperative and minimum 1-year postoperative Patient Reported Outcomes Measurement Information System (PROMIS) scores. Patients were divided into a “primary MTP fusion” cohort and a “prior cheilectomy” cohort based on their history of a previous cheilectomy. Preoperative, postoperative, and improvement in PROMIS scores, along with rates of complications including nonunion, infection, interphalangeal (IP) joint pain, and removal of hardware were compared between groups.Results:The prior cheilectomy group had significantly lower preoperative physical function scores than the primary MTP fusion group (P < .05). Postoperatively, the prior cheilectomy group had worse physical function (P < .017) and global physical health (P < .017) scores. However, there were no significant differences in pre- to postoperative change in PROMIS scores. There were no significant differences in rates of nonunion (P = .99), infection (P = .99), or hardware removal (P = .99). More patients in the prior cheilectomy group had IP joint pain (P = .034).Conclusion:This study found that a prior cheilectomy may not affect serious complication rates of a subsequent fusion, but it may be associated with worse baseline function. Overall, our results suggest that a prior failed cheilectomy does not influence the amount of improvement in function and pain from MTP fusion.Level of Evidence:Level III, retrospective cohort study.

Poster 177: The Impact of Pre-Referral Diagnostic Tests on Care of Atraumatic Shoulder Pain

Objectives:There is a paucity of evidence quantifying the utility and value of pre-referral imaging tests among patients with atraumatic shoulder pain. The primary aim of this study was to assess the prevalence and relative influence of radiographs and MRIs obtained prior to referral to an orthopedic specialist among patients with atraumatic shoulder pain. We hypothesized that there are no patient factors independently associated with undergoing a pre-referral MRI or radiograph. Similarly, there are no factors associated with change of care based on imaging findings, nor do patient factors influence post-referral imaging.Methods:A total of 665 consecutive new adult patients age 35 and older presenting to a single specialty care clinic were included in the study cohort. PROMIS Global Health, PROMIS Mental Health, Patient Health Questionnaire (symptoms of depression), and Generalized Anxiety Disorder questionnaire were completed at the first specialty care visit. Pre-referral shoulder imaging studies were obtained in 462 of 665 (69%) patients; 49% (n = 324) had radiographs and 21% (n = 138) had MRI. We used logistic regression to identify factors independently associated with prereferral imaging and post-referral imaging. We also recorded whether or not pre-referral imaging changed treatment.Results:Pre-referral MRI was associated with worse overall health (P=0.012), greater symptoms of depression (P=0.049), and longer duration of symptoms (P=0.0072). Pre-referral radiographs were associated with worse PROMIS Global Physical Health (P<0.001), worse PROMIS Global Mental Health (p=0.012), greater symptoms of anxiety (p=0.055), greater symptoms of depression (p=0.026), and longer duration of symptoms (p<0.005). There was no relationship between diagnosis and pre-referral MRI or radiographs (p=0.34, p= 0.17). There were no factors associated with post-referral MRI. Post-referral radiograph was associated with worse PROMIS Global Mental Health (p=0.013) and duration of symptoms (p=0.014). Eight of the pre-referral radiographs (2.5%) helped distinguish arthritis from adhesive capsulitis, and six (4%) of the pre-referral MRIs were useful for planning surgery. Ultimately, no images were necessary prior to referral, all could have waited for an order from the specialist.Conclusions:The finding that patient factors, including symptoms of depression or anxiety and poorer overall health correlated with pre-referral imaging suggests that non-specialists may feel pressed to order imaging when patients are more incapable, worried and despairing, perhaps to demonstrate compassion, and possibly in an attempt to prioritize specialty care. Specialists were less influenced by patient factors in ordering imaging tests, perhaps due to a more selective and discerning use of tests largely for planning surgery on discrete pathology. Given that pre-referral imaging does little to influence specialist management, a preferred approach may be immediate specialist referral or electronic consultation without imaging when typical supportive treatments such as a simple set of rotator cuff strengthening exercises are unsatisfying to the patient.

Analyses of Cross-Sectional Data to Link the PEG With the Patient Reported Outcomes Measurement and Information System (PROMIS) Global Physical Health Scale

It is challenging to synthesize findings across studies of pain impact. This study develops a link to estimate the Patient-Reported Outcomes Measurement Information System (PROMIS) global health measure from the 3-item Pain intensity, interference with Enjoyment of life, interference with General activity (PEG) scale. The PROMIS and PEG items were administered to 795 adults (average age = 51; 54% female, 79% White). We estimated correlations among the PEG and PROMIS items and conducted factor analysis to identify the best subset of PROMIS items for linking to the PEG. An item response theory graded response model was estimated to link the PEG with the 4-item PROMIS global physical health scale. A categorical single-factor model and a bifactor model provided support for a single dimension for the PEG and PROMIS global physical health items. The product-moment correlation between estimated PROMIS global physical health scale from the PEG and the actual global physical health score was .74. The mean difference between estimated PROMIS global physical health scale score from the PEG and the observed global physical health score was less than a T-score point. This study makes it possible to estimate the average global physical health for group-level comparisons in research that includes the PEG. PerspectiveThis article describes an empirical link of the PEG to the PROMIS global physical health scale that makes it possible to estimate the average global physical health in studies that include the PEG. This link can facilitate comparisons among studies that have not administered the PEG or the PROMIS global health scale.

Behavioral Activation for Orthopedic Trauma Patients After Discharge: A Case Series Report of an Open-Label, Prospective Observational Pilot Study

Patients discharged after surgery for orthopedic trauma are at high risk for depression and posttraumatic distress, but are underreached in terms of recovery-oriented mental health interventions. Behavioral activation (BA) is appropriate, given that maintaining self-reinforcing physical activity is congruent with physical and mental recovery among postsurgical patients. We report on a prospective observational pilot study evaluating the feasibility, acceptability, and efficacy of an adapted BA protocol developed as a preventative intervention to reduce the risk of depression among surgical patients with traumatic limb injury. We used a mixed-methods case series design to depict the population-specific adaptations made to Lejuez et al.’s (2011) brief BA protocol, as well as quantitative and qualitative outcomes among treatment completers (n = 5; all female; rangeage = 43−65 years). Completers reported either unchanged or modest improvements in global physical and mental health, and depressive and posttraumatic stress symptoms. Completers’ postintervention qualitative responses corroborated these observations, emphasizing positive aspects of the intervention and perceived benefits for mental health and physical recovery. Overall, completers viewed the intervention as acceptable and feasible, and offered concrete suggestions for intervention delivery refinement. Our adapted BA protocol for orthopedic trauma surgical recovery appears acceptable, feasible, and preliminarily efficacious. Future trials should include a control group, and consider delivery by non-specialists.

Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs

IntroductionValue-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs.MethodsAcute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated.ResultsWe included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs.ConclusionsA high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs.

My Wellness Coach: evaluation of a mobile app designed to promote integrative health among underserved populations.

Underserved populations, including those from racial and ethnic groups and with low socioeconomic status, often lack access to mobile apps aimed at reducing health risk factors. This study evaluated the feasibility, acceptability, and preliminary effectiveness of the mobile app, My Wellness Coach (MWC), designed to promote behavior change in seven core areas of integrative health among underserved populations. Patients and staff were recruited from clinic and other settings. Some participants used MWC in a weekly group setting (n = 5); others on their own with support from a coordinator (n = 36). Health outcomes were assessed at baseline and 3 months. Mobile app ratings were collected at 5 weeks and 3 months. Goal setting data were analyzed at 3 months. Most participants (76%) set at least one goal, 71% created action steps for goals, and 29% completed a goal. Patients in the group setting had the highest rate of goal completion (60%) compared to patients (20%) and staff (27%) using the app on their own. Significant (p < .05) changes in pre- and post-test scores were documented for overall wellbeing, global physical health, BMI, vigorous physical activity, and eHealth literacy. Most participants (75%-91%) gave MWC high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge, and awareness. This study documented preliminary evidence of the potential benefits of MWC among underserved communities. Future evaluations of Spanish and Android versions and comparisons between group and individual administration will inform implementation strategies for scaling MWC-based interventions to reach underserved communities nationally.

Patient-reported distress at a cancer center during the COVID-19 pandemic.

e18644 Background: Assessments of health-related quality of life (HRQOL) are conducted by health systems to analyze and improve patient-centered care. Numerous studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. However, the impact of the pandemic on HRQOL in patients with cancer is unknown. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. Methods: In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the PROMIS global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/2021, and valley2: 3/3/2021-6/15/2021). Results: A total of 29,983 surveys among 7,209 patients were included in the study. Mean GMH scores for patients before the COVID-19 pandemic (50.57) were similar to that during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14) (Table). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. Conclusions: In this single institution study, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores. [Table: see text]