Greater Improvement In Physical Function Research Articles

Functional disability and disease activity are affected by social determinants ofhealth in patients with rheumatoid arthritis.

The relationship between social determinants of health (SDH) and disease outcomes in rheumatoid arthritis (RA) is not well documented. Data were extracted from the Ontario Best Practices Research Initiative (OBRI) registry for patients between January 2008 and April 2022. Adjusted mixed models analysis was used to investigate the effect of baseline SDH on disease activity (Clinical Disease Activity Index (CDAI)) and functional disability (Health Assessment Questionnaire-Disability Index (HAQ-DI)) 12months after enrollment. The analyses were completed on multiple imputed data. There were 2651 patients with a mean age of 58.1years (SD 12.9). The majority (77.8%) were female. Greater improvements in physical function were seen in patients who were full-time employed (difference = - 0.20; 95% CI - 0.28, - 0.11), part-time employed (difference = - 0.10; 95% CI - 0.19, - 0.02), or retired (difference = - 0.17; 95% CI - 0.25, - 0.08), compared to unemployed, those with highest income ($75,000 or more) (difference = - 0.23; 95% CI - 0.37, - 0.09). Caucasian was also associated with a positive impact on functional ability (difference = - 0.09; 95% CI - 0.17, - 0.02). In contrast, smokers had smaller improvements in physical function (difference = 0.07; 95% CI 0.002, 0.14). Interestingly, women had greater improvement in CDAI (difference = - 2.40; 95% CI - 3.29, - 1.51), while they reported less improving in their physical function (difference = 0.33; 95% CI 0.27-0.39). Achieving CDAI low disease activity/remission state was also more common in females. Our findings suggest that disease activity and functional disability are affected by different SDH factors. The effects of SDH should be better understood and addressed by rheumatologists to provide equitable healthcare for all patients with RA. Key points • This study explored a comprehensive panel of social determinants of health and their relationship to clinical outcomes. • Previously unreported factors such as employment status and income were found to influence clinical outcomes. • Our findings can help physicians to identify high-risk patients who may benefit from additional attention to their social background.

The effectiveness of early mobilisation on physical function in patients after heart valve surgery: a systematic review

Background/Aims Literature suggests that early mobilisation, defined as the initiation of physical activity within 48 hours following surgery, improves outcomes after cardiac surgery. This systematic review assessed the effectiveness of early mobilisation on physical function and other outcomes, including length of hospital stay and cost following heart valve surgery. Methods The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL and Cochrane Library were systematically searched from inception until May 2022 using relevant key words. Randomised controlled trials comparing early mobilisation and usual care for patients who had received heart valve surgery were included in the review. Methodological quality was assessed using the Physiotherapy Evidence Database scale and risk of bias using the Cochrane Risk of Bias 2 tool. The data were narratively synthesised. Results The search identified 210 articles, with 98 remaining after duplicates were removed. Upon screening for eligibility, nine articles were assessed in full and three randomised controlled trials involving 161 patients were included in the review. Early mobilisation protocols varied across trials. Two trials (n=124) reported significantly greater improvement in physical function with early mobilisation compared to usual care, including handgrip strength (P=0.001). One study (n=41) found early mobilisation significantly reduced the length of hospital stay (P=0.000), in-hospital care costs (P=0.000) and intensive care unit stay (P=0.000) compared to usual care. Methodological quality scores ranged from six to nine on the Physiotherapy Evidence Database scale. The risk of biased judgement was ‘low’ in one study and ‘some concerns’ in two studies. Conclusions Early mobilisation may improve physical function and reduce hospital and intensive care unit stays after heart valve surgery. However, differences in protocols and limited studies indicate further high-quality research is needed, particularly regarding cost-effectiveness. Establishing clear early mobilisation protocols could enhance recovery in this population. Implications for practice Early mobilisation may require the coordinated effort of a multidisciplinary team of physiotherapists, nurses and possibly other medical professionals. For its seamless and effective implementation, it is essential to understand whether this intervention falls under the domain of physiotherapists or requires broader team collaboration. Given these complexities, strategies targeting early mobilisation that balance both safety and resource considerations are advised to improve physical function after heart valve surgery, especially among patients who are frail.

Worse Preoperative 12-Item Veterans Rand Physical Component Scores Prognosticate Inferior Outcomes Following Outpatient Lumbar Decompression.

Retrospective Review. Evaluate the influence of the 12-Item veterans Rand (VR-12) physical component score (PCS) on patient-reported outcome measures (PROMs) in an outpatient lumbar decompression (LD) cohort. The influence of baseline VR-12 PCS on postoperative clinical outcomes has not been evaluated in patients undergoing outpatient LD. Patients undergoing primary, elective, 1/2-level outpatient LD with baseline VR-12 PCS scores were retrospectively identified from a prospectively maintained single-surgeon database. Cohorts were preoperative VR-12 PCS<30 and VR-12 PCS≥30. Patient/perioperative characteristics and preoperative/postoperative 6-week/final follow-up (FF) PROMs were collected. Physical health PROMs included the VR-12 PCS, 12-Item Short Form (SF-12) PCS, patient-reported outcome measure information system-physical function (PROMIS-PF), visual analog scale (VAS)-back/leg, and Oswestry disability index (ODI). Mental health PROMs included the VR-12/SF-12 mental component score (MCS) and the patient-health questionnaire-9 (PHQ-9). Average FF was 13.8±8.9 months postoperatively. PROM improvements at 6 weeks/FF and minimal clinically important difference (MCID) achievement rates were determined. χ 2 analysis and the Student's t tests compared demographics, perioperative data, and preoperative PROMs. Multivariate linear/logistic regression compared postoperative PROMs, PROM improvements, and MCID achievement rates. Six weeks postoperatively, VR-12 PCS<30 reported worse baseline PROMs ( P ≤0.042, all) and worse scores except VR-12/SF-12 MCS ( P ≤0.043, all). Compared with VR-12 PCS≥30, VR-12 PCS<30 had worse FF VR-12 PCS, SF-12 PCS/MCS, PROMIS-PF, PHQ-9, and VAS-Back ( P ≤0.033, all). VR-12 PCS<30 experienced greater 6-week improvements in VR-12/SF-12 PCS, PHQ-9, VAS-Back, and ODI ( P ≤0.039, all). VR-12 PCS<30 had greater FF improvements in VR-12/SF-12 PCS, PHQ-9, and ODI ( P ≤0.001, all) and greater overall MCID achievement in VR-12 PCS/MCS, SF-12 PCS, PHQ-9, and ODI ( P ≤0.033, all). VR-12 PCS<30 patients-reported worse baseline/postoperative mental/physical health scores. However, they reported greater improvements in physical function, depressive burden, back pain, and disability by 6 weeks and FF and experienced greater MCID achievement for physical functioning, mental health, and disability scores.

Older Adults' Perceptions of Cognitive, Physical, and Exergame Training: A Mixed Methods Investigation of a Four-Armed Randomized Controlled Pilot Trial.

Purpose: Although the health benefits of behavioral interventions for older adults are well studied, research focused on intervention acceptability in older adult populations is less established and is needed. This mixed methods study investigated older adults' perceptions of training interventions. Methods: Community-dwelling older adults (N = 41) were randomized into three groups (cognitive, physical, and exergame) and completed 20 in-lab training sessions over 10 weeks. At every fifth session, participants provided feedback on their perceived gains across functional domains, enjoyment of and motivation to complete training, and aspects they most and least enjoyed regarding study participation. Results: Based on the multivariate analysis of variance, perceived cognitive and everyday function gains did not vary by training group. However, physical and exergame groups perceived greater improvement in physical function than the cognitive training group (P < 0.001). Enjoyment of and motivation to complete training did not vary by training group. Exploratory qualitative coding results suggest that participants across groups most enjoyed social interaction and feelings of improvement. Participants least enjoyed traveling to the study site and engaging in aspects of training (e.g., specific games, structure or duration of training). Conclusion: These findings highlight the importance of incorporating meaningful social engagement and balancing the challenge of training components with goal attainment when working with older adults, regardless of the intervention type. Future research and practice should consider salient aspects of the participant experience (e.g., social connection, accessible locations or remote options) when designing interventions for older adults.

Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic

ObjectivesExamine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs). DesignRetrospective cohort study using Minimum Data Set (MDS) 3.0 assessments. Settings and Participants12,606 Veterans in 133 VA CLCs between September 2019 and September 2020. MethodsDifference in physical function [MDS Activities of Daily Living Score (MDS-ADL)] and PT use (minutes in past 7 days) from admission to last assessment in a period were compared between the pre-CoVID-19 (September 2019 to February 2020) and early CoVID-19 (April 2020 to September 2020) period using mixed effects regression with multivariable adjustment. Assessments after a positive CoVID-19 test were excluded. Differences were examined in the sample and repeated after stratifying into short- and long-stay stratums. ResultsVeterans admitted during early CoVID-19 had more comorbidities, worse MDS-ADL scores, and were more often long-stay residents compared with those admitted during pre-CoVID-19. In comparison to pre-CoVID-19, Veterans in VA CLCs during early CoVID-19 experienced greater improvements in their MDS-ADL (−0.49 points, 95% CI –0.27, −0.71) and received similar minutes of therapy (2.6 minutes, 95% CI –0.8, 6.0). Stratification revealed short-stay residents had relative improvements in their function (−0.69 points, 95% CI –0.44, −0.94) and higher minutes of PT (5.1 minutes, 95% CI 0.9, 9.2) during early CoVID-19 whereas long-stay residents did not see differences in functional change (0.08 points, 95% CI –0.36, 0.51) or PT use (−0.6 minutes, 95% CI –6.1, 4.9). Conclusions and ImplicationsDuring early CoVID-19, physical function improved while the amount of PT received was maintained compared with pre-CoVID-19 for Veterans in VA CLCs. Short-stay residents experienced greater improvements in physical function and increases in PT use. These findings may be partly due to selection bias relating to Veterans admitted to CLCs during early CoVID-19.

Comparative Effects of Kabat Rehabilitation and Kinesiotaping on Functional Disability, Synkinesis and Patient Satisfaction in Patients with Bell’s Palsy

Comparative Effects of Kabat Rehabilitation and Kinesiotaping on Functional Disability, Synkinesis and Patient Satisfaction in Patients with Bell’s Palsy

P189 Bimekizumab in patients with psoriatic arthritis with prior inadequate response to TNF inhibitors: improvements of PsARC over 16 weeks in the Phase 3 BE COMPLETE trial

Abstract Background/Aims Bimekizumab (BKZ) is a humanised monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A and has demonstrated clinical effectiveness in both joint and skin outcomes in patients with active psoriatic arthritis (PsA). Psoriatic Arthritis Response Criteria (PsARC) is used routinely for drug reimbursement in clinical practice in the UK. We report PsARC response rates along with HRQoL estimates at week (wk) 16 in TNF inadequate responder (TNFi-IR) patients with active PsA from the phase 3, 16-wk BE COMPLETE trial (NCT03896581). Methods BE COMPLETE is a randomised, multicentre, double-blind, placebo (PBO)-controlled, parallel group study. Patients who had an inadequate response or intolerance to treatment with 1 or 2 TNFis were randomised (2:1) to BKZ 160 mg every 4 wks (Q4W) or PBO for 16 wk. We report response rates for PsARC at wk 16, and the association of PsARC responders with HRQoL-related outcomes for the randomised set. Data are reported as non-responder imputation (NRI) and observed cases. Results 400 patients were randomised at baseline (BKZ: 267; PBO: 133). Baseline characteristics were comparable between groups (mean age: 50.5 yrs; BMI: 29.8 kg/m2; disease duration: 9.5 yrs and 47.5% were male). At wk 16, PsARC response (NRI) was achieved by 85.4% with BKZ and 30.8% with PBO (Table). Numerically greater improvements in physical functioning and fatigue measure were achieved from baseline among PsARC responders compared to non-responders (Table). Over 16 wks, safety was in line with previous BKZ studies and no new safety signals were observed. Conclusion In patients with prior TNFi-IR with active PsA, BKZ treatment demonstrated a greater improvement in musculoskeletal symptoms at wk 16 compared to PBO. Patients with PsARC response had numerically greater improvements in HRQoL and improvements in fatigue measures. No new safety signals were observed. Disclosure P. Sharma: Other; PS has received conference sponsorship Amgen 2015 for National Osteoporosis Conference; Janssen Advisory Board board Nov 22. D.R. Jadon: Other; DRJ received research/education grants/honoraria: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Fresenius Kabi, Gilead, GSK, Healthcare Celltrion, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz and UCB. D. McGonagle: Grants/research support; DM has received research grants/research support from AbbVie, Celgene, Janssen, Merck, and Pfizer. Other; DM has recevied honoraria or consultation fees and has been paid as a speaker for AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer, and UCB Pharma. B. Ink: Shareholder/stock ownership; BI is a shareholder of AbbVie, GlaxoSmithKline and UCB Pharma. D. Assudani: Shareholder/stock ownership; Employee and shareholder of UCB Pharma. V. Taieb: Other; VT is employee of UCB Pharma. L.C. Coates: Consultancies; LCC has worked as a paid consultant for AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB Pharma. Member of speakers’ bureau; LCC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB Pharma. Grants/research support; LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma.

Aerobic and resistance exercise in heart failure inpatients: a scoping review.

Exercise performance is an essential tool for managing heart failure. Although the benefits of exercise are well documented for people with chronic and stable heart failure, there is still no consensus on their prescription in patients hospitalized with acute heart failure undergoing clinical stabilization. The aim of this study is to identify the literature on exercise programs encompassing the components of aerobic and resistance training for hospitalized patients admitted for acute heart failure. A scoping review was conducted according to the proposed methodology of the Joanna Briggs Institute. Studies with adults over 18years old, hospitalized, and diagnosed with acute heart failure who participated in aerobic and resistance exercise training programs during their hospital stay were included. Three studies met the inclusion criteria. One was a retrospective, observational analytical cohort study, in which the main outcome of the exercise program was improvement in the previous disabilities of the participants. The other two were multicenter randomized controlled studies that showed greater improvement in physical function, functional capacity, depression, quality of life, and frailty status in the intervention groups. The exercise prescriptions differed according to the principles of the exercise prescription-frequency of exercise, intensity of exercise, exercise time (duration), type (mode), exercise volume, and progression. It is too early to make recommendations based on evidence of the type structure of an exercise program with aerobic and strength-training components in this population. However, in the exercise programs of the reviewed studies, the predominance of light to moderate intensity and the importance of progressively increase the frequency and duration of the training sessions were demonstrated, with bicycle ergometers and walking being the most common types of aerobic exercises. It is recommended that investment and research in this area should continue with more methodologically robust studies.

Secukinumab improves physical function and quality of life and inhibits structural damage in patients with PsA with sustained remission or low disease activity: results from the 2-year phase 3 FUTURE 5 study

ObjectiveTo investigate the impact of sustained low disease activity (LDA)/remission (REM) on physical function, quality of life (QoL) and structural outcomes in secukinumab-treated psoriatic arthritis (PsA) patients from the FUTURE...

Postoperative opioid prescription and patient-reported outcomes after elective spine surgery: a Michigan Spine Surgery Improvement Collaborative study.

This study was designed to assess how postoperative opioid prescription dosage could affect patient-reported outcomes after elective spine surgery. Patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) from January 2020 to September 2021 were included in this study. Opioid prescriptions at discharge were converted to total morphine milligram equivalents (MME). A reference value of 225 MME per week was used as a cutoff. Patients were divided into two cohorts based on prescribed total MME: ≤ 225 MME and > 225 MME. Primary outcomes included patient satisfaction, return to work status after surgery, and whether improvement of the minimal clinically important difference (MCID) of the Patient-Reported Outcomes Measurement Information System 4-question short form for physical function (PROMIS PF) and EQ-5D was met. Generalized estimated equations were used for multivariate analysis. Regression analysis revealed that patients who had postoperative opioids prescribed with > 225 MME were less likely to be satisfied with surgery (adjusted OR [aOR] 0.81) and achieve PROMIS PF MCID (aOR 0.88). They were also more likely to be opioid dependent at 90 days after elective spine surgery (aOR 1.56). The opioid epidemic is a serious threat to national public health, and spine surgeons must practice conscientious postoperative opioid prescribing to achieve adequate pain control. The authors' analysis illustrates that a postoperative opioid prescription of 225 MME or less is associated with improved patient satisfaction, greater improvement in physical function, and decreased opioid dependence compared with those who had > 225 MME prescribed.

Abstract A011: Lifestyle behavior change interventions among adult rural cancer survivors: A systematic review

Abstract Introduction: Though lifestyle behavior, such as dietary pattern or physical activity, has been shown to improve symptoms related to cancer treatment and secondary comorbidities (i.e., pain, fatigue, poor functionality), adherence to health-promoting behavioral interventions is low, particularly among older, rural-dwelling survivors of cancer. Shifting population dynamics in cancer survivorship regarding both aging and rurality indicate that it is crucial to understand the health needs of this older, lower resourced population if acceptable and effective lifestyle interventions are to be developed and implemented. This review aimed to summarize lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. Methods: A systematic search of five databases (i.e., PubMed, CINAHL, CENTRAL, EMBASE, PsycINFO) identified randomized controlled trials and controlled clinical trials which targeted diet and/or physical activity change in adult cancer survivors living in rural areas. The conduct and reporting of this review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol for this review was registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42021282313). Articles were screened for eligibility by two independent reviewers and data were extracted using an a priori developed form. Results: Eight studies met the inclusion criteria. Average participant age was 59.9 years (range: 29-90 years). While three studies (37%) reported a mean sample age of 65 years or greater, none identified a priori inclusion criteria encompassing both older age and rurality. Most studies were conducted in Australia (n=4) or the United States (n=3), focused on breast cancer survivors (n=4), and included survivors at least 6-weeks post-treatment (n=5). Six (75%) had a fully remote or hybrid delivery model. Results from the three interventions which enrolled a mean study sample of 65 years or greater indicated that lower percentages of older, rural-dwelling participants met study goals related to fruit, vegetable, and saturated fat intake than younger and/or urban survivors. Older, rural-dwelling survivors reported greater improvements in physical function and physical activity post-intervention than older, urban-dwelling participants. Conclusions: Few studies have been conducted to evaluate the efficacy of lifestyle behavior change intervention among rural-dwelling survivors of cancer. None have been designed for older survivors living in rural areas, despite lower adherence to lifestyle behavior recommendations for survivors. There is a need to identify feasible and effective approaches to influence clinically meaningful behavior change for this population. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with older, rural-dwelling survivors of cancer. Citation Format: Samantha J. Werts, Rogelio Robles-Morales, Jennifer W. Bea, Cynthia A. Thomson. Lifestyle behavior change interventions among adult rural cancer survivors: A systematic review [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A011.

1553O Health-related quality of life (HRQoL) in the phase III TROPiCS-02 trial of sacituzumab govitecan (SG) vs chemotherapy in HR+/HER2- metastatic breast cancer (MBC)

The antibody-drug conjugate SG comprises an anti-Trop-2 antibody coupled to SN-38 via a hydrolyzable linker. In the ongoing randomized TROPiCS-02 trial, SG is being evaluated vs single-agent chemotherapy treatment of physician’s choice (TPC) after CDK 4/6 inhibitor, endocrine therapy, and at least 2 chemotherapies in HR+/HER2- MBC setting. Here we assess the impact of SG on HRQoL in TROPiCS-02. Patients (pts) with locally determined HR+/HER2- MBC following (2-4 prior chemotherapies) for metastatic disease, were randomized to receive SG (10 mg/kg IV on days 1 and 8 of a 21-day treatment [Tx] cycle) or TPC (capecitabine, eribulin, gemcitabine, or vinorelbine). HRQoL was assessed at baseline (BL), day 1 of each Tx cycle (CxDx) and at end of treatment visit using the EORTC QLQ-C30. The analysis included all pts with valid HRQoL assessments at BL and ≥1 post-BL visit. Linear mixed-effect models for repeated measures were used to estimate differences in overall least-square mean changes from BL between Tx arms, using on-Tx data up to C11D1 (n ≥25 in both arms). The analysis included 446 pts (236 SG, 210 TPC; median age 56 y). The EORTC QLQ-C30 completion rate was ≥85% up to C13D1 in both Tx arms. Mean HRQoL scores at BL were generally similar for SG and TPC. The SG arm showed a trend of improvement in most HRQoL domains. A significantly greater improvement in physical functioning and dyspnea was observed for SG vs TPC and greater worsening in diarrhea (table).Table: 1553OEORTC QLQ-C30 least-square mean change from baselineSG vs TPC (95% CI)Global health status/QoL2.4 (-0.7, 5.5)FunctioningPhysical3.9 (0.9, 6.9)Role3.1 (-1.2, 7.4)Emotional0.9 (-2.4, 4.3)Cognitive-0.2 (-3.3, 2.9)Social0.8 (-3.2, 4.7)Summary Score0.6 (-1.8, 3.1)SymptomsFatigue-3.3 (-7.1, 0.5)Pain-1.6 (-5.5, 2.3)Nausea/Vomiting1.4 (-0.9, 3.8)Dyspnea-4.3 (-8.5, -0.1)Insomnia-3.7 (-8.1, 0.8)Appetite Loss-3.3 (-7.3, 0.8)Constipation-1.0 (-5.5, 3.4)Diarrhea10.4 (6.3, 14.5)Financial Difficulties0.9 (-2.5, 4.2)Positive value represents improvement for functioning and worsening for symptoms.SG, sacituzumab govitecan; TPC, treatment of physician’s choice. Open table in a new tab SG, sacituzumab govitecan; TPC, treatment of physician’s choice. Despite the association with worsening diarrhea, SG demonstrated an overall HRQoL benefit in heavily-pretreated patients with HR+/HER2- MBC.

Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial

OBJECTIVETo determine whether silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) or laparoscopic sleeve gastrectomy (LSG) produces superior diabetes remission at 5 years.RESEARCH DESIGN AND METHODSIn a single-center, double-blind trial, 114 adults with type 2 diabetes and BMI 35–65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy) using a web-based service. Diabetes and other metabolic medications were adjusted according to a prespecified protocol. The primary outcome was diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life, and adverse events.RESULTSDiabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios 4.5 [95% CI 1.6, 15.5; P = 0.009] and 4.2 [1.3, 13.4; P = 0.015] in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference 10.7%; 95% CI 7.3, 14.0; P < 0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83; P < 0.001).CONCLUSIONSSR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications.

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial

BackgroundOne of the most common knee problems is patellofemoral pain syndrome (PFPS).It is of great importance to pay attention to the muscles of the hip area in people with PFPS, especially to the presence of trigger points within the gluteus medius (GM). Accordingly, using therapeutic interventions to eliminate trigger points is required. Therefore, the aim of the present study was to evaluate the effect of GM active trigger point dry needling (TrP-DN) on pain and physical function of non-athlete women with unilateral PFPS. Methods29 young non-athlete women aged between 17 and 40 years old with unilateral PFPS were randomly divided into two groups of experimental (n = 15) and control (n = 14) through the simple and convenience sampling method. Both groups received conventional physiotherapy twice a week up to 6 sessions. The experimental group also received GM active TrP-DN once a week for 3 sessions in addition to the conventional physiotherapy. Pain intensity and physical function of women with PFPS were measured in both groups in three stages of before, immediately after and one week after performing the treatment sessions. FindingsThe six-session physiotherapy treatment led to a significant reduction in pain intensity as well as an improvement in physical function in both groups (p < 0.001). In addition, the intergroup comparison showed a significant improvement in physical function of the experimental group after one week from the GM active TrP-DN, compared to the control group (p = 0.048). ConclusionThe present study indicated that conventional physiotherapy with or without GM active TrP-DN can reduce pain and improve physical function in non-athlete women with unilateral PFPS. This study also revealed that conventional physiotherapy combined with dry needling can lead to further reduction in pain and a greater improvement in physical function of this group of patients.

Association of Preoperative Physical Function and Changes in Mental Health After Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Few investigations have focused on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores, patient depression measured by the Patient Health Questionnaire-9 (PHQ-9), and their relationship in the setting of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). This study aims to detail the association between preoperative physical function with postoperative change in physical function and in depressive symptoms. A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to February 2019. Inclusion criteria were primary, single-level MIS TLIF procedures. Multilevel procedures and patients without PROMIS or PHQ-9 were excluded. Patients were grouped by preoperative PROMIS score (<35.0 and ≥35.0), with higher scores indicating greater physical function. A t test analyzed differences between PROMIS subgroups for operative time (skin incision to closure), estimated blood loss, length of stay, and discharge day. A t test also assessed the difference in PROMIS Physical Function (PF) and PHQ-9. Linear regression evaluated the relationship between pre- and postoperative PROMIS and PHQ-9. Of 119 patients, 53.8% were male and 47.9% were obese. The mean ± SD age was 52.2 ± 10.7 years. The PROMIS <35.0 group had a larger improvement of PROMIS scores compared to the PROMIS ≥35.0 group at 6 weeks, 12 weeks, and 6 months. There was a negative association between preoperative PROMIS and PROMIS score improvement at 6 weeks, 12 weeks, and 6 months. For all time points, improvement in PHQ-9 was not associated with preoperative PROMIS scores. From 0 weeks to 6 months after MIS TLIF, patients with lower preoperative physical function had larger improvements in PROMIS PF scores. Preoperative function was not predictive of postoperative changes in PHQ-9. While relationships between mental and physical health cannot be discounted, the lack of PHQ-9 association with physical function demonstrates the impact that MIS TLIF can have, regardless of PROMIS PF score. Patients demonstrating lower levels of preoperative physical function may be in position for greater improvements in physical function following MIS TLIF surgery. In this study, there was no clear relationship between preoperative physical function levels and postoperative improvement in mental health, suggesting that all patients may achieve similar mental health improvement following MIS TLIF. 3.

Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis.

Background:Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs).Methods:Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling.Results:The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = –9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = –6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF (β = 0.20, P = .07) and PI (β = –0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively (β = –0.74, P < .01; β = –0.61, P < .01).Conclusion:Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation.Level of Evidence:Level II, prospective comparative study.

P145. Evaluation of health-related quality of life improvement in patients undergoing spine vs adult reconstructive surgery after 1 year follow-up

BACKGROUND CONTEXT Patient Reported Outcome Information System (PROMIS) provides a tailored ability to compare different procedures. This study compares PROMIS results for patients undergoing common single-level spinal surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures with minimum 1 Year Follow-Up (FU). PURPOSE To evaluate the efficacy of spine surgery compared to adult reconstructive surgery. STUDY DESIGN/SETTING Single-center retrospective cohort study PATIENT SAMPLE A total of 98 spine patients (32 Laminectomy, 22 MLD, 44 TLIF) and 147 RECON patients (50 THA and 97 TKA). OUTCOME MEASURES Patient demographics, Physical-Function (PF), Pain-Intensity (PI) and Pain-Interference (P-IF). METHODS Included: Patients>18 years old who underwent single level spine surgery (Lami, MLD, TLIF) or RECON surgery with Baseline (BL) & 1Y PROMIS scores of PF, P-IF, and PI, which were grouped based on surgery type. Excluded: patients who underwent both single level spine and RECON surgeries. Paired t-tests calculated differences in BL, 1Y, and change in PROMIS scores for spine vs each RECON procedure. RESULTS Age and gender were similar between spine (Age=58.92±13.69; 45.91% Female) and RECON (Age=65.9±8.6; 63.95% Female) patients. Spine patients undergoing Laminectomy(PF: 13.3±15.4, P-IF: 90.9±7.3, PI:56.2±6.6), MLD (PF:9.8±16.1,P-IF:94.2±6.4,PI:61.2±6.5) , or TLIF (PF:10.6±10.9,P-IF:91.8±13.0,PI:56.4±6.5) had more disability and pain at BL than either THA(PF: 36.0±4.7,P-IF:64.0±5.5,PI:54.2±6.2) or TKA(PF:35.5±3.9,P-IF:63.6±6.2,PI:53.3±6.6)patients according to all 3 PROMIS categories. When assessing all lumbar surgery patients with RECON, spine patients had greater improvements in PF (15.5±21 vs 6.8±6.3, p<0.001) and P-IF (-17.2±21.3 vs -10.0±9.5, p=0.002) domains except PI (-7.2±9.9 vs -9.8±9.5,p=0.038). CONCLUSIONS Patients undergoing single level spinal surgery had worse baseline disability and pain compared to those undergoing recon surgery. PROMIS improvement is equivalent, and often greater in the spine patients compared to RECON. Although patients undergoing spine surgery had lower initial PROMIS scores than RECON patients, spine patients showed at least as good or better improvement at a 1Y postoperative time point. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Patient Reported Outcome Information System (PROMIS) provides a tailored ability to compare different procedures. This study compares PROMIS results for patients undergoing common single-level spinal surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures with minimum 1 Year Follow-Up (FU). To evaluate the efficacy of spine surgery compared to adult reconstructive surgery. Single-center retrospective cohort study A total of 98 spine patients (32 Laminectomy, 22 MLD, 44 TLIF) and 147 RECON patients (50 THA and 97 TKA). Patient demographics, Physical-Function (PF), Pain-Intensity (PI) and Pain-Interference (P-IF). Included: Patients>18 years old who underwent single level spine surgery (Lami, MLD, TLIF) or RECON surgery with Baseline (BL) & 1Y PROMIS scores of PF, P-IF, and PI, which were grouped based on surgery type. Excluded: patients who underwent both single level spine and RECON surgeries. Paired t-tests calculated differences in BL, 1Y, and change in PROMIS scores for spine vs each RECON procedure. Age and gender were similar between spine (Age=58.92±13.69; 45.91% Female) and RECON (Age=65.9±8.6; 63.95% Female) patients. Spine patients undergoing Laminectomy(PF: 13.3±15.4, P-IF: 90.9±7.3, PI:56.2±6.6), MLD (PF:9.8±16.1,P-IF:94.2±6.4,PI:61.2±6.5) , or TLIF (PF:10.6±10.9,P-IF:91.8±13.0,PI:56.4±6.5) had more disability and pain at BL than either THA(PF: 36.0±4.7,P-IF:64.0±5.5,PI:54.2±6.2) or TKA(PF:35.5±3.9,P-IF:63.6±6.2,PI:53.3±6.6)patients according to all 3 PROMIS categories. When assessing all lumbar surgery patients with RECON, spine patients had greater improvements in PF (15.5±21 vs 6.8±6.3, p<0.001) and P-IF (-17.2±21.3 vs -10.0±9.5, p=0.002) domains except PI (-7.2±9.9 vs -9.8±9.5,p=0.038). Patients undergoing single level spinal surgery had worse baseline disability and pain compared to those undergoing recon surgery. PROMIS improvement is equivalent, and often greater in the spine patients compared to RECON. Although patients undergoing spine surgery had lower initial PROMIS scores than RECON patients, spine patients showed at least as good or better improvement at a 1Y postoperative time point.

Efficacy and safety of filgotinib in methotrexate-naive patients with rheumatoid arthritis with poor prognostic factors: post hoc analysis of FINCH 3

ObjectiveThis analysis evaluated efficacy and safety of filgotinib, a Janus-associated kinase 1-preferential inhibitor, in methotrexate (MTX)-naive patients with rheumatoid arthritis (RA) with multiple poor prognostic factors (PPFs).MethodsThis was a post...

Hepatic Fat Reduction Due to Resmetirom in Patients With Nonalcoholic Steatohepatitis Is Associated With Improvement of Quality of Life

Nonalcoholic steatohepatitis (NASH) is a chronic liver disease associated with adverse clinical outcomes and impaired health-related quality of life (HRQL). Patients with biopsy-proven non-cirrhotic NASH with hepatic fat fraction of ≥10% by magnetic resonance imaging-proton density fat fraction were enrolled in a phase 2, multicenter, double-blind, randomized, placebo-controlled study of resmetirom. HRQL was assessed using Short Form-36 throughout 36 weeks of treatment. One hundred twenty-five NASH patients were enrolled (50 ± 11 years old, 50% male, 94% white, body mass index 35 ± 6 kg/m2, 39% with diabetes mellitus). Of these, 84 patients received 80 mg of resmetirom daily, and 41 received placebo. At baseline, HRQL scores were not different from general population norms (Physical Component Summary [PCS] 47.9 ± 9.3 vs 50, Mental Component Summary 50.4 ± 10.0 vs 50; all P > .05). By treatment week 12, patients who received resmetirom experienced improvement of Bodily Pain and Short Form-6D utility scores (P < .05); no HRQL improvement was noted in placebo (all P > .05). Improvement in PCS continued up to week 36 of treatment with resmetirom, again with no improvement in placebo group (all P > .05). Adjusted for the baseline score and clinicodemographic confounders, meeting the endpoint of a decrease in proton density fat fraction of ≥30% by week 12 (met by 54 of 116 treatment completers; 47 of 54 on resmetirom) was independently associated with greater improvements in Physical Functioning and PCS scores at week 36 (P < .05). Patients with improvement in NASH and fibrosis on liver biopsy also showed improvement in components of HRQL. Patients with NASH treated who improved their hepatic fat fraction and/or Nonalcoholic Fatty Liver Disease Activity Score on serial liver biopsy experienced improvement of HRQL. Further studies are needed to confirm long-term sustainability of that improvement. gov #NCT02912260.

Physical Rehabilitation for Older Patients Hospitalized for Heart Failure

BackgroundOlder patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established.MethodsWe conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause.ResultsA total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27).ConclusionsIn a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.)