Physical Function Research Articles

The association between hip adductor and extensor strength, and hip-related patient-reported outcomes in patients with longstanding hip and groin pain: an exploratory cross-sectional study

ObjectiveThe objective of this study was to assess the association between hip muscle strength and hip-related patient-reported outcome measures (PROMs) in patients with longstanding hip and groin pain (LHGP). DesignCross-sectional design SettingOrthopedic care ParticipantsEighty-one patients with LHGP were consecutively recruited Main Outcome MeasuresHip muscle strength was measured in adduction and extension. Hip-related PROMs was measured with the Copenhagen Hip and Groin Outcome Score (HAGOS) which includes six subscales (Symptoms, Pain, Activity in Daily Living (ADL), Physical Function in Sports and Recreation (Sport/Rec), Participation in Physical Activities (PA), and Quality of Life (QoL). Linear regression examined the association between hip muscle strength and each HAGOS subscale. ResultsGreater isometric hip muscle strength in adduction was associated with better HAGOS score for Pain and ADL (p≤0.037), but not for Symptoms, Sport/Rec, PA, or QoL (p≥0.154). Greater isometric hip muscle strength in extension was associated with better HAGOS score for Symptoms, Pain, and ADL (p ≤0.034), but not for Sport/Rec, PA, or QoL (p ≥0.084). ConclusionsIn patients with LHGP, greater isometric hip muscle strength seems to be associated with less symptoms and pain, and better function in ADL. No association was found for Sport/Rec, PA, or QoL.

Upper instrumented vertebra pedicle screw loosening following adult spinal deformity surgery: incidence and outcome analysis.

Surgical correction of adult spinal deformity (ASD) is associated with a high rate of hardware complication that can be challenging to predict. Hardware integrity and alignment after surgery are typically followed with standing radiography, where pedicle screw loosening may be incidentally identified but the clinical significance of which is often unclear. This study aimed to identify the incidence and implications of pedicle screw loosening at the upper instrumented vertebra (UIV) after surgical correction of ASD. A single-institution retrospective analysis was performed on a cohort of 217 patients who underwent long-segment fusion with pelvic fixation for correction of ASD between September 2013 and November 2021. Cases with a minimum 1-year follow-up were included. UIV pedicle screws were graded on radiographs for evidence of loosening with a 0- to 3-point scale: 0, no loosening; 1, lucency within screw threads; 2, lucency around screw threads; and 3, screw dislodgment/backout. Need for hardware revision surgery was assessed as the primary outcome. Patient-reported outcome measures (PROMIS and Oswestry Disability Index scores) were assessed as secondary outcomes among the patients with available scores. Low-grade UIV screw loosening (grade 1) was identified in 37 patients (17.1%), and high-grade UIV loosening (grade 2 or 3) was identified in 23 patients (10.6%). Low-grade UIV loosening was not associated with eventual need for hardware revision (OR 0.52, 95% CI 0.17-1.61, p = 0.258); however, high-grade loosening was associated with increased odds of hardware revision (OR 5.17, 95% CI 1.74-15.36, p = 0.003), including specifically surgery for correction of proximal junctional kyphosis (OR 5.73, 95% CI 1.27-25.95, p = 0.024). Among patients with PROMIS T-scores, those requiring hardware revision reported worse Pain Interference (65.0 ± 5.1 vs 59.6 ± 7.7, p = 0.001) and Physical Function (33.3 ± 5.6 vs 37.4 ± 7.4; p = 0.011). Patients with high-grade UIV loosening reported higher Oswestry Disability Index scores than those without high-grade loosening (grade 0 or 1), although this failed to reach statistical significance (44.0 ± 8.5 vs 33.7 ± 18.5, p = 0.101). Grade 1 UIV pedicle screw loosening may represent a benign incidental finding, whereas high-grade loosening is associated with significantly increased odds of hardware revision surgery. High-grade loosening may also be associated with worse patient-reported disability. The authors' findings suggest that while low-grade UIV loosening may often be managed expectantly, identification of high-grade UIV pedicle screw loosening on follow-up imaging warrants increased attention and continued surveillance.

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis

BackgroundPrevious research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses. ObjectiveTo identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors. MethodsPeople with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis. ResultsTwo hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables. ConclusionsPhenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain. Database registrationThe protocol is registered at ClinicalTrials.gov (NCT05380648).

Using Patient Reported Outcomes Measurement Information System (PROMIS®) Measures in Rheumatoid Arthritis Clinical Care, Research, and Trials

Patient-reported outcomes (PROs) are reports coming directly from patients about how they feel and function. PROs in the Rheumatoid Arthritis (RA) Core Set include the patient global assessment, and self-ratings of pain and physical function. As a result, these outcomes are widely collected in trials. The patient global assessment is a component included in several RA disease activity indices including the clinical disease activity index (CDAI) and the disease activity score (DAS28), which guide clinical decision-making for the initiation, maintenance, and change of disease modifying anti-rheumatic drugs (DMARDs).

LONG-TERM OUTCOMES OF CRITICALLY ILL PATIENTS WITH COVID-19: A SYSTEMATIC REVIEW

BackgroundSurvivors of critical illness are susceptible to long-term functional impairments following admission to an intensive care unit (ICU). In the context of the COVID-19 pandemic, there has been a surge in patients admitted to ICU with severe acute respiratory syndrome coronavirus type 2. The long-term consequences of critical illness due to COVID-19 illness remain unclear. Research QuestionTo determine the long-term outcomes of adult patients admitted to ICU for COVID-19. Study Design and MethodsWe searched Ovid MEDLINE and EMBASE using subject heading and free-text terms related to long-term outcomes of critically ill patients with COVID-19. We included all articles that reported original data on outcomes from 90 days onwards for adult patients admitted to ICU for COVID-19. Data extracted included study details, patient characteristics, outcomes reported, measurement tools used and timing of assessment. ResultsA total of 14,882 studies were screened, from which 134 studies fulfilled the selection criteria. Follow-up timepoints ranged from 90 days to 2 years following critical illness. Post-hospital mortality was the most reported outcome (n=60), with the general ICU cohort having an aggregate mortality rate of 35.5% (95% CI 34.7-36.2) at 90 days and 31.6% (95%CI 30.9-32.4) at 6 months. A plethora of other outcomes were assessed, including psychological function/mental health (n=49), persistent symptoms (n=47), quality of life (n=47), physical function (n=33) and cognitive function (n=31). For each outcome, different measurement tools were employed, making data synthesis across studies difficult. InterpretationImportant evidence gaps remain regarding the long-term health outcomes and healthcare needs for survivors of critical COVID-19 illness. This review found that mortality was the most reported long-term outcome. Significant heterogeneity was evident across studies in terms of outcomes assessed, measurement instruments used and the duration of follow-up. Future research requires increased consistency in outcomes assessed and measurement tools to inform clinical practice.

A prospective mixed‐methods pilot study of a novel group structured education programme for adults with cystic fibrosis diabetes

AbstractBackground: Cystic fibrosis diabetes (CFD) is associated with increased morbidity and mortality in adults with cystic fibrosis (CF). In addition, poor glycaemic control can result in microvascular complications. Group educational programmes for people with type 1 and 2 diabetes have been shown to improve diabetes outcomes. The national guidelines recommend that people with CFD should receive education regarding diabetes; however, specific CFD group education programmes have not been evaluated.Aims: This study aimed to test whether this novel diabetes contents and intervention for CFD based on the Beta Cell Education Resources for Training in Insulin and Eating (BERTIE) type 1 diabetes education programme was beneficial for adults with CFD. The adapted course, Improved Diabetes Education in Adults with Cystic Fibrosis (IDEA‐CF ), incorporated CFD‐specific topics and was delivered virtually via videoconference group sessions to facilitate peer learning and support without the risk of cross‐infection. A pilot study was conducted utilising this novel IDEA‐CF virtual structured program to ensure that the intervention met the patients’ educational needs.Methods: This randomised controlled multimethods pilot study recruited adults with CFD taking insulin therapy and cared for by a large regional CF centre. After providing written informed consent, the participants completed all the study forms and questionnaires before randomisation. Randomisation was performed using a computerised randomisation system that allocated adults with CFD into the intervention group (IDEA‐CF) or routine care group for the 12‐week study period. Participants who were randomised into the routine group continued to receive one‐on‐one education as before. Using the CF quality‐of‐life (QoL) questionnaire (revised Cystic Fibrosis Questionnaire [CFQ‐R]), outcomes were measured at baseline and 12‐week visits in both groups. The participants in the intervention group were asked to take part in a semistructured qualitative interview after the completion of the intervention, which was performed by a CF psychologist.Results: A total of 20 participants were recruited, with 18 completing the intervention and study follow‐up visits. In the CFQ‐R domains, physical functioning, emotional functioning, eating, role functioning and respiratory symptoms were significantly improved in the intervention group compared with the routine care group. The IDEA‐CF Knowledge Assessing Questionnaire (IDEA‐CF KAQ) scores in the intervention group improved compared with the IDEA‐CF KAQ scores in the control group, suggesting that education improves knowledge and understanding. The IDEA‐CF structured virtual group education group was well received, with participants valuing the educational content and the ability to interact with each other and to learn from their peers’ experiences constructively.Conclusions: Our study demonstrated that the IDEA‐CF education programme improved health‐related QoL and diabetes knowledge, as evidenced by the results of the IDEA‐CF KAQ. The participants valued the educational contents of the programme and reported a positive experience interacting with their peers.

Sex differences in the impact of lower respiratory tract infections on older adults’ health trajectories: a population-based cohort study

BackgroundLower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences.MethodsCohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores.ResultsThe study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period.ConclusionLRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

Minimal Clinically Important Differences in the Cancer Quality of Life Questionnaires in Patients with Head and Neck Cancer

Purpose: The purpose of this study is to determine the magnitude of change that is clinically meaningful in the EORTC QLQ-C30 and EORTC QLQ-HN35 instruments in head and neck cancer patients. Methods: Two hundred and twenty-two patients completed the EORTC QLQ-C30 and EORTC QLQ-HN35 at baseline and follow-up one to two months later. Minimal clinically important differences (MCIDs) were calculated through anchor- and distribution-based methods for improvement and deterioration. Karnofsky Performance status (KPS) was used as the anchor to determine meaningful change. Results: In the group of patients who deteriorated, more scales and symptoms demonstrated statistically significant meaningful change. EORTC QLQ-C30 meaningful change values for deterioration with KPS anchor ranged from 7.2 (physical functioning) to 16.7 units (Global Health Status), and for improvement ranged from 10.0 (role functioning) to 16.7 units (Global Health Status). Conclusions: We report—for the first time, to the best of our knowledge—MCID for EORTC QLQ-C30 and QLQ-HN35 in head and neck cancer patients. Knowledge of meaningful change in these questionnaires allows physicians to assess patient change over time, along with evaluating the impact of treatment on quality of life.

Incidence of Shoulder Prosthetic Joint Infection Throughout the COVID-19 Pandemic

Introduction1-2% of patients who undergo anatomic and reverse total shoulder arthroplasty are diagnosed with a prosthetic joint infection which requires revision surgery, prolonged recovery and rehabilitation, and antibiotic treatment. During the COVID-19 pandemic, anecdotal evidence suggested an increased rate of PJI among all patient populations. However, there have been no studies characterizing PJI incidence following shoulder arthroplasty during the COVID-19 pandemic. In the present study, we sought to evaluate the incidence of shoulder PJI during the COVID-19 pandemic. Materials & MethodsPatients undergoing revision shoulder arthroplasty for PJI at an academic medical center between 2017-2021 were identified: patients before COVID-19 (2017-2019) and patients during COVID-19 (2020-2021). Patient demographics, laboratory data, history of COVID-19 infection and vaccination, antibiotic treatment, and final surgical treatment were collected. Patient-reported outcome measures (PROMs) (ASES, SANE, SAS, PROMIS (Physical Function, Pain Intensity, Upper Extremity, Global 10), and VR/SF12) were collected. PJI incidence was calculated from a retrospective chart review which identified patients with PJI as defined by the International Consensus meeting (ICM) on Musculoskeletal Infection in 2018 and who underwent revision surgery and antibiotic treatment. Incidence rate analysis and independent t-tests were conducted to compare mean baseline PROMs. Descriptive analysis of the collected data included means and standard deviations for continuous variables and frequencies and percentages for discrete variables. Statistical significance was set at a p-value < 0.05. Results46 patients were identified with 20 patients undergoing a revision surgery for a PJI during the pre-COVID-19 time interval and 26 during the COVID-19 time interval. 20% underwent single stage revision (4 pre-COVID-19 and 5 during COVID-19), 50% underwent two stage revision (10 pre-COVID-19 and 13 during COVID-19), and 30% underwent a DAIR procedure (6 pre-COVID-19 and 8 during COVID-19). There was a significant increase in shoulder PJI infections between the pre-COVID-19 time interval and during COVID-19, with PJI incidence rates of 1.1% and 2.1%, respectively (p = .028). There was no significant difference in any outcome scores, microbes on aspiration, inflammatory markers, or duration of treatment between the two time intervals. ConclusionWhile this study does not show clear evidence to an underlying mechanism explaining the increased PJI incidence observed during the COVID-19 pandemic, this study does show a significant increase in the rate of shoulder PJI status post shoulder arthroplasty during COVID-19. Further investigation into how the vaccine and COVID-19 infection may affect the body’s immune system may provide insight into this increase.

Impact of perioperative high-protein nutritional support on the quality of life of patients with primary lung cancer: a Russian prospective multicenter comparative study (NUTRILUNC study)

BACKGROUND: Individuals over the age of 70 comprise over half of operable patients with stage 0–IIIA lung cancer. In the early postoperative period of this cohort, pain, fatigue, insomnia, and/or mood disturbances are the four most common symptoms, which can significantly diminish quality of life and functional status. Perioperative nutritional support in such patients, which enhances exercise tolerance, can have a positive impact on their quality of life and socialization. AIM: To assess the effect of perioperative nutritional support using high-protein oral nutrition supplements on the general health and quality of life of non-small cell lung cancer patients during the postoperative period. MATERIALS AND METHODS: Patients with primary non-small cell lung cancer (n=112, 69 males), aged 57.2±8.2, who were awaiting lung surgery and at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomly assigned into two groups. Oral nutritional support (Nutridrink Compact Protein, Nutricia LLC) was administered to the study group (n=55) at a rate of 250 ml/d (36 g of protein, 612 kcal) for 14 days prior to and 14 days following the surgery, in addition to the standard diet. Control group patients (n=57) were provided a standard diet. The quality of life was assessed using the Quality of Life Questionnaire Core-30. Results are presented as mean ± standard deviation. Differences were considered significant at p ≤0.05. RESULTS: Throughout the entire observation period, the study group exhibited superior growth indicators in terms of general health status, physical, and role functioning than the control group (p 0.05). The study group patients exhibited a propensity toward improved emotional functioning, and by the end of the study, weakness and insomnia were less pronounced (p 0.05). Other indicators did not exhibit any significant variations. CONCLUSION: Нigh-protein perioperative oral nutrition supplements exert a positive impact on the quality of life of non-small cell lung cancer patients.

Attitude of Healthcare Providers Towards Care of People with Disabilities, in Hail Region, Saudi Arabia.

Disability, whether congenital or acquired, poses significant challenges that affect individuals' physical, mental, psychological, and social functioning. This study aimed to examine the attitudes of healthcare providers in Hai'l City towards people with disabilities. A cross-sectional design was used, involving 321healthcare providers from the Hai'l region, employing the Scale of Attitudes towards Disabled Persons (SADP) for data collection. The data were collected through an online survey and analyzed using SPSS 26. The results indicated a generally positive attitude of healthcare providers towards people with disabilities, with mean scores exceeding 89 across various groups. Older providers (over 35 years old) exhibited the highest positivity rate (92.57), although differences in age, sex, educational level, years of experience, and professional role were not statistically significant. Master's degree holders had the highest average score (93.52), but the differences remained statistically insignificant. The study concludes that while healthcare providers generally have positive attitudes towards people with disabilities, there is a critical need for comprehensive training programs to enhance the quality of care provided. Future research should extend to other regions and employ qualitative methods to gain deeper insights into healthcare providers' attitudes toward and experiences with people with disabilities.

Blackcurrant Supplementation and Habitual Physical Activity Enhance Functional Capacity and Quality of Life in Previously Sedentary Older Women.

Loss of functional capacity negatively impacts the quality of life in older adults. This single-site randomized controlled study examined whether short- (one week) and long-term (three months) blackcurrant supplementations combined with habitual physical activity would improve functional capacity and quality of life in previously sedentary older women. Thirty sedentary, healthy older women were randomly assigned to receive blackcurrant supplementation (400 mg of blackcurrant extract) (Polyphenol group, n=15; 74.2±10.0 years) or no supplementation (capsules of 400 mg of corn flour) (Placebo group, n=15; 72.8±8.7 years). Each group consumed two capsules daily for one week and three months, with a washout period of one week between the two phases. The polyphenol group was required to increase habitual activity levels. Participants underwent a functional capacity assessment consisting of a sixminute walk, sit-to-stand test, Berg balance scale measurement and quality of life evaluation with the Scale of Life Satisfaction Index (LSI) at the start, after one week, and after three months of supplementation. Walking distance and time to sit-to-stand improved by 2.5% (p=0.005) and 7.5% (p=0.005), respectively, after one week in the polyphenol group. After 3 months, walking distance in the six-minute walk test increased by 12.3% (p=0.001) while the time to sit-to-stand decreased by 16% (p=0.002) in the polyphenol compared to placebo group, respectively. No differences in Berg balance scale were observed. Quality of life, indexed by LSI, improved by 39% (p=0.001) in the polyphenol compared to the placebo group. Blackcurrant supplementation, combined with habitual activity, may enhance functional capacity and quality of life in older women, offering a potential strategy to maintain independence. However, future studies should address longer durations to validate these findings.

Examining the health effects of public transport use on older adults: A systematic review

Background and aimPublic transport use has been linked to several health benefits in the general population and is crucial for older adults’ mobility, due to an age-related decline in physical and cognitive capacity and mobility, particularly the ability to use other modes of transport. The objective of this systematic review is to determine what is known about the physical and mental health outcomes of public transport use of older adults and to identify remaining gaps in the literature. MethodsFive electronic databases were searched in April 2023, and then updated in January 2024: Pubmed, Scopus, Web of Science, Ageline and Transport Research International Documentation (TRID). Included were studies that were in English, contained a measure of public transport use as exposure, and any health outcome, including mental or physical health, physical or cognitive function, morbidity, or mortality, among people aged ≥60 years. ResultsOf a total of 2247 unique records that were screened, the full text of 20 was assessed for eligibility and 11 were identified as eligible. Citation search identified two additional studies, amounting to a total of 13 included studies. Significant health outcomes described in assessed studies were decreased obesity and depressive symptoms, and to a lesser extent increased gait speed and cognitive function. ConclusionsInitial evidence suggests a positive impact of public transport use on obesity, depressive symptoms, gait and cognitive function, although available research was limited in context and methodology. Further research should focus on determining causality between public transport use and health, and be conducted in more diverse contexts. Transport and urban planners, as well as policymakers, should consider the implications of public transport on the health and independence of older adults.

A Randomized Controlled Trial of Gamification to Increase Physical Activity Among Black and Hispanic Breast and Prostate Cancer Survivors: Rationale and Design of the ALLSTAR Clinical Trial

Survivors of breast and prostate cancer, especially those that are Black and/or Hispanic, are at high risk for cardiovascular events. Physical activity can reduce the risk of cardiovascular events in cancer survivors, but Black and Hispanic people are less likely to engage in routine physical activity. Concepts from behavioral economics have been used to design scalable, low-touch, gamification interventions that increase physical activity in individuals at high risk for cardiovascular events, but the effectiveness of these strategies in Black and Hispanic survivors of breast and prostate cancer is uncertain. ALLSTAR (NCT05176756) is a pragmatic, virtual, randomized controlled trial designed to evaluate the effectiveness of a gamification intervention informed by behavioral economic concepts to increase daily physical activity in Black and Hispanic breast and prostate cancer survivors who received cardiotoxic therapies and have additional risk factors for cardiovascular disease. Patients were either referred by their cancer care team or identified by electronic health record searches; contacted by letter, email, text message and/or phone; and complete enrollment and informed consent on the Penn Way to Health online platform. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 1500-3000 steps from baseline, and are randomized 1:1 to control or gamification. Interventions continue for 6 months, with follow-up for an additional 3 months to evaluate the durability of behavior change. The trial has met its enrollment goal of 150 participants, with a primary endpoint of change from baseline in daily steps over the 6-month intervention period. Key secondary endpoints include change from baseline in daily steps over the 3-month post-intervention follow-up period, change in moderate to vigorous physical activity over the intervention and follow-up periods, and change in patient-reported measures of physical function, fatigue, and overall quality of life. ALLSTAR is a virtual, pragmatic randomized clinical trial powered to demonstrate whether gamification is superior to control in increasing physical activity in Black and Hispanic breast and prostate cancer survivors. Its results will have important implications for strategies to promote physical activity in survivors of breast and prostate cancer, specifically among minority populations. clinicaltrials.gov; https://clinicaltrials.gov/study/NCT05176756.

Use of Patient-Reported Outcomes in Risk Prediction Model Development to Support Cancer Care Delivery: A Scoping Review.

The integration of patient-reported outcomes (PROs) into electronic health records (EHRs) has enabled systematic collection of symptom data to manage post-treatment symptoms. The use and integration of PRO data into routine care are associated with overall treatment success, adherence, and satisfaction. Clinical trials have demonstrated the prognostic value of PROs including physical function and global health status in predicting survival. It is unknown to what extent routinely collected PRO data are used in the development of risk prediction models (RPMs) in oncology care. The objective of the scoping review is to assess how PROs are used to train risk RPMs to predict patient outcomes in oncology care. Using the scoping review methodology outlined in the Joanna Briggs Institute Manual for Evidence Synthesis, we searched four databases (MEDLINE, CINAHL, Embase, and Web of Science) to locate peer-reviewed oncology articles that used PROs as predictors to train models. Study characteristics including settings, clinical outcomes, and model training, testing, validation, and performance data were extracted for analyses. Of the 1,254 studies identified, 18 met inclusion criteria. Most studies performed retrospective analyses of prospectively collected PRO data to build prediction models. Post-treatment survival was the most common outcome predicted. Discriminative performance of models trained using PROs was better than models trained without PROs. Most studies did not report model calibration. Systematic collection of PROs in routine practice provides an opportunity to use patient-reported data to develop RPMs. Model performance improves when PROs are used in combination with other comprehensive data sources.

Predictive ability of the Cancer and Aging Research Group chemotherapy toxicity calculator in hematologic malignancy

IntroductionChemotherapy toxicity tools are rarely studied in patients with hematologic malignancy (HM). The primary aim of this pilot study was to determine the predictive ability of the Cancer and Aging Research Group (CARG) chemo-toxicity calculator in estimating grade 3–5 toxicity in patients with HM. Materials and MethodsPatients 60 years and older with HM were prospectively evaluated using the CARG chemo-toxicity calculator. Discrimination and calibration were checked by applying the published model in our data. Additionally, a full geriatric assessment (GA), the Short Physical Performance Battery (SPPB), and health related quality of life (HRQoL) were captured longitudinally at the start of treatment and at end of study. Secondary aims explored the association of GA metrics with chemo-related toxicities and survival. ResultsOne hundred forty-five patients were approached, 118 patients consented, and 97 patients were evaluable. Most patients were newly diagnosed (n = 91). The median CARG score was 9 (range 4–18). The CARG score was not validated in our cohort of older patients with HM, with area under the receiver operation characteristic curve being 0.53 (95 % CI: 0.41–0.65). In multivariable analysis, after controlling for disease type, risk factors associated with grade 3–5 toxicity included living alone (hazard ratio [HR] 4.24, 95 %CI: 2.07–8.68, p < 0.001), increase in body mass index (HR 1.06, 95 %CI: 1.01–1.12, p = 0.03) and a higher social activities score (HR 1.27, 95 %CI: 1.06–1.51, p = 0.01). In multivariable analysis of overall survival, the only prognostic factor was an objective marker of physical function (SPPB score HR = 0.85, 95 %CI:0.78–0.93, p < 0.001). DiscussionThe CARG chemo-toxicity calculator was not predictive of grade 3–5 toxicity in patients with hematologic malignancy. The SPPB was associated with overall survival in multivariable analysis, suggesting future use as an objective biomarker in HM. We also report a comprehensive trajectory of function, QoL, psychosocial well-being, and cognition among older adults with HM. The predictive accuracy of the CARG chemo-toxicity calculator may be affected by the diverse range of HM treatment options that are not traditional chemotherapy.

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Comparing Pain Outcomes and Treatment Adherence Between In-Person and Virtual Interdisciplinary Pain Rehabilitation Programs at the San Francisco VA Health Care System.

This study compares clinical pain outcomes between patients in a pain treatment program that was conducted in-person, compared to a virtual program. In-Person (N=127) and Virtual (N=101) pain treatment programs were compared based on patient-reported, practitioner-collected, and medical record data. The patients were measured at baseline and post treatment (week 12 for In-Person and week 8 for Virtual patients). We employed last observation carried forward (LOCF) to handle missing data. Both the In-Person and Virtual groups were similar in regard to all baseline outcomes, except the In-Person group having significantly more co-morbidities at baseline, with particularly more cases of mental, behavioral, or neurodevelopmental diseases. Both groups demonstrated significant improvements in the pain-related measurements of pain interference and pain catastrophizing thoughts, but neither group displayed a change in average pain across treatment. Further, both groups improved significantly on emotional well-being scores, but not on physical functioning scores. No significant differences existed between groups on outcomes, except for pain catastrophizing, which was higher in the Virtual group at both time points. The Virtual group had lower rates of dropouts compared to In-Person, while the In-Person group had a larger proportion reach a clinically meaningful change in pain-related outcomes, defined as a >30% improvement. While some changes were unique to the In-Person program, overall, patients in the Virtual program achieved similar treatment outcomes, suggesting that it can successfully treat Veterans seeking pain management, with less need for in-person facilities for both patients and clinicians.

The future of physiological research: A greater understanding of female master athletes and aging?

High caliber master athletes provide a valuable model for studying inherent physiological aging and performance capacity, without the confounding factor of physical inactivity. Despite the remarkable achievements of female master athletes, their participation rates remain significantly lower than those of their male counterparts, particularly at more advanced ages. This review examines the biological sex gap in sports participation among master athletes and the subsequent disparity in empirical research, thereafter exploring possible contributing factors. It highlights the importance of studying female master athletes to better understand the aging process and offers recommendations to address current evidence gaps. The need for more comprehensive mechanistic data on highly trained older women, novel cataloguing and analysis of real-world datasets, case studies/series, and longitudinal research are also emphasized. Although analyzing the records of female master athletes as a surrogate to determine age-related physiological and performance changes is a common approach, the process may be hindered by the considerably lower participation rates of women. Therefore, an important step toward bridging these gaps is the longitudinal, integrative study of female athletes engaged in lifelong exercise. Such analyses would improve our understanding of senescence in women and may inform interventions targeting the promotion of physical function in older adults.

Effect of a home-based exercise program on subsequent falls among community-dwelling older adults with cognitive frailty: A sub-group analysis of a randomized controlled trial

ObjectivesCognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment and is associated with increased risk of falls. Exercise is an evidence-based strategy to prevent falls, but whether exercise reduces falls in people with cognitive frailty is unknown. We examined the effects of home-based exercise on subsequent falls among community-dwelling older adults with cognitive frailty who have previously fallen. Study designA sub-group analysis of a 12-month, single-blind, randomized controlled trial among 344 adults aged 70 years or more who had fallen within the past 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or usual care (n = 172). In this sub-analysis, we included 192 participants with cognitive frailty (home-based exercise = 93; usual care = 99) with Short Physical Performance Battery scores ≤9/12 and Montreal Cognitive Assessment scores <26/30. Main outcome measuresOur primary analysis examined the effect of exercise on self-reported falls rate over 12 months. Secondary analyses investigated the intervention's effects on scores on the Short Physical Performance Battery and the Montreal Cognitive Assessment. We also explored whether greater than or equal to mean average monthly adherence (i.e., ≥45.5 %) moderated treatment effects. ResultsAt 12 months, falls rates were 35 % lower in the home-based exercise group compared with the usual care group (IRR = 0.65; p = 0.042). Score on the Short Physical Performance Battery significantly improved among home-based exercise participants with greater than or equal to mean adherence vs. those with less than mean adherence (estimated mean difference: 0.94; p = 0.022). ConclusionsExercise is a promising strategy for reducing subsequent falls in people with cognitive frailty. Greater exercise adherence improved physical function in this population.ClinicalTrials.gov identifier: NCT01029171