Significant Predictor Of Change Research Articles

Does Smoking Affect Short-Term Patient-Reported Outcomes After Lumbar Decompression?

Study Design:Retrospective cohort study.Objective:The goal of this study was to determine how smoking status influences patient-reported outcome measurements (PROMs) in patients undergoing lumbar decompression surgery.Methods:Patients undergoing lumbar decompression between 1 to 3 levels at a single-center, academic hospital were retrospectively identified. Patients <18 years old, and those undergoing surgery for infection, trauma, tumor, or revision, with less than 12 months of follow-up were excluded. Patients were divided into 3 groups: (1) never smokers (NSs); (2) current smokers (CSs); and (3) former smokers (FSs). PROMs analyzed included the Physical Component Score and Mental Component Score of the Short Form-12 Health Survey, the Oswestry Disability Index, and Visual Analogue Scale Back and Leg pain scores. One-way ANOVA was used to compare preoperative and postoperative scores between smoking groups, and multiple linear regression analysis was performed to determine whether smoking status predicted change in each outcome score, controlling for factors such as age, sex, body mass index, and other clinical variables. A P value <.05 was considered to be significant.Results:A total of 195 patients were included in the final cohort, with 121 (62.1%) patients in the NS group, 22 (11.3%) in the CS group, and 52 (26.6%) in the FS group. There were no significant differences between groups at baseline or postoperatively. Smoking status was also not a significant predictor of change in any outcome scores over time on multivariate analysis.Conclusion:These results suggest that smoking status does not significantly affect short-term complications or outcomes in patients undergoing lumbar decompression surgery.

The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort

ABSTRACT Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.

BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery.

This is a retrospective comparative review. The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery. Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes. Records from a single-center, academic hospital were used to identify patients undergoing 1 to 3-level lumbar decompression surgery. Patients under 18 years of age, those undergoing surgery for infection, trauma, tumor, or revision, and those with <1-year follow-up were excluded. Patients were split into groups based on preoperative BMI: class I: BMI <25.0 kg/m; class II: BMI 25.0-29.9 kg/m; class III: BMI 30.0-34.9 kg/m; and class IV: BMI >35.0 kg/m. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed. A total of 195 patients were included with 34 (17.4%) patients in group I, 80 (41.0%) in group II, 49 (25.1%) in group III, and 32 (16.5%) in group IV. Average age was 60.0 (58.0, 62.0) years and average follow-up was 13.0 (12.6, 13.4) months. All patients improved significantly within each group, except for class III and class IV patients, who did not demonstrate significant improvements in terms of Mental Component Score (MCS-12) scores (P=0.546 and 0.702, respectively). There were no significant differences between BMI groups for baseline or postoperative PROM values, recovery ratio, or the percent of patients reaching minimum clinically important difference. Multiple linear regression analysis revealed that BMI was not a significant predictor for change in outcomes for any measure. The 30-day readmission rate was 6.2% and overall revision rate at final follow-up was 5.1%, with no significant differences between groups. This study's results suggest that BMI may not significantly affect complications or patient outcomes at 1-year in those undergoing lumbar decompression surgery. Level III.

The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

BackgroundShockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT.MethodsA comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects.ResultsSixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes.ConclusionsSWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.

The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study

We previously reported inpatient and 30-day postoperative patient-reported outcomes (PROs) of a controlled, noncrossover pilot study using preoperative mindfulness-based stress reduction (MBSR) training for lumbar spine surgery. Our goal here was to assess 3-month and 12-month postoperative PROs of preoperative MBSR in lumbar spine surgery for degenerative disease. Intervention group participants were prospectively enrolled in a preoperative online MBSR course. A comparison standard care only group was one-to-one matched retrospectively by age, sex, surgery type, and prescription opioid use. Three-month and 12-month postoperative PROs for pain, disability, quality of life, and opioid use were compared within and between groups. Regression models were used to assess whether MBSR use predicted outcomes. Twenty-four participants were included in each group. At 3 months, follow-up was 87.5% and 95.8% in the comparison and intervention groups, respectively. In the intervention group, mean Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was significantly higher, whereas mean Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) and Oswestry Disability Index were significantly lower. The change from baseline in mean PROMIS-PF and PROMIS-PI was significantly greater than in the comparison group. At 12 months, follow-up was 58.3% and 83.3% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PI was significantly lower and change in mean PROMIS-PI from baseline was significantly greater. MBSR use was a significant predictor of change in PROMIS-PF at 3 months and in PROMIS-PI at 12 months. No adverse events were reported. Three-month and 12-month results suggest that preoperative MBSR may have pain control benefits in lumbar spine surgery.

Relationship between Beck Hopelessness Scale and suicidal ideation: A short-term longitudinal study

We aimed to clarify if the Beck Hopelessness Scale (BHS) predicted change in suicidal ideation in the general population. This study used a prospective cohort design (4-week survey interval) (N = 3,295). The online survey covered the BHS, suicidal ideation, depression/anxiety tendencies, and demographic details. Hierarchical multiple regression analysis showed hopelessness was a significant predictor of change in suicidal ideation from T1 to T2 (B = 0.07, 95% confidence interval: 0.05–0.09). Although high hopelessness was related to a short-term rise in suicidal ideation, the risk for suicide cannot be judged adequately by hopelessness from a clinical perspective.

Is research-based learning effective? Evidence from a pre–post analysis in the social sciences

ABSTRACT Research-based learning (RBL) is regarded as a panacea when it comes to effective instructional formats in higher education settings. It is said to improve a wide set of research-related skills and is a recommended learning experience for students. However, whether RBL in the social sciences is indeed as effective as has been postulated for other disciplines has not yet been systematically examined. We thus administered a pre–post-test study to N = 952 students enrolled in 70 RBL courses at 10 German universities and examined potential changes in cognitive and affective-motivational research dispositions. Latent change score modelling indicated that students increased their cognitive research dispositions, whereas most affective-motivational research dispositions decreased. The instructors’ interest in the students’ work served as a significant predictor of changes in research interest and joy. Practical implications for designing RBL environments can be inferred from the results.

The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF

Retrospective comparative study. The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology. The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood. Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements using multiple linear regression analysis-controlling for factors such as age, sex, and body mass index, etc. A P-value <0.05 was considered statistically significant. A total of 264 patients were included in the analysis, with an average age of 53 years and mean follow-up of 19.8 months (19.0-20.6). All patients with a diagnosis of depression or anxiety also reported medical treatment for the disease. The group with no depression or anxiety had significantly less baseline disability than the group with 2 mental health diagnoses, in MCS-12 (P=0.009), NDI (P<0.004), VAS Neck (P=0.003), and VAS Arm (P=0.001) scores. Linear regression analysis demonstrated that increasing occurrence of mental health disorders was not a significant predictor of change over time for any of the outcome measures included in the analysis. Despite more severe preoperative symptoms, patients with a preoperative mental health disorder(s) demonstrated significant improvement in postoperative outcomes after ACDF. No differences were identified in postoperative outcomes between each of the groups. Level III.

How Do Time Use and Social Relationships Affect the Life Satisfaction Trajectory of Korean Adolescents?

This study investigated the life satisfaction trajectory of Korean adolescents, and factors associated with changes in life satisfaction. Specifically, we focused on how changes in time use and social relationships were associated with changes in life satisfaction. Using three waves of the Korean Children and Youth Panel Survey, we conducted a series of multilevel growth curve modeling analyses. The results indicate that Korean adolescents’ life satisfaction decreased over a three-year period, and that time spent on leisure and sleeping were both significant predictors of changes in life satisfaction. Life satisfaction decreased at a slower rate for adolescents whose relationships with peers and teachers positively increased over time. Findings highlight the importance of ensuring adequate amount of sleep and providing various opportunities for leisure activities in improving Korean adolescents’ life satisfaction. Furthermore, social relationships, specifically with teachers and peers should be the focus of prevention and intervention for adolescents to maintain and improve their level of life satisfaction.

Longitudinal change in autonomic symptoms predicts activities of daily living and depression in Parkinson's disease.

The primary objective of this study was to examine the relationship of longitudinal changes in autonomic symptom burden and longitudinal changes in activities of daily living (ADLs); a secondary analysis examined the impact of depressive symptoms in this relationship. Data were retrieved from the Parkinson's Progression Markers Initiative (PPMI), a dataset documenting the natural history of newly diagnosed Parkinson's disease (PD). The analysis focused on data from baseline, visit 6 (24months after enrollment), and visit 12 (60months after enrollment). The impact of longitudinal changes in autonomic symptom burden on longitudinal changes in ADLs function was examined. A secondary mediation analysis was performed to investigate whether longitudinal changes in depressive symptoms mediate the relationship between longitudinal changes in autonomic symptom burden and ADLs function. Changes in autonomic symptom burden, cognitive function, depressive symptoms, and motor function all correlated with ADLs. Only changes in ADLs and depression were found to be associated with changes in autonomic symptom burden. We found that longitudinal change in autonomic symptoms was a significant predictor of change in ADLs at 24 and 60months after enrollment, with the cardiovascular subscore being a major driver of this association. Mediation analysis revealed that the association between autonomic symptoms and ADLs is partially mediated by depressive symptoms. Longitudinal changes in autonomic symptoms impact ADLs function in patients with early signs of PD, both directly and indirectly through their impact on depressive symptoms. Future investigation into the influence of treatment of these symptoms on outcomes in PD is warranted.

Are Outcomes of Anterior Cervical Discectomy and Fusion Influenced by Presurgical Depression Symptoms on the Mental Component Score of the Short Form-12 Survey?

Retrospective comparative study. The purpose of this study was to investigate whether preoperative depressive symptoms, measured by mental component score of the Short Form-12 survey (MCS-12), influence patient-reported outcome measurements (PROMs) following an anterior cervical discectomy and fusion (ACDF) surgery for cervical degeneration. There is a paucity of literature regarding preoperative depression and PROMs following ACDF surgery for cervical degenerative disease. Patients who underwent an ACDF for degenerative cervical pathology were identified. A score of 45.6 on the MCS-12 was used as the threshold for depression symptoms, and patients were divided into two groups based on this value: depression (MCS-12 ≤45.6) and nondepression (MCS-12 >45.6) groups. Outcomes including Neck Disability Index (NDI), physical component score of the Short Form-12 survey (PCS-12), and Visual Analogue Scale Neck (VAS Neck), and Arm (VAS Arm) pain scores were evaluated using independent sample t test, recovery ratios, percentage of patients reaching the minimum clinically important difference, and multiple linear regression - controlling for factors such as age, sex, and BMI. The depression group was found to have significantly worse baseline pain and disability than the nondepression group in NDI (P < 0.001), VAS Neck pain (P < 0.001), and VAS Arm pain (P < 0.001) scores. Postoperatively, both groups improved to a similar amount with surgery based on the recovery ratio analysis. The depression group continued to have worse scores than the nondepression group in NDI (P = 0.010), PCS-12 (P = 0.026), and VAS Arm pain (P = 0.001) scores. Depression was not a significant predictor of change in any PROMs based on regression analysis. Patients who presented with preoperative depression reported more pain and disability symptoms preoperatively and postoperatively; however, both groups achieved similar degrees of improvement. 3.

Is the Neck Disability Index an Appropriate Measure for Changes in Physical Function After Surgery for Cervical Spondylotic Myelopathy?

The Neck Disability Index (NDI) is a 10-item questionnaire about symptoms relevant to cervical spine pathology, originally validated in the physical therapy literature. It is unclear if all of the items apply to spine surgery. The purpose of this study was to determine if improvements in the composite NDI score or specific NDI domains are appropriate measures for tracking changes in physical function after surgical intervention for cervical spondylotic myelopathy (CSM). A retrospective cohort review of patients treated at a major academic medical center was undertaken. Baseline and postoperative standardized outcome measurement scores, including composite NDI, NDI subdomain, and SF-12 physical component score (PCS), were collected. Wilcoxon signed-rank test was used to determine whether patients exhibited improvement in each of the outcome measures included. Multiple linear regression was performed to determine whether change in NDI composite or subdomain scores predicted change in physical function after surgery for CSM-compared with the well-validated PCS score-controlling for factors such as age, sex, etc. Baseline data were collected on 118 patients. All outcome measures exhibited significant improvement after surgery based on the Wilcoxon signed-rank test. On linear regression, work (β = -2.419 [-3.831, -1.006]; P = .001) and recreation (β = -1.354 [-2.640, -0.068]; P = .039), as well as the NDI composite score (β = -0.223 [-0.319, -0.127]; P < .001), were significant predictors of change in physical function over time. Although the NDI composite score did predict change in PCS over time, only 2 of the 10 NDI subdomains were found to be associated with change in physical function over time. Based on these results, the item bank and composite scoring of the NDI are inappropriate for evaluating quality of life in studies of surgically treated cervical spondylotic myelopathy patients. NDI may not be a valid tool in the determination of physical function changes after surgery for CSM. III.

Specific Neuropsychiatric Symptoms Are Associated with Faster Progression in Alzheimer's Disease: Results of the Prospective Dementia Registry (PRODEM-Austria).

Neuropsychiatric symptoms (NPS) occur frequently in the course of Alzheimer's disease (AD) and are suspected to be associated with a faster dementia progression. Numerous reports have defined specific subsyndromes, summarized in clusters of items of the Neuropsychiatric Inventory (NPI). This study investigated the influence of specific NPI subsyndromes and clinical patient characteristics on dementia progression. Data of the prospective registry on dementia in Austria (PRODEM) were retrospectively analyzed. Cognitive functioning was determined at baseline and 2 yearly follow-up visits using the Mini-Mental State Examination (MMSE) and the Consortium to Establish a Registry for Alzheimer's dementia neuropsychological test battery (CERAD). To assess NPS, the NPI was used: NPI items were classified in three subsyndromes (psychotic cluster, behavioral cluster, emotional cluster). Out of the 662 included patients (mean age 76.4±8.4 years), 43% completed follow-up visits for two years. Significant correlation between higher scores in all three subsyndromes and worse cognitive performance were found for MMSE score, naming, and verbal fluency. Results of linear mixed model analysis revealed lower age and higher scores in the psychotic cluster as significant predictors of changes in MMSE with time. In this study, we report the influence of psychotic subsyndromes and lower age on faster MMSE decline in early AD. These results emphasize the importance of not only assessing but also differentiating neuropsychiatric symptoms in subsyndromes in the early stages of AD as a possible predictor of disease progression.

Predictability of 21-Gene Recurrence Score Assay by Using Pathological and Immunohistochemical Parameters in Breast Cancer.

Background:Oncotype Dx is used to predict the long-term recurrence risk in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer (BC). This study aimed at establishing a correlation between clinicopathological parameters and recurrence score (RS), subsequently improving predictability and ultimately justifying the use of the multigene assay.Materials and methods:A retrospective analysis of the pathology and clinical data of 114 female patients with BC who had Oncotype Dx testing between 2012 and 2019. The pathological parameters included are tumor cell type, tumor grade, pathological stage, and mitotic index (MI). The expression of ER, progesterone receptor (PR), HER2, and Ki67 was assessed by immunohistochemistry. A univariate and multivariate linear regression analysis was performed to assess the correlation between these parameters and the RS.Results:In univariate analysis, age (˂40 years), higher tumor grade, and low PR expression were significantly associated with higher RS (P = .02; ˂.001; and ˂.001, respectively). Both MI and Ki67 were also strongly correlated with an increase in the RS with a P value of .01 (Spearman correlation 0.34 and 0.33). In multivariate linear regression analysis, age, MI, and Ki67 lost their significance, but both higher grade and PR remained significantly associated with a higher RS along with the tumor stage (P ˂ .001; ˂.001; and .04, respectively).Conclusions:Tumor grade and PR immunohistochemical expression are the main predictors of RS in our study population. Other clinicopathological features were not significant predictors of change in RS in multivariate analysis.

Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain

BackgroundFoot orthoses and corticosteroid injection are common interventions used for plantar heel pain, however few studies have investigated the variables that predict response to these interventions.MethodsBaseline variables (age, weight, height, body mass index (BMI), sex, education, foot pain, foot function, fear-avoidance beliefs and feelings, foot posture, weightbearing ankle dorsiflexion, plantar fascia thickness, and treatment preference) from a randomised trial in which participants received either foot orthoses or corticosteroid injection were used to predict change in the Foot Health Status Questionnaire foot pain and foot function subscales, and first-step pain measured using a visual analogue scale. Multivariable linear regression models were generated for different dependent variables (i.e. foot pain, foot function and first-step pain), for each intervention (i.e. foot orthoses and corticosteroid injection), and at different timepoints (i.e. weeks 4 and 12).ResultsFor foot orthoses at week 4, greater ankle dorsiflexion with the knee extended predicted reduction in foot pain (adjusted R2 = 0.16, p = 0.034), and lower fear-avoidance beliefs and feelings predicted improvement in foot function (adjusted R2 = 0.43, p = 0.001). At week 12, lower BMI predicted reduction in foot pain (adjusted R2 = 0.33, p < 0.001), improvement in foot function (adjusted R2 = 0.37, p < 0.001) and reduction in first-step pain (adjusted R2 0.19, p = 0.011). For corticosteroid injection at week 4, there were no significant predictors for change in foot pain or foot function. At week 12, less weightbearing hours predicted reduction in foot pain (adjusted R2 = 0.25, p = 0.004) and lower baseline foot pain predicted improvement in foot function (adjusted R2 = 0.38, p < 0.001).ConclusionsPeople with plantar heel pain who use foot orthoses experience reduced foot pain if they have greater ankle dorsiflexion and lower BMI, while they experience improved foot function if they have lower fear-avoidance beliefs and lower BMI. People who receive a corticosteroid injection experience reduced foot pain if they weightbear for fewer hours, while they experience improved foot function if they have less baseline foot pain.

Does Smoking Status Influence Health-Related Quality of Life Outcome Measures in Patients Undergoing ACDF?

Study design:Retrospective comparative study.Objective:Whereas smoking has been shown to affect the fusion rates for patients undergoing an anterior cervical discectomy and fusion (ACDF), the relationship between smoking and health-related quality of life outcome measurements after an ACDF is less clear. The purpose of this study was to evaluate whether smoking negatively affects patient outcomes after an ACDF for cervical degenerative pathology.Methods:Patients with tumor, trauma, infection, and previous cervical spine surgery and those with less than a year of follow-up were excluded. Smoking status was assessed by self-reported smoking history. Patient outcomes, including Neck Disability Index, Short Form 12 Mental Component Score, Short Form 12 Physical Component Score (PCS-12), Visual Analogue Scale (VAS) arm pain, VAS neck pain, and pseudarthrosis rates were evaluated. Outcomes were compared between smoking groups using multiple linear and logistic regression, controlling for age, sex, and body mass index (BMI), among other factors. A P value <.05 was considered significant.Results:A total of 264 patients were included, with a mean follow-up of 19.8 months, age of 53.1 years, and BMI of 29.6 kg/m2. There were 43 current, 69 former, and 152 nonsmokers in the cohort. At baseline, nonsmokers had higher PCS-12 scores than current smokers (P = .010), lower VAS neck pain than current (P = .035) and former (P = .014) smokers, as well as lower VAS arm pain than former smokers (P = .006). Postoperatively, nonsmokers had higher PCS-12 scores than both current (P = .030) and former smokers (P = .035). Smoking status was not a significant predictor of change in patient outcome in multivariate analysis.Conclusions:Whereas nonsmokers had higher function and lower pain than former or current smokers preoperatively, smoking status overall was not found to be an independent predictor of outcome scores after ACDF. This supports the notion that smoking status alone should not deter patients from undergoing ACDF for cervical degenerative pathology.

Longitudinal Investigation of Older Adults' Ability to Self‐Manage Complex Drug Regimens

We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. Longitudinal cohort study funded by the National Institute on Aging. One academic internal medicine clinic and six community health centers. Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18-1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70-2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07-.34; P = .01), and number of baseline dosing errors (β = -.76; 95% CI = -.85 to -.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569-575, 2020.

Predictors of Improved Aerobic Capacity in Individuals With Chronic Stroke Participating in Cycling Interventions

ObjectiveTo determine demographic and physiological factors that predict improvement in aerobic capacity among individuals with chronic stroke participating in cycling interventions. DesignSecondary analysis of data from 2 randomized clinical trials. SettingResearch laboratory. ParticipantsIndividuals with chronic stroke (N=44). InterventionsParticipants were randomized to one of the following interventions: forced aerobic exercise and upper extremity repetitive task practice (FE+UERTP, n=16), voluntary aerobic exercise and upper extremity repetitive task practice (VE+UERTP, n=15), or a nonaerobic control group (control, n=13). All interventions were time-matched and occurred 3 times per week for 8 weeks. Main Outcome MeasureAerobic capacity as measured by peak oxygen consumption per unit time (VO2peak) during maximal cardiopulmonary exercise stress testing. ResultsSignificant improvements in VO2peak were observed from baseline to postintervention in the VE+UERTP group (P<.001). Considerable variability was observed among participants relating to postintervention change in VO2peak. Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, baseline VO2peak, and group allocation were significant predictors of change in VO2peak. ConclusionsHigh exercise rate (cycling cadence) appears to be an important variable in improving aerobic capacity and should be considered when prescribing aerobic exercise for individuals with chronic stroke. Those with low VO2peak at baseline may benefit the most from aerobic interventions as it relates to cardiorespiratory fitness. Further investigation is warranted to understand the precise role of other exercise and demographic variables in the prescription of aerobic exercise for this population and their effects on secondary stroke prevention and mortality.

MENTAL HEALTH POLICY OUTCOMES: AN EXAMINATION OF OLDER ADULTS’ MENTAL HEALTH SERVICE USE, 2002-2012

Objectives: Though several national-level mental health policies have been enacted and implemented over the past decade, older adults’ rates of mental health service (MHS) utilization remain low. We aimed to examine individual- and community-level factors that have fostered the most successful implementations of national mental health policies in recent years. Methods: We conducted a multilevel growth curve analysis to examine older adults’ MHS use using the Medical Expenditure Panel Survey – Household Component, or MEPS-HC. We considered MHS use in the MEPS-HC for the period of 2002-2012, during which members of MEPS Panels 6-17 provided responses. We identified 8,416 respondents aged 65+ with mental health need, and examined the rates of actual MHS utilization among this sample as it varied by insurance status, rural/urban location, and race/ethnicity. Results: Analyses revealed that rates of older adults’ MHS use did not increase significantly over our examination period, regardless of race/ethnicity or rurality of location. Only insurance status was a significant predictor of change in MHS use rates over the years 2002-2012; t=3.93 (19), p<0.001. Conclusions: Findings suggest that rates of MHS use remained stagnant over the decade examined, revealing problems with implementation of relevant policies for older adults. Additionally, our analyses highlighted that although there were no disparities in rates of MHS use by geographic location or race/ethnicity, there may be significant disparities in identified need for services among older adults. We make suggestions for ensuring greater efficiency and efficacy of efforts to improve older adults’ MHS use in the coming decade.

PREDICTORS OF MINIMAL CLINICALLY IMPORTANT DIFFERENCE OF QUALITY OF LIFE AND SEVERITY SCORE POST ATRIAL FIBRILLATION ABLATION

Atrial fibrillation (AF) significantly impairs patients’ quality of life (QOL). We performed this study to investigate the effect of AF ablation success and AF burden (AFB) on change in QOL measures. Overall, 230 patients with paroxysmal AF refractory to anti-arrhythmic drugs were enrolled and underwent ablation in a multicenter, prospective cohort study. Electrocardiogram, 48-hour Holter monitoring, Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF), short-form12 (SF12) health survey, and Atrial Fibrillation Effect on Quality of life (AFEQT) scales were used to assess patients at 3, 6, 9 and 12-months post-ablation. AFB was defined as the total duration of AF during the month prior to each visit (hours/month). The change in AFB was calculated as the difference in AFB between the month prior to the 12-month post-ablation and the baseline pre-ablation visits. The Minimal Clinically Important Difference (MCID) was considered as a 19-point change for AFEQT and 3 to 5-point change for MCS and PCS scores. A total of 217 patients were followed for 12 months post-procedure. During the12-months post-ablation, freedom from any atrial tachyarrhythmia >30 seconds was 41.7%. Mean AFB at 12-months post ablation was 20.1±123.1 hours/month. In univariate regression analysis, baseline scores were significant predictors of change in QOL and severity score measures. Female gender was a significant predictor of change in AFEQT score, which predicted an increase of ΔAFEQT by 8.9 points. During 12-months of follow-up, complications predicted an increase in the CCS-SAF score by 1.2 points (P=0.003), redo-ablation significantly predicted a decrease in PCS score by 6.04 points (p=0.01), and cardioversion significantly predicted a decrease the AFEQT score by 9.6 points (p=0.009). Recurrence was a significant predictor of change in QOL and severity scores, which could predict and increase of 0.8 (P < 0.001) and decrease of 9.4 (P=0.008) and 4.8 (P=0.003) points in CCS-SAF, AFEQT and PCS, respectively. AFB < 24 hours/month at 12 months post-ablation significantly predicted a decrease in CCS-SAF by 1.9 (P < 0.001) points and increase in AFEQT and PSC scores by 19.5 (P < 0.001) and 5.5 (P=0.03) points respectively. Moreover, AFB < 24 hours/month at 12-months post-ablation was associated with significant changes in QOL and severity scale measures even when adjusting for baseline scores and other covariates in multivariate regression analysis, which were consistent with the MCID scores. (Table1) AFB less than 24 hours/month at 12-months post-procedure significantly improves QOL scores regardless of AF recurrence, to a degree consistent with the MCID of each QOL measure.