Anthony B. Crum

Examination of the PROMIS upper extremity item bank

STUDY DESIGN Clinical measurement. INTRODUCTION The psychometric properties of the PROMIS v1.2 UE item bank were tested on various samples prior to its release, but have not been fully evaluated among the orthopaedic population. PURPOSE OF THE STUDY This study assesses the performance of the UE item bank within the UE orthopaedic patient population. METHODS The UE item bank was administered to 1197 adult patients presenting to a tertiary orthopaedic clinic specializing in hand and UE conditions and was examined using traditional statistics and Rasch analysis. RESULTS The UE item bank fits a unidimensional model (outfit MNSQ range from 0.64 to 1.70) and has adequate reliabilities (person = 0.84; item = 0.82) and local independence (item residual correlations range from -0.37 to 0.34). Only one item exhibits gender differential item functioning. Most items target low levels of function. DISCUSSION The UE item bank is a useful clinical assessment tool. Additional items covering higher functions are needed to enhance validity. CONCLUSIONS Supplemental testing is recommended for patients at higher levels of function until more high function UE items are developed. LEVEL OF EVIDENCE 2c.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

The relationship between family support; pain and depression in elderly with arthritis

Abstract The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

The Association Between Perceived Health Status and Health Information Communication Channels

Varying types of health information sources may influence health outcomes, but not much is known about their impact. The purpose of our study was to explore the association between health information sources and individuals’ health status. A total of 14,966 participants who responded to the Annenberg National Health Communication Survey between 2005 and 2012 were included. Controlling for demographics, comorbidities, communication patterns, and socioeconomic status, we utilized regression analysis to examine the relationship between sources of health information and perceived health status. Included in the study were a total of 8,103 females and 6,863 males between 18 and 101 years old (M = 49.14, SD = 16.13). Health information from the Internet and pharmaceutical companies was significantly associated with better health status (p < .05), whereas information from social media, health care apps, news outlets, and health care companies was not. Information from the Internet was significantly associated with better health status, suggesting that health information from the Internet may have benefits. However, use of social media and health care apps did not relate to better health status, which may indicate that these sources are not as useful to consumers or that these sources have not yet saturated the health information marketplace.

Dietary and Supplemental Vitamin C and D on Symptom Severity and Physical Function in Knee Osteoarthritis

ABSTRACT Vitamins C and D have been associated with decreasing pain and increasing function but these associations are not definitive. This cross-sectional study explores what relationships supplemental and dietary intake of vitamins C and D have on pain severity and physical function in patients with knee osteoarthritis. Using data from the Osteoarthritis Initiative, we performed regression analyses to examine relationships between vitamins C and D, pain, and function. Dietary vitamin D and dietary vitamin C were divided into >90th, 50th–90th, and <50th percentile. The high percentile group for supplemental vitamin D was divided into >85th percentile, whereas the high percentile group for supplemental vitamin C was divided into >90th percentile. We found the 90th/85th percentile levels of dietary and supplemental vitamin D to be positively associated with pain (β = 0.180; p = 0.028) and inversely related to physical function (β = −0.150, p = 0.028), respectively. Daily intake of vitamin C showed no statistical significance. We found that supplementary vitamin D was strongly associated with lessened disability for knee OA patients. The unexpected finding that associated dietary vitamin D with greater knee pain merits further study.

Are illicit drug users more likely to receive mental health treatment

Abstract Aims: The relationship between using illicit substances and seeking out mental health treatments has not been well studied. This study aimed to explore the relationship and identification of drug usage patterns related to the highest frequency of receiving mental health care. Methods: Data were obtained from the National Survey on Drug Use and Health from 2004 to 2013. Subjects were grouped according to their drug use. We examined whether there were differences between undergoing various mental health treatment and drug usage. Findings: A total of 322,869 adults were included in the study. Using a combination of analgesics and cocaine had the highest utilisation of inpatient treatment (2.9%). Using hallucinogens and cocaine showed the highest utilisation of outpatient treatment (13.3%). Those who used marijuana, hallucinogens and cocaine were most likely prescribed medicine for treatment (13.9%). There was a significant difference between drug users and non-users in all forms of mental health treatment (p < 0.05). Age, gender, marital status, education and race were all significant in the regression analyses (p < 0.05). Conclusions: Drug use was significantly related to receiving mental health treatment and showed a significant difference when compared to non-users, but the impact of issues such as age, gender, marital status, education and race should also be considered.