Kelli L. Dominick

Health-related quality of life among older adults with arthritis

BackgroundHealth-related quality of life (HRQOL) is a key outcome in arthritis, but few population-based studies have examined the relationship of specific arthritic conditions, such as osteoarthritis (OA) and rheumatoid arthritis (RA) with HRQOL.MethodsOlder adults in Pennsylvania completed a mail version of the Centers for Disease Control and Prevention (CDC) HRQOL modules. Medicare data were used to identify subjects with OA, RA, and no arthritis diagnosis. We compared HRQOL responses among these groups, and we also examined relationships of demographic characteristics to HRQOL among subjects with arthritis.ResultsIn analyses controlling for demographic characteristics and comorbidity, subjects with OA and RA had poorer scores than those without arthritis on all HRQOL items, including general health, physical health, mental health, activity limitation, pain, sleep, and feeling healthy and full of energy. HRQOL scores were also lower for those with RA compared to OA. Among individuals with arthritis, all subject characteristics (including age, race, sex, nursing home residence, marital status, income, and comorbid illnesses) were significantly related to at least one HRQOL item. Older age, nursing home residence, and greater comorbidity were the most consistently associated with poorer HRQOL.ConclusionsResults of this study show that both OA and RA have a significant impact on multiple dimensions of HRQOL among older adults. Results also suggest the CDC HRQOL items are suitable for use among older adults and in mail surveys. Due to the rising number of older adults in many countries, the public health burden of arthritis is expected to increase dramatically. Efforts are needed to enhance access to medical care and disseminate self-management interventions for arthritis.

Racial variations in self-reported osteoarthritis symptom severity among veterans

Background and aims: This study aimed at examining factors related to osteoarthritis (OA) symptom severity in African American and Caucasian veterans (n=202). Methods: OA symptom severity (lower extremity pain, stiffness, and physical function) was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We also examined whether racial differences existed when controlling for other important demographic and clinical variables, including age, gender, income, educational level, employment status, marital status, number of years with OA symptoms, location of arthritic joints (hip, knee, back, foot/ankle), use of exercise, and current use of OA medications. Lastly, we examined whether factors associated with self-reported OA symptom severity differed in African American and Caucasian veterans. Results: The mean WOMAC score for AfricanAmerican veterans (on a scale of 0–96) was 54.6 (SD=17.2), and the mean score for Caucasian veterans was 48.4 (SD=17.6; p=0.02). In a multivariable regression model including demographic and clinical variables, African American veterans had significantly higher WOMAC scores than Caucasians (β=0.185, p=0.009). In Caucasian veterans, greater number of years with OA, presence of hip OA, and a low income were associated with greater WOMAC scores. In African Americans, no use of exercise and the presence of OA in the hip or back were associated with greater WOMAC scores. Conclusions: Among this sample of veterans, African Americans had significantly higher WOMAC scores than Caucasians after controlling for other important demographic and clinical factors. Different and more intense treatment strategies may be needed for African American veterans with OA.

Provider characteristics and mammography recommendation among women in their 40s and 50s

OBJECTIVES Healthcare provider recommendation for mammography is one of the strongest predictors of womens mammography use, but few studies have examined the association of provider characteristics with mammography recommendations. We examined the relationship of provider gender, age, medical specialty, and duration of relationship with the patient to report mammography recommendation. METHODS Participants were women ages 40-45 and 50-55 who were part of a larger intervention study of decision making about mammography. We examined the relationship of provider characteristics to patient-reported mammography recommendations at baseline and at 24-month follow-up. RESULTS At baseline, 74% of women in their 40s and 79% of women in their 50s reported provider mammography recommendations within the prior 2 years. Proportions were similar at the 24-month follow-up. In multivariate logistic regression models including both patient and provider characteristics, women in their 40s who had female providers were more likely to report mammography recommendations than those with male providers at baseline (OR=1.83, p=0.01) and follow-up (OR=1.74, p=0.03). Among women in their 50s, participants whose regular providers were primary care physicians were more likely to report recommendations at baseline than those whose regular providers were obstetrician/gynecologists (OR=1.68, p=0.03). CONCLUSIONS About one fourth of women in this study reported not having been advised by a healthcare provider to have a mammogram. All women in the study had health insurance. Among women in their 40s, for whom mammography guidelines were controversial at the time of data collection, provider gender was an important predictor of patient-reported mammography recommendation.

Use of non-pharmacological therapies among patients with osteoarthritis

Background and aims: Non-pharmacological therapies are an important component of treatment for osteoarthritis (OA), but they may be under-used. This study examined the prevalence of self-reported use of common non-pharmacological therapies, as well as patient and physician-related predictors of use. Methods: Subjects included 205 veterans who completed a survey regarding OA symptoms and treatments. Analyses examined the prevalence of use of three specific non-pharmacological therapies: exercise, physical therapy (PT), and dietary/herbal supplements. We also examined whether patient variables (demographics, clinical characteristics, and perceived helpfulness of non-pharmacological therapies) and physician characteristics (age, gender, race, and recommendation of non-pharmacological therapies) were associated with use of each therapy. Results: Forty-six percent of subjects reported current use of exercise, 11% reported using PT, and 12%, dietary/herbal supplements. Patient demographic and clinical characteristics were generally poor predictors of use of non-pharmacological therapy. However, females were more likely to report exercising than males (p<0.05), and patients with greater disease severity were more likely to report current use of PT (p<0.001). Patients’ perceived helpfulness of each therapy significantly predicted use (p<0.05). Physician demographic characteristics were not strong predictors of patients’ use of therapy, but physician recommendation for exercise and PT predicted patients’ use (p≤0.05). Conclusions: Among this sample of veterans with OA, there was relatively low use of exercise, PT, and dietary/herbal supplements. Patients’ perceptions of treatment helpfulness and physician recommendations strongly predicted use. These results signal the importance of interventions aimed at educating both patients and physicians about these therapies.

Predicting peak oxygen uptake among older patients with chronic illness.

PURPOSE To compare three equations developed to predict VO2 among patients diagnosed with one of two chronic diseases: essential hypertension (HTN), and fibromyalgia (FM). The equations included the American College of Sports Medicine (ACSM) equation, the FAST equation developed from the Fitness and Arthritis in Seniors Trial (FAST), and an equation developed by Foster et al. METHODS One hundred twenty-two HTN subjects and 68 FM subjects completed a maximum exercise test according to the Duke/Wake Forest protocol. Measured peak VO2 was then compared with the VO2 predicted by the ACSM, FAST and FOSTER equations, using several statistical methods. RESULTS The ACSM equation overpredicted peak VO2 in the HTN group by 10.0 +/- 4.0 mL/kg-1/min-1, and in the FM group by 8.6 +/- 4.9 mL/kg-1/min-1 (P < 0.0001). The FAST equation, however, underestimated peak VO2 by 1.5 +/- 4.2 mL/kg-1/min-1 (P < 0.01) and 1.0 +/- 3.3 mL/kg-1/min-1 (P < 0.0001) in the HTN and FM groups, respectively. The FOSTER equation overestimated peak VO2 by 2.3 +/- 3.6 mL/kg-1/min-1 in the HTN group and by 2.1 +/- 3.5 mL/kg-1/min-1 in the FM group (P < 0.0001). A large degree of variability was found for each of the equations. CONCLUSION Results of this investigation indicate that all three equations produced peak VO2 values that were statistically different from measured values. Although the ACSM equation overestimated VO2 by more than 2 metabolic equivalents (METs) in each patient group, both the FAST and FOSTER equations produced differences that were less than 1 MET. Further research is needed to examine the FAST and FOSTER equations among other patient populations and with other exercise protocols.

Nonsteroidal Antiinflammatory Drug Use among Patients with GI Bleeding

BACKGROUND: Previous studies have suggested that recommended gastroprotective strategies such as gastroprotective agents (GPAs) and cyclooxygenase (COX) 2 inhibitors may be underutilized among individuals at risk for nonsteroidal antiinflammatory drug (NSAID)-related gastrointestinal (GI) bleeding. OBJECTIVE: To examine the use of traditional NSAIDs, COX-2 inhibitors, and GPAs among patients recently hospitalized for GI bleeding. METHODS: This was a retrospective cohort study of a national sample of 4338 veterans hospitalized for GI bleeding between January and June 1999. Prescription drug use was examined for 6 months following hospitalization. We examined relationships of subject characteristics (age, race, gender, geographic region, diagnosis of arthritis) to prescription of a high-risk NSAID, defined as a traditional NSAID but no GPA within 60 days before or after the NSAID. RESULTS: Approximately 20% of subjects were prescribed an NSAID or COX-2 inhibitor, but only 5% were prescribed a traditional NSAID with no GPA. In a multivariable analysis, subjects <65 years of age and those with arthritis were more likely to be prescribed a traditional NSAID without a GPA. No other subject characteristics were related to receipt of a high-risk prescription. CONCLUSIONS: In a national sample of veterans with a recent hospitalization for GI bleeding, high-risk NSAID prescriptions were uncommon. Underuse of gastroprotective strategies may be more common in patients with less recent GI bleeding—related hospitalization. Strategies to remind physicians and pharmacists to screen for GI risk factors may help to sustain appropriate prescribing and reduce NSAID-related adverse events.