Sheri L. Pohar

The burden of multiple sclerosis: A community health survey

BackgroundHealth-related quality of life (HRQL) in persons with multiple sclerosis (MS) who reside within the community relative to the general population is largely unknown. Data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) were used to compare HRQL of persons with MS and the general population.MethodsA representative sample of adults (18 years or older) from the cross sectional population health survey, CCHS 1.1, was examined to compare scores on the Health Utilities Index Mark 3 (HUI3), a generic preference-based HRQL measure, of respondents with (n = 302) and without (n = 109,741) MS. Selected sociodemographic covariates were adjusted for in ANCOVA models. Normalized sampling weights and bootstrap variance estimates were used in the analysis.ResultsThe mean difference in overall HUI3 scores between respondents with and without MS was 0.25 (95% CI: 0.20, 0.31); eight times greater than the clinically important difference. The largest differences in scores were seen with the ambulation (0.26; 95% CI: 0.20, 0.32) and pain attributes (0.14; 95% CI: 0.09, 0.19). Clinically important differences with dexterity and cognition were also observed.ConclusionWhile the proportion of the Canadian population with MS is relatively small in comparison to other diseases, the magnitude of the burden is severe relative to the general population.

Health-Related Quality of Life After Total Joint Arthroplasty A Scoping Review

A scoping review was completed to summarize the change in health status after THA and TKA. Although a recent study has performed a systematic review of functional recovery after THA,(61) we reviewed a broad topic of HRQL changes after total joint arthroplasty. This scoping review was not restricted by study design; however, the majority of studies were prospective single group, observational studies so that change over time could be reported. A variety of HRQL measures were used, including disease-specific, generic, and utility measures. We reported on 33 studies that met our inclusion criteria. Most studies’ primary outcomes were disease-specific measures. Not surprisingly, MCIDs were reported with recovery both short term and long term. These clinically relevant changes were accompanied with large effect sizes for pain and function using disease-specific measures such as the WOMAC. In general, smaller changes were reported with joint stiffness; however, this may also be related to inherent measurement properties of the WOMAC in that it uses two questions to evaluate stiffness. Overall, large effect sizes, in excess of 1.0, were seen not only short term but also long term, that is, more than a year after surgery. The changes may also be reflected in the low rate of complications reported with total joint arthroplasty.(62) The generic health measures showed a smaller magnitude of change, which is to be expected given the construct of these measures evaluate overall health and includes the effect of other health conditions. That being said, the largest changes were seen in those domains that were primary to total joint arthroplasty, pain and physical function. A challenge of evaluating change of health status after total joint arthroplasty is that each measure has individual strengths and limitations. This review introduced the measures and the MCIDs when available to evaluate clinical change. The derived MCIDs should be considered carefully because these values are dependent on a number of features such as the study setting, methodology used to derive the values, baseline scores, and severity of the disease.(63) Change over time was also presented by the effect sizes. The effect size provided another perspective to measuring recovery after total joint arthroplasty in which comparison across measures can be made. Regardless of the type of outcome measure, large effect sizes are seen with total joint arthroplasty both over short-term and long-term outcomes. Because a number of HRQL measures are used to evaluate the outcomes after total joint arthroplasties, comparisons can be challenging. This review summarized published findings to help place the magnitude of change seen with total joint arthroplasty in perspective. Changes seen with HRQL are one aspect of evaluating outcomes from a patient perspective; however, recovery is a complex concept(64) that needs many clinical and research-oriented measures to evaluate the full spectrum of recovery.

The burden of Parkinson disease (PD) and concomitant comorbidities

The impact of PD on health status is substantial, yet the disease burden has not been clearly defined. Using a representative sample of the community-dwelling Canadian population, we examined the burden of PD and the burden of concomitant comorbidities. Health status was compared in 261 respondents with PD from the Canadian Community Health Survey to 111,707 respondents without PD using the Health Utilities Index Mark 3 (HUI3). Differences in HUI3 scores were evaluated and selected sociodemographic covariates adjusted in ANCOVA models. The impact of specific comorbidities on the health status of PD were evaluated using ANCOVA models. Adjusted mean overall HUI3 scores were significantly lower for respondents with PD (0.61 vs. 0.83, p<0.05). The largest differences in single attribute scores were observed for ambulation (-0.11, 95% confidence interval=CI=-0.16 to -0.06), dexterity (-0.11, CI=-0.19 to -0.03), and cognition (-0.10, CI=-0.18 to -0.02). Additional burden was seen when persons with PD also had urinary incontinence (-0.22, CI=-0.40 to -0.05) or arthritis (-0.17, CI=-0.30 to -0.04). PD has detrimental effects on both physical and mental health relative to the general population. The findings provide baseline population estimates of disease burden for PD.

hIGh RATES OF ThE METABOLIc SYNDROME IN A FIRST NATIONS cOMMUNITY IN WESTERN cANADA: PREVALENcE AND DETERMINANTS IN ADULTS AND chILDREN

Objectives. Increasing type 2 diabetes in Aboriginal communities across North America raisesconcerns about metabolic syndrome in these populations. Some prevalence information for AmericanIndians exists, but little has been available for Canada’s First Nations. Study Design. Wescreened 60 % of the eligible population of a single First Nation in Alberta for diabetes, prediabetes, cardiovascular risk, and metabolic syndrome. Methods. NCEP/ATP III and IDF criteria were used to identify metabolic syndrome in participantsaged ≥ 18; modified NCEP/ATP III criteria were used for participants aged < 18. Logisticregression identified factors associated with the metabolic syndrome. Results. 297 individuals were screened (176 adults, 84 children/adolescents, with complete data).52.3 % of adults had metabolic syndrome using NCEP/ATP III criteria, and 50 % using IDFcriteria. 40.5 % of individuals aged < 18 had the condition. Waist circumference was the mostprevalent correlate. Bivariate analysis suggested that age, BMI, weight, A1c, LDL-C, ADA riskscore and activity pattern were associated with metabolic syndrome. Conclusions. Our data represent the first available for Western Cree and are consistent withprevalence reported for Aboriginal populations in Ontario and Manitoba. High rates of obesity, pre-diabetes and metabolic syndrome for participants aged < 18 raise concerns about future prevalenceof diabetes and cardiovascular disease.

Translating Knowledge in Rehabilitation: Systematic Review

Background Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. Purpose The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. Data Sources Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. Study Selection Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. Data Extraction Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Researchs (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Data Synthesis Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one studys primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. Limitations Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. Conclusions The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.

Comorbidity and Health-Related Quality of Life in People with Multiple Sclerosis

This study examined associations between comorbidity and health-related quality of life (HRQL) in people with multiple sclerosis (MS). Data were derived from the Canadian Community Health Survey (CCHS) Cycle 1.1, a cross-sectional survey conducted by Statistics Canada. A nationally representative sample of community-dwelling Canadians was interviewed to determine whether they had been diagnosed with various chronic conditions. Participants were also administered the Health Utilities Index Mark 3 (HUI3) questionnaire to evaluate HRQL. Of the 131,535 participants, 335 reported having MS. Comorbidities listed by at least 10% of respondents with MS were assessed for their relation to HRQL, with age, sex, education, marital status, income, and number of comorbidities included as covariates. Respondents averaged 1.6 comorbidities. Eight comorbidities were experienced by at least 10% of respondents: back problems (35%), nonfood allergies (29%), urinary incontinence (28%), arthritis (26%), hypertension (17%), chr...

Major depression and health-related quality of life in Parkinson's disease

UNLABELLED Depression is a common psychiatric condition in Parkinsons disease (PD), yet the burden of depression on health-related quality of life (HRQL) has not been clearly delineated in this patient population. OBJECTIVE To evaluate the impact of depression and life stress on HRQL in the Canadian community dwelling population with PD. METHODS A total of 259 respondents from the Canadian Community Health Survey (CCHS 1.1) with self-reported PD were interviewed. Measures included Health Utilities Index Mark 3 (HUI3), Composite International Diagnostic Interview Short Form for Major Depression and a single question regarding the amount of stress in their lives most days. Adjusted HUI3 scores were compared according to depression and life stress using ANCOVA models. RESULTS Respondents without depression had overall HUI3 scores that were 0.29 units higher than respondents with depression [adjusted mean (95% CI) 0.49 (0.39-0.59) vs. 0.20 (0.03-0.37)]. The difference in overall HUI3 scores between respondents who reported high levels of stress as those who did not was 0.19 [adjusted mean (95% CI) 0.42 (0.29-0.55) vs. 0.23 (0.10-0.36)]. CONCLUSIONS Substantial impact of depression and life stress, two modifiable factors, on HRQL is seen in PD. HRQL may be improved by clinical management of these nonmotor symptoms in PD.

Increasing rates of diabetes and cardiovascular risk in Métis settlements in northern Alberta

Abstract Objectives. To determine the prevalence of diabetes (using secondary data analysis), as well as undiagnosed diabetes and pre-diabetes (using primary research methods) among adult Métis Settlement dwellers in northern Alberta. We also sought to identify cardiovascular risk factors. Study design. Quantitative research study utilizing both population census and community-based diabetes screening data. Methods. Self-reported diabetes was analyzed from the results of the Métis Settlement specific censuses in 1998 and 2006. Mobile clinics travelled into each of the 8 Métis Settlement communities in Alberta recruiting 693 subjects for screening for undiagnosed diabetes, pre-diabetes and metabolic syndrome. Logistic regression analyses (adjusted for age and sex) were used to identify associated factors. Results. According to the censuses, 4,312 Métis individuals were living on Settlements in 1998 and 5,059 in 2006. Self-reported age-adjusted prevalence of diabetes increased significantly from 5.1% in 1998 to 6.9% in 2006 (p<0.01), with a crude prevalence increase of 66% (p<0.01). In 2006, diabetes prevalence was higher among females than males, 7.8% vs. 6.1% respectively (p<0.05). Of the 266 adults screened in the fasting state, 5.3% had undiagnosed diabetes, whereas 20.3% (Canadian Diabetes Association criteria) and 51.9% (American Diabetes Association criteria) had 434 International Journal of Circumpolar Health 68:5 2009 pre-diabetes. Rates of obesity and metabolic syndrome were 49.4% (n=693) and 46.4% (n=266), respectively. Hemoglobin A1c>6.1% was strongly associated with diabetes, pre-diabetes and metabolic syndrome. Conclusions. Our results indicate high rates of diabetes, undiagnosed diabetes, pre-diabetes and metabolic syndrome among adult Alberta Métis Settlement dwellers.