W.F. Peter

Avoidance of Activities in Early Symptomatic Knee Osteoarthritis: Results from the CHECK Cohort

BackgroundPain-related avoidance of activities is hypothesized to lead to lower muscle strength and thereby activity limitations. Negative affect (e.g., low vitality, depression) is thought to strengthen the tendency to avoid activities.PurposeThe aim of this study was to assess the validity of this “avoidance model” in patients with early symptomatic knee osteoarthritis (OA).MethodsCross-sectional data (n = 151) were used. The associations between pain, negative affect, avoidance, muscle strength, and activity limitations were modeled using structural equation modeling.ResultsPain and negative affect were associated with lower muscle strength via avoidance (mediation by avoidance). Avoidance was associated with activity limitations via lower muscle strength (mediation by muscle strength). There were also direct associations between pain, negative affect, avoidance, muscle strength, and activity limitations.ConclusionsThe results support the validity of the avoidance model, which explains the associations between pain, negative affect, avoidance, muscle strength, and activity limitations in patients with early symptomatic knee OA.

Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis

Background Exercise therapy is generally recommended for patients with osteoarthritis (OA) of the knee. Comorbidity, which is highly prevalent in OA, may interfere with exercise therapy. To date, there is no evidence-based protocol for the treatment of patients with knee OA and comorbidity. Special protocols adapted to the comorbidity may facilitate the application of exercise therapy in patients with knee OA and one or more comorbidities. Purpose The purpose of this study was to develop comorbidity-adapted exercise protocols for patients with knee OA and comorbidity. Method Several steps were undertaken to develop comorbidity-adapted protocols: selection of highly prevalent comorbidities in OA, a literature search to identify restrictions and contraindications for exercise therapy for the various comorbid diseases, consultation of experts on each comorbid disease, and field testing of the protocol in eleven patients with knee OA and comorbidity. Results Based on literature and expert opinion, comorbidity-adapted protocols were developed for highly prevalent comorbidities in OA. Field testing showed that the protocols provided guidance in clinical decision making in both the diagnostic and the treatment phase. Because of overlap, the number of exercise protocols could be reduced to three: one for physiological adaptations (coronary disease, heart failure, hypertension, diabetes type 2, chronic obstructive pulmonary diseases, obesity), one for behavioral adaptations (chronic a-specific pain, nonspecific low back pain, depression), and one for environmental adaptations (visual or hearing impairments). Evaluation of patient outcome after treatment showed significant (P<0.05) and clinically relevant improvements in activity limitations and pain. Conclusion Comorbidity-adapted exercise protocols for patients with knee OA were developed, providing guidance in clinical reasoning with regard to diagnostics and treatment. To evaluate the effectiveness of treatment in line with our protocols, a randomized clinical trial should be performed.

Development and preliminary testing of a computerized animated activity questionnaire in patients with hip and knee osteoarthritis.

To develop an Animated Activity Questionnaire (AAQ) based on video animations for assessing activity limitations in patients with hip/knee osteoarthritis (OA) that combines the advantages of self‐reported questionnaires and performance‐based tests without many of their limitations and to preliminarily assess its reliability and validity. We hypothesized that the AAQ would correlate highly with performance‐based tests and moderately with self‐reported questionnaires.

Proprioception, laxity, muscle strength and activity limitations in early symptomatic knee osteoarthritis: results from the CHECK cohort.

OBJECTIVE To establish whether proprioception and varus-valgus laxity moderate the association between muscle strength and activity limitations in patients with early symptomatic knee osteoarthritis. DESIGN A cross-sectional study. SUBJECTS A sample of 151 participants with early symptomatic knee osteoarthritis from the Cohort Hip and Cohort Knee study. METHODS Regression analyses were performed to establish the associations between muscle strength, proprioception (knee joint motion detection threshold in the anterior--posterior direction), varus-valgus laxity and activity limitations (self-reported and performance-based). Interaction terms were used to establish whether proprioception and laxity moderated the association between muscle strength and activity limitations. RESULTS Proprioception moderated the association between muscle strength and activity limitations: the negative association between muscle strength and activity limitations was stronger in participants with poor proprioception than in participants with accurate proprioception (performance-based activity limitations p = 0.02; self-reported activity limitations p = 0.08). The interaction between muscle strength and varus-valgus laxity was not significantly associated with activity limitations. CONCLUSION The results of the present study support the theory that in the absence of adequate proprioceptive input, lower muscle strength affects a patients level of activities to a greater degree than in the presence of adequate proprioceptive input.

Development and Validation of the Computer-Administered Animated Activity Questionnaire to Measure Physical Functioning of Patients With Hip or Knee Osteoarthritis

Background Physical functioning of patients with hip or knee osteoarthritis is measured by self-report questionnaires and performance-based tests. However, performance-based tests often are not feasible. Objective The aim of this study was to develop a computer-administered questionnaire (ie, the Animated Activity Questionnaire [AAQ]) to measure physical functioning in patients with hip or knee OA. By showing animations of activities, the influence of the patients own reference frame is minimized. The AAQ measures the same aspects of physical functioning as performance-based tests do. Design This was a development and preliminary validation (cross-sectional) study. Methods A pilot version of the AAQ was developed using motion capture to analyze the movement of a person performing 7 daily activities. Different animations of the same activity were made with 2 to 5 levels of difficulty. For each activity, participants were asked to choose one animation that best corresponds to their own way of performing the activity. A preliminary validation study was performed to compare the AAQ with validated self-report questionnaires (Knee Injury and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score, and questionnaires on walking, stair climbing, and rising and sitting down) and performance-based tests (walking, Timed “Up & Go” Test, Timed Stair Test) in 33 patients with hip or knee osteoarthritis. Results As expected, the AAQ showed a correlation above .70 (.79, 95% confidence interval=.61–.89) with the total score of the performance-based tests. On the subscore level, the results were partly as expected. Fifty-eight percent of the participants preferred the AAQ over self-report questionnaires and performance-based tests. Limitations The findings need to be replicated in larger samples of patients because the sample size of the study was rather small. Conclusion The AAQ might be a good alternative for measuring physical functioning of patients with hip or knee osteoarthritis. The AAQ can easily be adapted for use in other patient populations. However, further development and validation are needed.

Interobserver Reliability of the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST)

STUDY DESIGN Interobserver reliability study. INTRODUCTION A scale was developed to measure the severity of stenosing tenosynovitis: the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST). PURPOSE OF THE STUDY To study the interobserver reliability of the ASSiST. METHODS Patients suffering from various impairments in hand function were referred to our outpatient hand clinic. The grading of stenosing tenosynovitis was assessed independently. The observers were blinded for each others results. The ASSiST distinguishes between a nodular and a diffuse form. The severity was graded from grades 0 to 3. RESULTS Kappa coefficient for the distinction between the four grades was 0.72 (95% confidence interval [CI] 0.59-0.85) and for the distinction between the nodular and the diffuse forms 0.16 (95% CI 0.13-0.18). CONCLUSION The ASSiST can be used to reliably assess the severity of stenosing tenosynovitis in both nodular and diffuse forms, but it does not differentiate between these two forms. LEVEL OF EVIDENCE Not applicable.

Optimization of Analgesics for Greater Exercise Therapy Participation Among Patients With Knee Osteoarthritis and Severe Pain: A Feasibility Study.

Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol.

Optimization of analgesics allows patients with knee osteoarthritis and severe pain to participate in exercise therapy – a feasibility study

Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol.

Cross‐cultural and construct validity of the Animated Activity Questionnaire

The Animated Activity Questionnaire (AAQ) assesses activity limitations in patients with hip/knee osteoarthritis and consists of video animations; the patients choose the animation that best matches their own performance. The AAQ has shown good validity and reliability. This study aims to evaluate cross‐cultural and construct validity of the AAQ.

Cross-cultural validity of the Animated Activity Questionnaire (AAQ) for assessing activity limitations in patients with hip or knee osteoarthritis

22nd Annual Conference of the International Society for Quality of Life Research Springer International Publishing Switzerland 2015 Cutting Edge Research Plenary (1) Inflammatory gene SNPs as predictors of patient reported symptom related functioning in patients with multiple myeloma Xin Shelley Wang, MD, MPH, MD Anderson Cancer Center, Houston, TX, United States; Qiuling Shi, MD, PhD, MD Anderson Cancer center, Houston, TX, United States; Huei Kai Lin, PhD, MD Anderson Cancer Center, Houston, TX, United States; Guojun Li, MD, PhD, MD Anderson Cancer Center, Houston, TX, United States; Loretta Williams, PhD, UT MD Anderson Cancer Center, Houston, TX, United States; Robert Orlowski, MD, PhD, MD Anderson Cancer Center, Houston, TX, United States; Charles S. Cleeland, PhD, UT MD Anderson Cancer Center, Houston, TX, United States AIMS: Multiple myeloma (MM) is an incurable disease and most patients remain on therapy for extended periods of time. The disease and its treatment often produce significant functional impairment. We have previously shown a relationship between patient-reported symptom severity and markers of inflammation. In the current study, we expected that certain regulatory single-nucleotide polymorphisms (SNPs) in inflammation genes would be associated with functioning in patients with MM 1–5 years postdiagnosis. METHODS: In a crosssectional study, patients rated symptom-related functional impairment on the 6 interference items of the MD Anderson Symptom Inventory (MDASI) (symptom interference with general activity, work, walking, mood, enjoyment of life, relations with others). Symptom interference was rated on a 0–10 scale, with 0 = ‘‘does not interfere’’ and 10 = ‘‘interferes completely.’’ Patients also provided buccal-swab DNA samples. SNPs for 4 cytokine genes (IL6 -174G[C, IL1b -511C[T, TNFa -308G[A, IL10 -1082G[A) were tested. Twostep cluster analysis of a patient’s composite MDASI interference score indicated either good or poor functioning status. Logistic regression models, adjusted for age, sex, MM stage, performance status (PS), comorbidities, and body mass index, were used to identify SNPs that might predict poor functioning. RESULTS: Of 344 patients enrolled, 80 % received stem cell transplant, 21 % had progression/ relapse disease at time of study. Cluster analysis indicated that 31 % reported poor symptom-related functional status [mean 5.67 (SD 1.56)]. For non-Hispanic whites (n = 222, 64.4 %), the IL1b -511 CC genotype was associated with poor functioning (OR 2.14; 95 % CI 1.18–3.89; p = .012) and poor PS (OR 3.40; 95 % CI 1.55–7.46; p = .002). For other patients, no SNP was related to poor functioning, although poor PS (OR 5.36; 95 % CI 1.47–19.48; p = .011) and advanced-stage disease (OR 2.69; 95 % CI 1.13–6.39; p = .025) were related to poor functioning. CONCLUSIONS: We found that symptoms were interfering with physical and affective functioning in one-third of patients with MM, from patient rated MDASI interferences. Further, genetic associations with inflammation were associated with the poor functioning in non-Hispanic whites. Our study suggests that racial/ethnic factors contribute to this association. (2) A cluster-randomized study of clinician-patient shared vs standard reporting of symptomatic adverse events using PROCTCAE nested in a multicenter trial of multimodal therapy for rectal cancer (Alliance N1048 PROSPECT) Amylou C. Dueck, PhD, Mayo Clinic, Scottsdale, AZ, United States; Sandra A. Mitchell, PhD, CRNP, AOCN, National Cancer Institute, Rockville, MD, United States; Lauren J. Rogak, MA, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Brenda Ginos, MS, Mayo Clinic, Scottsdale, AZ, United States; Daniel J. Sargent, PhD, Mayo Clinic, Rochester, MN, United States; Qian Shi, PhD, Mayo Clinic, Rochester, MN, United States; Jeffrey M. Farma, MD, Fox Chase Cancer Center, Philadelphia, PA, United States; Cathy Eng, MD, FACP, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States; Christopher Crane, MD, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States; Hagen Kennecke, MD, British Columbia Cancer Agency, Vancouver, BC, Canada; Ann M. O’Mara, PhD, RN, FAAN, National Cancer Institute, Rockville, MD, United States; Lori M. Minasian, MD, FACP, National Cancer Institute, Rockville, MD, United States; Deborah Schrag, MD, MPH, Dana-Farber Cancer Institute, Boston, MA, United States; Ethan Basch, MD, MSc, University of North Carolina, Chapel Hill, NC, United States AIMS: Treatment toxicity in cancer trials is assessed through clinician grading of adverse events (AEs) using the U.S. National Cancer Institute (NCI) Common Terminology Criteria for AEs (CTCAE); however numerous studies document underreporting of symptomatic AEs. Patient-reported outcomes (PROs) have been proposed to improve detection of symptomatic AEs. Recently, the NCI developed a PRO companion measure to the CTCAE (PRO-CTCAE). To evaluate whether sharing patient-reported AEs with clinicians alters toxicity detection, we nested a cluster-randomized study within a multicenter trial (NCT01515787; neoadjuvant chemotherapy followed by selective chemoradiation or upfront chemoradiation in 123 Qual Life Res (2015) 24:1–191 DOI 10.1007/s11136-015-1078-4