Long-Term Exercise Therapy Resolves Ethnic Differences in Baseline Health Status in Older Adults with Knee Osteoarthritis

Background: Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. Methods: All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients’ baseline health status accounted for variability in outcomes, the proportion of variability ( R 2 ) explained by sequentially adding these variables to the model was quantified. Results: Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46–1.69). The greatest contribution to the variability in health status outcomes was from patients’ baseline KCCQ-OS score ( R 2 =25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. Conclusions: There is moderate variation across sites in their patients’ achievement of health status benefits from TMVr, with patient’s baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.

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Retrospective evaluation versus population norms for the measurement of baseline health status

Health and Quality of Life Outcomes ◽

10.1186/1477-7525-10-68 ◽

2012 ◽

Vol 10 (1) ◽

pp. 68 ◽

Cited By ~ 45

Author(s):

Ross Wilson ◽

Sarah Derrett ◽

Paul Hansen ◽

John Langley

Keyword(s):

Health Status ◽

Retrospective Evaluation ◽

Population Norms ◽

Baseline Health ◽

Baseline Health Status

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Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study

10.21203/rs.3.rs-70038/v1 ◽

2020 ◽

Author(s):

fenglan wang ◽

Xiaoli Zhang ◽

Xiao Tong ◽

Min Zhang ◽

Fengmei Xing ◽

...

Keyword(s):

Older Adults ◽

Knee Osteoarthritis ◽

Pain Intensity ◽

Physical Function ◽

Self Efficacy ◽

Exercise Program ◽

Exercise Group ◽

Strengthening Exercises ◽

Quasi Experimental

Abstract BackgroundExercise is recommended as a core treatment for individuals with KOA. However, the optimal exercise program to promote long-term compliance for KOA patients is not clear. The aim of this study is to compare the effects of the combination exercise program (quadriceps strengthening exercises (QSE) plus Baduanjin qigong) versus QSE alone on older adults with knee osteoarthritis (KOA). MethodsA two-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from one community center were assigned to combination exercise group while participants from the other center were assigned to QSE group. We assessed pain intensity, physical function, self-efficacy, and HRQoL with standardized instruments at baseline, 3 and 6 months. Results87 participants with KOA who aged above 60 completed the study. Over the 6 months, There were significant time by group interaction effects on pain intensity (F = 44.419, p < 0.001), physical function (F = 46.904, p < 0.001) and self-efficacy (F = 49.754, p < 0.001), as well as in the physical component summary (F = 15.205, p < 0.001) and mental component summary of SF-12 (F = 19.205, p < 0.001), with the combination exercise group exhibiting significantly greater improvements in all outcomes than QSE group. ConclusionsCombination exercise treatment is more effective than QSE for relieving pain, increasing physical functioning, and improving self-efficacy, and quality of life in community-dwelling KOA older adults. Also, it could promote long-term compliance for KOA community patients.Trial registrationChinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020

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Older patients/older donors: choosing wisely

Hematology ◽

10.1182/asheducation.v2013.1.70.3850587 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 70-75 ◽

Cited By ~ 1

Author(s):

Andrew S. Artz

Keyword(s):

Older Adults ◽

Health Status ◽

Older Patients ◽

Hematopoietic Cell Transplantation ◽

Performance Status ◽

Self Report ◽

Term Survival ◽

Long Term Survival ◽

Matched Sibling

Two lingering problems regarding transplantation in older adults have been how to select patients appropriately and whether to use older sibling donors. Allogeneic hematopoietic cell transplantation (HCT) of older patients may result in long-term survival due to GVL, but the data remain observational and mostly restricted to those 50 to 69 years of age. Patients with excellent performance status and low comorbidity have the best long-term survival after HCT. Novel measures of health status such as self-report or performance-based functional measures allow “staging the age” and may inform candidacy for less robust patients. Older matched sibling donors should be preferred over matched unrelated donors (MUDs) because outcomes are equivalent to superior for matched sibling donors compared with MUD. However, MUDs also achieve acceptable outcomes and long-term disease control. An alternative donor can be considered based on institutional protocols and expertise. Very limited information is available in patients or related donors 70 years of age and older. Future efforts to more completely characterize patient health status before transplantation will allow better application of HCT in older adults.

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Baseline health status and setting impacted minimal clinically important differences in COPD: an exploratory study

Journal of Clinical Epidemiology ◽

10.1016/j.jclinepi.2019.07.015 ◽

2019 ◽

Vol 116 ◽

pp. 49-61 ◽

Cited By ~ 2

Author(s):

Harma Alma ◽

Corina de Jong ◽

Danijel Jelusic ◽

Michael Wittmann ◽

Michael Schuler ◽

...

Keyword(s):

Health Status ◽

Exploratory Study ◽

Baseline Health ◽

Baseline Health Status

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Abstract 104: The Effect of Low Perceived Social Support on Health Outcomes in Young Patients with Acute Myocardial Infarction: Results from the VIRGO Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.104 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Emily M Bucholz ◽

Kelly M Strait ◽

Rachel P Dreyer ◽

Mary Geda ◽

Judith H Lichtman ◽

...

Keyword(s):

Quality Of Life ◽

Social Support ◽

Depressive Symptoms ◽

Health Status ◽

Perceived Social Support ◽

Young Patients ◽

Men And Women ◽

Baseline Health ◽

Baseline Health Status

Background: Social support is an important predictor of health outcomes after acute myocardial infarction (AMI), but significant variability in social support exists by sex and age. Most studies have been conducted in populations of predominately older, male patients; little is known about the impact of social support on outcomes after AMI in young patients, who may have unique demands and resources. Methods: We used data from the VIRGO study, an observational study of patients aged ≤55 years with AMI in the US and Spain, to examine the association of low perceived social support (LPSS) with baseline and 1-year health status, depression, and quality of life. Patients were categorized as having low vs. moderate/high social support using the ENRICHD Social Support Inventory (ESSI), which was collected during the index AMI hospitalization. A modified 5-item version of the 7-item ESSI was used for this study in order to examine marital status and instrumental support separately from perceived social support. Outcomes included health status (assessed by the Short Form-12 (SF-12) physical and mental component scores (PCS and MCS)), depressive symptoms (Patient Health Questionnaire (PHQ-9)), and angina-related quality of life (Seattle Angina Questionnaire (SAQ)) evaluated at baseline and 1-year. We used linear regression to compare 1-year health status between social support categories, adjusting for baseline health status, socio-demographics, comorbidities, severity of disease, and therapies used. Results: Among 3,432 patients, 728 (21.2%) were classified as having LPSS. Men and women had comparable levels of social support at baseline. On average, patients with LPSS reported lower functional status (PCS and MCS), lower quality of life, and more depressive symptoms at baseline and 1-year post-AMI. After multivariable adjustment, including baseline health status, LPSS was associated with lower mental functioning (mean MCS -2.34 (95% confidence interval [CI] -3.35, -1.34) p<0.001), lower quality of life (mean SAQ -4.58 (95% CI -4.58, -2.57), p<0.001), and more depressive symptoms (1.01 (95% CI 0.52, 1.51), p<0.001) at 1 year. The relationship between LPSS and worse physical functioning was not significant after adjustment (mean PCS -0.28 (95% CI -1.33, 0.77), p=0.6). We observed no interactions between social support, sex or country. Conclusion: Lower social support is associated with worse health status and more depressive symptoms 1-year after AMI in both young men and women recovering from an AMI.

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