Publications by authors named "David J Hunter"

1,017 Publications

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Assessing agreement between different polygenic risk scores in the UK Biobank.

Sci Rep 2022 Jul 27;12(1):12812. Epub 2022 Jul 27.

Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Polygenic risk scores (PRS) are proposed for use in clinical and research settings for risk stratification. However, there are limited investigations on how different PRS diverge from each other in risk prediction of individuals. We compared two recently published PRS for each of three conditions, breast cancer, hypertension and dementia, to assess the stability of using these algorithms for risk prediction in a single large population. We used imputed genotyping data from the UK Biobank prospective cohort, limited to the White British subset. We found that: (1) 20% or more of SNPs in the first PRS were not represented in the more recent PRS for all three diseases, by the same SNP or a surrogate with R > 0.8 by linkage disequilibrium (LD). (2) Although the difference in the area under the receiver operating characteristic curve (AUC) obtained using the two PRS is hardly appreciable for all three diseases, there were large differences in individual risk prediction between the two PRS. For instance, for each disease, of those classified in the top 5% of risk by the first PRS, over 60% were not so classified by the second PRS. We found substantial discordance between different PRS for the same disease, indicating that individuals could receive different medical advice depending on which PRS is used to assess their genetic susceptibility. It is desirable to resolve this uncertainty before using PRS for risk stratification in clinical settings.
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http://dx.doi.org/10.1038/s41598-022-17012-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329440PMC
July 2022

A narrative review of anti-obesity medications for obese patients with osteoarthritis.

Expert Opin Pharmacother 2022 Jul 27:1-15. Epub 2022 Jul 27.

Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

Introduction: The prevalence of both obesity and osteoarthritis (OA) is increasing worldwide (twindemic), and the association between the two chronic diseases is also well established.

Areas Covered: In this narrative review, we will briefly describe the double burdens of both diseases, the impact of weight loss or gain on OA incidence and structural progression and discuss the biomechanical and anti-inflammatory mechanisms mediating these effects. FDA-approved anti-obesity drugs are summarized in terms of their clinical efficacy and safety profile, and the completed or ongoing phase 2/3 clinical trials of such drugs in OA patients with obesity are examined.

Expert Opinion: We will discuss the perspectives related to principles of prescription of anti-obesity drugs, the potential role of phenotype-guided approach, time to drug effects in clinical trials, sustainability of weight loss based on the real-world studies, the importance of concomitant therapies, such as dieting and exercises, and the role of weight loss on non-weight bearing OA joints. Although obesity is the major risk factor for OA pathogenesis and progression, and there are a variety of anti-obesity medications on the market, research on the use of these disease-modifying drugs in OA (DMOAD) is still sparse.
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http://dx.doi.org/10.1080/14656566.2022.2104636DOI Listing
July 2022

Culture as both a risk and protective factor for vicarious traumatisation in nurses working with refugees: a literature review.

J Res Nurs 2022 Jun 8;27(4):357-371. Epub 2022 Jul 8.

Lecturer, Nursing & Health Care School, University of Glasgow, Glasgow, UK.

Background: There are an estimated 25.9 million refugees worldwide, who require health services while living in host countries. To effectively treat refugee patients, nurses must document their history which requires hearing about their traumatic journeys. Listening to trauma has been shown to cause vicarious traumatisation.

Aims: To identify the risk and protective factors involved in the development of vicarious traumatisation.

Methods: After searching four databases, nine studies were selected for review. Key words 'vicarious trauma', 'refugee' and 'nurse' formed the search. Articles were appraised using the Critical Appraisal Skills Program and Mixed Methods Appraisal Tool.

Results: Vicarious traumatisation is common amongst nurses working with refugees. Aspects of culture formed the principal risk and protective factors. Differences between cultures made for strained communication while similarities created better understanding. Some cultures provided more resilience than others. Vicarious resilience, a feeling of personal growth resulting from hearing about and helping patients overcome trauma, was also highlighted. The development of vicarious resilience was a protective factor.

Conclusions: Further investigation into how to minimise risk and establish protective factors is required. Some coping recommendations include personal reflection, comprehensive training and better access to counselling.
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http://dx.doi.org/10.1177/17449871221085863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272507PMC
June 2022

Correlations between objective and self-reported step count adherence following total knee replacement: A longitudinal repeated-measures cohort study.

Physiother Res Int 2022 Jul 13:e1966. Epub 2022 Jul 13.

Sydney Musculoskeletal Health, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Objective: To determine how physically active individuals are following total knee replacement (TKR) and how accurately they self-report their step count adherence compared to objective measure following TKR.

Methods: Observational cohort study, nested within the PATHway randomised-clinical trial. Participants (n = 102) who had recently undergone TKR were recruited for the main trial. Only participant data from the intervention group were used for this study (n = 51). Participants in the intervention group received an activity tracker to monitor their physical activity and fortnightly health-coaching sessions for 3 months. Adherence was objectively measured as percentage of steps completed divided by the amount prescribed by the health coach. Participants were asked to self-report their adherence on a 1-10 numerical rating scale during health coaching sessions.

Results: Data from 44 participants were available, resulting in a total of 224 paired measurements. Participant step count increased over the first 8 weeks of follow-up, and plateaued from 8 weeks onwards at approximately 7500 steps/day. About two-thirds (65.8%) of participants accurately self-reported their step count adherence up until 12 weeks, the remaining one-third (34.2%) underestimated their adherence. Paired t-tests demonstrated statistically significant differences between the paired measurements from weeks 2 to 10.

Discussion: Participants were generally active and completed the step goal most occasions. Two-thirds accurately self-reported their step goal adherence. Self-reported measures should be combined with an objective measure of adherence for greater accuracy. A further understanding of how people engage with activity trackers can be used to promote behaviour change in physiotherapy-led interventions.
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http://dx.doi.org/10.1002/pri.1966DOI Listing
July 2022

Predictors of adherence to a step count intervention following total knee replacement: an exploratory cohort study.

J Orthop Sports Phys Ther 2022 Jul 8:1-25. Epub 2022 Jul 8.

Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Australia.

Objective: To explore the person-level predictors of adherence to a step count intervention following total knee replacement (TKR).

Design: Prospective cohort study, nested within the PATHway trial.

Methods: Participants who had recently undergone TKR were recruited from three rehabilitation hospitals in Sydney, Australia, for the main trial. Only data from participants who were randomised to the TKR intervention group were analysed. Participants in the intervention group (n=51) received a wearable tracker to monitor the number of steps taken per day. Step count adherence was objectively measured at three months as the number of steps completed divided by the number prescribed and multiplied by 100 to express adherence as a percentage. Participants were classified into four groups: withdrawal, low adherence (0-79%), adherent (80-100%), >100% adherent. Ordinal logistic regression was used to identify which factors predicted adherence to the prescribed step count.

Results: Of the 51 participants enrolled, nine (18% of 51) withdrew from the study before three months. Half of participants were classified as >100% adherent (n=24, 47%). Ten were classified as low adherence (20%), and eight participants were classified as adherent (16%). In the univariable model, lower age (OR 0.90 95%CI 0.83 to 0.97), higher patient activation (OR 1.03 95%CI 1.00 to 1.06) and higher technology self-efficacy (OR 1.03 95%CI 1.00 to 1.06) were associated with higher adherence. After adjusting for age in the multivariable model, patient activation and technology self-efficacy were not significant.

Conclusions: Younger age, higher patient activation and technology self-efficacy were associated with higher adherence to a step count intervention following TKR in the univariable model. Patient activation and technology self-efficacy were not associated with higher adherence following adjustment for age.
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http://dx.doi.org/10.2519/jospt.2022.11133DOI Listing
July 2022

Metformin use and the risk of total knee replacement among diabetic patients: a propensity-score-matched retrospective cohort study.

Sci Rep 2022 Jul 7;12(1):11571. Epub 2022 Jul 7.

The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Postgraduate Education Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong, China.

Metformin has been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). The study aimed to test the association between regular metformin use with total knee replacement (TKR) in patients with diabetes. This is a retrospective study with electronic records retrieved in Hong Kong public primary care. Patients with diabetes aged ≥ 45 who visited during 2007 to 2010, were followed up for a four-year period from 2011 to 2014 to determine the incidence of TKR. Propensity score matching based on age, sex, co-medications and chronic conditions was conducted to adjust for confounding. Cox regression was implemented to examine the association between metformin use and TKR. In total, 196,930 patients were eligible and 93,330 regular metformin users (defined as ≥ 4 prescriptions over the previous year) and non-users were matched. Among 46,665 regular users, 184 TKRs were conducted, 17.1% fewer than that among non-users. Cox regression showed that regular metformin users had a 19%-lower hazard of TKR [hazard ratio (HR) = 0.81, 95% confidence interval: 0.67 to 0.98, P = 0.033], with a dose-response relationship. Findings suggest a potential protective effect of metformin on knee OA progression and later TKR incidence among diabetic patients.
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http://dx.doi.org/10.1038/s41598-022-15871-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262887PMC
July 2022

Health coaching for low back pain, hip and knee osteoarthritis: A Systematic Review with Meta-Analysis.

Pain Med 2022 Jul 1. Epub 2022 Jul 1.

Sydney Musculoskeletal Health, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Background And Objective: Health coaching aims to empower people to reach their goals and is increasingly used in healthcare settings. Whether health coaching improves pain and disability for people with hip and/or knee osteoarthritis (OA), or low back pain (LBP) is yet unknown.

Databases And Data Treatment: Six databases were searched for randomised controlled trials assessing health coaching or motivational programs in adults with hip, knee OA or LBP investigating each condition independently. Meta-analyses were performed using random-effects models in the Cochrane Collaboration Review Manager 5.3 program.

Results: 17 eligible studies were found. No studies found analysing hip OA alone. Pooled analyses found statistically significant decreases in mid-term pain (Mean Difference MD: -7.57, 95% CI: -10.08 to -5.07, p < 0.001, I2 = 0%), short-term disability (Standard Mean Difference SMD -0.22; 95% CI [-0.41, -0.03]; p = 0.02, z = 2.32, I2 = 0%) and mid-term disability (SMD -0.42; 95% CI [-0.75, -0.09]; p = 0.01, z = 2.49, I2 = 60%) favouring the intervention for chronic LBP. There were significant improvements in knee OA long-term functional disability (MD -3.04, 95% CI [-5.70, -0.38]; P = 0.03; Z = 2.24; I2 0%).

Conclusion: Meta-analyses provide evidence that health coaching, reduces both disability and pain, in people with chronic LBP and disability in knee OA, although the clinical significance is unknown. There is currently no evidence supporting or refuting it's use for hip osteoarthritis.
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http://dx.doi.org/10.1093/pm/pnac099DOI Listing
July 2022

Distinct reproductive risk profiles for intrinsic-like breast cancer subtypes: pooled analysis of population-based studies.

J Natl Cancer Inst 2022 Jun 20. Epub 2022 Jun 20.

Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Auerbachstr. 112, Stuttgart, 70376, Germany.

Background: Reproductive factors have been shown to be differentially associated with risk of estrogen receptor (ER) positive and ER-negative breast cancer. However, their associations with intrinsic-like subtypes are less clear.

Methods: Analyses included up to 23,353 cases, and 71,072 controls pooled from 31 population-based case-control or cohort studies in the Breast Cancer Association Consortium across 16 countries on 4 continents. Polytomous logistic regression was used to estimate the association between reproductive factors and risk of breast cancer by intrinsic-like subtypes (luminal A-like, luminal B-like, luminal B-HER2-like, HER2-enriched-like, and triple-negative) and by invasiveness. All statistical tests were 2-sided.

Results: Compared to nulliparous women, parous women had a lower risk of luminal A-like, luminal B-like, luminal B-HER2-like and HER2-enriched-like disease. This association was apparent only after approximately 10 years since last birth and became stronger with increasing time (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.49 to 0.71; and OR = 0.36, 95% CI = 0.28 to 0.46; for multiparous women with luminal A-like tumors 20-<25 years after last birth and 45-<50 years after last birth, respectively). In contrast, parous women had a higher risk of triple-negative breast cancer right after their last birth (for multiparous women: OR = 3.12, 95%CI = 2.02 to 4.83) that was attenuated with time but persisted for decades (OR = 1.03, 95%CI = 0.79 to 1.34, for multiparous women 25 to < 30 years after last birth). Older age at first birth (P-heterogeneity<.001 for triple-negative compared to luminal-A like) and breastfeeding (P-heterogeneity<.001 for triple-negative compared to luminal-A like) were associated with lower risk of triple-negative but not with other disease subtypes. Younger age at menarche was associated with higher risk of all subtypes; older age at menopause was associated with higher risk of luminal A-like but not triple-negative breast cancer. Associations for in situ tumors were similar to luminal A-like.

Conclusion: This large and comprehensive study demonstrates a distinct reproductive risk factor profile for triple-negative breast cancer compared to other subtypes, with implications for the understanding of disease etiology and risk prediction.
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http://dx.doi.org/10.1093/jnci/djac117DOI Listing
June 2022

Hip Contact Force Magnitude and Regional Loading Patterns are Altered in those with Femoroacetabular Impingement Syndrome.

Med Sci Sports Exerc 2022 Jun 11. Epub 2022 Jun 11.

Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, the University of Melbourne, Melbourne, Victoria, AUSTRALIA.

Purpose: The magnitude and location of hip contact force influences the local mechanical environment of the articular tissue, driving remodelling. We used a neuromusculoskeletal model to investigate hip contact force magnitudes and their regional loading patterns on the articular surfaces in those with femoroacetabular impingement (FAI) syndrome and controls during walking.

Methods: An EMG-assisted neuromusculoskeletal model was used to estimate hip contact forces in eligible participants with FAI syndrome (n = 41) and controls (n = 24), walking at self-selected speed. Hip contact forces were used to determine the average and spread of regional loading for femoral and acetabular articular surfaces. Hip contact force magnitude and region of loading were compared between groups using statistical parametric mapping and independent t-tests, respectively (p < 0.05).

Results: All the following report comparisons with controls. Those with FAI syndrome walked with lower magnitude hip contact forces (mean difference -0.7 N·BW-1, p < 0.001) during first and second halves of stance, and with lower anteroposterior, vertical and mediolateral contact force vector components. Participants with FAI syndrome also had less between-participant variation in average regional loading which was located more anteriorly (3.8°, p = 0.035) and laterally (2.2°, p = 0.01) on the acetabulum but more posteriorly (-4.8°, p = 0.01) on the femoral head. Participants with FAI syndrome had a smaller spread of regional loading across both the acetabulum (-1.9 mm, p = 0.049) and femoral head (1 mm, p < 0.001) during stance.

Conclusions: Compared with controls, participants with FAI syndrome walked with lower magnitude hip contact forces that were constrained to smaller regions on the acetabulum and femoral head. Differences in regional loading patterns might contribute to the mechanobiological processes driving cartilage maladaptation in those with FAI syndrome.
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http://dx.doi.org/10.1249/MSS.0000000000002971DOI Listing
June 2022

The Cost-Effectiveness of Surgical Weight Loss Interventions for Patients with Knee Osteoarthritis and Class III Obesity.

Arthritis Care Res (Hoboken) 2022 Jun 3. Epub 2022 Jun 3.

Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.

Objective: Class III obesity (BMI≥40 kg/m ) is associated with worse knee pain and total knee replacement (TKR) outcomes. As bariatric surgery yields sustainable weight loss for individuals with BMI≥40kg/m , we sought to establish the value of Roux-en-Y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy (LSG) in conjunction with usual care (UC) for knee osteoarthritis (OA) patients with BMI≥40kg/m .

Methods: We used the Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a healthcare sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.

Results: The UC+RYGB strategy increased quality adjusted life expectancy (QALE) by 1.35 years and lifetime costs by $7,209, compared to UC alone (ICER=$5,300/QALY). The UC+LSG strategy yielded less benefit than UC+RYGB and was dominated. Relative to UC alone, both UC+RYGB and UC+LSG reduced opioid utilization from 13% to 4%, and increased TKR utilization from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41kg/m , UC+LSG dominated UC+RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay (WTP) threshold of $50,000/QALY, UC+RYGB and UC+LSG were cost-effective in 70% and 30% of iterations, respectively.

Conclusion: RYGB offers good value among knee OA patients with BMI≥40kg/m , while LSG may provide good value among those with BMI between 35 and 40 kg/m .
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http://dx.doi.org/10.1002/acr.24967DOI Listing
June 2022

Context-dependent concordance between physiological divergence and phenotypic selection in sister taxa with contrasting phenology and mating systems.

Am J Bot 2022 Jun 2. Epub 2022 Jun 2.

Department of Biological and Environmental Sciences, East Central University, Ada, OK, 74820, USA.

Premise: The study of phenotypic divergence of, and selection on, functional traits in closely related taxa provides the opportunity to detect the role of natural selection in driving diversification. If the strength or direction of selection in field populations differs between taxa in a pattern that is consistent with the phenotypic difference between them, then natural selection reinforces the divergence. Few studies have sought evidence for such concordance for physiological traits.

Methods: Herbarium specimen records were used to detect phenological differences between sister taxa independent of the effects on flowering time of long-term variation in the climate across collection sites. In the field, physiological divergence in photosynthetic rate, transpiration rate, and instantaneous water-use efficiency were recorded during vegetative growth and flowering in 13 field populations of two taxon pairs of Clarkia, each comprising a self-pollinating and a outcrossing taxon.

Results: Historically, each selfing taxon flowered earlier than its outcrossing sister taxon, independent of the effects of local long-term climatic conditions. Sister taxa differed in all focal traits, but the degree and (in one case) the direction of divergence depended on life stage. In general, self-pollinating taxa had higher gas exchange rates, consistent with their earlier maturation. In 6 of 18 comparisons, patterns of selection were concordant with the phenotypic divergence (or lack thereof) between sister taxa.

Conclusions: Patterns of selection on physiological traits measured in heterogeneous conditions do not reliably reflect divergence between sister taxa, underscoring the need for replicated studies of the direction of selection within and among taxa.
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http://dx.doi.org/10.1002/ajb2.16016DOI Listing
June 2022

MRI-based Texture Analysis of Infrapatellar Fat Pad to Predict Knee Osteoarthritis Incidence.

Radiology 2022 May 31:212009. Epub 2022 May 31.

From the Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W., D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (J.L.); School of Biomedical Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.); Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.D.).

Background Infrapatellar fat pad (IPFP) quality has been implicated as a marker for predicting knee osteoarthritis (KOA); however, no valid quantification for subtle IPFP abnormalities has been established. Purpose The purpose of this study was to investigate whether MRI-based three-dimensional texture analysis of IPFP abnormalities could help predict incident radiographic KOA. Materials and Methods In this prospective nested case-control study, 690 participants whose knees were at risk for KOA were included from the Pivotal Osteoarthritis Initiative MRI Analyses incident osteoarthritis cohort. All knees had a Kellgren-Lawrence grade of 1 or less at baseline. During the 4-year follow-up, case participants were matched 1:1 to control participants, with incident radiographic KOA as the outcome. MRI scans were segmented at the incident time point of KOA (hereafter, P0), 1 year before P0 (hereafter, P-1), and baseline. MRI-based three-dimensional texture analysis was performed to extract IPFP texture features. Least absolute shrinkage and selection operator and multivariable logistic regressions were applied in the development cohort and evaluated in the test cohort. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative value of the clinical score, IPFP texture score, and MRI Osteoarthritis Knee Score. Results Participants were allocated to development ( = 500, 340 women; mean age, 60 years) and test ( = 190, 120 women; mean age, 61 years) cohorts. In both cohorts, IPFP texture scores (AUC ≥0.75 for all) showed greater discrimination than clinical scores (AUC ≤0.69 for all) at baseline, P-1, and P0, with significant differences in pairwise comparisons ( ≤ .002 for all). Greater predictive and concurrent validities of IPFP texture scores (AUC ≥0.75 for all) compared with MRI Osteoarthritis Knee Scores (AUC ≤0.66 for all) were also demonstrated ( < .001 for all). Conclusion MRI-based three-dimensional texture of the infrapatellar fat pad was associated with future development of knee osteoarthritis. ClinicalTrials.gov registration no.: NCT00080171 © RSNA, 2022 See also the editorial by Fischer in this issue.
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http://dx.doi.org/10.1148/radiol.212009DOI Listing
May 2022

Repurposed and investigational disease-modifying drugs in osteoarthritis (DMOADs).

Ther Adv Musculoskelet Dis 2022 20;14:1759720X221090297. Epub 2022 May 20.

Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia.

In spite of a major public health burden with increasing prevalence, current osteoarthritis (OA) management is largely palliative with an unmet need for effective treatment. Both industry and academic researchers have invested a vast amount of time and financial expense to discover the first diseasing-modifying osteoarthritis drugs (DMOADs), with no regulatory success so far. In this narrative review, we discuss repurposed drugs as well as investigational agents which have progressed into phase II and III clinical trials based on three principal endotypes: bone-driven, synovitis-driven and cartilage-driven. Then, we will briefly describe the recent failures and lessons learned, promising findings from predefined post hoc analyses and insights gained, novel methodologies to enhance future success and steps underway to overcome regulatory hurdles.
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http://dx.doi.org/10.1177/1759720X221090297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128067PMC
May 2022

Priorities for cancer research in low- and middle-income countries: a global perspective.

Nat Med 2022 04 19;28(4):649-657. Epub 2022 Apr 19.

International Association for Research on Cancer, Lyon, France.

Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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http://dx.doi.org/10.1038/s41591-022-01738-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108683PMC
April 2022

Hypertension, a dementia polygenic risk score, APOE genotype, and incident dementia.

Alzheimers Dement 2022 Apr 19. Epub 2022 Apr 19.

Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Introduction: There is inconsistent evidence on whether genetic risk for dementia modifies the association between hypertension and dementia.

Methods: In 198,965 dementia-free participants aged ≥60 years, Cox proportional-hazards models were used to investigate the association between hypertension and incident dementia. A polygenic risk score (PRS) based on 38 non-apolipoprotein E (APOE) single nucleotide polymorphisms and APOE ε4 status were used to determine genetic risk for dementia.

Results: Over 15 years follow-up, 6270 participants developed dementia. Hypertension was associated with a 19% increased risk of dementia (hazard ratio = 1.19, 95% confidence interval 1.11-1.27). The associations remained similar when stratifying by genetic risk, with no evidence for multiplicative interaction by dementia PRS (P = 0.20) or APOE ε4 status (P = 0.16). However, the risk difference between those with and without hypertension was larger among those at higher genetic risk.

Discussion: Hypertension was associated with an increased risk of dementia regardless of genetic risk for dementia.
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http://dx.doi.org/10.1002/alz.12680DOI Listing
April 2022

Genome-wide interaction analysis of menopausal hormone therapy use and breast cancer risk among 62,370 women.

Sci Rep 2022 04 13;12(1):6199. Epub 2022 Apr 13.

Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Use of menopausal hormone therapy (MHT) is associated with increased risk for breast cancer. However, the relevant mechanisms and its interaction with genetic variants are not fully understood. We conducted a genome-wide interaction analysis between MHT use and genetic variants for breast cancer risk in 27,585 cases and 34,785 controls from 26 observational studies. All women were post-menopausal and of European ancestry. Multivariable logistic regression models were used to test for multiplicative interactions between genetic variants and current MHT use. We considered interaction p-values < 5 × 10 as genome-wide significant, and p-values < 1 × 10 as suggestive. Linkage disequilibrium (LD)-based clumping was performed to identify independent candidate variants. None of the 9.7 million genetic variants tested for interactions with MHT use reached genome-wide significance. Only 213 variants, representing 18 independent loci, had p-values < 1 × 10. The strongest evidence was found for rs4674019 (p-value = 2.27 × 10), which showed genome-wide significant interaction (p-value = 3.8 × 10) with current MHT use when analysis was restricted to population-based studies only. Limiting the analyses to combined estrogen-progesterone MHT use only or to estrogen receptor (ER) positive cases did not identify any genome-wide significant evidence of interactions. In this large genome-wide SNP-MHT interaction study of breast cancer, we found no strong support for common genetic variants modifying the effect of MHT on breast cancer risk. These results suggest that common genetic variation has limited impact on the observed MHT-breast cancer risk association.
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http://dx.doi.org/10.1038/s41598-022-10121-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007944PMC
April 2022

Developing a Deeper Understanding of Osteoarthritis: Care to Joint Us?

Authors:
David J Hunter

Clin Geriatr Med 2022 05;38(2):xiii-xv

Kolling Institute, Level 10, 10 Westbourne Street, St Leonards, NSW 2064, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.cger.2021.11.014DOI Listing
May 2022

Surgery for Osteoarthritis: Total Joint Arthroplasty, Realistic Expectations of Rehabilitation and Surgical Outcomes: A Narrative Review.

Clin Geriatr Med 2022 05;38(2):385-396

Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia.

This narrative review highlights the prevalence of osteoarthritis as a chronic disease that directly contributes to the ever-growing health care expenditure to treat this condition. The increasing demand of total joint arthroplasty globally is explained in conjunction with the importance of understanding candidate suitability for arthroplasty surgery in order to maximize surgical outcomes and self-reported patient satisfaction after the surgery. Rehabilitation care following total hip arthroplasty and total knee arthroplasty, particularly the inappropriate use of inpatient rehabilitation service, is also explained, in addition to the enhanced recovery after surgery.
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http://dx.doi.org/10.1016/j.cger.2021.11.009DOI Listing
May 2022

Predictors and Measures of Adherence to Core Treatments for Osteoarthritis.

Clin Geriatr Med 2022 05;38(2):345-360

Department of Rheumatology, Institute of Bone and Joint Research, Kolling Institute, Royal North Shore Hospital and Northern Clinical School, University of Sydney, NSW 2065, Australia; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK. Electronic address:

Adherence has been proposed as a major barrier to implementing and maintaining the benefits of osteoarthritis (OA) core treatments and is influenced by many factors. Although there are reasonable data to support factors influencing adherence to exercise/physical activity in knee/hip OA populations, there is less research examining alternative interventions, or in the hand OA population. This problem is complicated by the lack of gold-standard measurement of adherence for core osteoarthritis treatments. The predictors of treatment adherence are not well understood, and findings are contradictory. Strategies incorporating behavior change techniques should be implemented to improve and maintain long-term adherence.
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http://dx.doi.org/10.1016/j.cger.2021.11.007DOI Listing
May 2022

Best Evidence Osteoarthritis Care: What Are the Recommendations and What Is Needed to Improve Practice?

Clin Geriatr Med 2022 05;38(2):287-302

Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney; Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia. Electronic address:

This article provides an overview of osteoarthritis (OA) management recommendations and strategies to improve clinical practice concordance with clinical guidelines. In many countries, the primary point of care for a person with OA is typically general practitioners and physiotherapists. Optimal primary care focuses on core OA treatments, namely education for self-management and lifestyle interventions encompassing increased physical activity, therapeutic exercise, and weight loss (if indicated). Quality indicators are used in clinical practice and research to determine the quality of care and in some settings, are used as knowledge translation tools to address existing evidence-to-practice gaps.
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http://dx.doi.org/10.1016/j.cger.2021.11.003DOI Listing
May 2022

Longitudinal Association of Infrapatellar Fat Pad Signal Intensity Alteration with Biochemical Biomarkers in Knee Osteoarthritis.

Rheumatology (Oxford) 2022 Apr 6. Epub 2022 Apr 6.

Menzies Institute for Medical Research,University of Tasmania, Hobart, Australia.

Objective: To explore the longitudinal association of quantitative infrapatellar fat pad (IPFP) signal intensity alteration with osteoarthritis (OA)-related biomarkers.

Method: Eighteen OA-related biochemical biomarkers of 600 knee OA participants in the Foundation for the National Institutes of Health OA Biomarkers Consortium (FNIH) study were extracted. The quantitative IPFP signal intensity measures was acquired based on magnetic resonance imaging, including mean value [Mean (IPFP)] and standard deviation [sDev (IPFP)] of the whole IPFP, median value [Median (H)] and upper quartile value [UQ (H)] of high signal intensity, the ratio of volume of high signal intensity to volume of whole IPFP [Percentage (H)] and Clustering factor (H). The linear mixed-effect model was applied to determine the longitudinal associations between IPFP signal intensity alteration and biochemical biomarkers over 2 years.

Results: All IPFP measures except for Clustering factor (H) were positively associated with urine collagenase-cleaved type II collagen neoepitope (uC2C), urine C-terminal cross-linked telopeptide of type II collagen (uCTX-II), urine C-terminal cross-linked telopeptide of type I collagen-α (uCTX-Iα) and urine N-terminal cross-linked telopeptide of type I collagen (uNTX-I). Mean (IPFP), Median (H) and Percentage (H) were positively associated with nitrated form of an epitope located in the triple helix of type II collagen (Coll2-1 NO2). Mean (IPFP), Median (H) and UQ (H) were positively associated with sCTX-I and uCTX-Iβ. Positive associations between sDev (IPFP), Percentage (H) and serum hyaluronic acid (sHA) were found.

Conclusion: Our results suggest a role of IPFP signal intensity alteration in joint tissue remodelling on a molecular level.
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http://dx.doi.org/10.1093/rheumatology/keac214DOI Listing
April 2022

Observed efficacy and clinically important improvements in participants with osteoarthritis treated with subcutaneous tanezumab: results from a 56-week randomized NSAID-controlled study.

Arthritis Res Ther 2022 03 29;24(1):78. Epub 2022 Mar 29.

Pfizer Inc., Groton, CT, USA.

Background: A recent phase 3 study demonstrated that treatment with tanezumab, a nerve growth factor inhibitor, or nonsteroidal anti-inflammatory drugs (NSAIDs) improves pain and physical function in participants with moderate-to-severe osteoarthritis (OA) of the hip or knee. Here, we evaluated the time course and clinical importance of these initial efficacy findings using a mixture of primary, secondary, and post hoc endpoints.

Methods: Participants on stable NSAID therapy and with a history of inadequate response to other standard OA analgesics were enrolled in an 80-week (56-week treatment/24-week safety follow-up), randomized, NSAID-controlled, phase 3 study primarily designed to assess the safety of tanezumab for moderate-to-severe OA of the knee or hip. Participants received oral NSAID (twice daily naproxen, celecoxib, or diclofenac) or subcutaneous tanezumab (2.5mg or 5mg every 8 weeks). Non-responders were discontinued at week 16. Changes from baseline in WOMAC Pain and Physical Function, Patient's Global Assessment of Osteoarthritis (PGA-OA), and average pain in the index joint were compared between tanezumab and NSAID groups over the 56-week treatment period. Clinically meaningful response (e.g., ≥30% and ≥50% improvement in WOMAC Pain and Physical Function), rescue medication use, and safety were also assessed.

Results: All groups improved WOMAC Pain, WOMAC Physical Function, PGA-OA, and average pain in the index joint over the 56-week treatment period relative to baseline. Across all groups, improvements generally occurred from the time of first assessment (week 1 or 2) to week 16 and then slightly decreased from week 16 to 24 before stabilizing from weeks 24 to 56. The magnitude of improvement and the proportion of participants achieving ≥30% and ≥50% improvement in these measures was greater (unadjusted p≤0.05) with tanezumab than with NSAID at some timepoints on or before week 16. Adverse events of abnormal peripheral sensation, prespecified joint safety events, and total joint replacement surgery occurred more frequently with tanezumab than with NSAID.

Conclusions: Tanezumab and NSAID both provided early and sustained (up to 56 weeks) efficacy relative to baseline. Improvements in pain and function were clinically meaningful in a substantial proportion of participants. Adverse events of abnormal peripheral sensation and joint safety events occurred more frequently with tanezumab than with NSAID.

Trial Registration: ClinicalTrials.gov NCT02528188 . Registered on 19 July 2015.
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http://dx.doi.org/10.1186/s13075-022-02759-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966257PMC
March 2022

Intra-articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis-Reply.

JAMA 2022 03;327(12):1187

Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1001/jama.2022.1315DOI Listing
March 2022

Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial.

BMC Musculoskelet Disord 2022 Mar 5;23(1):215. Epub 2022 Mar 5.

Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.

Background: Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months.

Methods: One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or; ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = 'no pain' and 10 = 'worst pain possible') at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness.

Discussion: This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain.

Trial Registration: ClinicalTrials.gov . Identifier: NCT04825483 . Registered 31st March 2021.
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http://dx.doi.org/10.1186/s12891-022-05128-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8898434PMC
March 2022

Neurological safety of subcutaneous tanezumab versus NSAID in patients with osteoarthritis.

J Neurol Sci 2022 Mar 14;434:120184. Epub 2022 Feb 14.

Pfizer Inc., Groton, CT, United States.

Objective: To assess the long-term neurological safety of tanezumab, a monoclonal antibody against nerve growth factor.

Methods: Patients with osteoarthritis of the hip or knee received stable doses of oral nonsteroidal anti-inflammatory drugs (NSAIDs) before study entry and during a ≤ 37-day screening period. Patients were randomized 1:1:1 to double-dummy tanezumab (2.5 mg or 5 mg, subcutaneous every 8 weeks) or oral NSAIDs (twice-daily) for 56 weeks, with a 24-week follow-up. Neurological safety evaluation focused on peripheral and sympathetic adverse events (AEs), neurologic examinations, and consultations with blinded, external diagnostic reviews.

Results: During the treatment period, 6.2%, 9.0%, and 4.6% of patients experienced AEs of abnormal peripheral sensation (APS) in the tanezumab 2.5 mg, 5 mg, and NSAID groups, respectively. Hypoesthesia, paresthesia, and carpal tunnel syndrome were the most common AEs of APS. Clinically significant worsening on examination occurred in <1% in any treatment group at the last study assessment. Diagnoses following external neurological consultation included mononeuropathy (1.3%, 2.1%, and 1.0%), radiculopathy (0.9%, 0.4%, and 0.5%), and polyneuropathy (0.3%, 0.5%, and 0%) in tanezumab 2.5 mg, 5 mg, and NSAID groups, respectively. AEs potentially associated with sympathetic neuropathy were reported for 1.8%, 2.3%, and 2.9% of patients in the tanezumab 2.5 mg, 5 mg, and NSAID groups, respectively. No patient was diagnosed with sympathetic neuropathy.

Conclusion: Tanezumab had an increased incidence of AEs of APS versus NSAID; these were typically mild/moderate in severity, resolved during the study, and rarely resulted in discontinuation. Tanezumab was not associated with peripheral neuropathy and did not adversely affect the sympathetic nervous system.

Trial Registration: ClinicalTrials.gov Identifier NCT02528188 (https://clinicaltrials.gov/ct2/show/NCT02528188).
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http://dx.doi.org/10.1016/j.jns.2022.120184DOI Listing
March 2022

Addressing Vaccine Inequity - Covid-19 Vaccines as a Global Public Good.

N Engl J Med 2022 03 23;386(12):1176-1179. Epub 2022 Feb 23.

From the Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom, and the Harvard T.H. Chan School of Public Health, Boston (D.J.H.); the Centre for the Aids Programme of Research in South Africa, Durban, and the Department of Epidemiology, Columbia Mailman School of Public Health, New York (S.A.K.); and the Wellcome Trust, London (J.J.F.).

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http://dx.doi.org/10.1056/NEJMe2202547DOI Listing
March 2022

TLC599 in patients with osteoarthritis of the knee: a phase IIa, randomized, placebo-controlled, dose-finding study.

Arthritis Res Ther 2022 02 21;24(1):52. Epub 2022 Feb 21.

Taiwan Liposome Company, Ltd., 2F, No. 3 Yuanqu St., Nangang Dist., Taipei City, 115, Taiwan.

Background: Corticosteroid injection for knee osteoarthritis is limited by its modest duration of treatment effect. The liposome formulation of dexamethasone sodium phosphate (TLC599) was developed for the sustained relief of osteoarthritis pain. This clinical study was conducted to evaluate the efficacy and safety of TLC599 at two dose levels in patients with knee osteoarthritis.

Methods: A randomized, double-blinded, placebo-controlled study was conducted in 75 patients with osteoarthritis of the knee from 13 study centers. Patients were randomized and administered a single intra-articular injection of TLC599 or placebo and assessed for efficacy and safety for 24 weeks. Patient-reported outcomes included the Western Ontario and McMaster Universities Arthritis (WOMAC) Index for pain and function and visual analog scale for pain.

Results: TLC599 at 12 mg demonstrated significantly greater reduction in WOMAC pain through 12 weeks (least squares (LS) mean difference = - 0.37, p = 0.0027) and through 24 weeks (LS mean difference = - 0.35, p = 0.0037) when compared to placebo. TLC599 12 mg also exhibited significantly greater improvement in function when compared to placebo at 24 weeks (LS mean difference = - 0.26, p = 0.0457). TLC599 18 mg did not significantly improve pain or function in comparison with placebo. The use of acetaminophen during the study was less in both TLC599 groups in comparison with placebo. No major or unexpected safety issues were reported.

Conclusions: In participants with symptomatic knee osteoarthritis, TLC599 is a well-tolerated treatment that reduces pain and improves function for up to 24 weeks, a longer duration than that reported for existing IA treatments.

Trial Registration: ClinicalTrials.gov , NCT03005873 . Registered on 29 December 2016.
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http://dx.doi.org/10.1186/s13075-022-02739-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862584PMC
February 2022

Use of Online Information in Musculoskeletal Conditions: An Analysis of Google Trends Data.

J Clin Rheumatol 2022 Apr;28(3):162-169

From the Faculty of Medicine and Health, School of Health Sciences and The Kolling Institute.

Background/objective: We aimed to investigate the yearly online public interest for gout, low back pain, neck pain, osteoarthritis, and rheumatoid arthritis, the most popular topics searched for these conditions, and the association between the change in their interest over time and the sociodemographic index of the search location.

Methods: We conducted online searches in Google Trends for the aforementioned conditions between 2004 and 2020. The search volumes for each condition (relative to all searches conducted in the period) and the top and rising related queries and topics were downloaded and summarized.

Results: There was a rise in the online interest for musculoskeletal conditions between 2008 and 2020, with low back pain (annual percent change, 7.4; 95% confidence interval [CI], 7.1-7.7) and neck pain (annual percent change, 7.2; 95% CI, 6.9-7.5) presenting the highest increases. There was a negative, statistically significant, but small association between change in online interest and the country's sociodemographic index for low back pain (-0.007; 95% CI, -0.011 to-0.003), neck pain (-0.005; 95% CI, 0.009 to -0.001), and rheumatoid arthritis (-0.009; 95% CI, -0.017 to -0.001) between 2013 and 2020. The interest for the cause and symptoms of the selected conditions increased over time, except for gout. The proportion of queries and topics related to treatment of all conditions decreased over time.

Conclusions: The worldwide interest in musculoskeletal conditions increased between 2008 and 2020. The public seems more interested in understanding what musculoskeletal conditions are and less interested in which treatment options are available. The results can guide the development of educational campaigns for musculoskeletal conditions.
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http://dx.doi.org/10.1097/RHU.0000000000001820DOI Listing
April 2022

Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study.

JMIR Form Res 2022 Jan 17;6(1):e32627. Epub 2022 Jan 17.

Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia.

Background: Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management.

Objective: The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations.

Methods: This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed.

Results: Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs.

Conclusions: Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958.
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http://dx.doi.org/10.2196/32627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804962PMC
January 2022

Osteoarthritis management: Does the pharmacist play a role in bridging the gap between what patients actually know and what they ought to know? Insights from a national online survey.

Health Expect 2022 Jun 8;25(3):936-946. Epub 2022 Jan 8.

Bayer Australia Pty., Ltd., Pymble, New South Wales, Australia.

Background: Guidelines encourage engagement in self-care activities for osteoarthritis (OA), but there are gaps in consumers' knowledge about suitable choices for self-care. Community pharmacists are in an ideal position to contribute to OA management through screening and supporting evidence-based pain management choices. Prior research established an association between health literacy and advice-seeking and appropriateness of analgesics choices (both lower in participants with limited health literacy) amongst people living with OA. This article explores the implications of these data for pharmacists in OA management.

Methods: A national online survey was conducted amongst 628 adults aged 45-74 years, currently residing in Australia, with self-reported symptoms of OA. All data were collected using a customized online questionnaire, which was completed only once. 'Self-reported symptoms of OA' was based on six validated screening questions to identify people with OA without a formal clinical diagnosis.

Results: Respondents matched the typical profile of people diagnosed with OA; more than half were female (56%), knees (59%) and hips (31%) were the primary affected joints and 74% were either overweight or obese. Self-identification of OA was limited (41%). Overall, 38% self-managed their pain, and limited health literacy was associated with less advice-seeking. Efficacy and ease of use were the main reasons cited for prompting use across all classes of nonprescription analgesic, with less than 20% reporting recommendation from a pharmacist. Participants were managing their pain with an average of 1.74 (95% confidence interval: 1.60-1.88) analgesics, but 73% reported inadequate pain relief and 54% had disrupted sleep.

Conclusion: Our findings highlight three key themes: lack of self-identification of OA, suboptimal pain relief and limited use of the community pharmacist as a source of management advice. Equipping community pharmacists with tools to identify OA could bridge this gap. More research is needed to determine if it will improve consumers' ability to appropriately manage OA pain.

Patient Or Public Contribution: Consumers living with OA contributed to the study outcomes, reviewed the survey questionnaire for face validity and advised on plain language terminology.
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http://dx.doi.org/10.1111/hex.13429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122430PMC
June 2022
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