Browsing by Author "Goode, Adam P"
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Item Open Access Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models.(Mayo Clinic proceedings. Innovations, quality & outcomes, 2021-04) Lentz, Trevor A; Hellkamp, Anne S; Bhavsar, Nrupen A; Goode, Adam P; Manhapra, Ajay; George, Steven ZObjective
To establish the frequency of concordant, discordant, and clinically dominant comorbidities among Medicare beneficiaries with knee osteoarthritis (KOA) and to identify common concordant condition subgroups.Participants and methods
We used a 5% representative sample of Medicare claims data to identify beneficiaries who received a diagnosis of KOA between January 1, 2012, and September 30, 2015, and matched control group without an osteoarthritis (OA) diagnosis. Frequency of 34 comorbid conditions was categorized as concordant, discordant, or clinically dominant among those with KOA and a matched sample without OA. Comorbid condition phenotypes were characterized by concordant conditions and derived using latent class analysis among those with KOA.Results
The study sample included 203,361 beneficiaries with KOA and 203,361 non-OA controls. The largest difference in frequency between the two cohorts was for co-occurring musculoskeletal conditions (23.7% absolute difference), chronic pain syndromes (6.5%), and rheumatic diseases (4.5%), all with a higher frequency among those with knee OA. Phenotypes were identified as low comorbidity (53% of cohort with classification), hypothyroid/osteoporosis (27%), vascular disease (10%), and high medical and psychological comorbidity (10%).Conclusions
Approximately 47% of Medicare beneficiaries with KOA in this sample had a phenotype characterized by one or more concordant conditions, suggesting that existing clinical pathways that rely on single or dominant providers might be insufficient for a large proportion of older adults with KOA. These findings could guide development of integrated KOA-comorbidity care pathways that are responsive to emerging priorities for personalized, value-based health care.Item Open Access Association between general joint hypermobility and knee, hip, and lumbar spine osteoarthritis by race: a cross-sectional study.(Arthritis research & therapy, 2018-04-18) Flowers, Portia PE; Cleveland, Rebecca J; Schwartz, Todd A; Nelson, Amanda E; Kraus, Virginia B; Hillstrom, Howard J; Goode, Adam P; Hannan, Marian T; Renner, Jordan B; Jordan, Joanne M; Golightly, Yvonne MBACKGROUND:Osteoarthritis (OA) prevalence differs by race. General joint hypermobility (GJH) may be associated with OA, but differences by race are not known. This community-based study examined the frequency of GJH and its relationship with knee, hip, and lumbar spine OA by race (African American vs. Caucasian). METHODS:Data were from the Johnston County OA project, collected 2003-2010. GJH was defined as Beighton score ≥4. OA symptoms were defined as the presence of pain, aching, or stiffness on most days separately at the knee, hip, and lower back. Radiographic OA (rOA) of the knee or hip was defined as Kellgren-Lawrence grade 2-4. Lumbar spine rOA was disc space narrowing grade ≥1 and osteophyte grade ≥2 in ≥ 1 at the same lumbar level. Lumbar spine facet rOA was present in ≥ 1 lumbar levels. Separate logistic regression models stratified by race were used to examine the association between hypermobility and rOA or OA symptoms at each joint site, adjusting for age, sex, previous joint injury, and body mass index (BMI). RESULTS:Of 1987 participants, 1/3 were African-American and 2/3 were women (mean age 65 years, mean BMI 31 kg/m2). Nearly 8% of Caucasians were hypermobile vs. 5% of African-Americans (p = 0.03). Hypermobility was associated with lower back symptoms in Caucasians (adjusted odds ratio (aOR) 1.54, 95% confidence interval (CI) 1.00, 2.39), but not in African-Americans (aOR 0.77, 95% CI 0.34, 1.72). Associations between hypermobility and other knee, hip, or lumbar spine/facet OA variables were not statistically significant. CONCLUSIONS:General joint hypermobility was more common in Caucasians than African-Americans. Although there were no associations between hypermobility and rOA, the association between hypermobility and lower back symptoms may differ by race.Item Open Access Association of Biomarkers with Individual and Multiple Body Sites of Pain: The Johnston County Osteoarthritis Project.(Journal of pain research, 2022-01) Norman, Katherine S; Goode, Adam P; Alvarez, Carolina; Hu, David; George, Steven Z; Schwartz, Todd A; Danyluk, Stephanie T; Fillipo, Rebecca; Kraus, Virginia B; Huebner, Janet L; Cleveland, Rebecca J; Jordan, Joanne M; Nelson, Amanda E; Golightly, Yvonne MIntroduction
Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain.Methods
This cross-sectional analysis included 689 community-based participants. Self-reported symptoms (ie, pain, aching, or stiffness) were ascertained about the neck, upper back/thoracic, low back, shoulders, elbows, wrist, hands, hips, knees, ankles, and feet. Measured analytes included CXCL-6, RANTES, HA, IL-6, BDNF, OPG and NPY. A standard dolorimeter measured PPT. Logistic regression was used determine the association between biomarkers and PPT with individual and summed sites of pain.Results
Increased IL-6 and HA were associated with knee pain (OR=1.30, 95% CI 1.03, 1.64) and (OR=1.32, 95% CI 1.01, 1.73) respectively; HA was also associated with elbow/wrist/hand pain (OR=1.60, 95% CI 1.22, 2.09). Those with increased NPY levels were less likely to have shoulder pain (OR=0.56, 95% CI 0.33, 0.93). Biomarkers HA (OR=1.50, 95% CI 1.07, 2.10), OPG (OR=1.74, 95% CI 1.00, 3.03), CXCL-6 (OR=1.75, 95% CI 1.02, 3.01) and decreased PPT (OR=3.97, 95% CI 2.22, 7.12) were associated with multiple compared to no sites of pain. Biomarker HA (OR=1.57, 95% CI 1.06, 2.32) and decreased PPT (OR=3.53, 95% CI 1.81, 6.88) were associated with multiple compared to a single site of pain.Conclusion
Biomarkers of inflammation (HA, OPG, IL-6 and CXCL-6), pain (NPY) and PPT may help to understand the etiology of single and multiple pain sites.Item Open Access Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.(The spine journal : official journal of the North American Spine Society, 2014-09) Goode, Adam P; Richardson, William J; Schectman, Robin M; Carey, Timothy SBackground context
Nationwide estimates examining bone morphogenetic protein (BMP) use with cervical spine fusions have been limited to perioperative outcomes.Purpose
To determine the 1-year risk of complications, cervical revision fusions, hospital readmissions, and health care services utilization.Study design
A retrospective cohort study from 2002 to 2009 using a nationwide claims database.Patient sample
There were 61,937 primary cervical spine fusions of which 1,677 received BMP.Outcome measures
Complications, revision fusions, 30-day hospital readmission, and health care utilization.Methods
Data for these analyses come from the Thomson Reuters MarketScan Commercial Claims and Encounters Database 2010. Patients were aged 18 to 64 years, receiving and not receiving BMP with a primary (C2-C7) cervical spine fusion. All outcomes were defined by International Classification of Diseases, 9th edition Clinical Modification and Current Procedural and Terminology, 4th edition codes. Complications were analyzed as any complication and stratified by nervous system, wound, and dysphagia or hoarseness. Cervical revision fusions were determined in the 1-year follow-up. Hospital readmission discharge records defined 30-day hospital readmission and reason for the readmission. The utilization of at least one health care service of cervical spine imaging, epidural usage or rehabilitation service was examined. Poisson regression models were used to estimate the relative risk and 95% confidence interval (CI). Linear regression was used to determine the time to hospital readmission. Results were stratified by anterior or posterior and circumferential approaches.Results
Patients receiving BMP were 29% more likely to have a complication (adjusted relative risk [aRR]=1.29 [95% CI, 1.14-1.46]) and a nervous system complication (aRR=1.42 [95% CI, 1.10-1.83]). Cervical revision fusions were more likely among patients receiving BMP (aRR=1.69 [95% CI, 1.35-2.13]). The risk of 30-day readmission was greater with BMP use (aRR=1.37 [95% CI, 1.07-1.73]) and readmission occurred 27.4% sooner on an average. Patients receiving BMP were more likely to receive computed tomography scans (aRR=1.34 [95% CI, 1.06-1.70]) and epidurals with anterior surgical approaches (aRR=1.29 [95% CI, 1.00-1.65]).Conclusions
These findings question both the safety and effectiveness of off-label BMP use in primary cervical spine fusions.Item Open Access Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries.(Arthritis research & therapy, 2021-11) Kim-Wang, Sophia Y; Holt, Abigail G; McGowan, Alyssa M; Danyluk, Stephanie T; Goode, Adam P; Lau, Brian C; Toth, Alison P; Wittstein, Jocelyn R; DeFrate, Louis E; Yi, John S; McNulty, Amy LBackground
Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries.Methods
Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects.Results
Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type.Conclusions
Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.Item Open Access Improving Veteran Access to Integrated Management of Back Pain (AIM-Back): Protocol for an Embedded Pragmatic Cluster-Randomized Trial.(Pain medicine (Malden, Mass.), 2020-12) George, Steven Z; Coffman, Cynthia J; Allen, Kelli D; Lentz, Trevor A; Choate, Ashley; Goode, Adam P; Simon, Corey B; Grubber, Janet M; King, Heather; Cook, Chad E; Keefe, Francis J; Ballengee, Lindsay A; Naylor, Jennifer; Brothers, Joseph Leo; Stanwyck, Catherine; Alkon, Aviel; Hastings, Susan NBackground
Coordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain treatments. This is an encouraging development; however, what constitutes best practice for nonpharmacologic management of low back pain (LBP) is largely unknown.Design
The Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) trial is an embedded pragmatic cluster-randomized trial that will examine the effectiveness of two different care pathways for LBP. Sixteen primary care clinics will be randomized 1:1 to receive training in delivery of 1) an integrated sequenced-care pathway or 2) a coordinated pain navigator pathway. Primary outcomes are pain interference and physical function (Patient-Reported Outcomes Measurement Information System Short Form [PROMIS-SF]) collected in the electronic health record at 3 months (n=1,680). A subset of veteran participants (n=848) have consented to complete additional surveys at baseline and at 3, 6, and 12 months for supplementary pain and other measures.Summary
AIM-Back care pathways will be tested for effectiveness, and treatment heterogeneity will be investigated to identify which veterans may respond best to a given pathway. Health care utilization patterns (including opioid use) will also be compared between care pathways. Therefore, the AIM-Back trial will provide important information that can inform the future delivery of nonpharmacologic treatment of LBP.Item Open Access Lumbar intervertebral disc diurnal deformations and T2 and T1rho relaxation times vary by spinal level and disc region.(European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022-03) Martin, John T; Oldweiler, Alexander B; Kosinski, Andrzej S; Spritzer, Charles E; Soher, Brian J; Erickson, Melissa M; Goode, Adam P; DeFrate, Louis EPurpose
Magnetic resonance imaging (MRI) is routinely used to evaluate spine pathology; however, standard imaging findings weakly correlate to low back pain. Abnormal disc mechanical function is implicated as a cause of back pain but is not assessed using standard clinical MRI. Our objective was to utilize our established MRI protocol for measuring disc function to quantify disc mechanical function in a healthy cohort.Methods
We recruited young, asymptomatic volunteers (6 male/6 female; age 18-30 years; BMI < 30) and used MRI to determine how diurnal deformations in disc height, volume, and perimeter were affected by spinal level, disc region, MRI biomarkers of disc health (T2, T1rho), and Pfirrmann grade.Results
Lumbar discs deformed by a mean of -6.1% (95% CI: -7.6%, -4.7%) to -8.0% (CI: -10.6%, -5.4%) in height and -5.4% (CI: -7.6%, -3.3%) to -8.5% (CI: -11.0%, -6.0%) in volume from AM to PM across spinal levels. Regional deformations were more uniform in cranial lumbar levels and concentrated posteriorly in the caudal levels, reaching a maximum of 13.1% at L5-S1 (CI:-16.1%, -10.2%). T2 and T1rho relaxation times were greatest in the nucleus and varied circumferentially within the annulus. T2 relaxation times were greatest at the most cranial spinal levels and decreased caudally. In this young healthy cohort, we identified a weak association between nucleus T2 and the diurnal change in the perimeter.Conclusions
Spinal level is a key factor in determining regional disc deformations. Interestingly, deformations were concentrated in the posterior regions of caudal discs where disc herniation is most prevalent.Item Open Access Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol).(Syst Rev, 2016-04-07) Goldstein, Karen M; McDuffie, Jennifer R; Shepherd-Banigan, Megan; Befus, Deanna; Coeytaux, Remy R; Van Noord, Megan G; Goode, Adam P; Masilamani, Varsha; Adam, Soheir; Nagi, Avishek; Williams, John WBACKGROUND: Vasomotor symptoms such as hot flashes and night sweats are a common concern of perimenopausal and postmenopausal women and are associated with a decreased quality of life. These symptoms can be effectively managed with hormone therapy, but safety concerns limit its use. Thus, understanding the effectiveness of nonpharmacologic therapies such as acupuncture or yoga is critical to managing these common symptoms in older women. Our review seeks to address the following question: In women with menopause-associated vasomotor symptoms, what are the effects on health-related quality of life, vasomotor symptoms, and adverse events of the following nonpharmacologic, nonherbal interventions as compared with any inactive control or active comparator: (a) acupuncture, (b) yoga, tai chi, and qigong, (c) structured exercise, and (d) meditation, mindfulness-based practices, and relaxation? METHODS: We describe a protocol for an umbrella review approach, supplemented by evaluating randomized controlled trials (RCTs) published after the most recent good-quality systematic review for each of the eligible interventions. Specific interventions were chosen based on current literature and with input from a technical expert panel and organizational stakeholders. We will conduct a thorough literature search and perform a quality assessment of potentially included systematic reviews and RCTs. DISCUSSION: Our umbrella review, supplemented by an additional search for eligible RCTs, aims to synthesize existing evidence on the use of nonpharmacologic, nonherbal interventions to manage bothersome vasomotor symptoms in perimenopausal and postmenopausal women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016029335.Item Open Access Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump.(Orthopaedic journal of sports medicine, 2021-03) Englander, Zoë A; Lau, Brian C; Wittstein, Jocelyn R; Goode, Adam P; DeFrate, Louis EBackground
There is little in vivo data that describe the relationships between patellar tendon orientation, patellar tendon strain, and anterior cruciate ligament (ACL) strain during dynamic activities. Quantifying how the quadriceps load the ACL via the patellar tendon is important for understanding ACL injury mechanisms.Hypothesis
We hypothesized that flexion angle, patellar tendon orientation, and patellar tendon strain influence ACL strain during a single-leg jump. Specifically, we hypothesized that patellar tendon and ACL strains would increase concurrently when the knee is positioned near extension during the jump.Study design
Descriptive laboratory study.Methods
Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon attachment sites of 8 male participants were generated from magnetic resonance imaging (MRI). High-speed biplanar radiographs during a single-leg jump were obtained. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones, ligament, and tendon attachment sites. Flexion angle, patellar tendon orientation, patellar tendon strain, and ACL strain were measured from the registered models. ACL and patellar tendon strains were approximated by normalizing their length at each knee position to their length at the time of MRI. Two separate bivariate linear regression models were used to assess relationships between flexion angle and patellar tendon orientation and between ACL strain and patellar tendon strain. A multivariate linear regression model was used to assess whether flexion angle and patellar tendon strain were significant predictors of ACL strain during the inflight and landing portions of the jump.Results
Both flexion angle and patellar tendon strain were significant predictors (P < .05) of ACL strain. These results indicate that elevated ACL and patellar tendon strains were observed concurrently when the knee was positioned near extension.Conclusion
Concurrent increases in patellar tendon and ACL strains indicate that the quadriceps load the ACL via the patellar tendon when the knee is positioned near extension.Clinical relevance
Increased ACL strain when the knee is positioned near extension before landing may be due to quadriceps contraction. Thus, landing with unanticipated timing on an extended knee may increase vulnerability to ACL injury as a taut ligament is more likely to fail.Item Open Access Physical therapy and opioid use for musculoskeletal pain management: competitors or companions?(Pain reports, 2020-09-24) George, Steven Z; Goode, Adam PMusculoskeletal (MSK) pain conditions are highly prevalent and a leading cause of disability globally. When people with MSK pain seek health care, they often receive treatment not aligned with best practices, including initial management options such as opioids. In recent practice guidelines, nonpharmacological treatments have been emphasized for initial pain management, and physical therapists are providers who routinely deliver nonpharmacological treatments. The purpose of this review is to describe the current and future state for how physical therapy may be used to increase exposure to nonpharmacological treatments for MSK pain conditions. For the current state, we review existing observational evidence investigating early exposure to physical therapy and its influence on subsequent opioid use. For the future state, we propose clinical research questions that could define the role of physical therapy on interdisciplinary teams working towards improving effectiveness of nonpharmacological treatments through more rigorous study designs. These clinical questions are intended to guide health services research and clinical trials when building an evidence base of nonpharmacological care options for MSK pain conditions.Item Open Access Quantifying the biochemical state of knee cartilage in response to running using T1rho magnetic resonance imaging.(Scientific reports, 2020-02-05) Heckelman, Lauren N; Smith, Wyatt AR; Riofrio, Alexie D; Vinson, Emily N; Collins, Amber T; Gwynn, Olivia R; Utturkar, Gangadhar M; Goode, Adam P; Spritzer, Charles E; DeFrate, Louis ERoughly 20% of Americans run annually, yet how this exercise influences knee cartilage health is poorly understood. To address this question, quantitative magnetic resonance imaging (MRI) can be used to infer the biochemical state of cartilage. Specifically, T1rho relaxation times are inversely related to the proteoglycan concentration in cartilage. In this study, T1rho MRI was performed on the dominant knee of eight asymptomatic, male runners before, immediately after, and 24 hours after running 3 and 10 miles. Overall, (mean ± SEM) patellar, tibial, and femoral cartilage T1rho relaxation times significantly decreased immediately after running 3 (65 ± 3 ms to 62 ± 3 ms; p = 0.04) and 10 (69 ± 4 ms to 62 ± 3 ms; p < 0.001) miles. No significant differences between pre-exercise and recovery T1rho values were observed for either distance (3 mile: p = 0.8; 10 mile: p = 0.08). Percent decreases in T1rho relaxation times were significantly larger following 10 mile runs as compared to 3 mile runs (11 ± 1% vs. 4 ± 1%; p = 0.02). This data suggests that alterations to the relative proteoglycan concentration of knee cartilage due to water flow are mitigated within 24 hours of running up to 10 miles. This information may inform safe exercise and recovery protocols in asymptomatic male runners by characterizing running-induced changes in knee cartilage composition.Item Open Access The risk of risk-adjustment measures for perioperative spine infection after spinal surgery.(Spine, 2011-04) Goode, Adam P; Cook, Chad; Gill, J Brian; Tackett, Sean; Brown, Christopher; Richardson, WilliamStudy design
Cross-sectional data analysis of the Nationwide Inpatient Sample (NIS).Objective
To develop a risk-adjustment index specific for perioperative spine infection and compare this specific index to the Deyo Comorbidity Index. Assess specific mortality and morbidity adjustments between teaching and nonteaching facilities.Summary of background data
Risk-adjustment measures have been developed specifically for mortality and may not be sensitive enough to adjust for morbidity across all diagnosis.Methods
This condition-specific index was developed by using the NIS in a two-step process to determine confounders and weighting. Crude and adjusted point estimates for the Deyo and condition-specific index were compared for routine discharge, death, length of stay, and total hospital charges and then stratified by teaching hospital status.Results
A total of 23,846 perioperative spinal infection events occurred in the NIS database between 1988 and 2007 of 1,212,241 procedures. Twenty-three diagnoses made up this condition-specific index. Significant differences between the Deyo and the condition-specific index were seen among total charges and length of stay at nonteaching hospitals (P < 0.001) and death, length of stay, and total charges (P < 0.001) for teaching hospitals.Conclusion
This study demonstrates several key points. One, condition-specific measures may be useful when morbidity is of question. Two, a condition-specific perioperative spine infection adjustment index appears to be more sensitive at adjusting for comorbidities. Finally, there are inherent differences in hospital disposition characteristics for perioperative spine infection across teaching and nonteaching hospitals even after adjustment.Item Embargo Using Patient Reported Outcomes to Inform Health Care Research and Practice(2024) Norman, KatherineUse of patient-reported outcomes (PROs) in addition to clinical (e.g., biomarkers, vitals, etc.) and organizational (e.g., admission, cost, etc.) outcomes are critical for integrating the patient perspective into medical product development, treatment algorithms, evaluation of care quality, measures of health-related quality of life, and more. Key regulatory bodies including Centers for Medicare and Medicaid Services, Patient-Centered Outcomes Research Institute, National Institute of Health Pragmatic Trial Collaboratory, Agency for Healthcare Research and Quality, and The United States Food and Drug Administration have urged for incorporation of PROs, typically in the form of PRO measures (PROMs) into clinical care and research trials as a means to increase patients’ perspectives into treatment development and delivery. While production and use of PROs and PROMs in research trials and clinical practice has exponentially increased, there remains a significant lack of knowledge of PRO and PROM adoption, administration, and interpretation to inform endpoints for research and clinical care. Therefore, this dissertation seeks to address the evidence gap by exploring various applications of health measures across different patient populations and settings to contribute information that will ultimately foster patient-centered, measurement-based care. The three components of this dissertation are outlined below to describe the range of patient populations, health contexts, and study designs used to provide doctoral level training in implementation strategies for health measurement and health services research. In the first project, we sought to determine which Patient Reported Outcome Measurement Information System (PROMIS) measures are associated with high-impact chronic pain (HICP) in patients status post shoulder arthroplasty (TSA) and propose cutoff scores to help guide future care recommendations. Identification of complex pain conditions, particularly HICP, is of growing interest among patients receiving total joint arthroplasty to better tailor pain interventions, as well as improve postoperative outcomes and quality of life. We performed a secondary analysis of a cohort of patients (n=227) who received a TSA at a single, academic medical center. Generalized linear models (GLM) estimated HICP from each PROMIS measure of physical function, pain interference, sleep disturbance, anxiety, and dyspnea individually, then in a combined model. Area under the curve (AUC) was calculated using receiver operator characteristic curves to assess accuracy of each PROMIS measure to estimate HICP status for patients receiving TSA. Bivariate GLM models and mean difference analyses revealed individuals with HICP had worse PROMIS scores in every included domain (all p-values <0.01). Only pain interference (AUC= 0.964) and physical function (AUC= 0.907) PROMIS measures met criteria (AUC>0.850) to accurately predict HICP. Cross validation and sensitivity analyses were performed to assess for differences among sociodemographic and surgical factors, and indicated little change in GLM models and cutoff scores for PROMIS measures. Further application and evaluation of these cutoff scores can be used to assist in refining assessment of outcomes for patients receiving TSA in registries, research trials, and clinical care. In the second project, we sought to perform a systematic review to understand what measures have been used to assess health-related quality of life (HRQoL) in patients experiencing acute bacterial skin and skin structure infection (ABSSSI) to guide measurement selection. ABSSSI can diminish patients’ HRQoL. The goal of this project was to identify and describe how HRQoL has been assessed in patients with ABSSSI in the literature to inform measurement selection for clinical antibacterial trials. We searched MEDLINE (PubMed), Embase (Elsevier), and CINAHL (EBSCO) for articles published between database inception and an updated search on October 14, 2022. We identified 37 articles that employed 42 distinct measures: 26 generic measures assessing HRQoL across multiple or singular domains, 14 condition-specific measures including repurposed dermatologic HRQoL metrics or measures relevant to surgical sites, and 2 author-developed questionnaires assessing treatment-related HRQoL. All findings were mapped to the Wilson and Cleary Model of HRQoL to explore domains of HRQoL captured in the evidence. We found reduced HRQoL for patients experiencing ABSSSI, which usually exhibited rapid onset and resolution related to symptom intensity. Pain had the greatest negative impact on HRQoL, and the most common HRQoL domain impacted was physical functioning. Progress has been made yet we did not identify a repurposed or novel tool that best captures HRQoL in patients with ABSSSI. For the final project of this dissertation, we sought to compare and contrast the health care experience for patients experiencing complicated urinary tract infections (cUTI) and their associated treating providers to inform future research on integration of patient reported outcome measures into patient-provider communication. Complicated urinary tract infections result in over 626,000 hospitalizations annually in the United States, yet little is known about the care experience of patients with cUTI and interactions with medical providers during care episodes. The perspectives of both patients receiving care for their cUTI and the providers navigating this complex condition are critical for informing how to increase patient perspective in research and clinical care. We used qualitative analysis to describe the care experience from patients who experienced a cUTI and care delivery from the perspective of their associated providers, and examine findings for similarities and differences. Single, semi-structured, individual, qualitative interviews were conducted via telephone or Zoom with all included patients and providers. We interviewed 12 patients and 16 providers, comprising 8 patient-provider dyads dyad (1 patient and corresponding (1) clinician) and 4 patient-provider triads (1 patient and corresponding (2) clinicians). Patient interviews averaged 44 (range 20–74) minutes and clinician interviews 21 (range 11–31) minutes. We used both structural and content analysis within and across interviews with patients and their treating providers, and organized findings using rapid, matrix-based techniques. Four concepts were identified: 1) time spent, 2) unknowns of care, 3) care coordination, and 4) discharge optimization. We found that increased or frequent interactions between patients and providers improved the care experience; however, a shared understanding of prognosis or cause for cUTI was critical for building patient-provider relationships. Additionally, there is a need for tools and strategies that promote care coordination across providers and settings, as well as a need to augment discharge preparedness and follow-up care. More research is needed to understand how PRO and/or PROMs can help to address concepts identified in this analysis.
Item Open Access Utility of an obstacle-crossing test to classify future fallers and non-fallers at hospital discharge after stroke: A pilot study(Gait & Posture, 2022-07) Feld, Jody A; Goode, Adam P; Mercer, Vicki S; Plummer, Prudence