Medicine (RMH) - Research Publications
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ItemChronic Primary or Secondary Noninflammatory Musculoskeletal Pain and Disrupted Sexual Function and Relationships: A Systematic Review(WILEY, 2022-06)OBJECTIVE: Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across noninflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and chronic secondary musculoskeletal pain with intimate relationships and sexual function. METHODS: Four electronic databases were searched from January 1, 1990 to September 5, 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary noninflammatory musculoskeletal pain, defined by International Classification of Diseases, Eleventh Revision classification criteria. RESULTS: Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores of ≤26.55 for the pain group, indicating sexual dysfunction. In 4 studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image, and self-worth. CONCLUSION: Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic noninflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centered musculoskeletal pain care.
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ItemCollecting patient-reported outcome measures(WILEY, 2017-12)Patient-reported outcome measures (PROM) are potentially useful outcome measures that may be reported at the individual clinical, health service and/or health system level. PROM require clearly defined patient populations to enable comparisons, and are most meaningful when integrated with clinical data sets. Where possible PROM should be measured pre- and post-intervention using reliable and validated tools. A variety of PROM collection methods exist which each have strengths and limitations, with selection depending on their purpose and patient factors. PROM programmes should be developed with high levels of clinician support and patient input to maximise collection of clinically relevant information.
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ItemLifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multinational Analysis Using National Registry Data(WILEY, 2017-11)OBJECTIVE: To compare the lifetime risk of total hip replacement (THR) surgery for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway, and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of THR was calculated for 2003 and 2013 using registry, life table, and population data. RESULTS: In 2003, lifetime risk of THR ranged from 8.7% (Denmark) to 15.9% (Norway) for females, and from 6.3% (Denmark) to 8.6% (Finland) for males. With the exception of females in Norway (where lifetime risk started and remained high), lifetime risk of THR increased significantly for both sexes in all countries from 2003 to 2013. In 2013, lifetime risk of THR was as high as 1 in 7 women in Norway, and 1 in 10 men in Finland. Females consistently demonstrated the highest lifetime risk of THR at both time points. Notably, lifetime risk for females in Norway was approximately double the risk for males in 2003 (females 15.9% [95% confidence interval (95% CI) 15.6-16.1], males 6.9% [95% CI 6.7-7.1]), and 2013 (females 16.0% [95% CI 15.8-16.3], males 8.3% [95% CI 8.1-8.5]). CONCLUSION: Using representative, population-based data, this study found statistically significant increases in the lifetime risk of THR in 5 countries over a 10-year period, and substantial between-sex differences. These multinational risk estimates can inform resource planning for OA service delivery.
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ItemProjected Burden of Osteoarthritis and Rheumatoid Arthritis in Australia: A Population-Level Analysis(WILEY, 2017-09-12)Objective To forecast the prevalence and direct health care costs of osteoarthritis (OA) and rheumatoid arthritis (RA) in Australia to the year 2030. Methods An epidemiologic model of the Australian population was developed. Data on the national prevalence of OA and RA were obtained from the Australian Bureau of Statistics (ABS) 2014–2015 National Health Survey. Future prevalence was estimated using ABS population projections for 2020, 2025, and 2030. Available government data on direct health care expenditure for OA and RA were modeled to forecast costs (in Australian $) for the years 2020, 2025, and 2030, from the perspective of the Australian public health care system. Results The number of people with OA is expected to increase nationally from almost 2.2 million in 2015 to almost 3.1 million Australians in 2030. The number of people with RA is projected to increase from 422,309 in 2015 to 579,915 in 2030. Health care costs for OA were estimated to be over $2.1 billion in 2015; by the year 2030, these are forecast to exceed $2.9 billion ($970 for every person with the condition). Health care costs for RA were estimated to be over $550 million in 2015, including $273 million spent on biologic disease‐modifying antirheumatic drugs. Health care costs for RA are projected to rise to over $755 million by the year 2030. Conclusion OA and RA are costly conditions that will impose an increasing health care burden at the population level. These projections provide tangible data that can be used to map future health service provision to expected need.
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ItemReturn to sport matterslonger-term quality of life after ACL reconstruction in people with knee difficulties(WILEY, 2017-05)Many individuals experience long-term quality of life (QOL) impairment following anterior cruciate ligament reconstruction (ACLR). Factors contributing to poor QOL and psychological health >5 years after ACLR remain unclear. This study aimed to describe QOL and psychological health outcomes in people with knee difficulties (pain, symptoms, or functional limitations) 5-20 years following ACLR and identify factors explaining variability in these outcomes. Participants with knee difficulties 5-20 years following ACLR completed a battery of validated patient-reported outcomes [including the Knee injury and Osteoarthritis Outcome Score (KOOS), ACL-QOL, and the Assessment of QOL (AQoL-8D) instrument]. Multivariable linear regression was used to identify factors explaining variability in outcomes. One hundred sixty-two participants aged 38 ± 9 (mean ± SD) years completed questionnaires 9 ± 4 (range 5-20) years following ACLR. Thirty-nine percent of participants returned to competitive sport, 28% returned to a lower level, and 32% did not return to sport after ACLR. Not returning to sport after ACLR was associated with worse KOOS-QOL (β = 0.29, P = 0.001 [mean ± SD (55 ± 20)], ACL-QOL [β = 0.48, P < 0.001; (57 ± 21)], and AQoL-8D [β = 0.22, P = 0.02 (0.80 ± 0.14)]) scores. Increased body mass index (56% were overweight/obese) was related to worse QOL and more depressive symptoms. Subsequent knee surgery and contralateral ACLR were also associated with poorer QOL outcomes in these individuals.
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ItemSafety of anti-rheumatic drugs for rheumatoid arthritis in pregnancy and lactation(WILEY, 2016-09)Women with rheumatoid arthritis (RA) are often of childbearing age and therefore questions regarding reproductive health and the use of medications, including disease-modifying anti-rheumatic drugs (DMARDs) may arise during the clinical consultation. Each patient requires individual assessment in order to effectively manage the disease while minimizing any treatment-associated risks to the fetus. Although good-quality controlled trials are lacking, there is an increasing volume of evidence surrounding the use of immunosuppressive therapies in pregnancy and lactation. This review summarizes the currently available information which can be of benefit to clinicians guiding patients and their families through the risks and benefits of continuing RA therapy during pregnancy and lactation. Further studies and ongoing surveillance of drug safety in pregnancy are required to resolve the uncertainties that remain regarding synthetic and biologic DMARDs.
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ItemSystematic Review of the Impact of Inflammatory Arthritis on Intimate Relationships and Sexual Function(WILEY, 2020-01)OBJECTIVE: To systematically review evidence of the impact of inflammatory arthritis on, or association of inflammatory arthritis with, intimate relationships and sexual function. METHODS: Ovid Medline, Ovid PsycINFO, Ovid Embase, and EBSCO CINAHL databases were searched. Two independent reviewers selected articles, extracted data, and conducted manual searches of reference lists from included studies and previous reviews. The quality of evidence was assessed using standard risk-of-bias tools. RESULTS: Fifty-five eligible studies were reviewed. Of these, 49 (89%) were quantitative, 5 (9.1%) were qualitative, and 1 (1.8%) used a mixed-method design. Few quantitative studies were rated as low risk of bias (n = 7 [14%]), many were rated as moderate (n = 37 [74%]) or high risk (n = 6 [12%]). Quantitative study sample sizes ranged from 10 to 1,272 participants, with a reported age range 32-63 years. Qualitative study sample sizes ranged from 8 to 57 participants, with a reported age range 20-69 years. In studies reporting the Female Sexual Function Index, all inflammatory arthritis groups demonstrated mean scores ≤26.55 (range of mean ± SD scores: 14.2 ± 7.8 to 25.7 ± 4.7), indicating sexual dysfunction. In studies reporting the International Index of Erectile Function, all inflammatory arthritis groups reported mean scores ≤25 (range of mean ± SD scores: 16.0 ± 5.3 to 23.8 ± 7.0), indicating erectile dysfunction. Key qualitative themes were impaired sexual function and compromised intimate relationships; prominent subthemes included inflammatory arthritis-related pain and fatigue, erectile dysfunction, diminished sexual desire, and sexual function fluctuations according to disease activity. CONCLUSION: Sexual dysfunction appears highly prevalent among men and women with inflammatory arthritis, and increased clinician awareness of this impairment may guide provision of tailored education and support.
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ItemProgression to total hip arthroplasty following hip arthroscopy(WILEY, 2018-05-24)BACKGROUND: Hip arthroscopy is a minimally invasive surgical technique increasingly being used to treat hip pathology. There is evidence that a proportion of patients require total hip arthroplasty in the years immediately following arthroscopy, suggesting that these patients have derived only a limited benefit from the procedure. Identification of risk factors for early progression to hip arthroplasty may enable refinement of hip arthroscopy indications and more informed decision making. The aim of this study is to identify the proportion of patients in a hip arthroscopy cohort who progress to total hip arthroplasty within 2 years of arthroscopy, and to analyse risk factors for this early progression. METHODS: A retrospective cohort analysis was conducted on all patients who underwent hip arthroscopy at one tertiary institution from 2004 to 2013. Hospital data were linked to the Australian Orthopaedic Association National Joint Replacement Registry in 2016 to identify subsequent hip arthroplasty. RESULTS: There were 989 arthroscopies performed on 947 patients; 447 were female (48.1%), the mean age was 41.1 years (SD: 14.23) and osteoarthritis was present at arthroscopy in 31.5%. Total hip arthroplasty occurred in 129 patients (13%) within 2 years. Multivariable logistic regression revealed osteoarthritis, age >50 years and previous arthroscopy were significant risk factors for arthroplasty within 2 years (adjusted odds ratios (confidence intervals): 4.6 (2.91-7.16), 3.8 (2.44-5.87), 2.5 (1.16-5.81)). CONCLUSIONS: Osteoarthritis, older age and history of arthroscopy were independent risk factors for early progression to arthroplasty; these factors should be considered within clinical decision-making, and when discussing potential arthroscopy outcomes with patients.
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ItemNo Preview AvailableLifetime Risk of Primary Shoulder Arthroplasty From 2008 to 2017: A Population-Level Analysis Using National Registry Data(WILEY, 2021-10)OBJECTIVE: To estimate the lifetime risk of primary shoulder arthroplasty in Australia and to examine changes over time. METHODS: For this retrospective population-level analysis, de-identified individual-level data on all primary partial shoulder arthroplasty (PSA) and total shoulder arthroplasty (TSA) procedures performed in Australia from 2008 to 2017 (n = 38,868) were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data and life tables were obtained from the Australian Bureau of Statistics. Lifetime risk of primary shoulder arthroplasty was calculated for each year using a standardized formula. Separate calculations were undertaken by sex and for PSA and TSA. RESULTS: The lifetime risk of shoulder arthroplasty increased significantly over time. For men, this risk more than doubled from 0.78% (95% confidence interval [95% CI] 0.73-0.84) in 2008 to 1.78% (95% CI 1.70-1.86) in 2017. Lifetime risk for women rose from 1.54% (95% CI 1.46-1.62) to 2.88% (95% CI 2.78-2.99) over the study period. This increase was predominantly driven by growth in lifetime risk of TSA. In contrast, lifetime risk of PSA decreased over time, from 0.25% (95% CI 0.22-0.28) in 2008 to 0.11% (95% CI 0.09-0.13) in 2017 for men, and from 0.55% (95% CI 0.51-0.60) to 0.11% (95% CI 0.09-0.13) for women. CONCLUSION: By the end of 2017, the lifetime risk of primary shoulder arthroplasty in Australia increased to 1 in 57 for men and 1 in 35 for women. Compared to declining PSA trends, there was substantial growth in TSA use over a decade. These data improve our understanding of the rising national burden of primary shoulder arthroplasty and can assist in planning to meet future surgical demand.
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ItemPhysical Therapists' Falls Prevention Knowledge, Beliefs, and Practices in Osteoarthritis Care: A National Cross-Sectional Study(WILEY, 2020-08)OBJECTIVE: To investigate physical therapists' knowledge, beliefs, and current practices around falls prevention in osteoarthritis (OA) care. METHODS: Currently registered, practicing Australian physical therapists who care for patients with hip and/or knee OA were invited to participate in this cross-sectional study. A comprehensive online survey was used to collect data that were analyzed descriptively or using chi-square tests; free-text responses were classified into key themes for analysis. RESULTS: Complete responses were received from 370 eligible physical therapists, with broad representation across Australian states and practice settings. Participants worked in public and private hospitals, community health centers, private practices, and aged-care facilities. The sample ranged from new graduates to experienced physical therapists (47% had practiced ≥11 years). Despite the majority having specific training or access to educational resources, physical therapists reported only moderate confidence in assessing falls risk (median 7 [interquartile range (IQR) 6-8]; range 0 [not at all confident] to 10 [extremely confident]) and delivering falls prevention care (median 7 [IQR 6-8]). While most participants asked about falls history (88%), only 39% used falls-risk screening tools, and of these, relatively few used appropriate tools. Time constraints (including competing clinical priorities) were the most frequently perceived barrier to including falls prevention activities within OA care. CONCLUSION: This national snapshot of contemporary OA practice has revealed clear opportunities for optimizing clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies. Improving practice in this area may yield substantial benefits to patients and the health system if more falls can be prevented.