2016 Summer AHPA Newsbrief
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AHPA Research Award
Recruitment For Research in JIA
ACPAC Program 2016-2017
Upcoming Courses and Conferences
Recent Articles and Online Resources
AHPA Research Award
Title: Are popular structured physical activity programs promising for the pain-management of Juvenile Idiopathic Arthritis? : A pilot randomized controlled trial
Objectives: The objectives of the proposed pilot randomized controlled trial (RCT) will be to examine the feasibility and initial effectiveness of a non-aerobic physical activity (PA) intervention (i.e. a Yoga training program) and an aerobic PA intervention (i.e. Zumba training program) on pain relief in female adolescents (14 to 18 years old) with juvenile idiopathic arthritis (JIA) compared to a waiting list control group. Specifically, the aim of the feasibility component is to obtain relevant data that will lead to the development of a future full-scale RCT.
The primary research question of the proposed pilot RCT is: “Do female adolescents (aged 14 to 18 years old) using non-aerobic PA (Group A: Yoga training program) or aerobic PA (Group B: Zumba training program) have reduced pain intensity when compared to waiting list control group (Group C), after 6 weeks post-intervention?” The secondary research question is as follows: “Do female adolescents (aged 14 to 18 years old) using non-aerobic PA (Group A: Yoga training program) or aerobic PA (Group B: Zumba training program have an increased functional status, enhanced self-efficacy to manage pain as well as an increase PA level and PA adherence when compared to a waiting list control group, after 6 weeks post-intervention (Group C)?”
The research questions related to the feasibility study: What are the recruitment rates, adherence rates to the interventions and study dropout rates? Is the randomization process realistic? Are the interventions appropriate for this sample of female adolescents (14-18 years-old)? Are the clinical and information communication technologies outcome measures selected appropriately? What is the standard deviation of the primary outcome measure in order to calculate the sample size for the full scale RCT?
Dr. Lucie Brosseau is a rehabilitation epidemiologist. She holds a University Research Chair in Evidence based Practice in Rehabilitation. She is also a member of the musculoskeletal group at Collaboration Cochrane. She co-developed the Ottawa Panel guidelines methodology.
Her main research interests are evidence-based practice and knowledge translation. Dr. Brosseau has conducted many meta-analyses on the effectiveness of rehabilitation care. She also conducted several validation studies of new clinical instruments and in conducting randomnized controlled trials to examine the effectiveness of treatments in rehabilitation She has also participated in developing and disseminating clinical guidelines in the musculoskeletal and rheumatological fields using innovative interventions, such as interactive educational workshops and innovative online technologies, directly to rehabilitation specialists in order to change their practice in using effective treatments for their patients or to prescribe self-management strategies based on the Ottawa Panel guidelines and translated in lay words (www.arthritis.ca/peoplegettingagrip) (Ottawa Panel, 2004-2016).
Recruiting for Important Research Related to Children with Juvenile Idiopathic Arthritis
We invite you to participate in a research study entitled “Translating Research into Practice: Identifying Factors that Influence the Uptake of Canadian Research Findings into the Clinical Care of Children with Arthritis.” The aim of this study is to identify barriers and facilitators to incorporating findings from Canadian JIA research into the clinical care of children with juvenile idiopathic arthritis by pediatric rheumatologists and allied health arthritis care providers caring for children across Canada. The study requires about 30-45 minutes of your time for a telephone interview which we will arrange at a time convenient for you.
The study is supported by a Canadian Rheumatology Association CIORA Grant. The study has been approved by the IWK Health Centre Research Ethics Board. No harm or personal benefit is anticipated from this research. Your participation in the study is completely voluntary.
If you are interested in participating in this research please click on the following link for more information
If you have any questions, please contact the Principle Investigator of this study
Dr. Elizabeth Stringer (Elizabeth.email@example.com)
Pediatric Rheumatologist, IWK Health Centre
Associate Professor of Pediatrics, Dalhousie University
Halifax, Nova Scotia, Canada
ACPAC Program 2016-2017
The Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program is pleased to announce that applications for the 2016-2017 program are now open.
Offered through the Office of Continuing Professional Development at the University of Toronto, ACPAC is an award-winning clinical-academic program that prepares experienced Physiotherapists, Occupational Therapists, and Nurses from across Canada for extended practice roles, including the diagnosis and management of patients with arthritis.
ACPAC graduates have been recognized at the local, provincial, national, and international level for providing:
Improved access to quality arthritis care
Reduced clinic wait times and improved triage for arthritis patients
Enhanced continuum of care for arthritis patients
The program runs from October 2016 to June 2017.
For more information contact firstname.lastname@example.org or visit http://acpacprogram.ca/about-the-program/register/
Upcoming Courses and Conferences
CBT Immersion - Cognitive Behaviour Therapy
All health care professionals address behaviour change in their clinical practice. This course is a unique, condensed course on the principles of CBT training to be used within the scope of non-mental health practitioners to help facilitate behaviour change in their patients. This course is offered in partnership between Wilfrid Laurier University Faculty of Social Work Professional Development and Qualia Counselling Services Inc.
Dates: Nov. 4, 5, 6, 2016 (Course duration is over 2 weekends)
Hours: 9:30 a.m. to 5 p.m.
Location: Wilfrid Laurier University 130 King St. West, Toronto
Cost: $1,599 after December 1, 2015
(textbooks, parking, lunch and accommodations not included)
TO REGISTER: call 519-884-0710 ext. 5265 or online at www.wlu.ca/fswpd
Bone Fit Workshops - Osteoporosis Canada
October 15-16, 2016
This evidence-informed exercise training workshop is designed for healthcare professionals & exercise practitioners to provide training on the most appropriate, safe & effective methods to prescribe & progress exercise for people with osteoporosis. Register for workshops at www.bonefit.ca
American College of Rheumatology Conference
Dates: Nov. 11-16 2016
Location: Washington DC, USA
Recent Articles and Online Resources
Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study
Barton, J. L., Trupin, L., Schillinger, D., Evans-Young, G., Imboden, J., Montori, V. M. and Yelin, E. (2016), Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study. Arthritis Care Res, 68: 889–898. doi: 10.1002/acr.22801
Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence; however, few tools support SDM in RA. Our objective was to pilot a low-literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications.
RA patients were consecutively enrolled into 1 of 3 arms: 1) control; patients received existing medication guide prior to clinic visit, 2) adapted guide prior to visit, and 3) adapted guide prior to plus decision aid during visit. Outcomes were collected immediately postvisit, at 1-week, and at 3- and 6-month interviews. Eligible adults had to have failed at least 1 disease-modifying antirheumatic drug and fulfill 1 of the following: age >65 years, immigrant, non–English speaker, less than high school education, limited health literacy, and racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions.
The majority of 166 patients were immigrants (66%), non–English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge postvisit in arm 3 was higher (78%) than arm 1 (53%; adjusted odds ratio 2.7, 95% confidence interval 1.2, 6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (P = 0.03). There were no significant differences in acceptability.
A low-literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with RA patients’ values and preferences.
Patient-Reported Outcomes From a Two-Year Head-to-Head Comparison of Subcutaneous Abatacept and Adalimumab for Rheumatoid Arthritis
Fleischmann, R., Weinblatt, M. E., Schiff, M., Khanna, D., Maldonado, M. A., Nadkarni, A. and Furst, D. E. (2016), Patient-Reported Outcomes From a Two-Year Head-to-Head Comparison of Subcutaneous Abatacept and Adalimumab for Rheumatoid Arthritis. Arthritis Care Res, 68: 907–913. doi: 10.1002/acr.22763
To report 2-year patient-reported outcomes (PROs) from the head-to-head Abatacept versus Adalimumab Comparison in Biologic-Naive RA Subjects with Background Methotrexate (MTX) (AMPLE) trial.
AMPLE was a phase IIIb, randomized, investigator-blinded trial. Biologic-naive patients with rheumatoid arthritis (RA) and an inadequate response to MTX were randomized to subcutaneous (SC) abatacept (125 mg/week) or adalimumab (40 mg every 2 weeks) with background MTX. PROs (pain, fatigue, ability to perform work, and ability to perform daily activities) were compared up to year 2 for patients in each treatment group, as well as those who achieved low disease activity at both years 1 and 2 (responders) and those who did not (nonresponders).
A total of 646 patients were randomized and treated with SC abatacept (n = 318) or adalimumab (n = 328). Baseline characteristics were balanced between the 2 treatment arms. Comparable improvements in PROs were observed in the abatacept and adalimumab groups over 2 years, with both groups achieving clinically meaningful improvements in PROs from baseline. At year 2, fatigue improved by 23.4 mm and 21.5 mm on a 100-mm visual analog scale with abatacept and adalimumab, respectively. Clinical responders achieved greater improvements in PROs than nonresponders.
In biologic-naive patients with active RA, despite prior MTX, treatment with SC abatacept or adalimumab with background MTX resulted in comparable improvements in PROs, which were highly correlated with physician-reported clinical response end points.
Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative
Collins, J. E., Deshpande, B. R., Katz, J. N. and Losina, E. (2016), Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative. Arthritis Care Res, 68: 965–973. doi: 10.1002/acr.22771
To determine race- and sex-specific rates of total knee arthroplasty (TKA) and to document independent effects of demographic factors on TKA incidence in a population with radiographically confirmed osteoarthritis (OA).
We used data from the Osteoarthritis Initiative, a US-based, multicenter longitudinal study of knee OA. We selected subjects with radiographic symptomatic OA at baseline and determined TKA incidence rates (ratio of TKAs to time at risk for TKA) over 84 months of followup. We used multivariable Poisson regression to identify independent associations between demographic factors and TKA utilization.
During the study period there were 223 TKAs among 1,915 subjects for an incidence of 1.9% (95% confidence interval [95% CI] 1.7–2.2%). The overall rate was 1.9% (95% CI 1.5–2.3%) in men versus 2.0% (95% CI 1.7–2.3%) in women, and 2.2% (95% CI 1.9–2.6%) in whites versus 1.0% (95% CI 0.7–1.5%) in nonwhites. We observed a statistically significant interaction between sex and age (stratified at followup), wherein male sex was associated with decreased risk of TKA for younger participants (relative risk [RR] 0.32) but not for older participants. Nonwhite race was associated with a decreased risk of TKA for both younger (RR 0.32) and older (RR 0.43) participants.
Our finding that nonwhites were less likely to undergo TKA than whites in adjusted analyses confirms racial differences observed in population-based studies and underscores the need for interventions to address lower use of TKA among nonwhites with OA
What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE
Arkema, E. V., Palmsten, K., Sjöwall, C., Svenungsson, E., Salmon, J. E. and Simard, J. F. (2016), What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE. Arthritis Care Res, 68: 988–994. doi: 10.1002/acr.22791
To assess maternal and fetal outcomes associated with subclinical (pre-systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population.
This prospective cohort study used population-based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre-SLE within 0–2 years, 133 pre-SLE within 2–5 years, and 12,847 general population). SLE was defined as ≥2 SLE-coded discharge diagnoses in the patient register with ≥1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran-Armitage tests evaluated trend across exposure groups.
Maternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent-SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre-SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2–5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre-SLE during pregnancy. The test for trend was significant for most outcomes.
Our data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.
The Arthritis Dietician
Dietary resources for patients living with Inflammatory Illnesses.
Next News Brief Deadline
The deadline for the September newsletter will be August 27th 2016. Please send any contributions to Julia Farquharson at Julia.email@example.com. We are particularly interested in notices of conferences or workshops, new resources for patients or health professionals and summaries of recent research/publications. We welcome contributions from members from all parts of the country