Chronic pelvic pain is a substantial clinical challenge that profoundly impacts quality of life for many women. The Neuro Emotional Technique (NET) is a novel mind-body intervention designed to attenuate emotional arousal of distressing thoughts and pain. This study evaluated functional connectivity changes in key areas of the brain in patients with chronic pelvic pain receiving the NET intervention. The goal was to assess whether the NET intervention was associated with functional connectivity (FC) changes in the brain related to reductions in emotional distress and pain, particularly in the limbic areas, sensory/pain regions, and cerebellum.

This is a prospectively designed study that included twenty-six patients with a diagnosis of chronic pelvic pain who were randomised to either the NET intervention or a waitlist control. To evaluate the primary outcome of neurophysiological effects, all participants received resting state functional blood oxygen level dependent (BOLD) magnetic resonance imaging (rs-fMRI) before and after the NET intervention or waitlist control period. Pain, mood, anxiety, and quality of life also were assessed.

Compared to the control group, the NET group demonstrated significant improvements in pain interference and pain intensity, and in emotional measures such anxiety and depression. Functional connectivity in the NET group compared to controls, was significantly decreased in the amygdala, cerebellum, and postcentral gyrus. There were also significant correlations between FC changes and changes in clinical measures.

This study is an initial step towards describing a neurological signature of reducing emotional distress in women with chronic pelvic pain. Specifically, FC changes between the cerebellum and the amygdala and sensory areas appears to be associated with a reduction in pain and the effects of that pain. Future, larger clinical trials are warranted to further evaluate these mechanisms and NET as a potential therapeutic intervention in patients with chronic pelvic pain.

Immune checkpoint inhibitors (ICIs) are first line treatment for advanced lung cancer. Tobacco use is a shared risk factor for lung cancer and chronic obstructive pulmonary disease (COPD). Although many patients with COPD and lung cancer receive ICIs, the impact of ICIs on COPD is unknown. Here, we evaluated whether ICI treatment was associated with increased COPD disease burden. We conducted a retrospective cohort study of lung cancer patients with and without preexisting COPD who received ICIs from 2011-2021 at The Ohio State University (OSU). For all patients, number of steroid courses and respiratory related hospitalizations were recorded. For those with COPD, COPD medications were collected at and after ICI initiation. Pulmonary function tests, COPD exacerbations, and COPD-related hospitalizations were compared before and after ICI treatment. Linear and generalized mixed models were used to account for potential confounders of worsening COPD. Among 1083 lung cancer patients who received ICIs, 585 (54.0%) had pre-ICI COPD. Patients with COPD were prescribed more COPD medications (3 [1, 4] vs 1 [0, 3], p < 0.001), had more COPD exacerbations (38.3% vs 25.8%, p < 0.001), and more COPD-related hospitalizations (27.9% vs 16.9%, p < 0.001) after ICI initiation compared to before. These findings persisted after multivariable analysis controlling for patients who received chemotherapy or chemoradiation within 12 months of ICI initiation, cancer type, age, BMI, sex, smoking status, type of ICI, and number of ICI doses (p < 0.001). This is a comprehensive study that describes lung cancer patients with COPD treated with ICIs have increased COPD disease burden after ICI initiation.

COVID-19 vaccination rates are decreasing despite vaccination being the most effective tool against severe disease from COVID-19. From October 1, 2022, to February 1, 2023, we conducted a cross-sectional study among adults in the Vaccine Safety Datalink about attitudes and beliefs regarding bivalent COVID-19 Omicron booster vaccine (hereafter referred to as COVID-19 bivalent vaccine) stratifying by vaccination status and race and ethnicity. Analysis was weighted for response and selection bias. The response rate was 27% (385/1430); 33% [95% CI: 21%-44%] of respondents were 'fully vaccinated' (had received COVID-19 bivalent vaccine), 54% [42%-67%] were partially vaccinated, and 13% [7%-19%] were unvaccinated. Fully vaccinated adults were more likely to consider COVID-19 bivalent vaccine 'very effective' (64%, [43%-86%]) at preventing hospitalization due to COVID-19 than partially (31%, [12%-50%]) or unvaccinated (2%, [0%-6%]) adults. Fully vaccinated adults were more likely to report COVID-19 bivalent vaccine was 'very safe' (83%, [69%-98%]) than partially (43%, [23%-63%]) or unvaccinated adults (2%, 0%-6%). Non-Hispanic White adults were more likely to report COVID-19 bivalent vaccine was 'very safe' (71%, [54%-87%]) than Non-Hispanic Black (36%, [21%-50%]) and Hispanic (26%, [7%-45%]) adults. A dose-response effect between vaccination status and perceptions of COVID-19 bivalent vaccine safety and effectiveness was observed, with fully vaccinated respondents having the most favorable attitudes. Racial and ethnic differences in perceived vaccine safety were also found. Improved communication about vaccine effectiveness and safety is key to improving low vaccination rates.

Oral pre-exposure prophylaxis (PrEP) for HIV prevention promises women more control over HIV prevention. To alleviate low PrEP uptake, rolling out long-acting PrEP methods could increase uptake in women's preferred ways. The study sought to determine injectable PrEP service delivery characteristics that effectively meet young women's service needs. In 2023, we conducted a discrete choice experiment in South African tertiary institutions. We recruited and interviewed 400 female students mostly queuing for sexual health services. Data were analysed using mixed logit and latent class models.Young women strongly prefer using campus clinics to non-campus clinics and returning to the facility for product information and its side effects to using a chatbot [OR  = 1.07, CI: 1.02, 1.13]. Also, compared to getting a free service, students were prepared to pay R50 ($2.90) [OR = 1.14, CI: 1.05, 1.25]. Three classes emerged from the latent class model and these differed by background characteristics like age group and study year. Receiving PrEP through campus services from sensitive, PrEP providers and providing accurate information on side effects was preferred by students over community-based primary health care clinics with public health nurses. PrEP-trained providers should provide PrEP services as young people prefer returning to facilities for further youth-friendly support.

To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy.

Females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications.

85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion.

Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.

Depressive disorders are associated with poor treatment outcomes, physical health, and quality of life among people living with TB (PLWTB) and TB/HIV (PLWTBHIV). Data on depression among PLWTB/HIV are limited in Ukraine.

This cross-sectional study aimed to examine depression risk and its correlates and describe the willingness to seek depression treatment among PLWTB/HIV in Ukraine.

This secondary analysis included patients with and without HIV who initiated TB treatment within 30 days in two tertiary hospitals in Kyiv and Odesa. A survey was conducted from February 2021 to October 2022 and reviewed patients' health records. We used the Center for Epidemiological Studies-Depression Scale (CES-D) to indicate risk for clinical depression. Factors associated with depressive symptoms were identified using logistic regression.

The sample included 209 participants (n = 100 with TB; n = 109 with TB/HIV). The mean age of participants was 43 (SD = 11) years; 66% of sample identified as male. Approximately 28% of participants were at risk for clinical depression; of whom 66% were willing to seek therapeutic or medical help. HIV coinfection (adjusted odds ratio [aOR] = 2.95, 95% confidence interval [CI]: 1.46,6.20), past 30 days illicit drug use (aOR = 3.57, 95% CI = 1.18,11.60), TB stigma (moderate stigma aOR = 7.40, 95% CI = 2.22,34.1; high stigma aOR = 15.50, 95% CI = 4.52,73.20), and unemployment status (aOR = 2.25, 95% CI = 1.12,4.60) were significantly associated with the odds of depressive symptoms among PLWTB.

Findings support integration of a brief depression screening tool into routine clinical care of PLWTB/HIV and highlight the importance of linking TB/HIV care with mental health services.

Survey-based studies are inherently subject to non-response bias. A comprehensive understanding of the factors contributing to non-response is important for minimizing attrition bias and ensuring generalizability of results. The purpose of this study was to determine the preoperative factors associated with survey non-response 2 years after hip arthroscopy.

Patients undergoing hip arthroscopy at a single center between October 2015 and March 2020 were approached for enrollment in a prospective registry. Patients were emailed an electronic survey at baseline and at 1 and 2 years postoperatively. The primary outcome was response to the 2-year postoperative survey. Patients who failed to complete any part of the 2-year postoperative survey after a series of standardized email, text message, and phone call reminders were considered non-responders. Baseline sociodemographics and patient-reported outcomes (PROs) were compared between the groups using Pearson Chi-Squared or Wilcoxon Rank-Sum tests. Logistic regression was used to identify predictors of non-response.

Ninty-nine patients were enrolled and completed the baseline survey. There were 25 non-responders (25 %) at 2 years. Non-responders demonstrated a higher proportion of patients who were male, identified as non-white, and did not respond to the 1-year postoperative survey. There were no differences in baseline PROs between responders and non-responders. When controlling for age and sex, patients who did not identify as white (OR = 4.3, 95 % CI [1.3, 14.4]) and patients who did not respond to the 1-year postoperative survey (OR = 4.5, 95 % CI [1.5, 13.8]) were more likely to be non-responders at 2 years.

Not responding to 1 year postoperative survey and non-white race are independent predictors of non-response at 2 years after hip arthroscopy. Baseline PROs do not differ between responders and non-responders.

Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.

638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived "completely better" status based on cluster group.

Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p < .001), and LOW-LOW group (OR = 5.17, p < .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).

Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affected health, economies, and lifestyles, but little is known about its impact on children. We aimed to investigate changes in 24-hour (h) movement behaviours of pre-school children before and during COVID-19, and factors that influenced these. Children aged 3-6 years were recruited in Beijing in 2019, and their movement behaviours over 24 ​h assessed by questionnaire, as part of the International Study of Movement Behaviors in the Early Years (SUNRISE) study. We conducted the survey again during COVID-19, and compared the children's movement behaviours before and during COVID-19 and associated factors. Overall, 196 parents completed the survey at both time points. The percentage of children meeting movement guidelines decreased during the pandemic (p ​< ​0.01). Total physical activity decreased less among children getting good quality sleep or with more adults in the household (p ​< ​0.01). Children who were not cared for primarily by their mother had a greater decrease in moderate to vigorous intensity physical activity (p ​= ​0.02), but the decrease was smaller among children whose parents used the internet to support their physical activity and/or screen time (p ​< ​0.05). Children who used electronic screen devices in the 2 ​h before bedtime or whose parents reported body temperature in webchats had a greater increase in sedentary screen time (p ​< ​0.05). Children spending more time outdoors showed a smaller decrease in sleep (p ​< ​0.01). Overall, children's movement behaviours changed significantly during the pandemic.

Postpartum depression (PPD) is associated with an increased risk of adverse outcomes for birthing parents, their children, and healthcare systems. Public health nurse (PHN)-delivered group cognitive behavioural therapy (CBT) can effectively treat PPD and has potential to be scaled, but its cost-effectiveness remains unknown. The purpose of this study was to examine the cost-utility of a PHN-delivered group CBT intervention for treating PPD added to treatment as usual (TAU) compared to TAU alone.

This economic evaluation was conducted alongside an RCT in Ontario, Canada. Birthing parents ≥18 years old with an infant ≤12 months and an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 were randomly assigned to receive PHN-delivered group CBT plus TAU or TAU alone. Costs were calculated based on healthcare service use over the 35-week trial period. The EQ-5D-3L was collected at baseline, 9 weeks, and 6 months later and used to calculate quality adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated. Non-parametric bootstrapping was used to estimate uncertainty and generate a cost-effectiveness acceptability curve (CEAC).

The intervention was associated with a 0.023 (95 % CI -0.058, 0.011) QALY gain and mean additional cost of $238 (95 % CI -$1749, $2227) compared to the control group. The ICER was $10,347 per QALY gained. At a willingness-to-pay of $50,000 for one QALY, PHN-delivered group CBT had a 75 % probability of being cost effective.

This trial-based cost-utility analysis found that PHN-delivered group CBT for treating PPD added to TAU may be cost-effective compared to TAU alone.

Patients undergoing transcatheter aortic valve implantation (TAVI) are at increased risk of rehospitalization in the early period after discharge from TAVI. The HOSPITAVI study aimed to compare the impact of a standard versus intensified outpatient follow-up on rehospitalization rates within 90 days after TAVI discharge. Patients were 1:1 randomized to either a standard or intensified outpatient follow-up after TAVI discharge. The primary endpoint was the 90-day hospital rehospitalization rate. In total, 300 patients were included: 150 patients were randomized to standard follow-up and 150 patients to intensified outpatient follow-up. The study population had a median age of 79 years, a median EuroSCORE II of 2.9%, and 72% were discharged the day after TAVI. Within 90 days after discharge, the mean number of all-cause hospital readmissions per patient was 0.44 versus 0.35 (HR 0.8 [95% CI, 0.6-1.2], p = 0.23) in the standard versus intensified group, respectively. The mean number of cardiovascular (CV) readmissions per patient was 0.27 versus 0.15 (HR 0.6 [95% CI, 0.4-1.0], p = 0.04) in the standard versus intensified group, respectively. This resulted in a mean number of CV readmission days per patient of 1.52 days versus 0.49 days within the first 90 days in the standard versus intensified group, respectively (p < 0.05). Following TAVI discharge, there was no significant difference in all-cause rehospitalization rates using a standard versus intensified outpatient follow-up approach. However, an intensified outpatient follow-up reduces the burden of early CV rehospitalization after TAVI discharge. (Rehospitalization after transcatheter aortic valve implantation [HOSPITAVI]; NCT05670041).

Despite its high prevalence and strong linkages with dangerous health outcomes, research on Adjustment Disorder (AjD) is hindered by lack of diagnostic clarity. AjD is categorized as a stress-related disorder, highlighting the important role of the stressor(s) on AjD symptom onset and severity. The military community shows increased risk for AjD, and existing tools do not capture the stressors most relevant and appropriate to this unique community. A diagnostic assessment tool developed specifically for this specialized population may provide critical capability to clinical assessment.

A Delphi method was used to create a military-specific version of the standard assessment for Adjustment Disorders (ADNM-20), named ADNM-20-MIL. This tool was pilot-tested in a sample of U.S. Active Duty Service Members (ADSMs) with AjD diagnoses.

Throughout the Delphi process, military-specific stressors were identified and integrated into the ADNM-20-MIL, then refined and validated, ensuring their applicability and relevance to the military context.

The ADNM-20-MIL will enable timely diagnosis and targeted treatment for AjD, which remains a highly prevalent and destabilizing diagnosis in ADSMs.

While molecular and non-molecular genetic testing are the gold standard for assessing a person's familial liability for substance use disorders, such testing is often inaccessible. Family history information collected at intake is an alternative, but tools to effectively utilize this information are excessively complex. The aims of the study are threefold: 1) Describe a protocol for the collection of family history in a thorough and straightforward manner. 2) Provide an algorithm to convert family history information to numerical scores. 3) Present the aggregated results from the pilot testing of the protocol.

All patients (N = 871) underwent a comprehensive assessment that included the family history protocol. Descriptive statistics, t-tests and Pearson Correlation were used to analyze the scores and determine key differences by demographic categories (sex/race/ethnicity/substance/age).

The protocol asked patients four key questions about 1st and 2nd degree relatives while completing a family pedigree. Answers were transferred into an algorithm to output a score for each patient. This score took affectedness and relatedness of each family member into account. The average number of affected relatives was 5.24 (SD=3.17), and there were significant sex, race, and primary substance score differences.

This study provides the addiction field with a novel, freely available, and easily implementable family history protocol that has several potential clinical applications. While more research is needed, pilot results provide a valuable research tool, insight into a typical family history for those at an inpatient addiction treatment center, and steps toward closing the research-to-practice gap in this field.

Cardiovascular disease (CVD) is associated with several risk and protective factors, including psychological variables, such as anxiety and depressive symptoms, stress and coping strategies. These factors may be either a cause or a consequence of CVD and are thought to influence the cardiac rehabilitation (CR) process after acute cardiac event, a multifaceted intervention that is crucial for reducing rehospitalisation and mortality. The main aim of this study was to correlate such psychological components with cardiac outcomes in a sample of 315 CVD referred to an in-hospital CR program.

Participants completed self-report questionnaires on perceived stress, anxiety and depressive symptoms, and coping styles.

Females (36.51 %) reported higher levels of depressive symptoms and turning to religion as a coping strategy compared to male. Perceived stress did not differ between male and female, but it was found to be significantly higher in heart failure patients, regardless of gender. Functional outcomes after a CR program were not predicted by any psychological variable, whereas clinical outcomes were predicted by depressive symptoms and coping strategies (social support and positive attitude). Finally, perceived health status was predicted by anxiety, depressive symptoms and avoidance.

These findings confirm the importance of conducting psychological screening in patients with CVD, as recommended by international guidelines, and highlight the need to provide them with adequate psychological support to reduce the adverse consequences of cardiac disease, and to promote protective attitudes and behaviours through tailored psychological interventions to improve outcomes after a CR program.

Safe Sleep Community Baby Showers (CBS) provide group education to reduce risk factors of sudden unexpected infant death (SUID). Based on CBS success, Safe Sleep Crib Clinics were developed to provide individual education. This study assessed Crib Clinic outcomes and differences in Crib Clinics compared to CBSs.

Certified Safe Sleep Instructors facilitated CBSs and/or Crib Clinics in their communities and collected participant data related to safe sleep, tobacco avoidance and breastfeeding. Crib Clinic data was compared pre- to post-test; post-test results were compared between Crib Clinics and CBSs.

Crib Clinic attendees exhibited significant increases in intention to have infant follow safe sleep recommendations, avoid secondhand smoke and breastfeed (all p < 0.001). Significant differences between Crib Clinic and CBS participants related to marital status, language, tobacco, education and insurance (all p < 0.01). CBS and Crib Clinic participants differed on items related to sleep environment, breastfeeding and tobacco (all p = 0.05).

Overall Crib Clinics appear to be effective in increasing knowledge, intentions and confidence related to safe sleep, tobacco avoidance and breastfeeding. Crib Clinics may offer flexibility (e.g., time, format) that increases accessibility to safe sleep education for families.

Results suggest the ability to shift education delivery method based on group size was important in both rural and urban settings.

Patient education, physical activity, and exercise are recommended as first-line treatments for mild to moderate hip and knee osteoarthritis (OA). We developed two novel healthcare interventions: an electronic medical record-embedded physical activity prescription tool (PARx) for physicians, and a free, online educational platform (Joint Management (JM)) with exercise programming and optional telerehabilitation with a physiotherapist for patients. Objectives: 1) Determine the effectiveness of PARx ​± ​JM on patient-reported outcomes, physical activity levels, and performance-based functional outcomes in individuals with mild to moderate hip or knee OA, versus usual care; 2) evaluate engagement and adherence to PARx ​+ ​JM; and 3) explore the feasibility of PARx and PARx ​+ ​JM.

NCT04544904.

Randomized controlled trial (type 1 hybrid implementation effectiveness). We will recruit 339 (113/group) participants ≥40 years old with mild to moderate hip or knee OA and randomize them into three groups: PARx, PARx ​+ ​JM, or control (usual care). Follow-up appointments will be completed at 2-, 6-, and 12-months. Primary outcome: Knee Injury/Hip Disability and OA Outcome Score. Secondary outcomes: physical activity levels, anthropometric measurements, physical function, and other patient-reported outcomes. We will assess intervention feasibility and hold focus groups with patients and providers to explore perceptions of the interventions.

Two novel healthcare interventions will be used to provide physical activity and exercise programming for individuals with mild-moderate knee and hip OA. This study will allow us to determine the effectiveness of these interventions on patient-reported outcomes, physical activity levels, and performance-based functional outcomes.

Cerebral palsy (CP) clinical research is fraught with challenges, in part due to health-related disparities common among people with disabilities. Perspectives of people with lived experience of CP, clinicians and researchers vary on how to address these disparities. The present initiative explores synergies and discrepancies among stakeholders (n = 212) representing these partner groups in perceived barriers and facilitators to high-quality clinical CP research and robust trainee pathways. The overarching goal is to generate priority actions to empower meaningful partner group engagement in CP research and, ultimately, improve health outcomes for people with CP.

Grounded in empowerment theory, mixed methods needs assessments were conducted separately with partner groups to capture perspectives on barriers and facilitators to high-quality CP research and strong trainee pathways. Thematic analysis was applied to focus groups and interviews to identify themes and subthemes.

Discrepancies among partner groups emerged related to informational needs, community connection, ethical research and equitable representation in research, and fair compensation for lived experience partner engagement in the research process.

Ongoing opportunities for researcher action to empower partner group engagement include building shared purpose, nurturing social connection within and among groups and intentional efforts to build trust and codesign studies.

The initiative described here was informed by caregivers of children with CP from Georgia, USA, using a community-based participatory research (CBPR) approach. CPBR is a collaborative approach, designed to give communities, which here include people with lived experience of CP, control over research processes and outcomes. Their perspectives were essential to the premise of this study and guided data interpretation, especially with regard to how their perspectives may or may not correspond to those of CP researchers and clinicians. To ensure inclusion of all perspectives, individuals with CP were also represented in these latter two engagement groups. Finally, the design, conduct, analysis and interpretation of data were informed by a researcher and a clinician-scientist, both of whom have lived experience as caregivers of children with CP.

The definition of 'physiological birth' by the World Health Organization in 1997 may need to be revisited to better align with current practices in labour and birth in the Australian context, and to better understand the perspectives of women and their care providers. This study explored if obstetric doctors, midwives, doulas, women, and support people (with experience in labour and birth in the last 12 months) recognise physiological birth differently, which interventions they consider congruent with physiological birth, and terms that should be included in a consensus statement of 'physiological birth'.

A self-administered, anonymous, 68-field questionnaire was developed and shared online via social media platforms (Facebook, X, and LinkedIn). The questionnaire included Visual Analogue Scales, multi-choice, Likert scale, and open-text items. Data were collected between August - November 2023.

733 participants interacted with the survey. Medical intervention such as vaginal examination to assess labour progress, was considered congruent with physiological birth, whereas continuous cardiotocography and artificial rupture of membranes were considered to be 'non-physiological'. Doulas associated physiological birth with being 'intervention-free' more strongly than any other group. Obstetrics doctors viewed birth as inherently risky. Respondents indicated that the psychological experience of birth, and terms such as 'spontaneous onset', 'no/minimal intervention' and 'spontaneous delivery/birth' should be included in a consensus statement of 'physiological birth'.

There are multiple understandings of the term 'physiological birth', implying that the term lacks clarity. There are disparities in how care providers and women view intervention in birth; suggesting a consensus statement of 'physiological birth' is appropriate for the Australian context.

Because of limited alternative options, intracoronary brachytherapy (ICBT) continues to be used for treating in-stent restenosis (ISR). We examined the indications, characteristics, and outcomes of ICBT in consecutive patients who underwent ICBT for ISR between January 2014 and December 2023 at a tertiary care center. During the study period 343 patients underwent ICBT of 502 lesions. The median patient age was 67 [60, 74] years, 73.4% of the patients were men, 77.3% had prior myocardial infarction, and 49.4% had prior coronary artery bypass graft surgery. The most common target vessel was the right coronary artery (38.7%) and 7.37% of lesions were in bypass grafts (33 saphenous vein grafts, 4 arterial grafts). A diffuse ISR pattern was found in 76.2% of lesions. Among the study lesions, 58.0% had 2 stent layers and 20.6% had 3 or more stent layers. Technical success was achieved in 96.1% of lesions. Follow-up was available for all patients with a mean follow-up of 701.5 days. The 3-year incidence of target lesion failure (TLF), target vessel myocardial infarction, and major adverse cardiac events were 36.4%, 17.2%, and 45.6%, respectively. In multivariable analysis, higher brachytherapy radiation dose was associated with a lower risk for TLF (aHR per 10 Gy: 0.73; 95% CI 0.54-0.93; p = 0.048). Repeat ICBT procedures had a higher incidence of TLF over 3 years compared with lesions treated with ICBT for the first time (log-rank test: p = 0.008). In conclusion, the 3-year incidence of TLF after ICBT is 36.4% and was lower with higher radiation dose and higher in lesions retreated with ICBT.

Patellofemoral arthroplasty (PFA) is an attractive option for patients who have isolated patellofemoral disease. This study aimed to assess the functional outcomes and revision rates of primary PFA with a third-generation implant with short- to medium-term follow-up.

We retrospectively reviewed the records of 49 patients (70 knees) undergoing PFA with the iBalance system by a single surgeon at a quaternary center between January 2015 and September 2022 for demographic and surgical data, as well as complications and revision rates. Patient-reported outcome scores were then collected.

The population was majority female (81.6%) with a median age of 50 years. Four knees were revised to a total knee arthroplasty (5.7%) at an average time point of 2.3 years postoperatively (range: 1.3-3.5 years). The median Single Assessment Numeric Evaluation score at the time of follow-up was 82.5, while the median Kujala score was 72. Lower preoperative Kellgren-Lawrence grade was significantly associated with lower Knee Injury and Osteoarthritis Outcome Scores in all 5 domains (P < .05 for all). Additional procedures were required in 17 knees (24.3%), in most cases to improve patella tracking.

This study is, to our knowledge, the first to examine outcomes of the iBalance PFA system. The results show favorable patient-reported outcomes in this cohort consistent with other 2nd and 3rd generation PFA implants, along with a revision rate similar to its prosthetic peers.

Uncontrolled hemorrhage is the most preventable cause of death following traumatic injury; children may be called to act as bystanders when hemorrhage control is necessary. The earliest age that children can learn hemorrhage control remains undetermined. We aimed to identify whether children aged 8 to 12 years can identify when and how to use a combat application tourniquet (CAT) and can appropriately place and tighten it to achieve hemorrhage control.

We conducted a prospective study of children aged 8 to 12 years old. A trained facilitator taught hemorrhage control and CAT placement on manikins in small group sessions. After each session, we assessed the comprehension and application skills of each participant using a standardized 4-question tool. If at least 60% of children within each age group correctly performed both comprehension (cognitive) and skills (psychomotor) assessments, the group was considered successful. We compared success rates between age groups and analyzed the association between performance and participant age, sex, and body mass index (BMI).

Of 326 eligible children, 322 completed the training and assessment (99%). Overall, 70% (225/322) of participants completed all 4 assessment questions correctly, 88% (284/322) of participants were able to answer both comprehension (cognitive) questions correctly, and 76% (246/322) of participants were able to accurately demonstrate both CAT placement skills (psychomotor) correctly. All age groups exceeded the 60% success rate in both assessments. Age, sex, and BMI were not significantly associated with assessment performance.

Children as young as 8 years old can successfully learn hemorrhage control techniques and combat application tourniquet application, suggesting this training can begin as early as third grade.

This study aimed to investigate U.S. minority nursing staff's discrimination experiences and the association of such experiences and other critical factors with their quality of life (QoL) during the COVID-19 pandemic.

Racial/ethnic minority nursing staff are at a higher risk of developing unfavorable health outcomes associated with race-based and related discrimination.

Minority nursing staff were recruited through a professional network. An online survey, consisting of validated measures, was used to assess perceived discrimination, fear of COVID-19, perceived risk of contracting COVID-19, resilience, social support, and QoL. We used the chi-square test, ANOVA, and path analysis to compare racial/ethnic group differences and variables associated with QoL among minority nursing staff.

Our sample consisted of 514 minority nursing staff (31.4% Black, 25.5% Hispanic/Latinx, 17.0% Asian, 13.5% American Indian/Alaska Native, and 12.7% Native Hawaiian/Pacific Islander). The sample reported a high prevalence of discrimination experiences (60% witnessed, 28.3% experienced). Greater exposure to witnessed discrimination, higher levels of perceived risk of contracting COVID-19, and fear of COVID-19 were associated with worse QoL, whereas higher levels of resilience and social support were associated with better QoL. Multiple group analysis revealed no significant differences in these outcomes across the racial/ethnic groups.

Our findings revealed that while discrimination, fear, and perceived risk were negatively related to minority nursing staff's QoL, resilience and social support were crucial in promoting their QoL, with no significant differences observed across racial/ethnic groups.

The findings highlight the importance of individual-, organizational-, and policy-level awareness of vulnerability related to racial/ethnic discrimination and areas that should be addressed to promote minority nursing staff's QoL.

Mirvetuximab soravtansine (MIRV) recently emerged as a promising therapeutic option for patients with platinum resistant ovarian cancer (PROC). In trials leading up to its approval, several ocular and other toxicities were identified. We report our experience with MIRV in a less-selected "real-world" population.

A retrospective review of patients with folate-receptor alpha positive, recurrent PROC treated with MIRV between December 2022-April 2024 was performed. Demographic, treatment, and toxicity data were abstracted from the medical record. The primary outcomes of interest were the incidence and nature of MIRV-related toxicities, as well as the clinical response to treatment.

25 patients were analyzed, and 44 % had >3 previous lines of treatment. The median duration of MIRV treatment 4.7 months, and 36 % of patients received more than 6 months of MIRV. Ocular events were common and occurred early, resulting in grade 1, 2, and 3 toxicity (28 %, 20 %, and 16 % respectively). As a result, 36 % of patients had an increased frequency of ophthalmologic care, 48 % required a medication change, and 32 % had dose reduction, but none required MIRV discontinuation. Pneumonitis occurred in 24 % of patients, was the leading cause of treatment discontinuation and may be associated with significant underlying cardiopulmonary comorbidities and pulmonary disease burden.

Our real-world experience with MIRV mirrors previously published data and suggests a benefit may also be seen in a more heavily pretreated population. Toxicities were similar to those previously reported, although our increased incidence of pneumonitis suggests care when treating patients with significant underlying cardiopulmonary comorbidities.

Preoperative expectations are a determinant of patient-reported outcomes (PROs) within several orthopaedic subspecialties. However, the impact on outcomes after hip arthroscopy is unclear. The aim of this study was to explore the relationship between preoperative patient expectations and PROs after hip arthroscopy.

Patients who underwent hip arthroscopy at a single institution were included. Patient expectations were measured preoperatively using the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) expectations domain. Patient-Reported Outcomes Measurement Information System (PROMIS) domains, a numeric pain scale (NPS), and the Marx activity rating scale (MARS) were assessed 2 years postoperatively. Spearman's coefficient was used to assess the correlation between preoperative expectations and 2-year PROs. Linear regression was used to ascertain the effect of preoperative expectations on 2-year PROs.

105 patients were included, and 78 (74 %) completed 2-year follow-up. The mean (SD) preoperative expectations score was 88.3 (15.3). Higher expectations correlated with better postoperative fatigue, anxiety, depression, pain, and activity levels, as well as more improvement in fatigue, pain, and activity. Expectations scores were higher for patients who achieved minimal clinically important difference (MCID) for PROMIS Fatigue (92.6 vs 82.0, p = .003) and MARS activity (95.3 vs 86.2, p = .014). When controlling for possible confounders, higher expectations independently predicted better postoperative PROMIS Fatigue (β = -0.26, SE = 7.23), Social Satisfaction (β = 0.24, SE = 0.09), and Anxiety (β = -0.24, SE = 0.08).

Higher preoperative expectations are an independent predictor of better psychosocial outcomes 2 years after hip arthroscopy. Setting positive expectations preoperatively may be important for enhancing psychosocial health postoperatively.

Postoperative rehabilitation for lumbar spine stenosis (LSS) surgery has been shown to improve functional status postoperatively. However, there is a lack of clinical guidelines on postsurgical recommendations, movement restrictions and rehabilitation practices, which can lead to variations in care. The purpose of this study was to describe current postoperative LSS surgery practices of spine surgeons, physiotherapists, and chiropractors in Canada related to movement restrictions, exercise recommendations and rehabilitation.

The cross-sectional online survey was distributed to spine surgeons, physiotherapists and chiropractors through newsletters and emails from professional colleges and associations. The surveys involved 3 clinical vignettes of patients with LSS, each with a different type of surgical intervention. Participants were asked to reflect on the cases and provide information on their postoperative practices.

Twenty-six spine surgeons and 151 rehabilitation professionals responded to the survey. Many of the spine surgeons in this study do not (35%) or occasionally refer (27%) their post-LSS surgery patients to outpatient postoperative rehabilitation and do not believe such programs are necessary for all patients (65.4%). There was significant variation on which restrictions should be applied and the length of time that restrictions should be used across all movements and conditions. Rehabilitation professionals observed movement restrictions that aligned with surgeons' recommendations in Cases 1 (decompression) and 3 (long fusion). However, in Case 2 (laminectomy with 1-3 level fusion), they noted more restrictions (eg, pushing, pulling, lifting) than those prescribed by surgeons. The range of exercise recommendations and treatment modalities rehabilitation professionals prescribe vary widely.

There is currently wide variation in care, demonstrating the need to build consensus among spine surgeons and rehabilitation professionals regarding the most optimal postoperative management. In addition, the reasoning behind imposed restrictions should be considered along with surgery-specific factors in refining current postoperative care pathways for the studied patient population.

Treatment strategies of mature B-cell non-Hodgkin lymphoma (B-NHL) have been investigated in cooperative group settings to balance toxicity and cure. A survey of institutions participating in the Children's Oncology Group (COG) was completed to assess current practice patterns for treatment strategies, supportive care, imaging, and potential interest in areas to de-escalate for lower risk patients. The survey results demonstrate heterogeneity in treatment regimens for lower risk patient populations but near uniformity in treatment regimens for higher risk patients. The supportive care provided and imaging utilized also varied amongst institutions that provide opportunities for further investigation into best practices.

Pain from acute sciatic radiculopathy (sciatica) can be debilitating, frequently leading to emergency department (ED) presentations. The primary objective of this study was to evaluate the efficacy of transgluteal sciatic nerve blocks (TGSNBs) for ED-based pain control in patients presenting with acute sciatica.

In this prospective, multicenter, observational study, a convenience sample of patients presenting to the ED with acute sciatica were recruited between January 2022 and August 2023. All patients underwent TGSNB. Patients' self-reported pain scores and timed up and go test results were recorded. Pain scores at 24 and 48 hours post-ED disposition were also recorded. Descriptive statistics, Wilcoxon signed rank, and ꭓ2 tests were utilized for statistical analysis.

In total, 63 patients were enrolled. The median pain score was 9 (IQR, 8-10) prior to TGSNB, decreased to 5 (IQR, 3-7; P < .001) post-TGSNB, and remained at 4 (IQR, 2-6.5; P < .001) at approximately 48 hours after disposition. On arrival, 27% (n = 17/63) of patients were unable to ambulate, which decreased to 11% (n = 7/63) post-TGSNB. The proportion of patients who completed the timed up and go test in under 10 seconds significantly increased to 33% (n = 19/63) at ED disposition compared to 1.6% (n = 1/63; P = .003) on presentation. One complication (1.6%, n = 1/63) of a transient foot drop was noted which resolved without further sequelae.

Among the specific study population, patients with acute sciatica who elected to have an ultrasound-guided TGSNB in the ED showed significant improvements in pain scores and function. Future studies comparing the efficacy of TGSNB versus standard medical therapy are needed.

Patients at psychiatric homes are a vulnerable group with several factors complicating their pharmacological treatment. Psychiatric patients in stable treatment are transferred from specialist care to primary care, which presents new challenges as general practitioners (GPs) may feel that they are not sufficiently trained in prescribing and tapering psychiatric drugs. Medication reviews (MRs) have been seen to improve the appropriateness of pharmacological treatment - especially when performed in interdisciplinary teams.

Thus, the aim of this study was to examine to which extent it was possible to conduct interdisciplinary MRs at a psychiatric home and with patient involvement. The study was a mixed-method evaluation study that included 11 quantitative MRs analyzed by descriptive analysis and 5 qualitative semi-structured interviews analyzed by thematic coding analysis.

The MR performance formed the basis of an interview study. The patients' GPs and psychiatrist accepted 32 of the 37 (86 %) recommended changes to the current medication. At six months follow-up, 75 % of changes had been implemented. Three main interview themes and seven sub-themes were identified, covering collaboration between healthcare professionals, patient involvement, and the MR method. Conduction of interdisciplinary MRs was affected by e.g. challenges in the collaboration between GP and psychiatrists and patient involvement.

Interdisciplinary MRs for psychiatric patients were seen as beneficial by healthcare professionals and had a high implementation rate of medication changes. In future use of the MR model, the involvement of patients and GPs should be ensured and include a psychiatrist in the MR team.

A significant portion of mothers (pregnant and postpartum) enrolled in U.S. home visiting programs report clinically significant depressive symptoms. Non-violent family conflict precipitates and exacerbates their depressive symptoms. This pilot randomized trial tested the preliminary effectiveness of a family therapy intervention, Resilience Enhancement Skills Training (REST), compared to the standard of care in home-visited mothers with moderate to severe depressive symptoms and moderate to high conflict with family members. A total of 83 mothers and their family members (N = 166) were randomized to receive REST or the standard of care. Both interventions were delivered by clinicians using HIPAA-compliant video conferencing technology. Outcomes were assessed by research assistants, blinded to study group assignment, at post-intervention, 3, and 6 months later. Linear mixed-effects models were used to analyze changes in continuous outcomes in mothers and family members, separately. Mixed-effects logistic regression was used to analyze changes in maternal job attainment/school enrollment. Participants in both study groups showed improvements in outcomes. When compared to standard-of-care participants, REST participants had significantly greater reductions in family conflict (mothers ES = -1.19, family members ES = -0.77), maternal depressive symptoms (ES = -0.96) and co-occurring anxiety symptoms (ES = -0.59), and greater increases in family cohesion (mothers ES = 0.99, family members ES = 0.94) and maternal job attainment/school enrollment (ES = 0.70). The results highlight the value of family therapy for the treatment of moderate to severe depressive symptoms in home-visited mothers, including those with co-occurring moderate to severe anxiety symptoms. Trial Registration: Registered in ClinicalTrials.gov on 02/04/2021. NCT04741776 https://clinicaltrials.gov/ct2/show/NCT04741776.

Missed Nursing Care is a global health problem with adverse consequences for patients, nurses and healthcare systems. It occurs when the necessary nursing care is not provided, is only partially provided or is delayed. This study aimed to investigate the prevalence, types and reasons for Missed Nursing Care in Danish hospitals on a national scale.

In a cross-sectional study, the Danish version of the MISSCARE survey was used to collect data from nursing staff.

A total of 3507 nursing staff from 35 regional and university hospitals participated. Nursing staff reported that 44% of nursing care elements were always, frequently or occasionally missed, ranging between 32% and 53% across hospitals. The most frequent missed nursing care elements included ambulation, turning patients, documentation, mouth care, participation in interdisciplinary care meetings, emotional support and patient teaching. The main reasons for Missed Nursing Care were inadequate staffing, unexpected increases in patient volume and acuity, urgent patient situations and high admission and discharge activity.

Missed Nursing Care is a prevalent problem in Danish hospitals, with nearly half of the necessary nursing care elements being missed. However, variations between hospitals exist. Fundamental physical and emotional nursing care elements were often missed, while nursing care to prevent critical situations was prioritised. The main reason for Missed Nursing Care was an imbalance between nursing resources, patient volume and acuity. Targeted interventions are needed to address Missed Nursing Care to improve the quality of nursing care and ultimately achieve better outcomes for patients and nursing staff.

Many studies have examined physiological responses to acute stress in healthy and clinical populations. Some have documented exaggerated physiological stress reactivity in response to acute stress, while others have reported blunted physiological stress reactivity. Although the literature is conflicted, the relationship between abnormal physiological stress reactivity and negative outcomes is well-established. However, past research has neglected a critical aspect of physiological stress response - respiration - and it is unclear whether differences in respiration rate responses to acute stress are related to health outcomes. This secondary cross-sectional analysis explored differences in outcomes between three subgroups: blunted, moderate, and exaggerated respiration rate reactivity to an acute stress task. In a sample of at least mildly-stressed older adults (n = 55), we found that perceived stress (b = -7.63; p = .004) and depression (b = -9.13; p = .007) were significantly lower in the moderate reactivity group compared to the high reactivity group, and that self-reported mindfulness (b = 10.96; p = .008) was significantly lower in the moderate reactivity group as compared to the low reactivity group. Across outcomes, participants in the moderate range of physiological reactivity showed less negative and more positive psychological attributes and better health outcomes, while the blunted subgroup demonstrated more negative and less positive psychological attributes and worse health outcomes overall, when compared to the exaggerated and moderate groups. This study extends the literature by adding respiration to markers of acute physiological stress reactivity and demonstrating the effects of blunted respiration reactivity on negative psychological attributes and health outcomes.

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

The Criança Feliz (Happy Child) parenting program is a home visiting intervention serving over a million low-income Brazilian families. The current study assessed its longitudinal associations with maternal and child speech and gestures in a subsample (n = 145) from the program's impact evaluation research. We performed a between-participants pragmatic randomized trial. Mothers (79.7% Black) and children (17-25 months of age; 50.3% female) were randomly assigned to control (n = 73) and intervention (n = 72) groups. One year later, mother-child pairs were recorded playing at home, and the videos were transcribed and analyzed for speech (quantity, vocabulary diversity, sentence complexity, and number of questions) and gestures (quantity). Intention-to-treat analysis revealed that the intervention was associated with the mother's vocabulary diversity (d = .35) regardless of schooling level. No direct or indirect (via maternal speech) associations were observed with the child's speech or gestures. This preliminary evidence suggests that participation in the Criança Feliz program is related to mothers' vocabulary diversity but not to children's speech or gesture measures. The program could focus on maternal gestures, questions, and book reading (complexity feature). Future research evaluating the impact of the program on language outcomes should include pretesting and child follow-up assessments.

Limb lengthening surgery is a contentious option for individuals with achondroplasia. This study aimed to assess real-world experiences, outcomes, and perspectives on limb lengthening in a multinational cohort of individuals with achondroplasia.

A cross-sectional, international online survey on limb lengthening experiences and perspectives was conducted in 11 languages across 16 countries from May until July 2024.

Out of 467 responders (229 self-responders, 238 parents/caregivers), 90 (19.3 %) reported undergoing limb lengthening (LL) surgery. The mean age at first surgery was 10.5 years (SD 4.5). On average, respondents underwent 3.7 (SD 2.9) procedures, resulting in 14.5 cm (SD10.4) added and final adult height of 137.1 cm in females and 142.1 cm in males. Significant improvements were described in activities such as car driving, bathing, brushing hair, and wiping after toileting for those who underwent both arm and leg lengthening (p ≤ 0.001). Among respondents, 23 % would recommend the procedure to others and 28 % would not recommend LL. Nearly half of respondents (49 %) was uncertain about recommending LL.

This is the largest international survey on LL in achondroplasia with results highlighting some of the differences in perspectives and choices of the individual with achondroplasia and their families, providing real-world evidence of the outcomes of this intervention. While significant functional improvements were reported, a reduced percentage of respondents recommended LL intervention. The findings underscore the existence of a triad when considering limb lengthening in achondroplasia as individual choices and life experiences, socio-cultural environment and access to clinical options.

In this planned ancillary analysis of our completed clinical trial, we hypothesized that among older children with sickle cell anemia (SCA) and severe acute malnutrition, those with higher levels of food insecurity would have lower end-of-trial body mass index (BMI) z-scores compared to their peers with SCA and lower levels of food insecurity.

Data from 108 children who completed the feasibility trial for managing severe acute malnutrition in older children with SCA in Nigeria were analyzed. Children aged 5-12 years old with severe acute malnutrition (BMI z-score of <-3.0) were randomly allocated to receive either supplemental ready-to-use therapeutic food (RUTF) alone or RUTF with moderate-dose hydroxyurea (20 mg/kg/day). Caregivers completed the United States Household Food Security Survey Module to measure food security. We focused on the childhood section for its accuracy in assessing food security in older children. Higher scores (0-8) indicate greater food insecurity. We constructed multivariable linear regression models to estimate the association between childhood food insecurity and BMI z-scores at baseline and endpoint.

Most participants were food insecure, with 55% (n = 59) and 34% (n = 37) having low and very low food security, respectively. Higher scores on the continuous food security measure, indicating lower food security, were associated with lower BMI z-scores at both study entry (β = -0.05, p = 0.047) and after malnutrition treatment (β = -0.07, p = 0.016).

Among severely malnourished children with SCA, lower childhood food security scores are associated with an adverse treatment response, reflected by a lower BMI z-score at the trial's end.

NCT03634488, https://clinicaltrials.gov/study/NCT03634488.

Total knee arthroplasty (TKA) is commonly performed to relieve pain in persons with severe knee osteoarthritis. Despite substantial pain reduction and functional improvements, physical activity (PA) does not necessarily increase post TKA. The premise for this randomized trial is that a behavioral intervention invoking internal and external motivators could lead to improvement in PA uptake post TKA.

KArAT (the Knee Arthroplasty Activity Trial) is a three-arm multi-center randomized controlled trial designed to establish the efficacy and sustainability of a personalized behavioral intervention in improving PA among TKA recipients with a primary diagnosis of knee osteoarthritis. The three arms include: 1) usual care, 2) attention control with Fitbit activity trackers, and 3) health coaching and financial incentives for reaching personalized PA goals. The primary outcome is defined as the proportion of participants engaged in at least 150 ​min of moderate-to-vigorous physical activity over a given week after the 6-month intervention. We also plan to conduct a cost-effectiveness analysis to establish the value and affordability of the KArAT interventions.

This paper aims to outline the rationale, study design, and implementation of KArAT.

Clinicaltrials.gov NCT04107649.