TY  - JOUR
AB  - BACKGROUND: The hazardous triad of osteopenia, sarcopenia and obesity was recently defined as osteosarcopenic obesity (OSO). The causes for OSO appear to be multifactorial, including age and gender, as well as chronic diseases. The impact of physical inactivity has not been studied so far. PURPOSE: The purpose of this study was to assess the association of short-term and long-term physical inactivity over a time period of 14 years on osteosarcopenic obesity in a population-based cohort from southern Germany. METHODS: Supine whole body MRI (3 T scanner, Magnetom Skyra, Siemens Healthcare) was performed in 400 subjects from the population-based observational cohort study "Kooperative Gesundheitsforschung in der Region Augsburg (KORA)" to determine bone marrow fat fraction (BMFF), skeletal muscle fat fraction (SMFF) and total adipose tissue (TAT). Based on this, phenotyping was conducted into the groups of the OSO complex. Physical inactivity was obtained via a questionnaire at three timepoints: exam 1 (1999 to 2001), exam 2 (2006 to 2008) and exam 3 (2013 and 2014). RESULTS: In total, 363 subjects (56.0 ± 9.1 years, 57.6% male) were included. The OSO phenotype was fully expressed in 81 (22,3%) participants. All pathological subgroups of the OSO complex, except isolated obesity were associated with less physical activity (< 1 h/week) at exam 3. Work activity correlated with the isolated osteopenic and sarcopenic phenotypes, as well as OSO, whereas neither walking, nor cycling activity correlated significantly with any phenotypic subgroup. Similarly, long-term physical inactivity was accompanied by isolated osteopenia, sarcopenia and osteosarcopenic obesity but not with isolated obesity. Lower back pain was present in 54.5% of all participants at exam 3. No correlation was shown with the OSO complex. CONCLUSION: Physical inactivity was strongly correlated with an isolated osteopenic, sarcopenic and OSO phenotype, but not with an isolated obese phenotype by MRI. Although slightly over fifty percent of participants reported back pain on exam 3, the manifestation of the OSO complex had no effect on this.
AU  - Kiefer, L.S.*
AU  - Lorbeer, R.*
AU  - Rospleszcz, S.
AU  - Rathmann, W.*
AU  - Meisinger, C.
AU  - Peters, A.
AU  - Schlett, C.L.*
AU  - Bamberg, F.*
AU  - Walter, S.S.*
AU  - Maurer, E.*
C1  - 75913
C2  - 58189
TI  - Long-term effect of physical inactivity on osteosarcopenic obesity - a MRI-based investigation from a population-based cohort.
JO  - BMC Musculoskelet. Disord.
VL  - 26
IS  - 1
PY  - 2025
ER  - 

TY  - JOUR
AB  - BACKGROUND: Patient-reported outcomes are of ever-increasing importance in medical decision-making. The EQ-5D is one of the generic instruments measuring health-related quality of life (HRQoL) in arthroplasty. This review aimed to identify possible predictors of HRQoL changes for patients undergoing total knee replacements (TKR) or total hip replacements (THR). METHODS: A systematic literature review according to the PRISMA guidelines was conducted, searching several databases. Preoperative to postoperative HRQoL changes were evaluated in patients undergoing THR or TKR, using the EQ-5D visual analog scale (VAS) or the preference-based EQ-5D Index were evaluated. Articles were considered with prospectively or retrospectively collected data, as well as registry data, each with statistical analyses of patient-related factors. RESULTS: Eight hundred eighty-two articles were found, of which 21 studies met the inclusion criteria. Predictors were distinguished in alterable and non-alterable ones. The EQ-5D Index indicated a tendency towards beneficial improvements for patients with a high body mass index (BMI) (> 40) and no significant results for the VAS. Additionally, one study found that patient education and preoperative physiotherapy appeared to enhance HRQoL. Some evidence indicated that male gender was negatively associated with changes in the VAS and the EQ-5D Index, but one study reported the opposite. Changes in VAS and EQ-5D Index were lower for older patients, whereas a higher educational level seemed to be advantageous. A high Charnley class led to deteriorating changes in VAS, although a high Kellgren Lawrence classification was positively associated with the EQ-5D Index, in a limited number of studies. For all results, clinical relevance was calculated differently and mainly reported as uncertain or small. CONCLUSIONS: The literature on this topic was weak and offers only limited guidance. Results for alterable predictors, such as the BMI, indicated valuable improvements for highly obese patients. Further, high-quality research is required to support medical decision-making. LEVEL OF EVIDENCE: Level IV, according to the OCEBM Levels of Evidence Working Group.
AU  - Schatz, C.
AU  - Klein, N.
AU  - Marx, A.
AU  - Buschner, P.*
C1  - 64131
C2  - 52088
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: A systematic review.
JO  - BMC Musculoskelet. Disord.
VL  - 23
IS  - 1
PB  - Bmc
PY  - 2022
ER  - 

TY  - JOUR
AB  - Background American Society of Anaesthesiologists (ASA) physical status classification system and its association with postoperative outcomes has been studied in different diseases. However, there is a paucity of studies on the relationship between ASA class and postoperative health-related quality of life (HRQoL) outcomes following total hip replacement (THR).The aim of this study was to assess the discriminative abilities of EQ-5D-3L value sets from Sweden, Germany, Denmark and the United Kingdom in relation to ASA classes and these value sets' abilities to show the predictive performance of ASA classes on HRQoL among THR patients in Sweden.MethodsA longitudinal study was conducted using data of patients in the Swedish Hip Arthroplasty Register who underwent THR between 2008 and 2016. We included 69,290 pre- and 1-year postoperative records and 21,305 6-year postoperative records. The study examined three experience-based EQ-5D-3L value sets (the Swedish VAS and TTO and the German VAS) and five hypothetical value sets (TTO from Germany and VAS and TTO value sets from Denmark and the UK each). Using linear models, the abilities of the value sets to discriminate among ASA classes and to show the predictive performance of ASA classes on HRQoL score were assessed.ResultsAll value sets differentiated among ASA classes and showed the predictive effect of ASA classes on HRQoL. ASA classes were found to predict HRQoL consistently for all value sets investigated, with small variations in prediction error among the models.ConclusionASA classes of patients undergoing THR predicted HRQoL scores significantly and consistently, indicating their importance in tailoring care for patients.
AU  - Teni, F.S.*
AU  - Burström, K.*
AU  - Berg, J.*
AU  - Leidl, R.
AU  - Rolfson, O.*
C1  - 59614
C2  - 48878
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Predictive ability of the American Society of Anaesthesiologists physical status classification system on health-related quality of life of patients after total hip replacement: Comparisons across eight EQ-5D-3L value sets.
JO  - BMC Musculoskelet. Disord.
VL  - 21
IS  - 1
PB  - Bmc
PY  - 2020
ER  - 

TY  - JOUR
AB  - BACKGROUND: Negative Pressure Wound Therapy (NPWT) is being increasingly used to treat postoperative infections after osteosynthetic fracture fixation. The aim of the present study was to analyze the influence of epidemiological and microbiological parameters on outcome. METHODS: Infections following operative fracture fixation were registered in a comprehensive Critical Incidence Reporting System and subsequently analyzed retrospectively for characteristics of patients including comorbidity, bacteria, and clinical factors. The influence of the investigated parameters was analyzed using logistic regression models based on data from 106 patients. RESULTS: Staged wound lavage in combination with NPWT allowed implant preservation in 44% and led to successful healing in 73% of patients. Fermentation characteristics, load and behavior after gram staining revealed no statistically significant correlation with either healing or implant preservation. Infecting bacteria were successfully isolated in 87% of patients. 20% of all infections were caused by bacterial combinations. We observed a change in the infecting bacterial species under therapy in 23%. Age, gender, metabolic diseases or comorbidities did not influence the probability of implant preservation or healing. The delayed manifestation of infection (>4 weeks) correlated with a higher risk for implant loss (OR 5.1 [95% CI 1.41-17.92]) as did the presence of bacterial mixture (OR 5.0 [95% CI 1.41-17.92]) and open soft-tissue damage ≥ grade 3 (OR 10.2 [CI 1.88-55.28]). Wounds were less likely to heal in conjunction with high CRP blood levels (>20 mg/l) at the time of discharge (OR 3.6 [95% CI 1.31-10.08]) or following a change of the infecting bacterial species under therapy (OR 3.2 [95% CI, 1.13-8.99]). CONCLUSIONS: These results indicate that the delayed manifestation of infection, high CRP blood levels at discharge, and alterations in the infecting bacterial species under therapy raise the risk of NPWT failure.
AU  - Izadpanah, K.*
AU  - Hansen, S.*
AU  - Six-Merker, J.
AU  - Helwig, P.*
AU  - Südkamp, N.P.*
AU  - Schmal, H.*
C1  - 51279
C2  - 43157
CY  - London
TI  - Factors influencing treatment success of negative pressure wound therapy in patients with postoperative infections after Osteosynthetic fracture fixation.
JO  - BMC Musculoskelet. Disord.
VL  - 18
PB  - Biomed Central Ltd
PY  - 2017
ER  - 

TY  - JOUR
AB  - Background: Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods: Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results: More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions: Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial. Trial registration: German Clinical Trial Register, DRKS00003123 (June 28th 2011).
AU  - Jegan, N.R.A.*
AU  - Brugger, M.
AU  - Viniol, A.*
AU  - Strauch, K.
AU  - Barth, J.*
AU  - Baum, E.*
AU  - Leonhardt, C.*
AU  - Becker, A.*
C1  - 50839
C2  - 42563
TI  - Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care.
JO  - BMC Musculoskelet. Disord.
VL  - 18
IS  - 1
PY  - 2017
ER  - 

TY  - JOUR
AB  - Background: Due to the heterogeneous nature of chronic low back pain (CLBP), it is necessary to identify patient groups and evaluate treatments within these groups. We aimed to identify groups of patients with CLBP in the primary care setting. Methods: We performed a k-means cluster analysis on a large data set (n = 634) of primary care patients with CLBP. Variables of sociodemographic data, pain characteristics, psychological status (i.e., depression, anxiety, somatization), and the patient resources of resilience and coping strategies were included. Results: We found three clusters that can be characterized as "pensioners with age-associated pain caused by degenerative diseases", "middle-aged patients with high mental distress and poor coping resources", and "middle-aged patients who are less pain-affected and better positioned with regard to their mental health". Conclusions: Our results supported current knowledge concerning groups of CLBP patients in primary care. In particular, we identified a group that was most disabled and distressed, and which was mainly characterized by psychological variables. As shown in our study, pain-related coping strategies and resilience were low in these patients and might be addressed in differentiating treatment strategies. Future studies should focus on the identification of this group in order to achieve effective treatment allocation.
AU  - Viniol, A.*
AU  - Jegan, N.*
AU  - Hirsch, O.*
AU  - Leonhardt, C.*
AU  - Brugger, M.
AU  - Strauch, K.
AU  - Barth, J.A.C.*
AU  - Baum, E.*
AU  - Becker, A.*
C1  - 28783
C2  - 31300
TI  - Chronic low back pain patient groups in primary care - a cross sectional cluster analysis.
JO  - BMC Musculoskelet. Disord.
VL  - 14
IS  - 1
PB  - Biomed Central Ltd
PY  - 2013
ER  - 

TY  - JOUR
AB  - BACKGROUND: Chronic pain is a common reason for consultation in general practice. Current research distinguishes between chronic localized pain (CLP) and chronic widespread pain (CWP). The aim of this study was to identify differences between CWP and chronic low back pain (CLBP), a common type of CLP, in primary care settings. METHODS: Fifty-eight German general practitioners (GPs) consecutively recruited all eligible patients who consulted for chronic low back pain during a 5-month period. All patients received a questionnaire on sociodemographic data, pain characteristics, comorbidities, psychosomatic symptoms, and previous therapies. RESULTS: GPs recruited 647 eligible patients where of a quarter (n = 163, 25.2%) met the CWP criteria according to the American College of Rheumatology. CWP patients had significantly more comorbidities and psychosomatic symptoms, showed longer pain duration, and suffered predominantly from permanent pain instead of distinguishable pain attacks. CWP patients were more often females, are less working and reported a current pension application or a state-approved grade of disability more frequently. We found no other differences in demographic parameters such as age, nationality, marital status, number of persons in household, education, health insurance status, or in health care utilization data. CONCLUSIONS: This project is the largest study performed to date which analyzes differences between CLBP and CWP in primary care settings. Our results showed that CWP is a frequent and particularly severe pain syndrome. TRIAL REGISTRATION: German Clinical Trial Register, DRKS00003123.  
AU  - Viniol, A.*
AU  - Jegan, N.*
AU  - Leonhardt, C.*
AU  - Brugger, M.
AU  - Strauch, K.
AU  - Barth, J.*
AU  - Baum, E.*
AU  - Becker, A.*
C1  - 29160
C2  - 31423
TI  - Differences between patients with chronic widespread pain and local chronic low back pain in primary care - a comparative cross-sectional analysis.
JO  - BMC Musculoskelet. Disord.
VL  - 14
IS  - 1
PB  - Biomed Central Ltd
PY  - 2013
ER  - 

TY  - JOUR
AB  - Background: Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design: Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion: This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.
AU  - Viniol, A.*
AU  - Jegan, N.*
AU  - Leonhardt, C.*
AU  - Strauch, K.
AU  - Brugger, M.
AU  - Barth, J.*
AU  - Baum, E.*
AU  - Becker, A.*
C1  - 8444
C2  - 30127
TI  - Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment - a cohort study.
JO  - BMC Musculoskelet. Disord.
VL  - 13
PB  - Biomed Central Ltd.
PY  - 2012
ER  -