The elderly were under-represented in osteoarthritis clinical trials.
ABSTRACT Osteoarthritis is the most common disease affecting joints in the elderly. We aimed to evaluate if elderly patients are properly represented in clinical trials of diverse osteoarthritis interventions.
Clinical trials of osteoarthritis interventions were retrieved from Cochrane Library systematic reviews (2006, issue 2). We examined the age distribution of the trial participants and eligibility criteria.
We analyzed data from 219 eligible trials from 18 systematic reviews. The average mean age of the participants was 63 years. Only 13 trials (6.4%) had a mean age between 71 and 80 years and only one trial had a mean age exceeding 80 years. Among trials where the age range of participants was available or could be approximately inferred, we estimated that 66 (38%) trials had not included any patients over 80 years old. Only 23 trials specifically excluded patients over 70 based on reported eligibility criteria, but 168 trials excluded patients with various comorbidities and 142 trials excluded patients receiving other specific treatments.
Elderly patients are considerably under-represented in clinical trials of osteoarthritis. This causes an important deficit in the utility, relevance, and generalizability of trial results for this very common condition.
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ABSTRACT: The present cross sectional study strove to examine the prevalence and extent of comorbid depressive symptoms and its relationship with pain, function, disease impact, body mass index, medication history, and self-efficacy for managing pain, and other symptoms among a cohort of generally healthy older knee osteoarthritis (OA) patients with mild to moderate disease. Data previously collected on 71 generally healthy active women and 15 men with either unilateral or bilateral knee mild to moderate knee osteoarthritis, mean age, 72.47+7.15 years were analyzed with correlation analysis and descriptive statistics using the SPSS program. Analyses revealed: 1. More than 20% of the present cohort could be categorized as having severe clinical depression using a more stringent cut-off point than the standard, even though none were being treated for this condition; 2) Cases categorized as exhibiting depressive symptoms indicative of depressed mood tended to have more pain, worse mobility, and lower self-efficacy perceptions than those who were not exhibiting such symptoms; 3) Those with low self-management related self-efficacy were more likely to report depressive symptoms than not (p <.01). It is concluded that it is essential to routinely screen older adults with early stage osteoarthritis of the knee for depression, as well as their beliefs about their ability to manage their disease in efforts to reduce the immense disability burden of knee osteoarthritis.
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ABSTRACT: Promising evidence from clinical studies of drug effects does not always translate to improvements in patient outcomes. In this review, we discuss why early evidence is often ill suited to the task of predicting the clinical utility of drugs. The current gap between initially described drug effects and their subsequent clinical utility results from deficits in the design, conduct, analysis, reporting, and synthesis of clinical studies-often creating conditions that generate favorable, but ultimately incorrect, conclusions regarding drug effects. There are potential solutions that could improve the relevance of clinical evidence in predicting the real-world effectiveness of drugs. What is needed is a new emphasis on clinical utility, with nonconflicted entities playing a greater role in the generation, synthesis, and interpretation of clinical evidence. Clinical studies should adopt strong design features, reflect clinical practice, and evaluate outcomes and comparisons that are meaningful to patients. Transformative changes to the research agenda may generate more meaningful and accurate evidence on drug effects to guide clinical decision making. Expected final online publication date for the Annual Review of Pharmacology and Toxicology Volume 55 is January 06, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.Annual Review of Pharmacology 08/2014; 55(1). DOI:10.1146/annurev-pharmtox-010814-124614 · 18.52 Impact Factor
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ABSTRACT: Moffatt eddies were observed as companions of each Stokes eigenmode in the square, in [Leriche E, Labrosse G. J Comput Phys 2004;200:489–511], regardless of the eigenmode symmetry. The present paper brings an answer about the possible existence of analogous localized corner vortices in trihedral rectangular corners, from numerically computed Stokes eigenmodes in a cubical cavity. Our spectrally accurate results do no exhibit such localized structure.Computers & Fluids 04/2011; 43(1):98-101. DOI:10.1016/j.compfluid.2010.09.037 · 1.53 Impact Factor