Objective Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person’s expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. Methods A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. Results Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR) = 2.11, 95% CI = 1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR = 3.17, 95% CI = 2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR = 4.9, 95% CI = 2.2, 11.1). Conclusion A variety of modifiable psychological factors impact people’s expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.
Introduction Transcranial electrical stimulation (tES) as a method of cognitive enhancement in both diseased and healthy individuals has gained popularity. Its potential for enhancing cognition in healthy individuals has gained the interest of the military. However, before it being implemented into military training or operational settings, further work is needed to determine its efficacy and safety. Although a considerable amount of literature exists, few studies have specifically evaluated its use in enhancing cognition relative to operational, military tasks. Therefore, in a first step to evaluate its efficacy, we completed a systematic literature review of studies using transcranial direct current stimulation (tDCS), a type of tES, to enhance cognitive processes in healthy individuals. Methods A systematic literature review was conducted to identify literature published between 2008 and 2018 that used a method of tES for cognitive enhancement. As part of a larger literature review effort, 282 articles were initially retrieved. These were then screened to identify articles meeting predetermined criteria, to include those using various methods of tES, resulting in 44 articles. Next, the articles were screened for those using tDCS or high-definition tDCS, resulting in 34 articles for review and information extraction. Results Of the 34 articles reviewed, 28 reported some degree of enhancement (eg, improved accuracy on tasks and reduced reaction times). Areas of cognitive enhancements included executive functioning, creativity/cognitive flexibility, attention/perception, decision-making, memory, and working memory. However, the precise outcomes of enhancement varied given the range in tasks that were used to assess the constructs. Additionally, the stimulation parameters in terms of intensity applied, duration of stimulation, and brain region targeted for stimulation varied. Conclusions The conclusions to be drawn from this systematic literature review include the identification of a brain region for targeting with stimulation to enhance a broad range of cognitive constructs applicable to military tasks, as well as stimulation parameters for duration and intensity. The dorsolateral prefrontal cortex was most frequently targeted in the studies that found enhanced performance across several cognitive constructs. Stimulation intensities of 2 mA and durations of 20 minutes or longer appeared frequently as well. Although several parameters were identified, further work is required before this type of technology can be recommended for operational use.
These findings suggest that Soldiers who experience combat should be observed for signs of increased threat-attention bias, as this may indicate that their capacities for information processing, decision-making, and emotion regulation could be compromised. The positive relationship we observe between a level of combat experience and attentional biases toward threatening stimuli may also help to explain why these veterans engage in "externalizing" behaviors that are risky, aggressive, or violent as well as relational problems and antisocial behaviors that are reported in higher-than-average rates among these populations of Soldiers. Acknowledging that increased threat attention may be a preclinical indication of developing PTSD or other related psychological conditions (e.g., depression, anxiety) should motivate clinicians to more actively diagnose and treat this condition.
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