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BackgroundOsteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. ObjectiveThis study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. MethodsA total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. ResultsA total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] –0.28, 95% CI –0.38 to –0.18 and SMD –0.26, 95% CI –0.35 to –0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD –0.10, 95% CI –0.17 to 0.03 and SMD –0.17, 95% CI –0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. ConclusionsDigital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.

Purpose: The well-known decline in the use of African American English (AAE) features by groups of school-aged AAE-speaking children was reexamined for patterns of overt-, zero-, and mixed-marking for individual features and individual speakers. Methods: Seven hundred twenty-nine typically developing children between the ages of 4 and 12-511 AAE-speakers learning General American English (GAE) as a second dialect, and 218 GAE-speaking controls-were administered the morphosyntax subtest of the Dialect Sensitive Language Test (Seymour, Roeper, & de Villiers, 2000). Responses to 33 items probing 10 target features were coded for overt marking, zero marking, or neither. A feature-by-feature marking profile for each child allowed us to track how many children at each age were characterized by 100% overt, zero, or mixed marking for different combinations of features. Results/Conclusions: Findings suggest that no feature was overtly marked for all AAE-first children at any age, and the 'mixed' pattern of usage was the most common trend across individual speakers even at age 12 years. Exclusive use of zero marking beyond age 8 years was rare and may serve as a diagnostic indicator. [ABSTRACT FROM AUTHOR]

Background: The unabated rise in medication costs particularly affects older persons with chronic conditions that require long-term medication use, but how prescription benefits affect medication adherence for such persons has received limited study.Objective: We sought to study the relationship among prescription benefit status, health, and medication acquisition in a sample of elderly HMO enrollees with 1 or more common, chronic conditions.Research Design: We implemented a cross-sectional cohort study using primary survey data collected in 2000 and administrative data from the previous 2 years.Subjects: Subjects were aged 67 years of age and older, continuously enrolled in a Medicare + Choice program for at least 2 years, and diagnosed with 1 or more of hypertension, diabetes, congestive heart failure, and coronary artery disease (n = 3073).Measures: Outcomes were the mean daily number of essential therapeutic drug classes and refill adherence.Results: In multivariate models, persons without a prescription benefit acquired medications in 0.15 fewer therapeutic classes daily and experienced lower refill adherence (approximately 7 fewer days of necessary medications during the course of 2 years) than those with a prescription benefit. A significant interaction revealed that, among those without a benefit, persons in poor health acquired medications in 0.73 more therapeutic classes daily than persons in excellent health; health status did not significantly influence medication acquisition for those with a benefit.Conclusions: Coverage of prescription drugs is important for improving access to essential medications for persons with the studied chronic conditions. A Medicare drug benefit that provides unimpeded access to medications needed to treat such conditions may improve medication acquisition and, ultimately, health. [ABSTRACT FROM AUTHOR]