Browsing by Author "Chang, T."

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Baseline characteristics of patients with knee osteoarthritis pain flares in a Sri Lankan cohort
(Sri Lanka Medical Association, 2017) Rathnasiri, K.A.D.V.; Athukorala, I.; Pathmeswaran, A.; Chang, T.; Hunter, D.J.
INTRODUCTION & OBJECTIVES: Patients with knee osteoarthritis (KOA) typically experience two broad types of pain – episodic and/or constant pain. This study explores the relationship between KOA pain episodes/flares, demographic haracteristics and putative triggers of pain reported at baseline. METHODS: Consecutive patients with KOA were recruited from rheumatology clinics at the National Hospital of Sri Lanka. KOA pain flares were defined as a >2 points increase on a 0-10 point numeric rating score (NRS) from lowest knee pain intensity at baseline. Patients were assessed for demographic and pain characteristics, potential risk factors for pain flares, the Knee Osteoarthritis Flare Ups Score (KOFUS) and knee effusion at baseline. RESULTS: A total of 100 patients (93% females) with a mean age of 59.8 years (SD 7.5) were recruited. Participants had mean height, weight and body mass index of 149.7 (SD 6.8) cm, 64.1 (SD 7.1) kg, 28.7 (SD 4.9) kg/m2 respectively. Mean (SD) score for usual pain and worst level of pain were 3.7 (1.8) and 7.5 (1.6). An average of 3.6 (SD 2) flares per month was reported. 9% reported a previous knee injury and 49% reported a previous episode of knee buckling. KOFUS score was >7 in 49%, and 44% had a knee effusion at baseline. There was no significant association between patient reported knee flares in the preceding month with previous knee injury, previous knee buckling or KOFUS score (p>0.05). CONCLUSION: This study did not demonstrate any association between previously identified KOA pain flare risk factors and KOA pain flares.
Can pain flares in knee osteoarthritis be predicted?
(:Taylor & Francis-Informa Healthcare, 2021) Atukorala, I.; Pathmeswaran, A.; Makovey, J.; Metcalf, B.; Bennell, K.L.; March, L.; Chang, T.; Zhang, Y.; Hunter, D.J.
OBJECTIVES: This study examined whether risk factors for knee osteoarthritis (KOA) pain such as age, gender, body mass index (BMI), baseline pain, and other putative risk factors for knee osteoarthritis pain flares (KOAF) (e.g. knee buckling, injury, mood/stress/social support scores, and footwear) could predict KOAF. METHOD: People with KOA and previous history of KOAF were selected from a 3-month web-based longitudinal study. KOAF was defined as an increase of ≥ 2 points on a numeric rating scale (compared with background pain) which resolved within 20 days. Predictors assessed at baseline were gender, age, duration of KOA, BMI, pain, knee injury (7 days before), knee buckling (2 days before), Lubben Social Support, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain score (ICOAP), Positive/Negative Affect Score, and footwear stability/heel height. Outcome was occurrence of any KOAF during the ensuing 30 days. The combined ability of the above variables to predict occurrence of any KOAF was evaluated by multiple logistic regression with a 10-fold cross-validation method to build and internally validate the model. Variables that assessed similar domains were eliminated using receiver operating characteristics curve assessment for best fit. RESULTS: Complete data were available for 313 people (66.6% female, mean ± sd age 62.3 ± 8.2 years, BMI 29.7 ± 6.5 kg/m2). Increasing age, years of osteoarthritis, BMI, background/worst levels of pain, knee injury, knee buckling, ICOAP, and footwear category/heel height significantly predicted the occurrence of KOAF during the following 30 days, with an area under the curve of 0.73 (95% confidence interval 0.67-0.80). Conclusion: A combination of risk factors assessed at baseline, including exposures with potential to vary, successfully predicts the KOAF in the ensuing 30 days.
Comparison of Meanings in Discourse among the Sinhala Speaking Aphasic and Non-aphasic Individuals
(University of Kelaniya, 2012) Rathnayake, S.P.; Shadden, B.B.; Chang, T.
Background: Aphasia is an acquired communication disorder that affects the individual’s use of language at all levels including the use of discourse. Aphasia can be diagnosed using clinical language assessment tools. In a language when the syntactic structure is flexible, the language errors could be more evident at discourse level than at sentence level ( Markenzie, 2000). Therefore, aphasia can be identified with discourse analysis in Sinhala, particularly the colloquial variety. Objective: To identify how mental (M), material (MT) ,verbal ( V) and relational ( R) types of meanings are distributed in the discourse of Sinhala-speaking non-aphasic ( NA) and aphasic ( A ) individuals. Methodology: 10 (05 Aphasics and 05 Non-Aphasics) participants were selected using purposive sampling within the age range of 36-78 yrs. Data was obtained via checklists and interviews on narrative, descriptive, conversational and procedural discourse. Each discourse was analyzed according to the meaning types of M, MT,V, and R. Data was analyzed using quantitative and qualitative techniques. Results: Marked differences were observed between aphasia and non-aphasia discourse types. Among 04 meanings types the Material (A- 17.5, NA-54.8) and Relational ( A-10.2,NA-40.2 ) functions were higher in both groups . Although the meaning types of Verbal and Mental functions were less common, with guided questions, all non-aphasics were able to add utterances with guided questions, but non-aphasics were unable to increase their utterances with guided questions. Among 05 participants with aphasia, marked variation was observed in discourse meaning types, as Material ranged from 0 - 5.5, Relational from 0 - 5, Verbal from 0 -.0.5 and Mental meaning from 0 - 0.2. Further, total number of utterances ranged from 01 to 64. Conclusion: Discourse meaning types can be useful in diagnosing aphasia as there is clear variation among aphasia compared to non-aphasia as well as within the group of aphasic individuals.
Do traditional risk factors for knee osteoarthritis predict pain flares in knee osteoarthritis?.
(BMJ Publishing, 2016) Atukorala, I.; Pathmeswaran, A.; Chang, T.; Zhang, Y.; Hunter, D.J.
BACKGROUND: Knee pain is the main cause of disability and reduced function in knee osteoarthritis (KOA). Though knee pain in osteoarthritis was previously perceived as a chronic condition it is now established that KOA pain fluctuates. There is emerging evidence that time variant risk factors-such as knee injury, buckling and mood- are associated with knee pain flares. But, it is not known whether conventional risk factors associated with KOA - age, gender, body mass index-are associated with pain flares in KOA. OBJECTIVES: This study examines whether conventional time invariant risk factors for KOA and baseline pain felt by the patient are associated with KOA pain flares. METHODS: Study participants were selected from a 3-month web-based longitudinal follow up study developed to identify risk factors for KOA pain flares. Participants were requested to complete online questionnaire at days 0, 30, 60 and 90 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow up period. A KOA pain flare was defined as current pain with a greater than 2 point increase (on a 0-10 point numeric rating scale) from the mildest KOA pain intensity reported at day 0. The association of pain flares with traditional risk factors for knee osteoarthritis -gender, weight, height, body mass index- was assessed by negative binomial regression. The duration of knee osteoarthritis, baseline pain intensity (lowest pain and highest pain scores at baseline) were similarly evaluated. The best explanatory variable was decided by forward selection. RESULTS: 345 persons (61.2% females) with multiple KOA pain flares were selected. Their mean age was 62.1years (SD +/-8.2). The mean body mass index was 29.8kg/m2 (SD +/-6.5). The participants rated their baseline pain (on a numeric rating scale) as being 4.41 (SD+/- 2.02) and their worst pain as being 7.91 (SD +/-1.74). An average of 1.92 (SD 2.59) flares were documented during the 3-month period. The levels of baseline pain - usual and worst pain felt at baseline- were the only parameters significantly associated with KOA pain flares (Table 1). CONCLUSIONS: The baseline pain scores were the strongest predictors of pain flares of knee osteoarthritis. The traditional risk factors associated with knee osteoarthritis did not usefully predict pain flares. The traditional time invariant risk factors may not be associated with short term variability in pain though they are associated with long term outcomes of knee osteoarthritis. It is postulated that as knee pain is already present, time invariant risk factors that contributed to the original symptom causation are not associated with pain flare. (Table Presented).
Is being barefoot, wearing shoes and physical activity associated with knee osteoarthritis pain flares? Data from a usually barefoot Sri Lankan cohort
(Oxford, 2021) Atukorala, I.; Pathmeswaran, A.; Batuwita, N.; Rajapaksha, N.; Ratnasiri, V.; Wijayaratne, L.; de Silva, M.; Chang, T.; Zhang, Y.; Hunter, D.J.
AIM: To identify the association between hours of being barefoot/wearing footwear, physical activity (PA) and knee osteoarthritis pain flares (KOAF). METHODS: Persons with a diagnosis of knee osteoarthritis, who reported previous KOAF, were followed up in a 3 months long telephone-based case-crossover study. Exposures to risk factors were assessed every 10 days and whenever the participants experienced a KOAF. Conditional logistic regression examined associations of KOAF with following: hours of being barefoot/using footwear and PA performed (P < .05). RESULTS: There were 260 persons recruited, of whom 183 continued longitudinal follow up. Of them, 120 persons had at least one valid KOAF and control period. Participants were female (90%) with mean (SD) age and body mass index of 59.9 (7.0) years, 28.0 (5.0) kg/m2 respectively. Participants were barefoot for a mean duration of 12.7 hours (SD 4.6) and used footwear for 5.1 (SD 4.7) hours daily; 99% wore heel heights <2.5 cm. Duration of being barefoot, 1 and 2 days before, demonstrated reduced multivariate odds of KOAF (odds ratio [OR] = 0.85; 95% CI 0.80-0.90). Moderate PA performed 1, 2 days prior was associated with a significantly increased risk of KOAF (multivariate OR 4.29; 2.52-7.30 and OR 3.36; 2.01-5.61). Similarly, hours of using footwear 1 and 2 days before flare demonstrated increased odds of KOAF (OR 1.15; 1.07-1.23 and 1.10; 1.03-1.18). CONCLUSIONS: Increased duration of being barefoot 1 to 2 days before is associated with reduced risk of KOAF. Performing moderate PA 1 to 2 days before was associated with an increased risk of KOAF. KEYWORDS: knee osteoarthritis pain.
Is there a relationship between the intermittent and constant osteoarthritis pain score (ICOAP) and pain flares in knee osteoarthritis?.
(W.B. Saunders-Elsevier, 2016) Atukorala, I.; Pathmeswaran, A.; Makovey, J.; Metcalf, B.; March, L.; Bennell, K.L.; Chang, T.; Zhang, Y.; Hunter, D.J.
PURPOSE: The Intermittent and Constant Osteoarthritis Pain Score (ICOAP) is a recently validated multidimensional osteoarthritis pain measure. This 11-item tool takes into account both the constant (6 items) and intermittent (5 items) pain of knee osteoarthritis (KOA) within 7 days summated to a single score. These items are scored from 0 (no pain) to 4 (extremely severe pain). The intent of this project was to assess the association and utility of ICOAP and its subscales in predicting pain flares in KOA identified by a 0-10 point numerical rating scale (NRS). METHODS: Study participants were selected from a 3-month web-based longitudinal follow up study developed to identify risk factors for KOA pain flares. Participants were requested to complete the ICOAP questionnaire at days 0, 30, 60 and 90 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow up period. A KOA pain flare was defined as current pain with a greater than 2 point increase (on a 0-10point NRS) from the mildest KOA pain intensity reported at day 0. The ICOAP score at point of a KOA pain flare was used to identify whether ICOAP was associated with occurrence of a pain flare. Conditional logistic regression was used to identify the odds of association with pain flare by the individual subscales and total ICOAP. Receiver Operating Characteristic Curves (ROC curves) were used to assess the utility of the ICOAP and its subscales (immediately preceding the flare) in predicting pain flares using the pain flares identified by the numeric rating scale as the gold standard. The ICOAP value for the first flare during the follow up period was used to predict pain. RESULTS: 213 persons (61%females) with multiple KOA pain flares were selected. Their mean age was 62.1 years (SD 8.5). The mean body mass index was 29.8 kg/m2 (SD 6.5). There were 652 flares documented with 1232 control periods over a 3- month period. 325 flares had a documented ICOAP within the preceding 30 days. The time gap between control period and flare period assessment points differed between subjects with the mean time gap being 18.5 days (SD 9.3). The mean number of flares per person per month was 1.97 (SD 2.65). None of the patients had a pain flare at baseline ICOAP total, constant and intermittent subscales had a significant association with pain flare (Table 1). However, the ICOAP scores (total, constant and intermittent) did not usefully predict pain flares and demonstrated an area under the ROC curves of 0.69 (95% confidence interval (CI)0.67-0.72), 0.69 (95% CI 0.67-0.72), 0.67 (95% CI 0.64-0.69) for total ICOAP score, constant pain and intermittent pain subscales respectively. CONCLUSIONS: The total ICOAP score (as well as the Constant and Intermittent subscales) recorded at point of flare was associated with KOA pain flares identified by the NRS. However, the ICOAP and its subscales did not usefully predict a pain flare. The lack of difference between the constant and intermittent ICOAP score can be attributed to correlation of items in the two subscales. The lack of complete correlation between the ICOAP values and pain flare assessed by the NRS is possibly due to the multidimensional nature of the ICOAP in contrast to the uni-dimensional nature of NRS. (Table Presented).
Neurological disorders associated with COVID-19 in Sri Lanka
(BioMed Central,, 2023) Chang, T.; Wijeyekoon, R.; Keshavaraj, A.; Ranawaka, U.; Senanayake, S.; Ratnayake, P.; Senanayake, B.; Caldera, M.C.; Pathirana, G.; Sirisena, D.; Wanigasinghe, J.; Gunatilake, S.; ASN COVID-19 Study Group
BACKGROUND: Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka. METHODS: COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 – May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations. RESULTS: One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain–Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 – 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 – 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p=0.046). CONCLUSIONS: The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.
Short-term pain trajectories in patients with knee osteoarthritis
(Wiley on behalf of the Asia Pacific League of Associations for Rheumatology, 2022) Atukorala, I.; Downie, A.; Pathmeswaran, A.; Deveza, L.M.A.; Chang, T.; Zhang, Y.; Hunter, D.J.
Aim: It is unknown if pain in knee osteoarthritis (KOA) follows distinct patterns over the short term. Therefore, the aim of this study was to identify whether persons with a previous history of KOA pain fluctuations have distinct trajectories of pain over 90 days and to examine associations between baseline characteristics and pain trajectories. Method: People with a previous history of KOA were selected from a web-based longitudinal study. Baseline variables were sex, age, being obese/overweight, years of KOA, knee injury, knee buckling, satisfactory Lubben Social Support Score, pain and stress scales, Intermittent Constant Osteoarthritis Pain Score (ICOAP), medication use, and physical activity. Participants completed a Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain subscale (KOOS-p, rated 0 = extreme to 100 = no knee problems) at 10-day intervals for 90 days. Short-term KOOS-p trajectories were identified using latent growth mixture modeling and the baseline risk factors for these pain trajectories were examined. Results: Participants (n = 313) had a mean age of 62.2 (SD ± 8.1) years and and a body mass index of 29.8 (SD ± 6.6) kg/m2 . The three-class latent growth mixture modeling quadratic model with best fit indices was chosen (based on lowest sample-size-adjusted Bayesian Information Criterion, high probability of belonging, interpretability). Three distinct pain trajectory clusters (over 90 days) were identified: low-moderate pain at baseline with large improvement (n = 11), minimal change in pain over 90 days (n = 248), and moderate-high pain with worsening (n = 46). Higher ICOAP (intermittent scale), perceived stress, negative affect score, and knee buckling at baseline were associated with a worse knee pain trajectory (P < 0.05). Conclusions: Persons with KOA showed unique short-term pain trajectories over 90 days, with distinct characteristics at baseline associated with each trajectory.