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Reynolds KA, Sommer JL, Roy R, Kornelsen J, Mackenzie CS, El-Gabalawy R. A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences. Pain Manag Nurs 2024; 25:409-416. [PMID: 38697887 DOI: 10.1016/j.pmn.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024]
Abstract
We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate.
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Affiliation(s)
- Kristin A Reynolds
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada.
| | - Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada
| | - Rachel Roy
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3A 1R9, Canada
| | - Corey S Mackenzie
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada; CancerCare Manitoba, Manitoba, R3E 0V9, Canada
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Ten Noever de Brauw GV, Aalders MB, Kerkhoffs GMMJ, Zuiderbaan HA, Keijser LCM, Benner JL. The mind matters: Psychological factors influence subjective outcomes following unicompartmental knee arthroplasty-A prospective study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38796718 DOI: 10.1002/ksa.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE This study aimed to investigate how psychological factors, including pain catastrophizing (PC), anxiety and depression affect preoperative and postoperative subjective outcomes in patients undergoing unicompartmental knee arthroplasty (UKA). METHODS A prospective comparative study was performed among 150 patients undergoing medial or lateral UKA for isolated unicompartmental osteoarthritis. Patients were categorized based on their preoperative PC and Hospital Anxiety and Depression Scale, stratifying them into groups with PC, anxiety or depression, and those without these psychological factors. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score-Physical function Short form (KOOS-PS), 5-level EQ5D Visual Analogue Scale (EQ5D-VAS), Forgotten Joint Score (FJS) and Numeric Rating Scale for pain (NRS-pain) were compared between groups preoperatively and at 6-, 12-, and 24-month follow-up. RESULTS At 24 months, PC patients had inferior outcomes in KOOS-PS (66.9 ± 16.5 vs. 77.6 ± 14.7, p = .008), EQ5D-VAS (63.5 ± 19.9 vs. 78.9 ± 20.1, p = .003) and FJS (73.7 ± 14.3 vs. 84.6 ± 13.8, p = .003). Anxiety was associated with inferior KOOS-PS (65.4 ± 15.2 vs. 78.2 ± 14.5, p = <.001), EQ5D-VAS (64.2 ± 23.2 vs. 79.3 ± 19.4, p = .002), FJS (75.7 ± 16.8 vs. 84.6 ± 13.4, p = .008) and NRS-pain (27.4 ± 24.6 vs. 13.7 ± 19.3, p = .023) at 24 months. Depression consistently resulted in inferior outcomes in KOOS-PS, EQ5D-VAS, FJS and NRS-pain across all follow-up assessments (p = <.05). Additionally, patients with anxiety and depression experienced longer length of hospital stay compared to those without these psychological factors (anxiety: 2.3 ± 2.3 vs. 0.8 ± 0.8 days, p = .006; depression: 2.3 ± 2.4 vs. 0.8 ± 0.8 days, p = .017). CONCLUSIONS Preoperative PC, anxiety and depression are associated with inferior subjective outcomes both prior to and following UKA. Among these factors, depression seemed to exert the most substantial adverse impact on outcomes following UKA. Patients with anxiety and depression had an extended duration of hospitalization lasting over twice as long as patients without these psychological factors. It seems that inferior outcomes primarily stem from the suboptimal preoperative condition rather than an inherent inability to benefit from UKA. LEVEL OF EVIDENCE Level II, prospective study.
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Affiliation(s)
- Gaby V Ten Noever de Brauw
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Margot B Aalders
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-North, The Netherlands
| | - Lucien C M Keijser
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Centre for Orthopedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
| | - Joyce L Benner
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Centre for Orthopedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
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Ohmine T, Demizu S, Murakami T, Yoshioka T, Aisu J, Katsuda H, Shimada N. Improvement in Gait Speed Affects Short-term Improvement in Activities of Daily Living in Patients with Moderate and Severe Knee Osteoarthritis. Prog Rehabil Med 2024; 9:20240002. [PMID: 38250176 PMCID: PMC10796275 DOI: 10.2490/prm.20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives It is unclear whether improvements in knee pain or physical function lead to improvements in activities of daily living (ADL) and quality of life (QOL) in patients with moderate to severe knee osteoarthritis (KOA). This study aimed to investigate whether improvements in knee pain and physical function, achieved through exercise therapy, lead to improvements in ADL and QOL in patients with moderate to severe KOA. Methods This case-control study included 18 patients with KOA. We evaluated knee range of motion, knee extension muscle strength (KEM), gait speed, knee pain, Knee Injury and Osteoarthritis Outcome Score (KOOS)-ADL, and KOOS-QOL at the first visit and after 3 months of exercise therapy. Patients were classified into the ADL and QOL improvement or no-improvement groups. Statistical analysis used split factorial analysis of variance with time and group as the main effects. When interactions were observed, post-hoc analysis was performed with two-sample t-tests. Results For ADL improvement, the improvements in KEM of the affected side and gait speed were statistically significant. At 3 months, the gait speed of the improvement group was significantly higher than that of the no-improvement group. For QOL improvement, there was no significant interaction for any of the factors evaluated. Conclusions No factor showed significant contribution to improved QOL in patients with moderate to severe KOA. However, increased gait speed may improve ADL and contribute to the development of efficient rehabilitation programs for patients with moderate to severe KOA.
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Affiliation(s)
- Toshimitsu Ohmine
- Department of Rehabilitation Sciences, Faculty of Allied
Health Sciences, Kansai University of Welfare Sciences, Kashiwara City, Japan
- Department of Rehabilitation, Shimada Hospital, Habikino
City, Japan
- Department of Rehabilitation, Faculty of Medicine, Osaka
Metropolitan University, Habikino City, Japan
| | - Seiji Demizu
- Department of Rehabilitation, Shimada Hospital, Habikino
City, Japan
| | - Takayuki Murakami
- Department of Rehabilitation, Shimada Hospital, Habikino
City, Japan
| | - Toyoki Yoshioka
- Department of Rehabilitation, Shimada Hospital, Habikino
City, Japan
- Department of Rehabilitation, Ohnari Orthopedics Clinic,
Katano City, Japan
| | - Jun Aisu
- Department of Rehabilitation, Shimada Hospital, Habikino
City, Japan
| | - Hiroshi Katsuda
- Department of Orthopedic Surgery, Shimada Hospital, Habikino
City, Japan
| | - Nagakazu Shimada
- Department of Orthopedic Surgery, Shimada Hospital, Habikino
City, Japan
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Lawrence C. Preoperative Education and Prehabilitation in Total Hip Arthroplasty Patients: A Commentary. HSS J 2023; 19:507-510. [PMID: 37937081 PMCID: PMC10626941 DOI: 10.1177/15563316231193394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/03/2023] [Indexed: 11/09/2023]
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Jochimsen KN, Kim JS, Jayabalan P, Lawrence C, Lewis CL, Prather H, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 3: Rehabilitation and Exercise. HSS J 2023; 19:447-452. [PMID: 37937088 PMCID: PMC10626932 DOI: 10.1177/15563316231192098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from 5 presentations given on hip-related rehabilitation at the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City.
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Affiliation(s)
- Kate N Jochimsen
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Prakash Jayabalan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cecelia Lawrence
- Acute Care Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
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Pulling BW, Braithwaite FA, Butler DS, Vogelzang AR, Moseley GL, Catley MJ, Murray CM, Stanton TR. Item development and pre-testing of an Osteoarthritis Conceptualisation Questionnaire to assess knowledge and beliefs in people with knee pain. PLoS One 2023; 18:e0286114. [PMID: 37773973 PMCID: PMC10540977 DOI: 10.1371/journal.pone.0286114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/09/2023] [Indexed: 10/01/2023] Open
Abstract
Many people with osteoarthritis hold beliefs that physical activity is unhelpful or dangerous for their joints, despite high-level evidence suggesting otherwise. Recent advances in scientific understanding of osteoarthritis have led to new treatments that target an individual's understanding both of their condition and the importance of best-practice management strategies, such as physical activity. Conceptual change has been proposed as an important mechanism by which cognitive interventions, such as pain science education, may reduce pain and improve function. There are currently no specific assessments of osteoarthritis conceptualisation to determine the effectiveness of cognitive interventions in effecting conceptual change in people with knee osteoarthritis. Therefore, we aimed to develop an item bank, as the first phase of developing a questionnaire to assess people's conceptualisations about their knee osteoarthritis and the role of physical activity in managing their osteoarthritis. Using a guideline-informed mixed method design, a panel of experts identified domains relevant to conceptualisation about knee osteoarthritis and physical activity (knowledge, beliefs, understanding) based upon available evidence. The panel created 33 provisional items. Qualitative and quantitative pretesting were used to explore how people with knee osteoarthritis understood the provisional items. Eighteen people with knee osteoarthritis completed cognitive interviews about their comprehension of the wording/grammar of each provisional item. The provisional item bank was field tested with 100 people with knee osteoarthritis. Readability was adequate with a Flesch reading ease score of 57.7. Although 14.7% used the 'Strongly agree' response option, only 3.4% of responses used the 'Strongly disagree' option, suggesting possible response bias. Predictive quality testing identified relevant modifications to the questionnaire instructions. The panel of experts appraised the qualitative data to assess whether and how items should be modified to address the problems identified, resulting in a final item bank of 45 items that can be evaluated for psychometric properties in future research.
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Affiliation(s)
- Brian W. Pulling
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Felicity A. Braithwaite
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - David S. Butler
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna R. Vogelzang
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Mark J. Catley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Carolyn M. Murray
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Tasha R. Stanton
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
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De Klerk TC, Dounavi DM, Hamilton DF, Clement ND, Kaliarntas KT. Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty. Bone Jt Open 2023; 4:315-328. [PMID: 37142259 PMCID: PMC10159731 DOI: 10.1302/2633-1462.45.bjo-2023-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
The aim of this study was to determine the effectiveness of home-based prehabilitation on pre- and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA). A systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Library, and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool. A total of 22 RCTs (1,601 patients) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.001), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69; p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD -0.18; p = 0.16) prior to THA, but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p = 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.001) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5% (SD 6.82). Prehabilitation interventions improve pain and function prior to TKA and THA and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively.
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Affiliation(s)
| | | | - David F. Hamilton
- Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Nick D. Clement
- Edinburgh Orthopaedics, University of Edinburgh, Edinburgh, UK
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Chen CC, Huang JF, Lin WC, Cheng CT, Chen SC, Fu CY, Lee MS, Liao CH, Chung CY. The Feasibility and Performance of Total Hip Replacement Prediction Deep Learning Algorithm with Real World Data. Bioengineering (Basel) 2023; 10:458. [PMID: 37106645 PMCID: PMC10136253 DOI: 10.3390/bioengineering10040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Hip degenerative disorder is a common geriatric disease is the main causes to lead to total hip replacement (THR). The surgical timing of THR is crucial for post-operative recovery. Deep learning (DL) algorithms can be used to detect anomalies in medical images and predict the need for THR. The real world data (RWD) were used to validate the artificial intelligence and DL algorithm in medicine but there was no previous study to prove its function in THR prediction. (2) Methods: We designed a sequential two-stage hip replacement prediction deep learning algorithm to identify the possibility of THR in three months of hip joints by plain pelvic radiography (PXR). We also collected RWD to validate the performance of this algorithm. (3) Results: The RWD totally included 3766 PXRs from 2018 to 2019. The overall accuracy of the algorithm was 0.9633; sensitivity was 0.9450; specificity was 1.000 and the precision was 1.000. The negative predictive value was 0.9009, the false negative rate was 0.0550, and the F1 score was 0.9717. The area under curve was 0.972 with 95% confidence interval from 0.953 to 0.987. (4) Conclusions: In summary, this DL algorithm can provide an accurate and reliable method for detecting hip degeneration and predicting the need for further THR. RWD offered an alternative support of the algorithm and validated its function to save time and cost.
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Affiliation(s)
- Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Wei-Cheng Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Shann-Ching Chen
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Mel S. Lee
- Department of Orthopaedic Surgery, Pao-Chien Hospital, Pingtung 90078, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
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Petersen KKS. Predicting pain after standard pain therapy for knee osteoarthritis - the first steps towards personalized mechanistic-based pain medicine in osteoarthritis. Scand J Pain 2023; 23:40-48. [PMID: 35993966 DOI: 10.1515/sjpain-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The prevalence of osteoarthritis (OA) is rising, and pain is the hallmark symptom of OA. Pain in OA is complicated and can be influenced by multiple joint-related factors and factors related to, e.g., physiological, epigenetic, and pain sensory profiles. Increasing evidence suggests that a subset of patients with OA are pain sensitive. This can be assessed using quantitative sensory testing (QST). Common treatments of OA are total knee arthroplasty (TKA) and administration of 3-weeks of non-steroidal anti-inflammatory drugs (NSAIDs), which provide pain relief to many patients with OA. However, approx. 20% of patients experience chronic postoperative pain after TKA, whereas NSAIDs provide an average pain relief of approx. 25%. The current topical review focuses on the emerging evidence linking pretreatment QST to the treatment response of TKA and NSAID treatments. CONTENT MEDLINE was systematically searched for all studies from 2000 to 2022 on pretreatment QST, TKA, and NSAIDs. Pre-clinical studies, reviews, and meta-analyses were excluded. SUMMARY Currently, 14 studies on TKA and four studies on NSAIDs have been published with the aim to attempt prediction of the treatment response. The QST methodologies in the studies are inconsistent, but 11/14 (79%) studies on TKA and 4/4 (100%) studies on NSAIDs report statistically significant associations between pretreatment QST and chronic postoperative pain after TKA or analgesic effect after NSAID treatment. The strength of the associations remains low-to-moderate. The most consistent pretreatment QST predictors are pressure pain thresholds, temporal summation of pain, and conditioned pain modulation. OUTLOOK The use of QST as predictors of standard OA treatment is interesting, but the predictive strength remains low-to-moderate. A transition of QST from a research-based setting and into the clinic is not advised until the predictive strength has been improved and the methodology has been standardized.
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Affiliation(s)
- Kristian Kjær-Staal Petersen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production, Aalborg University, Aalborg, Denmark
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Vervullens S, Meert L, Baert I, Smeets RJEM, Verdonk P, Rahusen F, Meeus M. Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care. Ann Phys Rehabil Med 2022; 66:101705. [PMID: 36115573 DOI: 10.1016/j.rehab.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA). PURPOSE We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life. METHODS A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included. RESULTS After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies). CONCLUSION More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA. REGISTRATION NUMBER This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).
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Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; CIR Revalidatie, location Eindhoven, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium and ASTARC department, Antwerp University, Belgium
| | - Frank Rahusen
- Department of Orthopaedics, St Jans Gasthuis Weert, the Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands.
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Hamada K, Tamura H, Hirohama K, Mitsutake T, Imura T, Tanaka S, Tanaka R. The effectiveness of group education in people over 50 years old with knee pain: A systematic review and meta-analysis of randomized control trials. Musculoskelet Sci Pract 2022; 62:102627. [PMID: 35926473 DOI: 10.1016/j.msksp.2022.102627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND International guidelines recommend educational intervention to treat knee osteoarthritis. However, they do not specify the type of intervention and the effectiveness of group educational intervention for knee pain is unclear. OBJECTIVES We aimed to examine the effectiveness of group educational interventions for people over 50 years old with knee pain compared with a control group. DESIGN A systematic review and meta-analysis of randomized controlled trials (RCTs). METHOD We searched Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature and screened for RCTs involving participants over 50 years old that reported the effects of group education on knee pain. We performed meta-analyses and evaluated the methodological quality and evidence quality using the Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS The search retrieved 1,177 studies. Seven RCTs were ultimately included, four of which were subjected to meta-analysis, showing standardized mean differences of -0.22 (95% confidence interval [CI]: -0.42 to -0.02, n = 423; I2 = 0% GRADE: low). All studies included in the meta-analysis involved exercise without individualized instruction in addition to group educational intervention. CONCLUSIONS Group education, when delivered in addition to exercises, significantly reduces knee pain in people over 50 years old.
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Affiliation(s)
- Kazuaki Hamada
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Wako Orthopedic Clinic, Hiroshima, Japan.
| | - Hiroyuki Tamura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; NEC Livex,Ltd., Karada Care Business Promotion Office, Tokyo, Japan
| | - Kenta Hirohama
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Sakamidorii Hospital, Hiroshima, Japan
| | - Tsubasa Mitsutake
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Department of Physical Therapy, Fukuoka International University of Health and Welfare, Japan
| | - Takeshi Imura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Shigeharu Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan; Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Japan.
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March MK, Harmer AR, Thomas B, Maitland A, Black D, Dennis S. Does resilience predict hospital length of stay after total knee arthroplasty? A prospective observational cohort study. ARTHROPLASTY 2022; 4:27. [PMID: 35794680 PMCID: PMC9261017 DOI: 10.1186/s42836-022-00128-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Resilience, or the ability to bounce back from stress, is a key psychological factor that is associated with ongoing functional independence and higher quality of life in older adults in the context of chronic health conditions. Emerging research has explored resilience and patient-reported outcomes after TKA. Our primary aim was to explore the relationship between resilience and acute hospital length of stay after total knee arthroplasty (TKA).
Methods
A prospective observational study recruited 75 participants one month before total knee arthroplasty from two Australian hospitals. Two preoperative psychological measures were used: the Brief Resilience Scale, and for comparison, the Depression, Anxiety and Stress Scale-21 (DASS-21). We collected sociodemographic, medical and surgical details, patient-reported pain, function, fatigue and quality of life one month before TKA. Health service data describing acute hospital length of stay, inpatient rehabilitation use, and physiotherapy occasions of service were collected after TKA. Non-parametric analysis was used to determine any differences in length of stay between those with low or high resilience and DASS-21 scores. Secondary regression analysis explored the preoperative factors affecting acute hospital length of stay.
Results
No significant difference was detected in length of stay between those with a low or a high resilience score before TKA. However, the group reporting psychological symptoms as measured by the DASS-21 before TKA had a significantly longer acute hospital length of stay after TKA compared to those with no psychological symptoms [median length of stay 6 (IQR 2.5) days vs. 5 (IQR 2) days, respectively (Mann-Whitney U = 495.5, P=0.03)]. Multivariate regression analysis showed that anesthetic risk score and fatigue were significant predictors of length of stay, with the overall model demonstrating significance (χ2=12.426, df = 4, P=0.014).
Conclusions
No association was detected between the brief resilience score before TKA and acute hospital length of stay after TKA, however, symptoms on the DASS-21 were associated with longer acute hospital length of stay. Preoperative screening for psychological symptoms using the DASS-21 is useful for health services to identify those at higher risk of longer acute hospital length of stay after TKA.
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Muacevic A, Adler JR. Physiotherapy Interventions for Preventing Spinal Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Review. Cureus 2022; 14:e30314. [PMID: 36381707 PMCID: PMC9650952 DOI: 10.7759/cureus.30314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine that appears in late childhood or adolescence. The aim of this systematic review was to present and synthesize the most relevant therapeutic advice and evidence on the efficacy of physiotherapy exercises for preventing the growth of spinal curvature caused by adolescent idiopathic scoliosis. "Adolescent idiopathic scoliosis," "exercise," "Cobb angle," and "physiotherapy" were the sole keywords used for the published research. Using these keywords and a combination of them, electronic resources such as PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), Elton B. Stephens Company (EBSCO) host, and ScienceDirect (Elsevier) were searched. The search was restricted to studies that were conducted in English between 2010 and 15 January 2022 that were controlled, randomized, and non-randomized. Studies were selected based on their titles and abstracts, with the exception of any that did not pertain to the study's goals. The Cobb angle was the important outcome measure. For each intervention, the Cobb angle's mean change score, the difference between the final and baseline scores, was determined. Nine studies were evaluated to be of outstanding quality out of a total of 20 studies that were reviewed for eligibility. With an exercise regimen of at least seven weeks, controls on lowering the Cobb angle in patients with AIS would provide encouraging outcomes. It also shows that bracing can strengthen the Cobb angle compared to exercise in the community. However, long-term orthotic activity ultimately results in trunk resistance and muscle loss in the center of the back. The combination of techniques and treatment methods seems to have better results in treating scoliosis, particularly using exercises involving the Schroth and scientific exercise approach to scoliosis (SEAS).
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14
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Taki S, Iwamoto Y, Imura T, Mitsutake T, Tanaka R. Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials. J Clin Neurosci 2022; 101:186-192. [DOI: 10.1016/j.jocn.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 12/15/2022]
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15
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Husted RS, Troelsen A, Husted H, Grønfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions/week using a home-based one-exercise program: a randomized dose-response trial of knee-extensor resistance exercise in patients eligible for knee replacement (the QUADX-1 trial). Osteoarthritis Cartilage 2022; 30:973-986. [PMID: 35413476 DOI: 10.1016/j.joca.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate firstly the efficacy of three different dosages of one home-based, knee-extensor resistance exercise on knee-extensor strength in patients eligible for knee replacement, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. METHOD One-hundred and forty patients eligible for knee replacement were randomized to three groups: 2, 4 or 6 home-based knee-extensor resistance exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks. PRIMARY OUTCOME isometric knee-extensor strength. SECONDARY OUTCOMES Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-min walk test, stair climbing test, exercise adherence and "need for surgery". RESULTS Primary analysis: Intention-to-treat analysis of 140 patients did not find statistically significant differences between the groups from baseline to after 12 weeks of exercise in isometric knee-extensor strength: Group 2 vs 4 (0.003 Nm/kg (0.2%) [95% CI -0.15 to 0.15], P = 0.965) and group 4 vs 6 (-0.04 Nm/kg (-2.7%) [95% CI -0.15 to 0.12], P = 0.628). Secondary analysis: Intention-to-treat analyses showed statistically significant differences between the two and six sessions/week groups in favor of the two sessions/week group for Oxford Knee Score: 4.8 OKS points (15.2%) [1.3 to 8.3], P = 0.008) and avg. knee pain last week (NRS 0-10): -1.3 NRS points (-19.5%) [-2.3 to -0.2], P = 0.018. After the 12-week exercise intervention, data were available for 117 patients (N = 39/group): 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. CONCLUSION In patients eligible for knee-replacement we found no between-group differences in isometric knee extensor strength after 2, 4 and 6 knee-extensor resistance exercise sessions per week. We saw no indication of an exercise dose-response relationship for isometric knee-extensor strength and only clinically irrelevant within group changes. For some secondary outcome (e.g., KOOS subscales) we found clinically relevant within group changes, which could help explain why only one in three patients decided to have surgery after the simple home-based exercise intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02931058. Preprint: https://doi.org/10.1101/2021.04.07.21254965.
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Affiliation(s)
- R S Husted
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - H Husted
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - B M Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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Liu X, Seidel JE, McDonald T, Patel AB, Waters N, Bertazzon S, Shahid R, Marshall DA. Rural–Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137706. [PMID: 35805363 PMCID: PMC9266058 DOI: 10.3390/ijerph19137706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient’s postal code to the physician’s postal code was calculated using origin–destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3–25.7) to GPs, 28.9 (IQR = 14.8–65.0) to Ortho, and 33.7 (IQR = 23.1–47.3) to PTs. We observed significant rural–urban disparities in realized access to GPs (2.9 and IQR = 0.0–92.1 in rural remote areas vs. 12.6 and IQR = 6.4–21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3–363.7 in rural remote areas vs. 21.3 and IQR = 14.0–29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0–232.1 in rural remote areas vs. 32.1 and IQR = 25.2–39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
| | - Judy E. Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Terrence McDonald
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Alka B. Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Nigel Waters
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Civil Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Environmental Science and Policy, College of Science, George Mason University, Fairfax, VA 22030, USA
| | - Stefania Bertazzon
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Rizwan Shahid
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Deborah A. Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Correspondence: ; Tel.: +1-403-210-6377; Fax: +1-403-210-9574
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Schaller SJ, Kiselev J, Loidl V, Quentin W, Schmidt K, Mörgeli R, Rombey T, Busse R, Mansmann U, Spies C. Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial. Trials 2022; 23:468. [PMID: 35668532 PMCID: PMC9167908 DOI: 10.1186/s13063-022-06401-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. METHODS Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. DISCUSSION Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04418271 . Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820.
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Affiliation(s)
- Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Jörn Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Verena Loidl
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Katrin Schmidt
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117, Berlin, Germany.
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18
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Bumberger A, Borst K, Willegger M, Hobusch GM, Windhager R, Waldstein W, Domayer S. Specific knowledge and resilience affect short-term outcome in patients following primary total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:1229-1237. [PMID: 34081194 PMCID: PMC9110532 DOI: 10.1007/s00402-021-03967-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of the present study was to investigate the potential associations between specific knowledge, resilience and patient-reported outcome measures (PROMS) following primary total hip arthroplasty (THA). METHODS In a cross-sectional prospective study, consecutive patients following primary THA were included at a rehabilitation center. A novel knowledge score and the validated Connor Davidson Resilience Scale (CD-RISC) were utilized to assess patients' specific knowledge and resilience, respectively. Additionally, patients completed a qualitative questionnaire regarding the information they had received. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as the University of California and Los Angeles Score (UCLA) served as primary outcome measures. Stepwise multiple regression analysis was performed to identify potential predictors of outcome. RESULTS A total of 103 patients at a mean age of 67.5 years (SD 10.5, 38-88) were included in the analysis at a median of 55.5 days (IQR 43-81) following primary THA. The mean knowledge and resilience scores were 3.8 (SD 1.6, 0-7) and 69.5 (SD 18.5, 0-100), respectively. Forty-seven percent of patients were afraid of harming their prosthesis and these patients had up to 59% worse WOMAC scores (p < 0.001). WOMAC scores on admission to rehabilitation were predicted by resilience and knowledge scores (R2 = 0.106, p = 0.036). UCLA scores at the time of admission were predicted by knowledge scores (R2 = 0.078, p = 0.007). CONCLUSION The present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary THA. Moreover, it could be shown that higher specific knowledge and resilience are associated with a better functional outcome according to validated PROMS. While these findings need to be prospectively validated in future studies, specific patient knowledge and resilience may have a direct impact on the outcome of primary THA.
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Affiliation(s)
- Alexander Bumberger
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Katharina Borst
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Madeleine Willegger
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Stephan Domayer
- Sonderkrankenanstalt Zicksee, Otto Pohanka Platz, 7161, Sankt Andrä am Zicksee, Austria
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19
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Jack K, Evans C, Bramley L, Cooper J, Keane T, Cope M, Hendron E. Identifying and Understanding the Non-Clinical Impacts of Delayed or Cancelled Surgery in Order to Inform Prioritisation Processes: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5542. [PMID: 35564937 PMCID: PMC9103788 DOI: 10.3390/ijerph19095542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
The COVID-19 pandemic has resulted in significant delays to non-urgent elective surgery. Decision making regarding prioritisation for surgery is currently informed primarily by clinical urgency. The ways in which decision making should also consider potential social and economic harm arising from surgical delay are currently unclear. This scoping review aimed to identify evidence related to (i) the nature and prevalence of social and economic harm experienced by patients associated with delayed surgery, and (ii) any patient assessment tools that could measure the extent of, or predict, such social and economic harm. A rapid scoping review was undertaken following JBI methodological guidance. The following databases were searched in October 2020: AMED; BNI; CINAHL; EMBASE; EMCARE; HMIC; Medline; PsychINFO, Cochrane, and the JBI. A total of 21 publications were included. The findings were categorised into five themes: (i) employment, (ii) social function and leisure, (iii) finances, (iv) patients' experiences of waiting, and (v) assessment tools that could inform decision making. The findings suggest that, for some patients, waiting for surgery can include significant social, economic, and emotional hardship. Few validated assessment tools exist. There is an urgent need for more research on patients' experiences of surgical delay in order to inform a more holistic process of prioritising people on surgical waiting lists in the COVID-19 pandemic recovery stages.
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Affiliation(s)
- Kathryn Jack
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottinghamshire NG7 2RD, UK;
| | - Louise Bramley
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Joanne Cooper
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Tracy Keane
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Marie Cope
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Elizabeth Hendron
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
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Vasileiadis D, Drosos G, Charitoudis G, Dontas IA, Vlamis J. The Efficacy of High-Intensity Preoperative Physiotherapy Training on Postoperative Outcomes in Greek Patients Undergoing Total Knee Arthroplasty: A Quasi-Experimental Study. Cureus 2022; 14:e23191. [PMID: 35444879 PMCID: PMC9010031 DOI: 10.7759/cureus.23191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose: Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). Methods: Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA. Results: Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087). Conclusions: Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities.
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Affiliation(s)
- Dimitrios Vasileiadis
- Laboratory for Research of the Musculoskeletal System, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Drosos
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
| | - Georgios Charitoudis
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
| | - Ismene A Dontas
- Veterinary Medicine, Laboratory for Research of the Musculoskeletal System, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
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21
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Nguyen C, Boutron I, Roren A, Anract P, Beaudreuil J, Biau D, Boisgard S, Daste C, Durand-Zaleski I, Eschalier B, Gil C, Lefèvre-Colau MM, Nizard R, Perrodeau É, Rabetrano H, Richette P, Sanchez K, Zalc J, Coudeyre E, Rannou F. Effect of Prehabilitation Before Total Knee Replacement for Knee Osteoarthritis on Functional Outcomes: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e221462. [PMID: 35262716 PMCID: PMC8908069 DOI: 10.1001/jamanetworkopen.2022.1462] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Multidisciplinary prehabilitation before total knee replacement (TKR) for osteoarthritis may improve outcomes in the postoperative period. OBJECTIVE To compare multidisciplinary prehabilitation with usual care before TKR for osteoarthritis in terms of functional independence and activity limitations after surgery. DESIGN, SETTING, AND PARTICIPANTS This prospective, open-label randomized clinical trial recruited participants 50 to 85 years of age with knee osteoarthritis according to the American College of Rheumatology criteria for whom a TKR was scheduled at 3 French tertiary care centers. Recruitment started on October 4, 2012, with follow-up completed on November 29, 2017. Statistical analyses were conducted from March 29, 2018, to March 6, 2019. INTERVENTIONS Four supervised sessions of multidisciplinary rehabilitation and education (2 sessions per week, at least 2 months before TKR, delivered to groups of 4-6 participants at each investigating center; session duration was 90 minutes and included 30 minutes of education followed by 60 minutes of exercise therapy) or usual care (information booklet and standard advice by the orthopedic surgeon) before TKR. MAIN OUTCOMES AND MEASURES The short-term primary end point was the proportion of participants achieving functional independence a mean (SD) of 4 (1) days after surgery defined as level 3 on the 4 functional tests. The midterm primary end point was activity limitations within 6 months after TKR assessed by the area under the receiver operating characteristic curve of the self-administered Western Ontario Questionnaire and McMaster Universities Osteoarthritis Index function subscale. RESULTS A total of 262 patients (mean [SD] age, 68.6 [8.0] years; 178 women [68%]) were randomized (131 to each group). A mean (SD) of 4 (1) days after surgery, 34 of 101 (34%) in the experimental group vs 26 of 95 (27%) in the control group achieved functional independence (risk ratio, 1.4; 97.5% CI, 0.9-2.1; P = .15). At 6 months, the mean (SD) area under the curve for the Western Ontario Questionnaire and McMaster Universities Osteoarthritis Index function subscale was 38.1 (16.5) mm2 in the experimental group vs 40.6 (17.8) mm2 in the control group (absolute difference, -2.8 mm2; 97.5% CI, -7.8 to 2.3; P = .31 after multiple imputation). No differences were found in secondary outcomes. CONCLUSIONS AND RELEVANCE This randomized clinical trial found no evidence that multidisciplinary prehabilitation before TKR for osteoarthritis improves short-term functional independence or reduces midterm activity limitations after surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01671917.
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Affiliation(s)
- Christelle Nguyen
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
- INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Paris, France
| | - Isabelle Boutron
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d’Épidémiologie Clinique, Paris, France
- METHODS Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
- ECaMO Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
- Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Philippe Anract
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- ECaMO Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Johann Beaudreuil
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Médecine Physique et de Réadaptation, AP-HP Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - David Biau
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- ECaMO Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Stéphane Boisgard
- Service de Chirurgie Orthopédique, Centre Hospitalo-Universitaire (CHU) de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Camille Daste
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
- ECaMO Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
| | - Isabelle Durand-Zaleski
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d’Épidémiologie Clinique, Paris, France
- METHODS Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
| | - Bénédicte Eschalier
- Service de Médecine Physique et de Réadaptation, CHU de Clermont-Ferrand, Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Clermont-Ferrand, France
| | - Charlotte Gil
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
- ECaMO Team, INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, Paris, France
- Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Rémy Nizard
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Chirurgie Orthopédique, AP-HP Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Élodie Perrodeau
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d’Épidémiologie Clinique, Paris, France
| | - Hasina Rabetrano
- L’unité de Recherche Clinique en Économie de la Santé, Hôpital Hôtel-Dieu, Paris, France
| | - Pascal Richette
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Rhumatologie, AP-HP Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Katherine Sanchez
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
| | - Jordan Zalc
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU de Clermont-Ferrand, Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Clermont-Ferrand, France
| | - François Rannou
- Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre–Université de Paris, Hôpital Cochin, Paris, France
- INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Paris, France
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22
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Bolton K, Wallis JA, Taylor NF. Benefits and harms of non-surgical and non-pharmacological management of osteoporotic vertebral fractures: A systematic review and meta-analysis. Braz J Phys Ther 2022; 26:100383. [PMID: 35063701 PMCID: PMC8784306 DOI: 10.1016/j.bjpt.2021.100383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/17/2021] [Accepted: 12/17/2021] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures affect a large number of older adults OBJECTIVES: Systematically review evidence of the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with standard care (control); and evaluate the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with an alternative non-pharmacological, non-invasive intervention. DESIGN Systematic review and meta-analysis of randomized controlled trials. Five electronic databases (CINAHL, EMBASE, MEDLINE, PUBMED, and COCHRANE) were searched. Eligible trials included participants with primary osteoporosis and at least one vertebral fracture diagnosed on radiographs, with treatment that was non-surgical and non-pharmacological involving more than one session. RESULTS Twenty randomized controlled trials were included with 2083 participants with osteoporotic vertebral fractures. Exercise, bracing, multimodal therapy, electrotherapy, and taping were investigated interventions. Meta-analyses provided low certainty evidence that exercise interventions compared to no exercise were effective in reducing pain in patients with osteoporotic vertebral fractures (mean difference (MD)= 1.01; 95% confidence interval (CI): 0.08, 1.93), and low certainty evidence that rigid bracing intervention compared with no bracing was effective in reducing pain in patients with osteoporotic vertebral fractures (MD= 2.61; 95%CI: 0.95, 4.27). Meta-analyses showed no differences in harms between exercise and no exercise groups. No health-related quality of life or activity improvements were demonstrated for exercise interventions, bracing, electrotherapy, or multimodal interventions. CONCLUSIONS Exercise and rigid bracing as management for patients with osteoporotic vertebral fractures may have a small benefit for pain without increasing risk of harm. TRIAL REGISTRATION PROSPERO registration number CRD42012002936.
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Affiliation(s)
- Karen Bolton
- Acute & Aged Medicine: Emergency Department / General Medicine, Eastern Health, Australia.
| | - Jason A Wallis
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Victoria, Australia; Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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23
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Mitsutake T, Imura T, Hori T, Sakamoto M, Tanaka R. Effects of Combining Online Anodal Transcranial Direct Current Stimulation and Gait Training in Stroke Patients: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 15:782305. [PMID: 34955795 PMCID: PMC8708562 DOI: 10.3389/fnhum.2021.782305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
Objective: Combining transcranial direct current stimulation (tDCS) and repetitive gait training may be effective for gait performance recovery after stroke; however, the timing of stimulation to obtain the best outcomes remains unclear. We performed a systematic review and meta-analysis to establish evidence for changes in gait performance between online stimulation (tDCS and repetitive gait training simultaneously) and offline stimulation (gait training after tDCS). Methods: We comprehensively searched the electronic databases Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature, and included studies that combined cases of anodal tDCS with motor-related areas of the lower limbs and gait training. Nine studies fulfilled the inclusion criteria and were included in the systematic review, of which six were included in the meta-analysis. Result: The pooled effect estimate showed that anodal tDCS significantly improved the 10-m walking test (p = 0.04; I 2 = 0%) and 6-min walking test (p = 0.001; I 2 = 0%) in online stimulation compared to sham tDCS. Conclusion: Our findings suggested that simultaneous interventions may effectively improve walking ability. However, we cannot draw definitive conclusions because of the small sample size. More high-quality studies are needed on the effects of online stimulation, including various stimulation parameters.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tomonari Hori
- Department of Rehabilitation, Fukuyama Rehabilitation Hospital, Hiroshima, Japan
| | - Maiko Sakamoto
- Education and Research Centre for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
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24
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Frydendal T, Christensen R, Mechlenburg I, Mikkelsen LR, Overgaard S, Ingwersen KG. Total hip arthroplasty versus progressive resistance training in patients with severe hip osteoarthritis: protocol for a multicentre, parallel-group, randomised controlled superiority trial. BMJ Open 2021; 11:e051392. [PMID: 34686555 PMCID: PMC8543646 DOI: 10.1136/bmjopen-2021-051392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA. METHODS AND ANALYSIS This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study. ETHICS AND DISSEMINATION The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04070027).
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Affiliation(s)
- Thomas Frydendal
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Ramer Mikkelsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Gordon Ingwersen
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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25
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Stanton TR, Braithwaite FA, Butler D, Moseley GL, Hill C, Milte R, Ratcliffe J, Maher C, Tomkins-Lane C, Pulling BW, MacIntyre E, Esterman A, Stanford T, Lee H, Fraysse F, Metcalf B, Mouatt B, Bennell K. The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis. BMC Musculoskelet Disord 2021; 22:738. [PMID: 34454458 PMCID: PMC8401372 DOI: 10.1186/s12891-021-04561-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program. Methods Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. Discussion We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04561-6.
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Affiliation(s)
- Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
| | - Felicity A Braithwaite
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - David Butler
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.,NOIgroup Pty Ltd, Adelaide, South Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Brian W Pulling
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Erin MacIntyre
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Francois Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Brendan Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
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26
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Mohammadi S, Miller WC, Wu J, Pawliuk C, Robillard JM. Effectiveness of eHealth Tools for Hip and Knee Arthroplasty: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:696019. [PMID: 36188859 PMCID: PMC9397702 DOI: 10.3389/fresc.2021.696019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Abstract
Objective: This study aimed to compare the effectiveness and costs of eHealth tools with usual care in delivering health-related education to patients' undergoing total hip or knee arthroplasty due to osteoarthritis.Data Sources: Six electronic databases were searched to identify randomized controlled trials and experimental designs (randomized or not) examining the effect of eHealth tools on pre- or post-operative care. Only manuscripts written in English were included. In the current study, no specific primary or secondary outcomes were selected. Any study that investigated the impacts of eHealth tools on hip or knee arthroplasty outcomes were included.Review Methods: Two researchers reviewed all titles and abstracts independently and in duplicate. Two researchers also conducted full-text screening and data extraction from the 26 selected articles.Results: The data were descriptively reported, and themes could emerge from each outcome. Two researchers separately assessed the Risk of Bias for each paper using the Cochrane risk of bias assessment tool. The majority of studies evaluated the impact of eHealth tools on physical (n = 23) and psychosocial outcomes (n = 19). Cost-related outcomes were measured in 7 studies. eHealth tools were found to be equivocal to usual care, with few studies reporting statistically significant differences in physical or psychosocial outcome measures. However, cost-related outcomes showed that using eHealth tools is more cost-effective than usual care.Conclusions: This review demonstrated that eHealth tools might be as effective as usual care, and possibly more cost-effective, a crucial implication for many overly burdened health care systems.
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Affiliation(s)
- Somayyeh Mohammadi
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William C. Miller
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Wu
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children Hospital Research Institute, Vancouver, BC, Canada
| | - Julie M. Robillard
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Julie M. Robillard
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Peiris CL, Leahy E, Galletti J, Taylor NF. Multidisciplinary Intervention Before Joint Replacement Surgery May Improve Outcomes for People with Osteoarthritis and Metabolic Syndrome: A Cohort Study. Metab Syndr Relat Disord 2021; 19:428-435. [PMID: 34283929 DOI: 10.1089/met.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Metabolic syndrome has been associated with poorer outcomes in the immediate postoperative period following joint replacement surgery for osteoarthritis. The aim of this study was to determine whether a multidisciplinary, preoperative intervention would minimize postoperative differences between people with and without metabolic syndrome who underwent joint replacement surgery for osteoarthritis. Method: A retrospective cohort study of older adults with multiple comorbidities (n = 230) attending a preoperative intervention service before lower limb joint replacement surgery. The intervention aimed to optimize the patient's health and functional reserve before surgery through weight loss, physical activity and medical management. Patient outcomes were adverse events, discharge destination and function. Health service outcomes were length of stay, hospital readmissions and emergency department presentations over a 2-year follow-up. Results: Two-thirds of participants (n = 151) had metabolic syndrome. There were no significant differences between those with and without metabolic syndrome in terms of discharge destination or adverse events during the acute hospital admission. There were no differences in function during rehabilitation but people with metabolic syndrome had significantly more adverse events (P = 0.037) during rehabilitation. In the 2 years following surgery, there were no differences in hospital readmission rates but people with metabolic syndrome had a higher observed frequency of potentially avoidable emergency department presentations (P = 0.066). Conclusions: Providing a preoperative intervention may help minimize differences between people with and without metabolic syndrome in the immediate postoperative period. However, having a diagnosis of metabolic syndrome may still adversely affect some long-term health service outcomes following joint replacement surgery.
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Affiliation(s)
- Casey L Peiris
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Edmund Leahy
- Department of Physiotherapy, La Trobe University, Melbourne, Australia.,Physiotherapy Department, Northern Health, Epping, Australia
| | - Jayde Galletti
- Physiotherapy Department, Northern Health, Epping, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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Bove AM, Dong ER, Hausmann LRM, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Exploring Race Differences in Satisfaction with Rehabilitation Following Total Knee Arthroplasty: a Qualitative Study. J Gerontol A Biol Sci Med Sci 2021; 77:e48-e55. [PMID: 33978153 DOI: 10.1093/gerona/glab132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHODS We conducted a series of qualitative focus group discussions with groups of Non-Hispanic White and Non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of post-operative physical therapy received, and overall satisfaction with the post-operative rehabilitation process. RESULTS Thirty-six individuals participated in focus groups. Three major themes emerged: (1) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation", and often mentioned specific interventions they felt were most helpful in their recovery. (2) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (3) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS Individuals undergoing TKA can largely expect positive rehabilitation experiences post-operatively. However, some barriers to post-operative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Erin R Dong
- Penn Presbyterian Medical Center; Philadelphia, PA, USA
| | - Leslie R M Hausmann
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System; Pittsburgh, PA, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University; Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
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Mechlenburg I, Reimer LCU, Kjeldsen T, Frydendal T, Dalgas U. Exercise as Medicine During the Course of Hip Osteoarthritis. Exerc Sport Sci Rev 2021; 49:77-87. [PMID: 33481454 DOI: 10.1249/jes.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise is now considered medicine in numerous chronic conditions and is essentially without side effects. We hypothesize that exercise is primary, secondary, and tertiary prevention at different stages of hip osteoarthritis (preclinical, mild-moderate, and severe hip osteoarthritis) and after total hip arthroplasty.
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Affiliation(s)
| | | | | | | | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Ho KW, Pong G, Poon WC, Chung KY, Kwok YY, Chiu KH. Progression of health-related quality of life of patients waiting for total knee arthroplasty. J Eval Clin Pract 2021; 27:69-74. [PMID: 32202045 PMCID: PMC7891587 DOI: 10.1111/jep.13388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) remains the surgical gold standard treatment for patients suffering from end-stage osteoarthritis (OA) of the knee. However, due to the high demand and scarce medical resources, the waiting time for surgery is astoundingly lengthy. Controversies are shown in numerous studies, on whether physical functionality and mental status decline or remain stable over the waiting period. This study aims to evaluate the progression in patients suffering from end-stage OA while on the waiting list for TKA. METHODS One hundred and twenty-seven patients suffering from end-stage OA who were on the TKA waiting list were prospectively recruited from our orthopaedics specialist clinic. They were assessed once a year for 2 years or until surgery. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), SF-36 self-rated questionnaire and 15D health-related quality of life (HRQoL) questionnaire were used as outcome measurements for functionality and disability assessment. RESULTS Patients on the waiting list for TKA showed a progressive increase in pain and disability level within the first year (P = .035). Those patients waiting for more than 2 years showed worsening HRQoL (P < .05) as time progressed. However, no significant difference was observed between the first and second years. CONCLUSIONS A decline in functionality and increase in disability were shown in follow-up assessments conducted every year. However, a plateau effect is observed with end-stage disease. This emphasizes that more active conservative management programmes should be introduced and implemented while patients are enlisted on the TKA waiting list. Moreover, timely surgical intervention can improve patients' overall function. TRIAL REGISTRATION This study involved human participants and reports health-related outcomes concerning the HRQoL in patients with end-stage OA of the knee. Thus, it was registered, retrospectively, as a clinical trial under the U.S. National Library of Medicine ClinicalTrials.gov (https://clinicaltrials.gov/) on March 4, 2018.
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Affiliation(s)
- Ki Wai Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Gerald Pong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Wai Chin Poon
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Kwong Yin Chung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Yan-Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kwok Hing Chiu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
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A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study. Pain Rep 2021; 5:e830. [PMID: 33490835 PMCID: PMC7808687 DOI: 10.1097/pr9.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This feasibility study of contemporary pain science education to increase activity levels in people with painful knee osteoarthritis supports progression to a larger trial. Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit. Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis. Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback). Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of “physiotherapy”, that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness. Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
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Stares A, Bains M. The Additive Effects of Creatine Supplementation and Exercise Training in an Aging Population: A Systematic Review of Randomized Controlled Trials. J Geriatr Phys Ther 2021; 43:99-112. [PMID: 30762623 DOI: 10.1519/jpt.0000000000000222] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The role of creatine supplementation in young athletes and bodybuilders is well established including ergogenic properties of muscular hypertrophy, strength, power, and endurance. Whether the benefits of creatine supplementation translate to an aging population with moderate training stimulus remains unclear especially in regard to gender, creatine dose, and duration. This systematic review assessed whether creatine supplementation combined with exercise results in additive improvements in indices of skeletal muscle, bone, and mental health over exercise alone in healthy older adults. METHODS PubMed, CINAHL, and Web of Science databases were utilized to identify randomized controlled trials of creatine supplementation combined with exercise in an aging population with additional predetermined inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, and performed quality assessments using the Physiotherapy Evidence Database scale. RESULTS AND DISCUSSION Seventeen studies were comprehensively reviewed according to categories of strength, endurance, functional capacity, body composition, cognition, and safety. These studies suggest that any additive ergogenic creatine effects on upper and/or lower body strength, functional capacity, and lean mass in an older population would require a continuous and daily low-dose creatine supplementation combined with at least 12 weeks of resistance training. Potential creatine specific increases in regional bone mineral density of the femur are possible but may require at least 1 year of creatine supplementation combined with moderate resistance training, and additional long-term clinical trials are warranted. The limited data suggested no additive effects of creatine over exercise alone on indices of mental health. The beneficial effects of creatine supplementation are more consistent in older women than in men. CONCLUSIONS Creatine monohydrate is safe to use in older adults. While creatine in conjunction with moderate- to high-intensity exercise in an aging population may improve skeletal muscle health, additional studies are needed to determine the effective dosing and duration paradigm for potential combined creatine and exercise effects on bone and cognition in older adults.
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Affiliation(s)
- Aaron Stares
- School of Physical Therapy, University of the Incarnate Word, San Antonio, Texas
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Chen L, Chen G. The Effect of Resistance Training on the Function after Hip Replacement: A Meta-analysis of Randomized Controlled Trials. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:383-390. [PMID: 33296947 DOI: 10.1055/a-1154-8949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The efficacy of resistance training for hip replacement remains controversial. We conducted a systematic review and meta-analysis to explore the influence of resistance training on functional recovery for hip replacement. METHODS We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through April 2018 for randomized controlled trials (RCTs) assessing the effect of resistance training on hip replacement. RESULTS Five RCTs involving 251 patients are included in the meta-analysis. Overall, compared with the control group for post-hip replacement patients, resistance training can significantly improve hip-related quality of life (standard mean difference [SMD] = 0.35; 95% CI = 0.02 to 0.68; p = 0.04), symptoms (SMD = 0.41; 95% CI = 0.08 to 0.74; p = 0.02), sports and recreation (SMD = 0.41; 95% CI = 0.08 to 0.75; p = 0.01), and reduce pain scores (SMD = 0.41; 95% CI = 0.08 to 0.74; p = 0.02), but has no remarkable impact on activities of daily living function (SMD = 0.48; 95% CI = 0 to 0.96; p = 0.05), sit to stand (SMD = 0.17; 95% CI = - 0.25 to 0.59; p = 0.44), stair climb performance (SMD = 0.06; 95% CI = - 0.36 to 0.48; p = 0.77), and leg extension power (SMD = 0.42; 95% CI = - 0.17 to 1.01; p = 0.17). CONCLUSIONS Resistance training is associated with significantly improved hip-related quality of life, symptoms, and sports and recreation, and decreased pain scores in post-hip replacement patients.
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Affiliation(s)
- Langxin Chen
- Surgery Department of Joint and Extremities Osteopathy, Maoming People Hospital, Guangdong, China
| | - Guanlin Chen
- Surgery Department of Joint and Extremities Osteopathy, Maoming People Hospital, Guangdong, China
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Husted RS, Juhl C, Troelsen A, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials. Osteoarthritis Cartilage 2020; 28:1412-1426. [PMID: 32890744 DOI: 10.1016/j.joca.2020.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this systematic review was to evaluate the relationship between prescribed knee-extensor strength exercise dosage in pre-operative exercise intervention and the effect on knee-extensor muscle strength prior to and following TKA. Additional meta-analyses report the effect of pre-habilitation on outcomes prior to and following TKA. DESIGN A systematic literature search was performed including RCT's evaluating the effect of pre-operative exercise prior to and following TKA. Meta-regression analysis was performed to evaluate the dose-response relationship between prescribed exercise dose and the pooled effect, measured as standardized mean difference (SMD). The prescribed exercise dose was quantified using a formula accounting for as many exercise descriptors as possible. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool. RESULTS Twelve trials with 616 patients were included. Meta-regression analysis showed no relationship between prescribed pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither prior to (slope 0.0005 [95%CI -0.007 to 0.008]) or 3 months following TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Prior to TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not at 3 months following TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Risk of bias was generally assessed as unclear. CONCLUSION Meta-regression analysis of existing trials suggests no relationship between the prescribed pre-operative knee-extensor exercise dosage and the change in knee-extensor strength observed prior to and following TKA. Pre-operative exercise including knee-extensor muscle strength exercise increased knee-extensor strength moderately prior to but not 3 months following TKA. PROTOCOL REGISTRATION PROSPERO ID (CRD42018076308) (http://www.crd.york.ac.uk/PROSPERO/).
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Affiliation(s)
- R S Husted
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - C Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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Mitsutake T, Imura T, Tanaka R. The Effects of Vestibular Rehabilitation on Gait Performance in Patients with Stroke: A Systematic Review of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2020; 29:105214. [PMID: 33066892 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. METHODS The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. RESULTS Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. CONCLUSION This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan.
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
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Zhang Z, Huang C, Jiang Q, Zheng Y, Liu Y, Liu S, Chen Y, Mei Y, Ding C, Chen M, Gu X, Xing D, Gao M, He L, Ye Z, Wu L, Xu J, Yang P, Zhang X, Zhang Y, Chen J, Lin J, Zhao L, Li M, Yang W, Zhou Y, Jiang Q, Chu CQ, Chen Y, Zhang W, Tsai WC, Lei G, He D, Liu W, Fang Y, Wu D, Lin J, Wei CC, Lin HY, Zeng X. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1213. [PMID: 33178745 PMCID: PMC7607097 DOI: 10.21037/atm-20-4665] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Osteoarthritis (OA) is a degenerative disease of middle-aged and elderly people, contributed a higher burden of disease in China and the world. In 2017, under the support of the Rheumatology and Immunology Expert Committee of the Cross-Strait Medical and Health Exchange Association. The objective was to develop an evidence-based diagnosis and treatment guideline for OA in China based on emerging new evidence. The guideline was registered at International Practice Guidelines Registry Platform (IPGRP-2018CN028). The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations, and the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was followed to report the guideline. The guideline provides recommendations for the OA diagnosis, disease risks monitoring and evaluate, treatment purpose and physical, medical and surgical interventions. This guideline is intended to serve as a tool for Chinese clinicians for the best decisions-making on diagnosis and treatment of OA.
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Affiliation(s)
- Zhiyi Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Jiang
- Department of Rheumatism, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Zheng
- Department of Rheumatology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences, Beijing, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengyun Liu
- Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjuan Chen
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifang Mei
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xin Gu
- Department of Rehabilitaion Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Dan Xing
- Department of Orthopaedics, Peking University People's Hospital, Beijing, China
| | - Min Gao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan He
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhizhong Ye
- Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, the People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jianhua Xu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pinting Yang
- Department of Rheumatic Immunology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuewu Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yue Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Chen
- Department of Rheumatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Like Zhao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR, USA
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
| | - Wei-Chung Tsai
- Department of Internal Medicine, Kaohsiung Medical College, Kaohsiung
| | - Guanghua Lei
- Department of Orthopedic, Xiangya Hospital, Central South University, Changsha, China
| | - Dongyi He
- Department of Arthrology, Guanghua Integrative Medicine Hospital, Shanghai, China
| | - Wei Liu
- Department of Rheumatology and Immunology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongfei Fang
- Department of Rheumatology and Immunology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Darong Wu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianhao Lin
- Department of Orthopedics, Peking University People's Hospital, Beijing, China
| | - Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung
| | - Hsiao-Yi Lin
- Veterans General Hospital, Taipei and National Yang-Ming Medical University, Taipei
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Holsgaard-Larsen A, Hermann A, Zerahn B, Mejdahl S, Overgaard S. Effects of progressive resistance training prior to total HIP arthroplasty - a secondary analysis of a randomized controlled trial. Osteoarthritis Cartilage 2020; 28:1038-1045. [PMID: 32376477 DOI: 10.1016/j.joca.2020.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate 1-year postoperative effect of preoperative resistance training (RT) in patients undergoing total hip arthroplasty (THA) on patient-reported outcomes on activity and function and objective outcomes on muscle strength and physical performance. DESIGN A 3-12 months follow-up of a randomized controlled trial. Patients scheduled for THA were randomized into: RT-group, twice a week for 10 weeks prior to THA, or 'care-as-usual' (CG). Primary endpoint of this sequel analysis is HOOS-ADL at 12 months follow-up. Secondary outcome measures are; other HOOS subscales, knee- and hip muscle strength plus function (gait, ascending/descending stairs, and sit-to-stand) at three and/or 12 months. CLINICALTRIALS.GOV: NCT01164111. RESULTS Eighty patients (70% women, 70.4 ± 7.6 years, BMI of 27.8 ± 4.6) were randomized to RT (n = 40) or CG (n = 40); data from 85% were available at 12 months. No superior effects were observed at 12 months for HOOS ADL (between-group change score [95%CI]) (2.6 [-4.2; 9.8], P = 0.44) or remaining subscales. However, ascending (1.3 s [0.3; 2.3], P = 0.01)) and descending stairs (1.6 s [0.3; 2.9], P = 0.01) demonstrated additional effects. At 3 months clinically relevant change-scores in favour of RT was observed on HOOS-Sport/Rec (10.5 points [1.4; 19.6], P = 0.023), together with higher knee strength of the affected side (14.6 Nm [6.3; 22.9], P < 0.001), and selected outcomes of physical function. CONCLUSIONS At 12 months after surgery, there was no additional effect of preoperative RT compared with THA alone, but rehabilitation was accelerated at 3 months.
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Affiliation(s)
- A Holsgaard-Larsen
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
| | - A Hermann
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Department of Orthopedic Surgery, Herlev University Hospital, Denmark.
| | - B Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Denmark.
| | - S Mejdahl
- Department of Orthopedic Surgery, Herlev University Hospital, Denmark.
| | - S Overgaard
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
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van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care 2020; 18:575-595. [PMID: 32643252 DOI: 10.1002/msc.1492] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this paper is to revise the 2010 Dutch guideline for physical therapy (PT) in patients with hip or knee osteoarthritis (OA), issued by the Royal Dutch Society for Physical Therapy (KNGF). METHOD This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation (AGREE) and Guidelines International Network (G-I-N) standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers to current care. A narrative or systematic literature review was undertaken in response to each clinical question. The panel formulated recommendations based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS A comprehensive assessment should be based on the International Classification of Functioning Disability and Health (ICF) core set for OA, including the identification of OA-related red flags. Based on the assessment, four treatment profiles were distinguished: (1) education and instructions for unsupervised exercises, (2) education and short-term supervised exercise therapy, (3) education and longer term supervised exercise therapy, and (4) education and exercise therapy before and/or after total hip or knee surgery. Education included individualized information, advice, instructions, and self-management support. Exercise programs were tailored to individual OA-related issues, were adequately dosed, and were in line with public health recommendations for physical activity. Recommended measurement instruments included the Patient-Specific Complaints Instrument, the Numeric Pain Rating Scale, the Hip Disability and Osteoarthritis Outcome Score/the Knee Injury Osteoarthritis Outcome Score, and the Six Minute Walk Test. CONCLUSION An evidence-based PT guideline for the management of patients with hip or knee OA was developed. To improve quality of care for these patients, an extensive implementation strategy is necessary.
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Affiliation(s)
| | - Guus A Meerhoff
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands.,Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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March MK, Harmer A, Godfrey E, Venkatesh S, Thomas B, Dennis S. The KOMPACT-P study: Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy-Pilot study protocol. BMJ Open 2020; 10:e032675. [PMID: 32499254 PMCID: PMC7279646 DOI: 10.1136/bmjopen-2019-032675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Incidence of total knee arthroplasty (TKA) is projected to rise 276% in 2030, and psychological distress affects up to 42% of people with knee osteoarthritis undergoing TKA, with demonstrated detrimental effects on postoperative outcomes. Few studies have assessed psychological treatment in people awaiting TKA, and these have been psychologist-delivered treatments. No evidence exists regarding psychologically-informed interventions delivered by health professionals currently embedded in TKA clinical pathways. The primary aim of this pilot study is to explore the safety, acceptability and feasibility of the Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy (KOMPACT) approach in people awaiting TKA. METHODS AND ANALYSIS 51 community-dwelling adults scheduled for a primary TKA at two hospitals will be recruited to this pilot, mixed-methods, prospective randomised controlled trial with assessor blinding. Participants will be randomised in a 1:2 ratio to either usual care (education class) or usual care plus KOMPACT (2 hours 20 min of preoperative physiotherapy informed by Acceptance and Commitment Therapy). Our primary outcome measures are safety (length of stay, complications and psychological health after KOMPACT), acceptability (treatment credibility and qualitative data) and feasibility (recruitment, retention and intervention fidelity) of the KOMPACT approach. Secondary outcomes include health service outcomes, patient-reported physical and psychological outcomes, and physical performance measures. Quantitative data collection was conducted at baseline, 1-2 weeks before TKA, 6 weeks after TKA and 6 months after TKA. Qualitative data collection is 1-2 weeks before TKA. Data analysis will take a quantitative-led approach with triangulation after thematic analysis of the qualitative data. ETHICS AND DISSEMINATION This study has full ethics approval (HREC/18/WMEAD/440). Results from this study will be published in peer-reviewed journals and presented at local and international conferences. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry (ACTRN12618001867280p).
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Harmer
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Godfrey
- Department of Health Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Shruti Venkatesh
- Renal Supportive Care, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Bijoy Thomas
- Orthopaedic Department, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
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Holm PM, Schrøder HM, Wernbom M, Skou ST. Low-dose strength training in addition to neuromuscular exercise and education in patients with knee osteoarthritis in secondary care - a randomized controlled trial. Osteoarthritis Cartilage 2020; 28:744-754. [PMID: 32179197 DOI: 10.1016/j.joca.2020.02.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the effects of lower limb strength training in addition to neuromuscular exercise and education (ST + NEMEX-EDU) compared to neuromuscular exercise and education alone (NEMEX-EDU) on self-reported physical function in patients with knee osteoarthritis (KOA). DESIGN Patient-blinded, parallel-group randomized controlled trial (RCT). METHODS The trial included 90 patients in secondary care with radiographic and symptomatic KOA, ineligible for knee replacement. Both groups exercised twice weekly for 12 weeks. Additional strength training consisted of a single, fatiguing knee extension set (30-60RM) before four sets of leg-press (8-12RM). Primary outcome was the between-group difference on the subscale activities of daily living from the Knee Injury and Osteoarthritis Outcome Score (KOOSADL) at 12 weeks. Secondary outcomes included KOOS symptoms, pain, function in sport and recreation, and quality of life, 40 m walk, stair climb, leg extension power, EuroQol-5D-5L, pain medication usage, and adverse events. RESULTS There was no statistically significant between-group difference in KOOSADL at 12-weeks; adjusted mean difference -1.15 (-6.78 to 4.48). Except for the stair climb test, which demonstrated an adjusted mean difference of 1.15 (0.09-2.21) in favor of ST + NEMEX-EDU, all other outcomes showed no statistically significant between-group differences. Neither group improved leg extension power. CONCLUSION The addition of lower-limb strength training, using a low-dose approach, to neuromuscular exercise and education carried no additional benefits on self-reported physical function or on most secondary outcomes. Both groups displayed similar improvements at 12-week follow-up. Hence, the current low-dose strength training approach provided no additional clinical value in this group of KOA patients. Trial identifier (ClinicalTrials.gov): NCT03215602.
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Affiliation(s)
- P M Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse & Næstved, Denmark.
| | - H M Schrøder
- Department of Orthopedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark
| | - M Wernbom
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse & Næstved, Denmark
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Tanaka S, Tamari K, Amano T, Robbins SM, Inoue Y, Tanaka R. Self-reported physical activity is related to knee muscle strength on the unaffected side and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty: a cross-sectional study. Physiother Theory Pract 2020; 38:441-447. [PMID: 32436476 DOI: 10.1080/09593985.2020.1768457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Additional evidence regarding the effectiveness of self-management programs for patients awaiting total knee arthroplasty is required.Objective: The study aimed to determine if self-reported physical activity was related to muscle strength and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty.Methods: The study included subjects with knee osteoarthritis awaiting total knee arthroplasty (n = 767). Walking ability and bilateral knee muscle strength were measured as dependent variables. Self-report physical activity was assessed based on the guidelines from the Japanese Ministry of Health, Labor and Welfare. Multiple regression models determined if self-reported physical activity was significantly related to dependent variables, after accounting for other related factors.Results: Physical activity was associated with both higher knee flexion (β = -0.09, p = .013) and higher extension (β = -0.09, p = .007) muscle strength on the unaffected side only. In addition, physical inactivity was associated with a lower walking ability level (TUG: β = 0.08, p = .015; 5mWT: β = 0.10, p = .005).Conclusions: These results can help health-services providers develop educational and/or self-management programs to maintain muscle strength on the unaffected side and walking ability in patients awaiting total knee arthroplasty.
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Affiliation(s)
- Shigeharu Tanaka
- Division of Physical Therapy, School of Rehabilitation, Kanagawa University of Human Services, Yokosuka, Japan.,Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kotaro Tamari
- Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Shizuoka, Japan
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Yu Inoue
- Research Institute of Health and Welfare, KIBI International University, Okayama, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
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Lenguerrand E, Artz N, Marques E, Sanderson E, Lewis K, Murray J, Parwez T, Bertram W, Beswick AD, Burston A, Gooberman-Hill R, Blom AW, Wylde V. Effect of Group-Based Outpatient Physical Therapy on Function After Total Knee Replacement: Results From a Multicenter Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2020; 72:768-777. [PMID: 31033232 PMCID: PMC7317425 DOI: 10.1002/acr.23909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
Objective To evaluate the long‐term clinical effectiveness of a novel group‐based outpatient physical therapy (PT) following total knee replacement (TKR). Methods In this 2‐center, unblinded, superiority, randomized controlled trial, 180 patients on a waiting list for primary TKR due to osteoarthritis were randomized to a 6 session group‐based outpatient PT intervention and usual care (n = 89) or usual care alone (n = 91). The primary outcome was patient‐reported functional ability measured by the Lower Extremity Functional Scale at 12 months postoperative. Secondary outcomes included knee symptoms, depression, anxiety, and satisfaction. Questionnaires were completed preoperatively and at 3, 6, and 12 months postoperatively. Results The mean difference in function between groups was 4.47 (95% confidence interval [95% CI] 0.20, 8.75; P = 0.04) at 12 months postoperative, favoring the intervention. The mean difference in function between groups decreased over time, from 8.1 points at 3 months (95% CI 3.8, 12.4; P < 0.001) to 5.4 (95% CI 1.1, 9.8; P = 0.015) at 6 months postoperative. There were no clinically relevant differences in any secondary outcomes between groups, although patients in the intervention group were more likely to be satisfied with their PT. No serious adverse events related to the intervention were reported. Conclusion Supplementing usual care with this group‐based outpatient PT intervention led to improvements in function at 12 months after TKR, although the magnitude of the difference was below the minimum clinically important difference of 9 points. However, patient satisfaction was higher in the intervention group, and there was some evidence of clinically relevant improvements in function at 3 months.
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Affiliation(s)
| | - Neil Artz
- University of West of England, Bristol, UK
| | | | | | - Kristina Lewis
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James Murray
- University of Bristol and Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Tarique Parwez
- Luton and Dunstable Hospital, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Wendy Bertram
- University of Bristol and Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | | | - Rachael Gooberman-Hill
- University of Bristol and NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ashley W Blom
- University of Bristol, Southmead Hospital, North Bristol NHS Trust, and NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Vikki Wylde
- University of Bristol and NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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A Qualitative Study of Preparation for Lumbar Spinal Stenosis Surgery: Perceptions of Patients and Physical Therapists. J Orthop Sports Phys Ther 2020; 50:198-205. [PMID: 31663813 DOI: 10.2519/jospt.2020.8887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To gain the perspectives of patients who underwent lumbar spinal stenosis (LSS) surgery and physical therapists who treat spine-related disorders regarding rehabilitation and other care prior to LSS surgery. DESIGN Qualitative focus group study. METHODS Sixteen patients (4 female; average ± SD age, 64.3 ± 8.8 years; time since surgery, 9.9 ± 4.4 months) and 10 physical therapists (2 female; average ± SD age, 40.9 ± 6.6 years; time in practice, 17.2 ± 7.7 years) participated. Four groups were conducted: 2 with patients post LSS surgery and 2 with physical therapists who treat spine-related disorders. Participants were asked open-ended questions by a trained facilitator regarding their perceptions of preoperative LSS education and rehabilitation. Transcripts were coded and themes were identified. RESULTS Analyses revealed 4 themes within the discussions: (1) desire for helpful information, (2) benefits of preoperative rehabilitation, (3) downfalls of preoperative rehabilitation, and (4) desire for coordinated care. Varying opinions on preoperative physical therapy between patients and physical therapists were discussed, revealing that similar numbers of participants held positive and negative perceptions of preoperative physical therapy. A desire for more thorough preoperative education and care was expressed by both groups. CONCLUSION There is a clear need for standardized preoperative LSS care and education. This may decrease misunderstandings about LSS surgery and its treatments in the future as well as improve coordinated care between surgeons and physical therapists. J Orthop Sports Phys Ther 2020;50(4):198-205. Epub 30 Oct 2019. doi:10.2519/jospt.2020.8887.
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Tanaka R, Hayashizaki T, Taniguchi R, Kobayashi J, Umehara T. Effect of an intensive functional rehabilitation program on the recovery of activities of daily living after total knee arthroplasty: A multicenter, randomized, controlled trial. J Orthop Sci 2020; 25:285-290. [PMID: 31182258 DOI: 10.1016/j.jos.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/27/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postoperative exercise is effective for improving activities of daily living (ADL) in patients undergoing total knee arthroplasty (TKA), and exercise has been included in standard care after surgery provided in Japan. However, it is unknown whether standard care has room to develop for improving ADL. The goal of this study was to investigate the effect of an intensive functional rehabilitation (IFR) program in addition to standard care on the recovery of ADL following surgery. METHODS A total of 104 inpatients with knee osteoarthritis undergoing TKA were randomly assigned to either the experimental or the control group. The experimental group (n = 57) were given standard care and participated in the IFR program immediately after surgery (e.g., stand up and sit down, strengthen the knee extensor muscle, climbing onto a platform, and walking laterally). The control group (n = 47) were given standard care only. Primary outcomes were the score of Functional Independence Measure (FIM) and the Barthel Index (BI) at 2 weeks postoperatively. Matching using the propensity score was performed to control the influence of the patient characteristic on the outcome. RESULTS As a result of matching, 42 patients were extracted. The averages (standard deviation) of the FIM motor score were 79.0 (10.8) for the experimental group and 80.5 (9.4) for the control group. The BI scores were 88.1 (13.3) for the experimental group and 91.0 (10.1) for the control group. The experimental and control groups did not show significant intergroup differences in either score. CONCLUSIONS Our study shows that as compared to standard care, IFR program for 2 weeks in addition to standard care after surgery did not significantly improve ADL in patients undergoing TKA.
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Affiliation(s)
- Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
| | | | - Ryoji Taniguchi
- Department of Rehabilitation, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Jun Kobayashi
- Department of Rehabilitation, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
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Wu SY, Lin CH, Chang NJ, Hu WL, Hung YC, Tsao Y, Kuo CEA. Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients: A protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19541. [PMID: 32195960 PMCID: PMC7220484 DOI: 10.1097/md.0000000000019541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. METHODS Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention. OBJECTIVES This protocol aims to investigate the combined effect of EA and LA in KOA patients.
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Affiliation(s)
- Szu-Ying Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- Department of Nursing, Meiho University, Pingtung
- Department of Sports Medicine
| | - Chien-Hung Lin
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | | | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- College of Medicine, Kaohsiung Medical University
- Fooyin University College of Nursing
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- School of Chinese Medicine for Post Baccalaureate, I-Shou University
| | - Yu Tsao
- College of Management, National Kaohsiung University of Science and Technology
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan
| | - Chun-En Aurea Kuo
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- Department of Nursing, Meiho University, Pingtung
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Ascione F, Braile A, Romano AM, di Giunta A, Masciangelo M, Senorsky EH, Samuelsson K, Marzano N. Experience-optimised fast track improves outcomes and decreases complications in total knee arthroplasty. Knee 2020; 27:500-508. [PMID: 31883758 DOI: 10.1016/j.knee.2019.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/07/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to describe an advanced total knee arthroplasty (TKA) fast-track programme and determine discharge parameters during hospitalisation, as well as patient satisfaction, outcomes and complications within the first 12 months after surgery. METHODS This prospective study was based on patients selected consecutively for primary elective TKA, undergoing surgery between 2014 and 2017 in an established fast-track setting. Hospitalisation-related parameters were collected: demographics, body mass index (BMI), surgical time, ischaemia time, haemoglobin values, blood transfusions, length of stay, weight-bearing and stair-climbing time, opioid administration, preoperative and discharge loss of extension and maximum active flexion of the knee, visual analogue scale (VAS), 12-month follow-up satisfaction rate and range of motion, any complications, hospital re-admission and re-operation within the first 12 months. Differences were determined using t-tests. RESULTS A total of 704 total knee replacements implanted in 481 patients were included in the study and 223 patients had a bilateral TKA. Their mean age was 69.8 years (range 57-88 years). At the 12-month follow-up, 623 patients (88.5%) reported being satisfied or very satisfied and 15 (2.1%) were dissatisfied with their TKA, mean active flexion and loss of extension were 104.4° and 2.3°, respectively. A total of 15 complications occurred (two percent): five painful knees, three knee stiffness, three haematomas, two infections, one hospital re-admission and one deep venous thrombosis. No cases of pulmonary embolism and death related to surgery were reported. CONCLUSION The study reports on an advanced fast-track programme for TKA with a low incidence of surgery- and hospitalisation-related issues and complications and without any severe adverse events during the first year. On average, the fast-track programme had a short length of stay, an early recovery of weight-bearing, knee mobility, pain control and a high satisfaction rate, accompanied with an acceptable 12 month range of motion.
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Affiliation(s)
- Francesco Ascione
- Department of Shoulder Surgery, Campolongo Hospital, Salerno, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Napoli, Italy
| | - Adriano Braile
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Napoli, Italy.
| | - Alfonso Maria Romano
- Department of Shoulder Surgery, Campolongo Hospital, Salerno, Italy; Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Napoli, Italy
| | - Angelo di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marco Masciangelo
- Orthopedics and Sport Medicine Unit, Casa di Cura 'Sileno e Anna Rizzola', San Donà di Piave, Venezia, Italy
| | - Eric Hamrin Senorsky
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nicola Marzano
- Orthopedics and Sport Medicine Unit, Casa di Cura 'Sileno e Anna Rizzola', San Donà di Piave, Venezia, Italy
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Dennis J, Wylde V, Gooberman-Hill R, Blom AW, Beswick AD. Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2020; 10:e033248. [PMID: 31964670 PMCID: PMC7045074 DOI: 10.1136/bmjopen-2019-033248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%-34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR. DESIGN MEDLINE, Embase, CINAHL, The Cochrane Library and PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation. PRIMARY AND SECONDARY OUTCOMES Pain at 6 months or longer; adverse events. INTERVENTIONS Presurgical interventions aimed at improving TKR outcomes. RESULTS Eight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI -0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions. CONCLUSIONS We found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR. PROSPERO REGISTRATION NUMBER CRD42017041382.
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Affiliation(s)
- Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - A W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew David Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
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Svinøy OE, Bergland A, Risberg MA, Pripp AH, Hilde G. Better before-better after: efficacy of prehabilitation for older patients with osteoarthritis awaiting total hip replacement-a study protocol for a randomised controlled trial in South-Eastern Norway. BMJ Open 2019; 9:e031626. [PMID: 31892650 PMCID: PMC6955471 DOI: 10.1136/bmjopen-2019-031626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Health professions need to prepare for the increase of older patients with osteoarthritis requiring health services including those requiring total joint arthroplasty (TJA). The primary objective of this study is to assess the effect of a tailored prehabilitation programme of older patients awaiting primary surgery for total hip replacement on physical function measured by walking speed within 1 week after intervention as well as 6 weeks and 3 months after TJA surgery. METHODS AND ANALYSIS This is a single-blinded randomised controlled trial. The participants are 70 years or older, scheduled for primary total hip replacement due to late stage osteoarthritis. The intervention group will receive patient education and exercise for 6-12 weeks. The control group will receive care as usual. The primary outcome is gait speed. Secondary outcomes are lower body strength, mobility, aerobic capacity, activity of daily living, length of stay at the hospital, referral to an inpatient rehabilitation clinic, pain, quality of life and cost-effectiveness. Estimated sample size is 150 participants randomised into the two arms. The data will be analysed following the intention-to-treat principle with methods for repeated measurements. ETHICS AND DISSEMINATION The project proposal has been approved by The Regional Committee for Medical Research Ethics in South Norway (ref no. 2018/503). The results will be published in peer-reviewed articles. TRIAL REGISTRATION NUMBER NCT03602105.
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Affiliation(s)
- Odd-Einar Svinøy
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Department of Reserach, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Gunvor Hilde
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Dowsey M, Castle D, Knowles S, Monshat K, Salzberg M, Nelson E, Dunin A, Dunin J, Spelman T, Choong P. The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: A randomised controlled trial. Complement Ther Med 2019; 46:195-201. [DOI: 10.1016/j.ctim.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 12/27/2022] Open
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O'Brien P, Bunzli S, Ayton D, Dowsey MM, Gunn J, Manski-Nankervis JA. What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis. BMJ Open 2019; 9:e031310. [PMID: 31551388 PMCID: PMC6773346 DOI: 10.1136/bmjopen-2019-031310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) are often the first health professionals to assess patients with osteoarthritis (OA). Despite clinical guideline recommendations for non-surgical intervention as first-line therapies, the most frequent referral from a GP for a person with knee OA is to an orthopaedic surgeon. The aim of our study was to explore patient factors that impact on the decision to progress to total knee replacement (TKR), including the experience of patients in general practice, their perceptions of their condition, and their access and use of community-based allied health interventions. DESIGN Qualitative investigation using semi-structured interviews. The Candidacy framework was selected as a lens to examine the factors driving healthcare access. Data were analysed using a thematic analysis approach. Codes identified in the data were mapped to the seven Candidacy domains. Themes corresponding to each domain were described. SETTING A public hospital in Melbourne, Australia. PARTICIPANTS 27 patients with knee OA who were on a waiting list to undergo TKR. RESULTS Ten themes described factors influencing access and use of non-surgical interventions and decision-making for undergoing TKR: (1) History of knee problems, change in symptoms; (2) Physical and psychosocial functioning (Identification of Candidacy); (3) GP and social networks as information sources, access to care (Navigation); (4) Referral pathways (Permeability of services); (5) Communication of impact (Appearances at health services); (6) GP-Surgeon as the predominant referral pathway (Adjudications); (7) Physical activity as painful; (8) Beliefs about effectiveness of non-surgical interventions (Offers and resistance); (9) Familiarity with local system; and (10) Availability (Operating conditions and local production of Candidacy). CONCLUSIONS Using the Candidacy framework to analyse patients' experiences when deciding to progress to TKR highlighted missed opportunities in general practice to orient patients to first try non-surgical interventions. Patients with knee OA also require improved support to navigate allied health services.
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Affiliation(s)
- Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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