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Wang L, Xie S, Bao T, Zhu S, Liang Q, Wang X, Zhang R, Xiang X, Du C, He C. Exercise and education for community-dwelling older participants with knee osteoarthritis: a video-linked programme protocol based on a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:470. [PMID: 34022825 PMCID: PMC8141198 DOI: 10.1186/s12891-021-04331-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background Neuromuscular and quadriceps exercises have been shown to be effective approaches to relieve pain and to improve function for patients with knee osteoarthritis. In this study, we aim to provide an informative feasible model in which therapeutic exercise and education will be undertaken with physiotherapy supervision and instruction via video link. We also aim to explore the relationship between program-induced pain alleviation/functional improvements and reduction in irritability, which might be mediated through program-induced psychosocial benefits. Methods In this proposed two-parallel group (neuromuscular exercise versus quadriceps exercise), single-blinded, randomised controlled trial, participants aged ≥50 years with osteoarthritic knee pain will undergo a 12-week intervention, comprising video-linked education, supervised exercises, and a 12-week follow-up. Seven measurements will be taken to collect longitudinal data. A generalised estimating equation will be used to establish the adjusted difference in effectiveness on pain, function, irritability, and psychosocial outcomes between participants undertaking neuromuscular exercises and those undertaking quadriceps exercises. The primary outcomes are overall average pain in the knee joint during walking, as assessed through the 11-point Numerical Pain Rating Scale, and the Western Ontario and McMaster Universities osteoarthritis index physical function subscale. Furthermore, pressure pain threshold and changes in self-report pain scores pre-, during, and post-exercise were also measured as an indication of irritability. In addition, both the 6-min walk test and a timed up & go test were used to assess walking function performance. Finally, patients’ emotions (e.g., fear and catastrophising), self-trust, needs in terms of disease knowledge, mental resilience, social support and health-related quality of life were investigated. Two four-wave cross-lagged models will be used to investigate directional relationships, aiming to investigate the complex mechanisms concerning the effects of exercise programmes. Discussion Through summarising the study’s strengths and limitations, this study may provide promising insights in terms of exercise therapy optimisation for people with knee osteoarthritis and/or other chronic pain within a psychosocial framework. Trial registration ChiCTR2100041978 (chictr.org.cn), January 10, 2021.
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Affiliation(s)
- Lin Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Suhang Xie
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Tianjie Bao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Siyi Zhu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Qiu Liang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Xiaoyi Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Ruishi Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Xiaona Xiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Chunping Du
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China. .,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P. R. China. .,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China. .,Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China.
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52
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Flowers DW, Brewer W, Mitchell K, Ellison J. Why are we neglecting the core muscles in patients with knee osteoarthritis? A narrative review of the literature. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1907947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel W. Flowers
- Program in Physical Therapy, LSU Health-Shreveport, Shreveport, Louisiana, USA
| | - Wayne Brewer
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Jennifer Ellison
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
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53
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Wang F, Zhang X, Tong X, Zhang M, Xing F, Yang K, Jiao N, Duan Z. The effects on pain, physical function, and quality of life of quadriceps strengthening exercises combined with Baduanjin qigong in older adults with knee osteoarthritis: a quasi-experimental study. BMC Musculoskelet Disord 2021; 22:313. [PMID: 33781238 PMCID: PMC8008642 DOI: 10.1186/s12891-021-04179-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise is recommended as a principal treatment for individuals with knee osteoarthritis (KOA). However, the best choice for an optimal exercise program able to promote long-term compliance in KOA patients is not clear. This study aims to compare the effect of combined exercise (CE: quadriceps strengthening exercises (QSE) and Baduanjin qigong training (BDJ)) versus QSE alone and BDJ alone on older adults with KOA. METHODS A three-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from three community centers were assigned respectively to QSE group, BDJ group and CE group. We assessed pain intensity, physical function, self-efficacy, and health-related quality-of-life (HRQoL) using standardized instruments at baseline, 3 months and 6 months follow-up. RESULTS One hundred and twenty-eight participants with KOA aged over 60 completed the study. Over the 6 months, there were significant group interaction effects on pain intensity (F = 28.888, P < 0.001), physical function (F = 26.646, P < 0.001), and self-efficacy (F = 22.359, P < 0.001), and, based on a short form-12 item health survey questionnaire (SF-12), physical component summary (F = 7.470, P < 0.001), and mental component summary (F = 10.207, P < 0.001). Overall, the CE group exhibited significantly greater improvement in all outcomes when compared to the QSE group and the BDJ group. CONCLUSIONS CE treatment is more effective than QSE and BDJ in pain relief, increasing physical function, improving self-efficacy, and raising quality-of-life in community-dwelling KOA older adults. Moreover, it promotes long-term compliance in KOA community patients. TRIAL REGISTRATION Chinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020.
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Affiliation(s)
- Fenglan Wang
- School of Nursing, Shanxi Medical University, 56 Xinjian Road, Yingze District, Taiyuan, 030001 China
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Xiaoli Zhang
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Xiao Tong
- Department of Joint Surgery, The Second Hospital of Tangshan, 21 Jianshe Road, Lubei District, Tangshan, 063000 China
| | - Min Zhang
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Fengmei Xing
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Kun Yang
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Nana Jiao
- College of Nursing and Rehabilitation, North China University of Science and Technology, 21 Bohai Road, Caofeidian District, Tangshan, 063210 China
| | - Zhiguang Duan
- School of Nursing, Shanxi Medical University, 56 Xinjian Road, Yingze District, Taiyuan, 030001 China
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Dantas LO, Salvini TDF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther 2021; 25:135-146. [PMID: 33262080 PMCID: PMC7990728 DOI: 10.1016/j.bjpt.2020.08.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation. OBJECTIVE To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA. CONCLUSION There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | | | - Timothy E McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA.
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55
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Tittlemier BJ, Wittmeier KD, Webber SC. Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis. J Eval Clin Pract 2021; 27:93-102. [PMID: 32219960 DOI: 10.1111/jep.13391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) for knee osteoarthritis (OA) guide the provision of high-quality healthcare for people with knee OA, which may improve outcomes. Our aim was to evaluate the quality of and content within recently published CPGs for people with knee OA. METHODS CPGs (2014-2019) that described recommendations for nonpharmacological interventions for knee OA were included in the analysis. Two pairs of evaluators used the Appraisal of Guidelines Research and Evaluation II instrument (AGREE II) to assess the quality of guideline development. CPG content was reviewed and summarized for comparison. RESULTS Ten CPGs were identified for inclusion in the quality and content analysis (seven newly developed and three recently updated). Overall CPG scores ranged between 42% and 100%. Six CPGs were found to be high-quality. Exercise was the only intervention recommended by all CPGs that we appraised. Weight-management and education were the next most frequently recommended interventions. Inter-rater reliability scores were high in domain 1: scope and purpose, (P-value = .001, intraclass correlation coefficient [ICC] = 0.90, 95% confidence interval [CI] = 0.62-0.98), domain 3: rigor of development (P-value = .000, ICC = 0.95, 95% CI = 0.80-0.99) and domain 5: applicability (P-value = .001, ICC = 0.91, 95% CI = 0.64-0.98). CONCLUSION Several CPGs have been developed or recently updated since 2014. Over half of the ten CPGs we appraised were deemed to be high-quality. Exercise, education, and weight-management advice are interventions that were most commonly recommended by CPGs.
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Affiliation(s)
- Brenda J Tittlemier
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristy D Wittmeier
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra C Webber
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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56
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Amano T, Tanaka R, Tanaka S. Clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty: A prospective cohort study. Phys Ther Res 2021; 23:202-208. [PMID: 33489660 DOI: 10.1298/ptr.e10044] [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: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. METHODS This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. RESULTS The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. CONCLUSIONS The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University
| | - Shigeharu Tanaka
- Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services
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57
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Review of Clinical Trials on the Effects of Tai Chi Practice on Primary Hypertension: The Current State of Study Design and Quality Control. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2020:6637489. [PMID: 33456486 PMCID: PMC7787759 DOI: 10.1155/2020/6637489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/02/2022]
Abstract
The modulation of Tai Chi in physiological function and psychological status attracts sustaining attention. This paper collected original articles regarding the effects of Tai Chi practice on modulating primary hypertension from 7 electronic databases (PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Chinese Knowledge Resource Integrated Database, Wanfang Database, and China Science and Technology Journal Database) from their dates of origin to October 1st, 2020. A total of 45 articles were included. The literature analyses have shown that the benefits of Tai Chi practice for blood pressure management have been identified in all of the included 45 studies, and Tai Chi exercise has shown significant efficacy in improving hypertension clinical symptoms and quality of life, compared to the majority of control interventions, though there are also some methodological issues, including small sample sizes, lack of exact randomization methods and quality control criteria, and lack of specific standards used to measure the characteristics of Tai Chi practice. In the future, the inclusion of additional design standards, stricter quality controls, and evaluation measures for the features of Tai Chi practice is required in trials evaluating its effects on hypertension.
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58
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Cartilage Targets of Knee Osteoarthritis Shared by Both Genders. Int J Mol Sci 2021; 22:ijms22020569. [PMID: 33430025 PMCID: PMC7827374 DOI: 10.3390/ijms22020569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
As the leading cause of disability, osteoarthritis (OA) affects people of all ages, sexes, and races. With the increasing understanding of OA, the sex differences have attracted specific attention as the burden of OA is greater in women. There is no doubt that gender-specific OA management has great potential for precision treatment. On the other hand, from the marketing aspect, a medication targeting the OA-responsive biomarker(s) shared by both genders is more favorable for drug development. Thus, in the current study, a published transcriptome dataset of knee articular cartilage was used to compare OA and healthy samples for identifying the genes with the same significantly different expression trend in both males and females. With 128 genes upregulated and 143 genes downregulated in both OA males and females, 9 KEGG pathways have been enriched based on the current knowledge, including 'renal cell carcinoma,' 'ECM-receptor interaction,' 'HIF-1 signaling pathway,' 'MicroRNAs in cancer,' 'focal adhesion,' 'Relaxin signaling pathway,' 'breast cancer,' 'PI3K-Akt signaling pathway,' and 'human papillomavirus infection.' Here, we explore the potential impacts of these clusters in OA. We also analyze the identified 'cell plasma membrane related genes' in-depth to identify the potential chondrocyte cell surface target(s) of OA management.
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Vader K, Abebe AB, Chala MB, Varette K, Miller J. Determining the feasibility of a trial to evaluate the effectiveness of phototherapy versus placebo at reducing pain during physical activity for people with knee osteoarthritis: a pilot randomized controlled trial. Pilot Feasibility Stud 2020; 6:186. [PMID: 33292671 PMCID: PMC7690125 DOI: 10.1186/s40814-020-00729-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although practice guidelines recommend physical activity and exercise for the management of knee osteoarthritis, pain is a common barrier to participation. Phototherapy has been shown to reduce pain intensity for people with knee osteoarthritis, but it is unclear if it reduces pain during physical activity or contributes to improved rehabilitation outcomes. OBJECTIVE The aim of this study is to assess the feasibility of performing a fully powered randomized controlled trial (RCT) comparing an active phototherapy intervention versus placebo on pain during physical activity for people with knee osteoarthritis. METHODS A pilot RCT was conducted to test the feasibility of a trial comparing 8-sessions (4 weeks) of active phototherapy versus placebo. People were able to participate if they (1) were an English speaking adult (> 18 years of age), (2) had received a diagnosis of knee osteoarthritis from a physician, and (3) self-reported experiencing pain and disability related to their knee osteoarthritis for > 3 months. Primary outcomes were the feasibility of participant recruitment, retention, assessment procedures, and maintaining high treatment fidelity. Secondary outcomes piloted for a full trial included pain during physical activity (primary outcome of full trial); self-reported pain severity, physical function, stiffness, adherence to prescribed exercise, global rating of change, patient satisfaction, and adverse events; 6-min walk test; and pressure pain threshold. RESULTS Twenty participants (4 men; 16 women) with knee osteoarthritis and a mean age of 63.95 (SD: 9.27) years were recruited over a 3-week period (6.7 participants per week). Fifteen out of 20 (75%) of participants completed the primary outcome assessment at 4 weeks and 19/20 (95%) of participants were retained and completed the final 16-week assessment. Overall, 89% of all assessment items were completed by participants across all time-points. Fifteen out of 20 participants (75%) completed all 8 treatment sessions. Treatment fidelity was 100% for all completed treatment sessions. No adverse events were reported by participants in either group. CONCLUSIONS Results suggest that the trial methodology and intervention are feasible for implementation in a fully powered randomized controlled trial to determine the effectiveness of phototherapy at reducing pain during physical activity for people with knee osteoarthritis. TRIAL REGISTRATION ClinicalTrials.gov , NCT04234685 , January 21, 2020-Retrospectively registered.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Abey Bekele Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | - Kevin Varette
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
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Bennell K, Nelligan RK, Schwartz S, Kasza J, Kimp A, Crofts SJ, Hinman RS. Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial. J Med Internet Res 2020; 22:e21749. [PMID: 32985994 PMCID: PMC7551110 DOI: 10.2196/21749] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Exercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision. Objective This study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS. Methods A two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ≥30 kg/m2 who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory–informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia. Results A total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0%) completed both primary outcomes (48/56, 86% SMS group and 51/54, 94% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes. Conclusions An SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes. Trial Registration Australian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5 International Registered Report Identifier (IRRID) RR2-10.1186/s12891-019-2801-z
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Affiliation(s)
- Kim Bennell
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Carlton, Australia
| | - Rachel K Nelligan
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Carlton, Australia
| | - Sarah Schwartz
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Carlton, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alexander Kimp
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Carlton, Australia
| | - Samuel Jc Crofts
- Melbourne School of Population and Global Health, University of Melbourne, Centre for Epidemiology and Biostatistics, Parkville, Australia
| | - Rana S Hinman
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Carlton, Australia
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61
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Lesnak JB, Sluka KA. Mechanism of exercise-induced analgesia: what we can learn from physically active animals. Pain Rep 2020; 5:e850. [PMID: 33490844 PMCID: PMC7808683 DOI: 10.1097/pr9.0000000000000850] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/26/2020] [Accepted: 07/31/2020] [Indexed: 12/29/2022] Open
Abstract
Physical activity has become a first-line treatment in rehabilitation settings for individuals with chronic pain. However, research has only recently begun to elucidate the mechanisms of exercise-induced analgesia. Through the study of animal models, exercise has been shown to induce changes in the brain, spinal cord, immune system, and at the site of injury to prevent and reduce pain. Animal models have also explored beneficial effects of exercise through different modes of exercise including running, swimming, and resistance training. This review will discuss the central and peripheral mechanisms of exercise-induced analgesia through different modes, intensity, and duration of exercise as well as clinical applications of exercise with suggestions for future research directions.
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Affiliation(s)
- Joseph B. Lesnak
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA, USA
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA, USA
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62
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Li C, Zheng Z. Identification of Novel Targets of Knee Osteoarthritis Shared by Cartilage and Synovial Tissue. Int J Mol Sci 2020; 21:ijms21176033. [PMID: 32842604 PMCID: PMC7504179 DOI: 10.3390/ijms21176033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Arthritis is the leading cause of disability among adults, while osteoarthritis (OA) is the most common form of arthritis that results in cartilage loss. However, accumulating evidence suggests that the protective hyaline cartilage should not be the sole focus of OA treatment. Particularly, synovium also plays essential roles in OA’s initiation and progression and warrants serious consideration when battling against OA. Thus, biomarkers with similar OA-responsive expressions in cartilage and synovium should be the potential targets for OA treatment. On the other hand, molecules with a distinguished response during OA in cartilage and synovium should be ruled out as OA therapeutic(s) to avoid controversial effects in different tissues. Here, to pave the path for developing a new generation of OA therapeutics, two published transcriptome datasets of knee articular cartilage and synovium were analyzed in-depth. Genes with statistically significantly different expression in OA and healthy cartilage were compared with those in the synovium. Thirty-five genes with similar OA-responsive expression in both tissues were identified while recognizing three genes with opposite OA-responsive alteration trends in cartilage and synovium. These genes were clustered based on the currently available knowledge, and the potential impacts of these clusters in OA were explored.
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Affiliation(s)
- Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Zhong Zheng
- Section of Orthodontics, Dental and Craniofacial Research Institute and Division of Growth and Development, School of Dentistry, University of California, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-(310)-206-5646
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Bierma-Zeinstra S, van Middelkoop M, Runhaar J, Schiphof D. Nonpharmacological and nonsurgical approaches in OA. Best Pract Res Clin Rheumatol 2020; 34:101564. [PMID: 32773214 DOI: 10.1016/j.berh.2020.101564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteoarthritis (OA) is a chronic, disabling, and common disease. Nonpharmacological and nonsurgical treatments are seen as the core treatments for OA. This paper presents an overview of the recommendations from international guidelines on nonpharmacological and nonsurgical interventions. Education, advice, or information about the etiology, progression, prognosis, and treatment options of OA are recommended to be an ongoing and integral part of care. Weight loss (if overweight) is an important core treatment in knee and hip OA. Exercise is a key core treatment in knee, hip, and hand OA and should be considered regardless of age, structural disease severity, functional status, pain levels, or the presence of comorbidities. Walking aids/devices are recommended for both hip and knee OA, while orthoses are recommended for patients with carpometacarpal (CMC) joint OA. Trained healthcare providers with the skills to provide the core treatments are essential. In addition, there should be a proactive management from the first consultation for OA symptoms. Tools for such proactive management and for better uptake of the core interventions are discussed.
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Affiliation(s)
- Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Alenazi AM, Alshehri MM, Alothman S, Alqahtani BA, Rucker J, Sharma NK, Bindawas SM, Kluding PM. The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative. Phys Ther 2020; 100:1977-1986. [PMID: 32750122 PMCID: PMC7596886 DOI: 10.1093/ptj/pzaa144] [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] [Accepted: 07/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA. METHODS A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed. RESULTS Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01-3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02-3.10) or severe (OR = 2.52; 95% CI = 1.01-6.28) pain while walking. Diabetes was associated with decreased walking speed (B = -0.064; 95% CI = -0.09 to -0.03). CONCLUSIONS Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population. LAY SUMMARY Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.
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Affiliation(s)
| | | | - Shaima Alothman
- Lifestyle and Health Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Ganjeh S, Rezaeian ZS, Mostamand J. Low Level Laser Therapy in Knee Osteoarthritis: A Narrative Review. Adv Ther 2020; 37:3433-3449. [PMID: 32621270 DOI: 10.1007/s12325-020-01415-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 12/19/2022]
Abstract
Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to old age. KOA also results in many complications like changes in gait. Nowadays, changes in lifestyle and the reduced physical activity make people more vulnerable to KOA. Therefore, considering the increasing prevalence of KOA in many societies and the costs imposed on the afflicted people and their governments, providing conservative management approaches with a view to saving time and money is important. There are an assortment of conservative strategies in the management of KOA including low level laser therapy (LLLT). Since the introduction of lasers in the medical field in 1960, various types of lasers with widespread administration programs are used for medical conditions from cosmetics to surgery. However, there are conflicting findings on the application of lasers in osteoarthritis. To discuss the basis of the highest level of evidence, only systematic reviews with or without meta-analyses published up to January 2019 were included in the present work. In this regard, Scopus, PEDro, Medline, ISI Web of Science, Cochrane, PubMed, Irandoc, Iran Medex, Magiran, and SID were searched to retrieve articles in English or Persian. A total of 22 systematic reviews and meta-analyses were found, 14 of which were included in this study. The accepted articles were published between 1991 and up to 2019. The purpose of this narrative review was to investigate the effect of LLLT on pain and function in subjects with KOA. The result of the present review may help clinicians in making evidence-based decisions on optimal care in relation to administering LLLT.
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Affiliation(s)
- Soheila Ganjeh
- Musculoskeletal Research Center, and Student Research Committee of Rehabilitation Students (Treata), Rehabilitation Sciences Research Institute, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sadat Rezaeian
- Musculoskeletal Research Center, Rehabilitation Sciences Research Institute, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javid Mostamand
- Musculoskeletal Research Center, Rehabilitation Sciences Research Institute, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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Li R, Sun J, Hu H, Zhang Q, Sun R, Zhou S, Zhang H, Fang J. Research Trends of Acupuncture Therapy on Knee Osteoarthritis from 2010 to 2019: A Bibliometric Analysis. J Pain Res 2020; 13:1901-1913. [PMID: 32801848 PMCID: PMC7394582 DOI: 10.2147/jpr.s258739] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background Acupuncture has been widely applied to relieve knee osteoarthritis (KOA) in many countries. However, the bibliometric analysis of the global use of acupuncture on KOA is largely unknown. Therefore, this study aimed to explore the current status and trends of the global use of acupuncture on KOA in recent 10 years by using CiteSpace (5.6.R3). Methods Publications regarding acupuncture therapy for treating KOA between 2010 and 2019 were extracted from the Web of Science database. CiteSpace was used to analyze the number of publications, countries, institutions, journals, authors, cited references and keywords by using standard bibliometric indicators. Results A total of 343 publications were retrieved from 2010 to 2019. The total number of publications continually increased over the past four years, and the most active journals, countries, institutions and authors in the field of acupuncture therapy on patients with KOA were identified. The Evid Based Complement Alternat Med (28) was the most prolific journal, and the Ann Intern Med (202) was the most cited journal. The most productive country and institution in this field was China (115) and University of York (18), respectively. Hugh Macpherson (18) was the most prolific author and Witt C ranked the first in the cited authors. In the ranking of frequency in cited reference, the first article was published by Scharf HP (54). The keyword of ‘randomized controlled trial’ ranked first for research developments with the highest citation burst (3.9486). Besides, there were three main frontiers in keywords for KOA research, including ‘research method, ‘age’ and ‘measure of intervention’. Conclusion The findings from this bibliometric study provide current status and trends in clinical research of acupuncture therapy on patients with KOA over the past ten years, which may help researchers identify hot topics and explore new directions for future research in this field.
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Affiliation(s)
- Rongrong Li
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Jing Sun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China.,The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Hantong Hu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China.,The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Qifei Zhang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Ruohan Sun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Shuning Zhou
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Haijuan Zhang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Jianqiao Fang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China.,The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People's Republic of China
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Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation. Nat Rev Rheumatol 2020; 16:434-447. [DOI: 10.1038/s41584-020-0447-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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Cicero AFG, Girolimetto N, Bentivenga C, Grandi E, Fogacci F, Borghi C. Short-Term Effect of a New Oral Sodium Hyaluronate Formulation on Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. Diseases 2020; 8:diseases8030026. [PMID: 32650511 PMCID: PMC7564147 DOI: 10.3390/diseases8030026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: the aim of this pilot study was to test the short-term effect of oral supplementation with a sodium hyaluronate with a large spectrum of molecular weights (FS-HA®) on the symptoms and functionality of knee osteoarthritis (OA). Methods: 60 subjects affected by clinical and/or radiological diagnosis of symptomatic knee OA were consecutively enrolled in a randomized, double blind, placebo-controlled, clinical trial. At randomization visit, at day 28 (visit 2), and day 56 (visit 3), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), the Lequesne Functional Index (LFI) and the Visual Analogue Scale (VAS) for pain (VAS-p) were administered to the enrolled patients. Then, patients were asked how many times they used rescue medications (non-steroidal antinflammatory drugs–NSAIDs and/or anti-pain drugs) during the previous 4 weeks. Finally, the range of knee joint motion (ROM) was also instrumentally measured. Results: In FS-HA® treated subjects, VAS-p, pain and total WOMAC score, LFI and ROM significantly improved compared to the baseline values (p < 0.05). At 60 days, the VAS-p and the pain WOMAC score were significantly lower after FS-HA® treatment when compared with placebo as well (p < 0.05). The FS-HA® treated subjects significantly reduced the weekly use of NSAIDs and/or antipain drugs when compared to the placebo-treated ones (p < 0.05). Conclusion: the oral supplementation with a FS-HA® characterized by a large spectrum of molecular weight was associated with a short-term improvement in symptomatology and functionality of osteoarthritis-affected knees, and associated with a reduction in the use of NSAIDS and anti-pain drugs.
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Affiliation(s)
- Arrigo F. G. Cicero
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.B.); (E.G.); (F.F.); (C.B.)
- Correspondence: ; Tel.: +39-05-1214-2224
| | - Nicolò Girolimetto
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
| | - Crescenzio Bentivenga
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.B.); (E.G.); (F.F.); (C.B.)
| | - Elisa Grandi
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.B.); (E.G.); (F.F.); (C.B.)
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.B.); (E.G.); (F.F.); (C.B.)
| | - Claudio Borghi
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.B.); (E.G.); (F.F.); (C.B.)
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Ogura Dantas L, Serafim Jorge AE, Regina Mendes da Silva Serrão P, Aburquerque-Sendín F, de Fatima Salvini T. Cryotherapy associated with tailored land-based exercises for knee osteoarthritis: a protocol for a double-blind sham-controlled randomised trial. BMJ Open 2020; 10:e035610. [PMID: 32482668 PMCID: PMC7265131 DOI: 10.1136/bmjopen-2019-035610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION There is an unmet need to develop tailored therapeutic exercise protocols applying different treatment parameters and modalities for individuals with knee osteoarthritis (KOA). Cryotherapy is widely used in rehabilitation as an adjunct treatment due to its effects on pain and the inflammatory process. However, disagreement between KOA guidelines remains with respect to its recommendation status. The aim of this study is to verify the complementary effects of cryotherapy when associated with a tailored therapeutic exercise protocol for patients with KOA. METHODS AND ANALYSIS This study is a sham-controlled randomised trial with concealed allocation and intention-to-treat analysis. Assessments will be performed at baseline and immediately following the intervention period. To check for residual effects of the applied interventions, 3-month and 6-month follow-up assessments will be performed. Participants will be community members living with KOA divided into three groups: (1) the experimental group that will receive a tailored therapeutic exercise protocol followed by a cryotherapy session of 20 min; (2) the sham control group that will receive the same regimen as the first group, but with sham packs filled with dry sand and (3) the active treatment control group that will receive only the therapeutic exercise protocol. The primary outcome will be pain intensity according to a Visual Analogue Scale. Secondary outcomes will be the Western Ontario & McMaster Universities Osteoarthritis Index; the Short-Form Health Survey 36; the 30-s Chair Stand Test; the Stair Climb test; and the 40-m fast-paced walk test. ETHICS AND DISSEMINATION The trial was approved by the Institutional Ethics Committee of Federal University of São Carlos, São Paulo, Brazil. Registration approval number: CAAE: 65966617.9.0000.5504. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03360500.
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Affiliation(s)
- Lucas Ogura Dantas
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Ana Elisa Serafim Jorge
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | | | - Francisco Aburquerque-Sendín
- Sociosanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Cordoba, Andalucía, Spain
- Instituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Andalucía, Spain
| | - Tania de Fatima Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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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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The effect of physical therapy and rehabilitation modalities on sleep quality in patients with primary knee osteoarthritis: A single-blind, prospective, randomized-controlled study. Turk J Phys Med Rehabil 2020; 66:73-83. [PMID: 32318678 DOI: 10.5606/tftrd.2020.3089] [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: 04/06/2018] [Accepted: 01/23/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives In this study, we aimed to evaluate the effect of physical therapy modalities on pain, sleep, mental status, and quality of life of patients with osteoarthritis (OA). Patients and methods Between January 2017 and June 2017, a total of 40 patients (9 males, 31 females; mean age 56.6±8.9 years; range, 40 to 70 years) who were diagnosed with knee OA according to the American College of Rheumatology (ACR) criteria and were in Kellgren- Lawrence Grade 2-3 were included in the study. The patients were divided into two groups equally. Both groups received 15 sessions of exercise therapy, whereas the intervention group also received 10 consecutive physical therapy sessions in the form of hot pack, therapeutic ultrasound (US), and transcutaneous electrical nerve stimulation (TENS) by a single physiotherapist. Isometric and isotonic exercises were planned as 10 reps for three times a day as a home-based program. Clinical assessments were performed using the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Short Form 36 (SF-36) before and after treatment. Results Pre-treatment VAS, ESS, PQSI, BDI, WOMAC, and SF-36 scores showed no significant difference between the groups, whereas post-treatment scores showed a significant difference in the intervention group (p<0.05). The difference between the pre- and post-treatment VAS, ESS, PQSI, BDI, WOMAC, and SF-36 scores were significantly higher in the intervention group, compared to the controls (p<0.05). Conclusion Our study results show positive effects of exercise and physical therapy modalities on pain, disease activity, sleep quality, depression, and quality of life in knee OA patients.
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Effect of Shoes Reducing Varus Instability of the Knee on Gait Parameters, Knee Pain, and Health-Related Quality of Life in Females With Medial Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dnes N, Coley B, Frisby K, Keller A, Suyom J, Tsui C, Grant G, Vader K, Hunter J. "A little bit of a guidance and a little bit of group support": a qualitative study of preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain. Disabil Rehabil 2020; 43:3347-3356. [PMID: 32223460 DOI: 10.1080/09638288.2020.1742801] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose: To understand preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain.Materials and Methods: An interpretive description methodology based on semi-structured interviews was conducted. Adults (age>18 years) living with chronic pain (pain >3 months in duration) were recruited from a multidisciplinary chronic pain clinic in Toronto, Canada. Thematic analysis was used to conceptualize interview data.Results: Fifteen adults living with chronic pain (11/15 women) were interviewed. Four themes regarding preferences, barriers, and facilitators to participation in community-based exercise are described: (1) accessibility (e.g., cost, location, scheduling, and access to program information from healthcare providers); (2) intrinsic factors (e.g., pain, mental health, and motivation); (3) social factors (e.g., isolation, participation with people with similar capabilities, and safe environment); and (4) program factors (e.g., tailored to adults living with chronic pain, gentle exercise, group-based, and delivered by an instructor knowledgeable about chronic pain).Conclusions: Participation in community-based exercise opportunities among adults living with chronic pain may be influenced by accessibility, intrinsic factors, social factors, and program factors. Results provide a foundation of understanding to develop person-centered community-based exercise opportunities that are tailored to meet the preferences of this population.Implications for RehabilitationAlthough community-based exercise is commonly recommended as part of ongoing self-management of chronic pain, there is limited research exploring perspectives towards community-based exercise opportunities from the perspective of adults living with chronic pain.Adults living with chronic pain reported specific preferences, barriers, and facilitators to participating in community-based exercise opportunities, including accessibility, instrinsic factors, social factors, and program factors.Most adults living with chronic pain reported a preference for community-based exercise opportunities that: (1) are delivered by an instructor who is knowledgeable about chronic pain; (2) involve gentle exercise; (3) are group-based; and (4) include other individuals with similar physical capabilities.Healthcare providers, community-based organizations, and researchers should develop, implement, and evaluate person-centered community-based exercise opportunities for adults living with chronic pain that consider their unique preferences, barriers, and facilitators to participation.
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Affiliation(s)
- Natalie Dnes
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Bridget Coley
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kaitlyn Frisby
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Anna Keller
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jezreel Suyom
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cindy Tsui
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gillian Grant
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Canada
| | - Kyle Vader
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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Cardenas-Rojas A, Pacheco-Barrios K, Giannoni-Luza S, Rivera-Torrejon O, Fregni F. Noninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis. Expert Rev Neurother 2020; 20:401-412. [PMID: 32130037 DOI: 10.1080/14737175.2020.1738927] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: The use of noninvasive brain stimulation (NIBS) combined with exercise could produce synergistic effects on chronic pain conditions. This study aims to evaluate the efficacy and safety of NIBS combined with exercise to treat chronic pain as well as to describe the parameters used to date in this combination.Methods: The search was carried out in Medline, Central, Scopus, Embase, and Pedro until November 2019. Randomized clinical trials (RCTs) and quasi-experimental studies reporting the use of noninvasive brain stimulation and exercise on patients with chronic pain were selected and revised.Results: The authors included eight studies (RCTs), reporting eight comparisons (219 participants). Authors found a significant and homogeneous pain decrease (ES: -0.62, 95% CI:-0.89 to -0.34; I2 = 0.0%) in favor of the combined intervention compared to sham NIBS + exercise, predominantly by excitatory (anodal tDCS/rTMS) motor cortex stimulation. Regarding NIBS techniques, the pooled effect sizes were significant for both tDCS (ES: -0.59, 95% CI: -0.89 to -0.29, I2 = 0.0%) and rTMS (ES: -0.76, 95% CI: -1.41 to -0.11, I2 = 0.0%).Conclusions: This meta-analysis suggests a significant moderate to large effects of the NIBS and exercise combination in chronic pain. The authors discuss the potential theoretical framework for this synergistic effect.
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Affiliation(s)
- Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA.,Unidad De Investigación Para La Generación Y Síntesis De Evidencias En Salud, Universidad San Ignacio De Loyola, Lima, Perú.,SYNAPSIS Mental Health and Neurology, Non-Profit Organization, Lima, Peru
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
| | | | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
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75
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Vader K, Patel R, Doulas T, Miller J. Promoting Participation in Physical Activity and Exercise Among People Living with Chronic Pain: A Qualitative Study of Strategies Used by People with Pain and Their Recommendations for Health Care Providers. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:625-635. [PMID: 31592526 PMCID: PMC7060401 DOI: 10.1093/pm/pnz246] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore strategies used by people living with chronic pain when participating in physical activity and exercise and their recommendations for health care providers when promoting participation in physical activity and exercise. DESIGN Interpretive description qualitative study. SETTING Participants were recruited from primary care sites and a hospital-based chronic pain clinic in Kingston, Ontario, Canada. SUBJECTS Adults (>18 years of age) who self-identified as experiencing chronic pain (three months' duration) were interviewed. METHODS In-depth semistructured interviews were conducted with participants. Interviews were audio-recorded, transcribed verbatim, and reviewed for accuracy by the interviewer. Transcripts were analyzed using thematic analysis. Peer debriefing, reflexivity, and multiple in-person meetings were used to establish trustworthiness. RESULTS Sixteen adults (five men, 11 women) with a median age of 53 years were interviewed. Strategies used by people living with chronic pain to participate in physical activity and exercise included 1) finding the motivation, 2) setting up for success, 3) leveraging social support, and 4) managing pain and discomfort during activity. Recommendations for health care providers when promoting participation in physical activity and exercise for people living with chronic pain included 1) the importance of listening, 2) providing tailored advice, 3) being supportive, and 4) making physical activity and exercise programming accessible. CONCLUSIONS People living with chronic pain reported using multiple strategies to participate in physical activity and exercise. Recommendations for health care providers centered on the importance of listening and taking a supportive approach when promoting engagement in physical activity and exercise for this population.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
- Chronic Pain Clinic, Kingston Health Sciences Centre-Hotel Dieu Hospital Site, Kingston, ON, Canada
| | - Rupa Patel
- Kingston Community Health Centre, Kingston, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
| | - Tom Doulas
- Chronic Pain Clinic, Kingston Health Sciences Centre-Hotel Dieu Hospital Site, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
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76
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de Rooij M, van der Leeden M, van der Esch M, Lems WF, Meesters JJL, Peter WF, Roorda LD, Terbraak MS, Vredeveld T, Vliet Vlieland TPM, Dekker J. Evaluation of an educational course for primary care physiotherapists on comorbidity-adapted exercise therapy in knee osteoarthritis: an observational study. Musculoskeletal Care 2020; 18:122-133. [PMID: 31985164 PMCID: PMC7318645 DOI: 10.1002/msc.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Abstract
Objective The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage. Method The present research was an observational study with a pretest‐posttest design using mixed methods. PTs were offered a postgraduate course consisting of e‐learning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi‐structured interviews. Results Thirty‐four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6‐month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self‐) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians. Conclusion A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large‐scale implementation of exercise therapy can take place in these complex patients.
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Affiliation(s)
- Mariëtte de Rooij
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin van der Esch
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Willem F Lems
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jorit J L Meesters
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Wilfred F Peter
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Leo D Roorda
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Michel S Terbraak
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Tom Vredeveld
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Karateev DE, Luchikhina EL, Osnovina IP, Makevnina AV. [The role of rehabilitation and apparatus physiotherapy in rheumatic disease treatment strategies]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2020; 97:92-98. [PMID: 33054013 DOI: 10.17116/kurort20209705192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rheumatic diseases are a serious medical and social problem. The variability of mechanisms for the development of this group of diseases requires different approaches: strategies of drug and non-medicament therapy in modern rheumatology are designed to complement each other. EULAR recommendations pay insufficient attention to the use of non-medical methods of joint disease treatment. According to modern research, multi-disciplinary rehabilitation strategies, including, in addition to drug therapy, educational programmes, physical training of various intensities, as well as the use of apparatus rehabilitation methods, have proven to be the most effective. Hardware physiotherapy seems to be optimal for the treatment of rheumatic patients due to its higher accessibility and lower cost in comparison with classical balneo- and peloidotherapy. With the use of magnetotherapy there is also greater safety and fewer contraindications to the procedures. The method of using pulsed magnetic fields is the most justified in the treatment of joint diseases, since the sensitivity of biological tissues to them is the highest. The clinical effectiveness of pulsed magnetotherapy has been demonstrated in several randomized placebo-controlled multi-centre studies. Against the background of carried out magnetic field therapy in patients were statistically significant reduction of pain and stiffness, improvement of joint function, which indicates the expediency of including the physical factor in the strategy of treatment of rheumatic diseases in combination with drug therapy.
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Affiliation(s)
- D E Karateev
- M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E L Luchikhina
- M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | | | - A V Makevnina
- M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
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TUDORACHI NB, EVA I, MOSCALU M, AL- HIARY R, MORARU AC, BARBIERU B, STANCIU C, CORCIOVA C, ARDELEANU V. Evaluating risk factors involved in the alteration of biomechanics in relation to knee osteoarthritis. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The knee joint is very complex in terms of degrees of mobility and for normal biomechanics it is necessary for all the anatomical structures at this level to be within physiological limits. Problems can be caused by a number of risk factors such as age, sex, weight, or local risk factors such as patellar changes represented by patela alta or patella baja, which can lead to instability of the lower limb. Risk factors that may influence the development and progression of knee osteoarthritis have been evaluated. Changes in patellar position in relation to knee osteoarthritis were also studied. A group of 377 patients hospitalized for unilateral or bilateral knee pain with instability were included in the study. 239 of the 377 starting group presented knee osteoarthritis, constituting the study group. The risk factors analyzed were age, patient sex, BMI, weight status, anatomical changes in position of the patella (patella alta and patella baja), COBB angle and spine deviation. The results indicated that obesity, anatomical changes in the position of the patella, (patella alta), COBB angle and spine deviations represent significant risk factors in the onset of knee osteoarthritis.
Key words: risk factors, joint instability, knee osteoarthritis,
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Affiliation(s)
| | - Iuliana EVA
- „Iacob Czihac” Emergency Military Clinical Hospital, Iasi, România
| | - Mihaela MOSCALU
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, România
| | - Rami AL- HIARY
- „Ovidius” University of Constanta, Faculty of Medicine, PhD student, România
| | | | - Bogdan BARBIERU
- „Iacob Czihac” Emergency Military Clinical Hospital, Iasi, România
| | - Costin STANCIU
- „Iacob Czihac” Emergency Military Clinical Hospital, Iasi, România
| | - Calin CORCIOVA
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, România
| | - Valeriu ARDELEANU
- „Ovidius” University, Constanta, „Dunarea de Jos” University, Galati, General Hospital CF, Galati, România
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79
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Vårbakken K, Lorås H, Nilsson KG, Engdal M, Stensdotter AK. Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study. BMC Musculoskelet Disord 2019; 20:593. [PMID: 31818286 PMCID: PMC6902587 DOI: 10.1186/s12891-019-2957-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023] Open
Abstract
Background To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints. Methods The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen’s d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance. Results The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] −0.73 [−1.26,-0.20], − 0.74 [−1.26,-0.21], −0.71 [−1.24,-0.19], respectively; p < 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint–strength directions: the involved leg’s ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg’s ankle dorsal flexion (p < 0.05). There was no significant difference for 17 of 24 tests. Conclusions For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings.
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Affiliation(s)
- K Vårbakken
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - H Lorås
- Department of Physical Education and Sport Science, Nord University, Levanger, Norway
| | - K G Nilsson
- Umea University, Surgical and Perioperative Sciences, Umea, Sweden
| | - M Engdal
- Department of Physiotherapy, Clinic of Clinical Services, Trondheim University Hospital, Trondheim, Norway
| | - A K Stensdotter
- Norwegian University of Science and Technology, Trondheim, Norway
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Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial. Clin J Pain 2019; 34:1149-1158. [PMID: 29864043 PMCID: PMC6250299 DOI: 10.1097/ajp.0000000000000634] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA). Materials and Methods: In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months. Results: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ2=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months. Discussion: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA. Level of Evidence: Level 1b—therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).
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81
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Vårbakken K, Lorås H, Nilsson KG, Engdal M, Stensdotter AK. Relative difference among 27 functional measures in patients with knee osteoarthritis: an exploratory cross-sectional case-control study. BMC Musculoskelet Disord 2019; 20:462. [PMID: 31638971 PMCID: PMC6805424 DOI: 10.1186/s12891-019-2845-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient’s situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures’ selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61 years, 64% women) referred by general physicians to a hospital’s osteoarthritis-school, and 31 healthy participants (mean age 55 years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen’s d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins’ scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results Very large differences between patients and controls were found on the Pain numeric rating scale1, the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)2, as well as the Örebro Musculoskeletal psychosocial scale3 (P < 0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test4 and Accelerometer registered vigorous-intensity physical activity in daily life5 (P < 0.001). Respectively, these measures clustered on ICF as follows: 1body function, 2all three ICF-dimensions, 3body function and participation, 4activity, and 5participation. Limitations The limited sample excluded elderly patients with severe obesity. Conclusions Very large differences across all ICF dimensions were indicated for the KOOS and Örebro questionnaires together for patients aged 45–70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions.
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Affiliation(s)
- K Vårbakken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway. .,Faculty of Medicine and Health Sciences, NTNU, Health og Social building, 7491, Trondheim, Norway.
| | - H Lorås
- Department of Physical Education and Sport Science, Nord University, Levanger, Norway
| | - K G Nilsson
- Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - M Engdal
- Department of Physiotherapy, Clinic of Clinical Services, Trondheim University Hospital, Trondheim, Norway
| | - A K Stensdotter
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Medicine and Health Sciences, NTNU, Health og Social building, 7491, Trondheim, Norway
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83
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Nelligan RK, Hinman RS, Atkins L, Bennell KL. A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel. JMIR Mhealth Uhealth 2019; 7:e14619. [PMID: 31628786 PMCID: PMC7012505 DOI: 10.2196/14619] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 01/12/2023] Open
Abstract
Background Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
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Affiliation(s)
- Rachel K Nelligan
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Rana S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
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84
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Vader K, Doulas T, Patel R, Miller J. Experiences, barriers, and facilitators to participating in physical activity and exercise in adults living with chronic pain: a qualitative study. Disabil Rehabil 2019; 43:1829-1837. [PMID: 31613655 DOI: 10.1080/09638288.2019.1676834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To explore experiences, barriers, and facilitators to participating in physical activity and exercise in adults living with chronic pain. MATERIALS AND METHODS An interpretive description qualitative study using semi-structured interviews was conducted. Participants included adults living with chronic pain (pain >3 months in duration). Transcripts were analyzed using thematic analysis. RESULTS Sixteen participants (five men; 11 women) with a median age of 53 years (range: 28-87) were interviewed. Three major themes related to physical activity and exercise in adults living with chronic pain were conceptualized by the researchers: the challenge of staying active (decreased activity levels, discomfort during physical activity, and uncertain and fluctuating abilities); diverse factors influence participation (pain, fatigue, perceived risks, beliefs about physical activity, competing demands, social support, motivation, other health conditions, and access to supports for physical activity or exercise); and perceived outcomes (pain management, functional improvements, social participation, mental health, and overall well-being). CONCLUSIONS Participating in physical activity and exercise was a challenge for adults living with chronic pain, whereby participation was influenced by multiple factors. Rehabilitation providers should aim to reduce modifiable barriers to physical activity and exercise for adults living with chronic pain, with the goal of improving health outcomes for this population.Implications for rehabilitationDespite the perceived benefits, participation in physical activity and exercise is a challenge for adults living with chronic pain.Diverse factors can influence participation in physical activity and exercise from the perspective of adults living with chronic pain.Rehabilitation providers should aim to reduce modifiable barriers to physical activity and exercise for adults living with chronic pain.Results can be used to inform future person-oriented physical activity and exercise interventions for adults living with chronic pain.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Tom Doulas
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Rupa Patel
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Kingston Community Health Centre, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Dantas LO, Breda CC, da Silva Serrao PRM, Aburquerque-Sendín F, Serafim Jorge AE, Cunha JE, Barbosa GM, Durigan JLQ, Salvini TDF. Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial. J Physiother 2019; 65:215-221. [PMID: 31521551 DOI: 10.1016/j.jphys.2019.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Does short-term cryotherapy improve pain, function and quality of life in people with knee osteoarthritis (OA)? DESIGN Randomised controlled trial with concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis. PARTICIPANTS People living in the community with knee OA. INTERVENTIONS The experimental group received cryotherapy, delivered as packs of crushed ice applied to the knee with mild compression. The control group received the same regimen but with sham packs filled with sand. The interventions were applied once a day for 4 consecutive days. OUTCOME MEASURES Participants were assessed at baseline and on the day after the 4-day intervention period. The primary outcome was pain intensity according to a visual analogue scale. Secondary outcomes were baseline to post-intervention changes according to the Western Ontario and McMaster Universities Osteoarthritis, Knee injury and Osteoarthritis Outcome; Timed Up and Go test; and 30-Second Chair to Stand test. RESULTS Sixty participants were randomised into the experimental group (n = 30) or the control group (n = 30). Twenty-nine participants from each group completed the trial. The mean between-group difference in change in pain severity was -0.8 cm (95% CI -1.6 to 0.1), where negative values favour the experimental group. This result did not reach the nominated smallest worthwhile effect of 1.75 cm. The secondary outcomes had less-precise estimates, with confidence intervals that spanned worthwhile, trivial and mildly harmful effects. CONCLUSION Short-term cryotherapy was not superior to a sham intervention in terms of relieving pain or improving function and quality of life in people with knee OA. Although cryotherapy is considered to be a widely used resource in clinical practice, this study does not suggest that it has an important short-term effect, when compared with a sham control, as a non-pharmacological treatment for people with knee osteoarthritis. REGISTRATION NCT02725047.
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Affiliation(s)
| | | | | | - Francisco Aburquerque-Sendín
- Departamento de Ciencias sociosanitarias, Radiología y Medicina física, Universidad de Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba, Spain
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86
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Nelligan RK, Hinman RS, Kasza J, Schwartz S, Kimp A, Atkins L, Bennell KL. Effect of a short message service (SMS) intervention on adherence to a physiotherapist-prescribed home exercise program for people with knee osteoarthritis and obesity: protocol for the ADHERE randomised controlled trial. BMC Musculoskelet Disord 2019; 20:428. [PMID: 31521136 PMCID: PMC6745064 DOI: 10.1186/s12891-019-2801-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a highly prevalent condition. People with knee OA often have other co-morbidities such as obesity. Exercise is advocated in all clinical guidelines for the management of knee OA. It is often undertaken as a home-based program, initially prescribed by a physiotherapist or other qualified health care provider. However, adherence to home-based exercise is often poor, limiting its ability to meaningfully change clinical symptoms of pain and/or physical function. While the efficacy of short message services (SMS) to promote adherence to a range of health behaviours has been demonstrated, its ability to promote home exercise adherence in people with knee OA has not been specifically evaluated. Hence, this trial is investigating whether the addition of an SMS intervention to support adherence to prescribed home-based exercise is more effective than no SMS on self-reported measures of exercise adherence. METHODS We are conducting a two-arm parallel-design, assessor-and participant-blinded randomised controlled trial (ADHERE) in people with knee OA and obesity. The trial is enrolling participants exiting from another randomised controlled trial, the TARGET trial, where participants are prescribed a 12-week home-based exercise program (either weight bearing functional exercise or non-weight bearing quadriceps strengthening exercise) for their knee by a physiotherapist and seen five times over the 12 weeks for monitoring and supervision. Following completion of outcome measures for the TARGET trial, participants are immediately enrolled into the ADHERE trial. Participants are asked to continue their prescribed home exercise program unsupervised three times a week for 24-weeks and are randomly allocated to receive a behaviour change theory-informed SMS intervention to support home exercise adherence or to have no SMS intervention. Outcomes are measured at baseline and 24-weeks. Primary outcomes are self-reported adherence measures. Secondary outcomes include self-reported measures of knee pain, physical function, quality-of-life, physical activity, self-efficacy, kinesiophobia, pain catastrophising, participant-perceived global change and an additional adherence measure. DISCUSSION Findings will provide new information into the potential of SMS to improve longer-term exercise adherence and ultimately enhance exercise outcomes in knee OA. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry. Reference: ACTR N12617001243303 Date/version: August 2019/two.
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Affiliation(s)
- Rachel K. Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Sarah Schwartz
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Alexander Kimp
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia
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88
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Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis. Rheumatol Int 2019; 39:1159-1179. [DOI: 10.1007/s00296-019-04289-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
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89
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Nagai N, Yagyu S, Hata A, Nirengi S, Kotani K, Moritani T, Sakane N. Maslinic acid derived from olive fruit in combination with resistance training improves muscle mass and mobility functions in the elderly. J Clin Biochem Nutr 2019; 64:224-230. [PMID: 31138956 PMCID: PMC6529705 DOI: 10.3164/jcbn.18-104] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022] Open
Abstract
Maslinic acid, derived from olive fruit, reduces pro-inflammation cytokines, which are involved in muscle fiber atrophy. Therefore, the maslinic acid ingestion may enhance the muscular response to resistance training through anti-inflammatory action. We therefore conducted a parallel, double-blind, randomized, placebo-controlled trial that examined whether a combination of maslinic acid supplementation and resistance training improve mobility functions in community-dwelling elderly persons. Over a 12-week period, 36 participants underwent moderate resistance training and are assigned to the maslinic acid supplementation (n = 17, 60 mg/day) or the placebo (n = 19) group. At baseline and at 12-weeks, we assessed body composition, grip strength, walking speed, leg strength, mobility functions, and knee pain scores. Following the 12-weeks, skeletal muscle mass, segmental muscle mass (right arm, left arm, and trunk) and knee pain score of the right leg were significantly improved in the maslinic acid group, while there was no change or parameters had worsened in the placebo group. Grip strength of the better side significantly increased only in the maslinic acid group. These results suggest that maslinic acid supplementation combined with moderate resistance training may increase upper muscle mass and grip strength, and reduce knee pain, could be effective for preventing mobility-related disability in elderly persons. Clinical trial registration number: UMIN000017207.
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Affiliation(s)
- Narumi Nagai
- School of Human Science and Environment, University of Hyogo,1-1-12 Shinzaike-honcho, Himeji, Hyogo 670-0092, Japan
| | - Satomi Yagyu
- School of Human Science and Environment, University of Hyogo,1-1-12 Shinzaike-honcho, Himeji, Hyogo 670-0092, Japan
| | - Anna Hata
- School of Human Science and Environment, University of Hyogo,1-1-12 Shinzaike-honcho, Himeji, Hyogo 670-0092, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.,Division of Community and Family Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan
| | - Toshio Moritani
- Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kamo-honmachi, Kita-ku, Kyoto 603-8555, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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90
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Spitaels D, Hermens RPMG, Luyten FP, Vandenneucker H, Aertgeerts B, Verschueren S, Van Assche D, Vankrunkelsven P. Educational outreach visits to improve knee osteoarthritis management in primary care. BMC MEDICAL EDUCATION 2019; 19:66. [PMID: 30823900 PMCID: PMC6397491 DOI: 10.1186/s12909-019-1504-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy. METHODS An educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP. RESULTS The intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group. CONCLUSIONS This intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners' prescription behavior, more extensive or combined interventional approaches seem warranted.
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Affiliation(s)
- David Spitaels
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, J building, 3000 Leuven, Belgium
| | - Rosella P. M. G. Hermens
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, J building, 3000 Leuven, Belgium
- Radboud Institute for Health Sciences (RIHS), IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank P. Luyten
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Vandenneucker
- Division of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium
| | - Bert Aertgeerts
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, J building, 3000 Leuven, Belgium
| | | | - Dieter Van Assche
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, J building, 3000 Leuven, Belgium
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91
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Collins NJ, Hart HF, Mills KAG. Osteoarthritis year in review 2018: rehabilitation and outcomes. Osteoarthritis Cartilage 2019; 27:378-391. [PMID: 30529739 DOI: 10.1016/j.joca.2018.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Conduct a systematic review of systematic reviews and randomised controlled trials (RCTs) from the past year evaluating rehabilitation for people with osteoarthritis, and provide narrative synthesis of findings focused on core recommended treatments for osteoarthritis (exercise, education, biomechanical interventions, weight loss). DESIGN A comprehensive search strategy was used to search PubMed, EMBASE and Cochrane databases (16th May 2017 to 22nd March 2018). Search terms included 'osteoarthritis', 'rehabilitation', 'systematic review', and 'randomised controlled trial'. Inclusion criteria were: (1) RCT, or systematic review of randomised clinical trials (RCTs); (2) human participants with osteoarthritis (any joint); (3) evaluation of rehabilitation intervention; and (4) at least one patient-reported measure. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) tool (systematic reviews) and PEDro rating scale (RCTs). Narrative synthesis mapped findings to core recommendations from existing osteoarthritis clinical guidelines. RESULTS From 1994 records, 13 systematic reviews and 36 RCTs were included. 73% of these evaluated knee osteoarthritis (36 studies). The remaining studies evaluated hand osteoarthritis (6 studies), hip, hip/knee and general osteoarthritis (each 2 studies), and neck osteoarthritis (1 study). Exercise was the most common intervention evaluated (31%). Updated recommendations for exercise prescription and preliminary guidance for psychological interventions are provided. CONCLUSION Level 1 and 2 osteoarthritis rehabilitation literature continues to be dominated by knee osteoarthritis studies. Consistent with current clinical guidelines, exercise should be a core treatment for osteoarthritis, but future studies should ensure that exercise programs follow published dose guidelines. There is a clear need for research on rehabilitation for hip, hand, foot/ankle, shoulder and spine osteoarthritis.
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Affiliation(s)
- N J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - H F Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia; School of Physical Therapy and Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - K A G Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Abstract
Pain significantly restricts the quality of life and well-being of older adults. With our increasingly ageing population, it is important to examine whether differing classes of biopsychosocial risk factors can predict the development of pain in older adults. Latent class analysis provides a model-based approach to identifying underlying subgroups in a population, based on some measured characteristics. In this study, latent class analysis was used to identify biopsychosocial risk classes in people aged 50 years and older, from The Irish Longitudinal Study on Ageing, who reported not often being troubled by pain at wave 1 and completed the 2-year follow-up at wave 2 (n = 4458). Four classes were identified based on 11 potential risk factors at wave 1. These classes were characterised as "Low Risk," "Physical Health Risk," "Mental Health Risk," and "High Risk." The Low-Risk class accounted for over half the sample (51.2%), whereas the High-Risk class represented 7.8% of the sample. At follow-up (wave 2), 797 (17.9%) participants reported being troubled by pain. Associations between the biopsychosocial risk classes and developing pain were examined using logistic regression, adjusting for sociodemographic variables. The High-Risk class was more likely to develop pain compared with the Low-Risk class (adjusted OR = 3.16, 95% CI = 2.40-4.16). These results add to existing data in other populations supporting the role of a range of biopsychosocial risk factors that increase the risk of developing pain. These findings have important implications for the identification, and potential moderation, of these risk factors.
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93
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Cerqueira MS, de Brito Vieira WH. Effects of blood flow restriction exercise with very low load and low volume in patients with knee osteoarthritis: protocol for a randomized trial. Trials 2019; 20:135. [PMID: 30777115 PMCID: PMC6379934 DOI: 10.1186/s13063-019-3238-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background Knee osteoarthritis (OA) is characterized by chronic pain, physical dysfunction, and reduced quality of life. Low-load resistance exercises with blood flow restriction (BFR) have presented results similar to those of high-intensity resistance exercise (HIRE) without BFR provided that the exercise volume in both is paired. However, it is unclear whether BFR exercise with reduced load and volume generates clinical improvements similar to those of HIRE. The aim of the proposed study is to evaluate the effects of BFR resistance exercise with very low load and low volume against HIRE in patients with knee OA for the outcomes of knee pain, muscle performance, physical function, disease severity, quality of life, perceived exertion during the exercises, adherence, and patient satisfaction with treatment. Methods This two-arm, prospectively registered, randomized controlled trial with blinded assessors and volunteers will involve 40 patients with knee OA. Two weekly treatment sessions will be provided for 12 weeks. Patients will perform very low-load (10% of 1-RM) and low-volume BFR exercise or HIRE (60% of 1-RM) for strengthening thigh muscles. The primary outcome will be the knee pain measured after 12 weeks of treatment. The secondary outcomes include knee pain 6 months after randomization, physical function, disease severity, quality of life, muscle performance, knee pain and perceived exertion during exercise, adherence, and patient satisfaction with treatment. Discussion If the improvements in the outcomes are similar in the two groups, BFR exercise with reduced load and volume may be an interesting alternative in the treatment of knee OA, especially when exercises with high loads generate joint pain. Trial registration Registro Brasileiro de Ensaios Clínicos (REBEC), RBR-6pcrfm. Registered on July 10, 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3238-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000 - Campus Universitário, Lagoa Nova, Natal, Rio Grande do Norte, 59072-970, Brazil.
| | - Wouber Hérickson de Brito Vieira
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000 - Campus Universitário, Lagoa Nova, Natal, Rio Grande do Norte, 59072-970, Brazil
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Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:263-271. [DOI: 10.1136/bjsports-2018-099683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2018] [Indexed: 12/15/2022]
Abstract
ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.
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95
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Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, Wang P, Xiao L, Tong P. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine (Baltimore) 2018; 97:e13823. [PMID: 30593178 PMCID: PMC6314737 DOI: 10.1097/md.0000000000013823] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to systemically review the effectiveness of aquatic exercise (AQE) compared to land-based exercise (LBE) in treating knee osteoarthritis (OA). METHODS The Medline, Embase, Web of Science, Cochrane Central Register of Controlled Clinical Trials, CINAHL, and psyclNFO databases were comprehensively searched for randomized controlled trials (RCTs) evaluating the effectiveness of AQE and LBE for knee OA from their inception date to September 24, 2018. The risk of bias was examined using the Cochrane Collaboration Tool, and Review Manager 5.3 was used for data collation and analysis. RESULTS Eight RCTs were included, involving a total of 579 patients. The meta-analysis showed that there was no significant difference between AQE and LBE for pain relief, physical function, and improvement in the quality of life, for both short- and long-term interventions, in patients with knee OA. However, the adherence and satisfaction level for AQE was higher than for LBE. Compared to no intervention, AQE showed a mild effect for elevating activities of daily living (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI] [-0.94, -0.16], P = .005) and a high effect for improving sports and recreational activities (SMD: -1.03, 95% CI [-1.82, -0.25], P = .01). CONCLUSION AQE is comparable to LBE for treating knee OA.
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Affiliation(s)
- Rui Dong
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
| | - Yunyao Wu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi
| | | | - Lei Zhang
- Xiaoshan Traditional Chinese Medical Hospital
| | - Jun Ying
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
| | - Hongting Jin
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
| | - Pinger Wang
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
| | - Luwei Xiao
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
| | - Peijian Tong
- The First Clinical Medical College of Zhejiang Chinese Medical University
- Institute of Orthopaedic and Traumatology, Zhejiang Province, Hangzhou, Zhejiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Semciw AI, Pizzari T, Woodley S, Zacharias A, Kingsley M, Green RA. Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial - Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials 2018; 19:511. [PMID: 30236151 PMCID: PMC6149073 DOI: 10.1186/s13063-018-2873-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis. METHODS Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)). DISCUSSION This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0.
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Affiliation(s)
- Adam Ivan Semciw
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia
| | - Stephanie Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Anita Zacharias
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
| | - Michael Kingsley
- Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Rod A Green
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
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97
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Wang J, Yang L, Li Q, Wu Z, Sun Y, Zou Q, Li X, Xu Z, Ye C. Construction of an adherence rating scale for exercise therapy for patients with knee osteoarthritis. BMC Musculoskelet Disord 2018; 19:263. [PMID: 30053843 PMCID: PMC6064120 DOI: 10.1186/s12891-018-2200-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is one of the most common chronic diseases in the elderly and is the primary cause of the loss of motor function and disability in this population. Exercise therapy is a core, basic and matureand treatment method of treating patients with KOA. Exercise therapy is “strongly recommended” or “recommended” in the diagnosis and treatment guidelines of osteoarthritis in many countries, and most scholars advocate exercise therapy as the preferred rehabilitation method for KOA patients. However, poor long-term adherence is a serious problem affecting the therapeutic effect of this mature treatment. The objective of this study was to construct a concise and practical adherence rating scale (ARS) based on the exercise therapy adherence prediction model in patients with knee osteoarthritis. Methods A binary logistic regression model was established, with the adherence of 218 cases of KOA patients as the dependent variable. The patients’ general information, exercise habits, knowledge, attitude, and exercise therapy were independent variables. The regression coefficients were assigned to various variables in the model, and the ARS was constructed accordingly. Receiver operating characteristic curves and curve fitting were used to analyse the effect of the ARS in predicting the adherence and to determine the goodness of fit for the adherence. The external validity of the ARS was examined in a randomized controlled trial. Results The construction of the adherence model and the ARS included the following variables: age (1 point), education level (1 point), degree of social support (2 points), exercise habits (3 points), knowledge of KOA prevention and treatment (2 points), degree of care needed to treat the disease (1 point), familiarity with exercise therapy (4 points) and treatment confidence (3 points). The critical value of the total score of the ARS was 6.50, with a sensitivity of 87.20% and a specificity of 76.34%. Conclusions A KOA exercise therapy adherence model and a simple and practical ARS were constructed. The ARS has good internal validity and external validity and can be used to evaluate the adherence to exercise therapy in patients with KOA.
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Affiliation(s)
- Jianji Wang
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Long Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Qingjun Li
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Zhanyu Wu
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Yu Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Qiang Zou
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Xuanze Li
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Zhe Xu
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Chuan Ye
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China. .,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China. .,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China. .,China Orthopedic Regenerative Medicine Group (CORMed), Guiyang, China.
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98
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Brosseau L, Thevenot O, MacKiddie O, Taki J, Wells GA, Guitard P, Léonard G, Paquet N, Aydin SZ, Toupin-April K, Cavallo S, Moe RH, Shaikh K, Gifford W, Loew L, De Angelis G, Shallwani SM, Aburub AS, Mizusaki Imoto A, Rahman P, Álvarez Gallardo IC, Cosic MB, Østerås N, Lue S, Hamasaki T, Gaudreault N, Towheed TE, Koppikar S, Kjeken I, Mahendira D, Kenny GP, Paterson G, Westby M, Laferrière L, Longchamp G. The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis. Clin Rehabil 2018; 32:1449-1471. [PMID: 29911409 DOI: 10.1177/0269215518780973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE: To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P < 0.05). RESULTS: Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength. CONCLUSION: Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.
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Affiliation(s)
- Lucie Brosseau
- 1 Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Odette Thevenot
- 2 School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Olivia MacKiddie
- 2 School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Jade Taki
- 3 Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- 4 School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paulette Guitard
- 5 Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Guillaume Léonard
- 6 Research Center on Aging, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Nicole Paquet
- 1 Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Karine Toupin-April
- 8 Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, Faculty of Medicine and School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina Cavallo
- 9 School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Rikke Helene Moe
- 10 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kamran Shaikh
- 11 Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Wendy Gifford
- 12 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Laurianne Loew
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gino De Angelis
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Ala' S Aburub
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Aline Mizusaki Imoto
- 14 Evidence-based Health Department, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Prinon Rahman
- 15 Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Milkana Borges Cosic
- 16 Department of Physical Education and Sport, University of Cadiz, Cadiz, Spain
| | - Nina Østerås
- 17 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sabrina Lue
- 18 Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Tokiko Hamasaki
- 19 Hand Center, Centre Hospitalier de l'Université de Montréal and School of Rehabilitation, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Nathaly Gaudreault
- 20 Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Sahil Koppikar
- 21 Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Ingvild Kjeken
- 17 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dharini Mahendira
- 21 Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Glen P Kenny
- 22 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Marie Westby
- 24 Mary Pack Arthritis Program, Vancouver Coastal Health and Centre for Hip Health and Mobility and Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Lucie Laferrière
- 25 Canadian Forces Health Services Group, National Defense, Ottawa, ON, Canada
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99
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Slade SC, Hay-Smith J, Mastwyk S, Morris ME, Frawley H. Strategies to assist uptake of pelvic floor muscle training for people with urinary incontinence: A clinician viewpoint. Neurourol Urodyn 2018; 37:2658-2668. [PMID: 29797360 DOI: 10.1002/nau.23716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/22/2018] [Indexed: 12/18/2022]
Abstract
AIMS The experiences and information needs of clinicians who use pelvic floor muscle training to manage urinary incontinence were explored. METHODS Qualitative methods were used to conduct thematic analysis of data collected from clinician focus groups and interviews. Participants were registered physiotherapists and continence nurses in Melbourne, Australia. Recruitment was through a combination of purposive and "snowball" sampling and continued until data adequacy was reached. RESULTS Twenty-eight physiotherapists and one continence nurse participated in seven focus groups and one interview. The main finding communicated by the participants was that pelvic floor muscle training requires comprehensive descriptions of program details in order for clinicians to implement evidence-based interventions. The following themes were identified: (1) pelvic floor muscle training tailored to the needs of each individual is essential; (2) training-specific cues and verbal prompts assist patients to learn and engage with exercises; and (3) clinicians can benefit from research summaries and reports that provide explicit and comprehensive descriptions and decision rules about intervention content and progression. The data indicated that some clinicians can have difficulty interpreting and applying research findings because it is not always well reported. CONCLUSIONS Clinicians who use pelvic floor muscle training to treat urinary incontinence advised can benefit from accessing explicit details of interventions tested in research and reported as effective. They viewed tailoring therapy to individual goals and the use of verbal prompts and visualization cues as important engagement strategies for effective exercise performance. Explicit reporting could be facilitated by using an exercise guideline template, such as the Consensus on Exercise Reporting Template (CERT).
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Affiliation(s)
- Susan C Slade
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, La Trobe University, Bundoora, Australia
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit (RTRU), Department of Medicine, University of Otago, Wellington, New Zealand
| | - Sally Mastwyk
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, La Trobe University, Bundoora, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, La Trobe University, Bundoora, Australia.,Healthscope, North Eastern Rehabilitation Centre, Ivanhoe, Australia
| | - Helena Frawley
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
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100
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O'Neil J, McEwen D, Del Bel MJ, Jo D, Thevenot O, MacKiddie OS, Brosseau L. Assessment of the content reporting for therapeutic exercise interventions among existing randomized controlled trials on knee osteoarthritis. Clin Rehabil 2018. [PMID: 29529871 DOI: 10.1177/0269215518763714] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose/Rationale: Physical exercise interventions for the management of knee osteoarthritis are well known to be effective and accessible forms of rehabilitation and symptom management. However, without adequate reporting of these interventions, accurate replication and clinical use is negatively impacted. OBJECTIVES The main objective of this article was to assess content reporting using The Consensus on Exercise Reporting Template list and 2016 American College of Sports Medicine guidelines among moderate- to high-quality exercise interventions randomized controlled trials (total score of ≥6/10 on the PEDro scale) involving individuals with knee osteoarthritis. RESULTS The Consensus on Exercise Reporting Template mean total score for all 47 included randomized controlled trials was 4.42 out of 19, demonstrating generally low quality of reporting. The Consensus on Exercise Reporting Template list and the 2016 American College of Sports Medicine guidelines scores were moderately correlated (based on 95% confidence interval, intraclass correlation coefficient = 0.508) for aerobic interventions only. CONCLUSION The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.
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Affiliation(s)
- Jennifer O'Neil
- 1 School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Daniel McEwen
- 1 School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael J Del Bel
- 1 School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Donguk Jo
- 1 School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Odette Thevenot
- 2 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Olivia S MacKiddie
- 2 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- 1 School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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