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Willett MJ, Greig C, Rogers D, Fenton S, Duda J, Rushton A. Barriers and facilitators to recommended physical activity in lower-limb osteoarthritis: protocol for a qualitative study exploring patients and physiotherapist perspectives using the theoretical domains framework and behaviour change taxonomy. BMJ Open 2019; 9:e029199. [PMID: 31662360 PMCID: PMC6830663 DOI: 10.1136/bmjopen-2019-029199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is the leading cause of disability and pain in older adults. Although increasing physical activity (PA) can help reduce symptoms, patients with lower-limb OA are less active than the general public. Although physiotherapists commonly deliver PA programmes, they lack knowledge of key barriers and facilitators to adherence to prescribed PA that patients with lower-limb OA experience while attending physiotherapy appointments (treatment period) and after discharge (post-treatment period). This study aims to explore the perspectives of patients with lower-limb OA of barriers and facilitators to adherence to physiotherapy prescribed PA in the treatment and post-treatment time periods to inform the development of intervention underpinned by behaviour change theory. METHODS AND ANALYSIS A qualitative study, based on phenomenology, will purposively recruit patients with lower-limb OA who have had physiotherapy. In-depth semi-structured interviews will be undertaken following discharge from physiotherapy at a single time point. Participants' perspectives of physiotherapy interventions, including barriers and facilitators to prescribed PA and techniques that they felt optimised adherence to physiotherapist PA prescription will be explored (phase I). The acceptability and feasibility of delivering a physiotherapy intervention incorporating the techniques identified in the semi-structured interviews will then be explored through focus groups conducted with physiotherapists (phase II). Data will be coded following thematic analysis, with barriers and facilitators mapped to the constructs on the theoretical domains framework, and behaviour change techniques identified following definitions from Michie's V1 taxonomy. ETHICS AND DISSEMINATION Findings from this study will inform development of a physiotherapy intervention underpinned by behaviour change theory aiming to optimise adherence to PA prescription in patients with lower-limb OA during the treatment and post-treatment time periods. This study has ethical approval (IRAS 247904) and results will be disseminated through publications in peer-reviewed journals and presentations at conferences and to study participants.
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Affiliation(s)
- Matthew James Willett
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - David Rogers
- Centre for Musculoskeletal Medicine, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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152
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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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153
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Vina ER, Hannon MJ, Hausmann LRM, Ibrahim SA, Dagnino J, Arellano A, Kwoh CK. Modifiable Determinants of Exercise Use in a Diverse Ethnic Population With Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:1495-1503. [PMID: 30762309 DOI: 10.1002/acr.23852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the extent of ethnic differences in the use of exercise for therapy and identify relevant modifiable determinants of exercise use among patients with knee/hip osteoarthritis (OA). METHODS Knee/hip OA study participants were identified. Surveys were administered to collect patient sociodemographic and clinical information, and beliefs and attitudes about providers and treatments. Final multivariable logistic regression models were created using a fully conditional method. RESULTS Hispanic participants (n = 130), compared to non-Hispanic participants (n = 232), were less likely to have private medical insurance (9.2% versus 31.0%) or to report having excellent/very good health (40.7% versus 52.6%). They were also less likely to report using exercise for OA treatment in the last 6 months (56% versus 73%; P = 0.003). When adjusted for age and disease severity, the difference in exercise use among ethnicities remained significant (odds ratio [OR] 0.59 [95% confidence interval (95% CI) 0.36-0.99]). In a multivariable logistic regression model designed to determine the most important determinants of exercise use for OA treatment, in the last 6 months the following were all associated with exercise use: having knee instead of hip OA (OR 2.83 [95% CI 1.51-5.29]), having family/friends who exercise (OR 3.20 [95% CI 1.76-5.84]), having a good understanding of what happens after exercise (OR 2.19 [95 CI 1.15-4.19]), and higher perceived benefit of exercise (OR 2.24 [95% CI 1.64-3.04]). CONCLUSION Among patients with knee/hip OA, Hispanics were less likely to exercise for OA treatment. Increased knowledge about the benefits of exercise for treatment and improved familiarity with exercise as treatment for OA may increase exercise use.
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Affiliation(s)
- Ernest R Vina
- University of Arizona, College of Medicine and/or Arthritis Center, Tucson
| | - Michael J Hannon
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Leslie R M Hausmann
- University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Jazmin Dagnino
- University of Arizona, College of Medicine and/or Arthritis Center, Tucson
| | - Andrea Arellano
- University of Arizona, College of Medicine and/or Arthritis Center, Tucson
| | - C Kent Kwoh
- University of Arizona, College of Medicine and/or Arthritis Center, Tucson
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154
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Niemeijer A, Lund H, Stafne SN, Ipsen T, Goldschmidt CL, Jørgensen CT, Juhl CB. Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis. Br J Sports Med 2019; 54:1073-1080. [PMID: 31563884 DOI: 10.1136/bjsports-2018-100461] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the relative risk (RR) of serious and non-serious adverse events in patients treated with exercise therapy compared with those in a non-exercising control group. DESIGN Systematic review and meta-analysis. DATA SOURCES Primary studies were identified based on The Cochrane Database of Systematic Reviews investigating the effect of exercise therapy. ELIGIBILITY CRITERIA At least two of the authors independently evaluated all identified reviews and primary studies. Randomised controlled trials were included if they compared any exercise therapy intervention with a non-exercising control. Two authors independently extracted data. The RR of serious and non-serious adverse events was estimated separately. RESULTS 180 Cochrane reviews were included and from these, 773 primary studies were identified. Of these, 378 studies (n=38 368 participants) reported serious adverse events and 375 studies (n=38 517 participants) reported non-serious adverse events. We found no increase in risk of serious adverse events (RR=0.96 (95%CI 0.90 to 1.02, I2: 0.0%) due to exercise therapy. There was, however, an increase in non-serious adverse events (RR=1.19 (95%CI 1.09 to 1.30, I2: 0.0%). The number needed to treat for an additional harmful outcome for non-serious adverse events was 6 [95%CI 4 to 11). CONCLUSION Participating in an exercise intervention increased the relative risk of non-serious adverse events, but not of serious adverse events. Exercise therapy may therefore be recommended as a relatively safe intervention.PROSPERO registration numberCRD42014014819.
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Affiliation(s)
- Andre Niemeijer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Hans Lund
- Centre for Evidence-Based Practice, Hogskulen pa Vestlandet, Bergen, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Clinical Services, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
| | - Thomas Ipsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Claus Thomas Jørgensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
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155
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Jönsson T, Eek F, Dell'Isola A, Dahlberg LE, Ekvall Hansson E. The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden. PLoS One 2019; 14:e0222657. [PMID: 31536554 PMCID: PMC6752869 DOI: 10.1371/journal.pone.0222657] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023] Open
Abstract
We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish “Better Management of Patients with Osteoarthritis” registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear–avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara’s test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25–0.57 and hip OA of 0.15–0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear–avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of –0.04 to 0.43 and hip OA of –0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear–avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.
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Affiliation(s)
- Thérése Jönsson
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
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156
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Bartholdy C, Bliddal H, Henriksen M. Effectiveness of text messages for decreasing inactive behaviour in patients with knee osteoarthritis: a pilot randomised controlled study. Pilot Feasibility Stud 2019; 5:112. [PMID: 31516729 PMCID: PMC6732192 DOI: 10.1186/s40814-019-0494-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background One of the big contributors to physical inactivity in the elderly population is osteoarthritis (OA) of the knee. Digital motivation seems to have a positive effect on individual physical inactivity level, but limited evidence exists on the effects of digital motivation on patients with knee OA. Objective To investigate if motivational text messages reduce time spent physically inactive in patients with knee OA. Method This study was designed as an unblinded pilot randomised controlled trial, randomising participants equally (1:1) to an intervention group (motivational text messages) or control group (no intervention). Participants were recruited from six physical therapy clinics in Denmark. Inclusion criteria were age ≥ 18, diagnosed with knee OA, owner of a smartphone or tablet, and participating or commencing participation in the GLA:D® program. The primary outcome was time spent physically inactive, measured with a tri-axial accelerometer mounted on the lateral side of the thigh. Data on OA symptoms were obtained using the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Results A total of 49 participants were screened, and 38 participants were included and randomised to either the intervention group (n = 19) or the control group (n = 19). No statistically significant difference between the two groups was found in average change of time spent physically inactive (mean difference 13.2 min/day [95% CI − 41.0 to 67.3]; P = 0.63), time spent standing (mean difference 3.0 min/day [95% CI − 22.7 to 28.7]; P = 0.81), or time spent moving (mean difference − 20.4 min/day [95% CI − 63.0 to 22.3]; P = 0.34) nor was there any difference in change between the two groups on KOOS. Conclusion Motivational text messages have seemed to have no effect on overall time spent physically inactive. Trial registration clinicaltrials.gov, NCT03339011. Registered 9 November 2017 Electronic supplementary material The online version of this article (10.1186/s40814-019-0494-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilie Bartholdy
- 1The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,2Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- 1The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marius Henriksen
- 1The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,2Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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157
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Goh SL, Persson MSM, Stocks J, Hou Y, Lin J, Hall MC, Doherty M, Zhang W. Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 62:356-365. [PMID: 31121333 PMCID: PMC6880792 DOI: 10.1016/j.rehab.2019.04.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another. OBJECTIVE To evaluate the efficacy of exercise and its potential determinants for pain, function, performance, and quality of life (QoL) in knee and hip osteoarthritis (OA). METHODS We searched 9 electronic databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, PEDro, PubMed, SPORTDiscus and Google Scholar) for reports of randomised controlled trials (RCTs) comparing exercise-only interventions with usual care. The search was performed from inception up to December 2017 with no language restriction. The effect size (ES), with its 95% confidence interval (CI), was calculated on the basis of between-group standardised mean differences. The primary endpoint was at or nearest to 8 weeks. Other outcome time points were grouped into intervals, from<1 month to≥18 months, for time-dependent effects analysis. Potential determinants were explored by subgroup analyses. Level of significance was set at P≤0.10. RESULTS Data from 77 RCTs (6472 participants) confirmed statistically significant exercise benefits for pain (ES 0.56, 95% CI 0.44-0.68), function (0.50, 0.38-0.63), performance (0.46, 0.35-0.57), and QoL (0.21, 0.11-0.31) at or nearest to 8 weeks. Across all outcomes, the effects appeared to peak around 2 months and then gradually decreased and became no better than usual care after 9 months. Better pain relief was reported by trials investigating participants who were younger (mean age<60 years), had knee OA, and were not awaiting joint replacement surgery. CONCLUSIONS Exercise significantly reduces pain and improves function, performance and QoL in people with knee and hip OA as compared with usual care at 8 weeks. The effects are maximal around 2 months and thereafter slowly diminish, being no better than usual care at 9 to 18 months. Participants with younger age, knee OA and not awaiting joint replacement may benefit more from exercise therapy. These potential determinants, identified by study-level analyses, may have implied ecological bias and need to be confirmed with individual patient data.
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Affiliation(s)
- Siew-Li Goh
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK; Sports Medicine Unit, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Monica S M Persson
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Joanne Stocks
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Yunfei Hou
- Arthritis Clinical and Research Centre, Peking University People's Hospital, Beijing, China
| | - Jianhao Lin
- Arthritis Clinical and Research Centre, Peking University People's Hospital, Beijing, China
| | - Michelle C Hall
- Division of Physiotherapy Rehabilitation Sciences Education, University of Nottingham, NG5 1PB Nottingham, UK
| | - Michael Doherty
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Weiya Zhang
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK.
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158
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Young JJ, Kopansky-Giles D, Ammendolia C. Multimodal non-surgical intervention for individuals with knee osteoarthritis: a retrospective case series. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2019; 63:92-99. [PMID: 31564747 PMCID: PMC6743648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The purpose of this study is to review the pain and functional outcomes of a multimodal intervention in three patients with knee osteoarthritis (OA). This study explores how manual therapy can be delivered within an evidence-based framework for the management of knee OA. METHODS Medical records were reviewed for three patients with knee OA who underwent a standardized multimodal intervention including education, exercise, and manual therapy. Changes in pain intensity and function from baseline to post-intervention were calculated and compared to thresholds for minimal clinically important differences. RESULTS One participant met the threshold for clinically significant improvement in pain and two participants for function. No adverse events were reported. CONCLUSION Combined education, exercise, and manual therapy delivered over a 6-week period improved function in two of the three patients reviewed. Higher quality research is required to explore whether this multimodal intervention may improve outcomes in individuals with knee OA.
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Affiliation(s)
- James J. Young
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Carlo Ammendolia
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, ON
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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159
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Jacobs H, Hoffmann F, Callhoff J, Postler A, Saam J, Zink A, Günther KP, Goronzy J. [Utilization of individual out-of-pocket health services (IGeL) in persons with osteoarthritis in Germany : Results of a survey from the PROCLAIR study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1013-1019. [PMID: 31273415 DOI: 10.1007/s00103-019-02986-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Little is known about the utilization of individual health services performed by a physician (IGeL) and the services and supplements provided outside a doctor's office (MuPaP) for osteoarthritis patients. OBJECTIVES The aims of this study are to analyze the use of osteoarthritis-specific IGeL and MuPaP as well as predictors for their utilization. MATERIALS AND METHODS For this cross-sectional study, claims data was used to identify all persons with hip, knee, or polyarticular osteoarthritis in 2014 (n = 657,807). A random sample (n = 8995) was sent a questionnaire about their usage of IGeL and MuPaP. Furthermore, the type of physicians conducting or recommending services was evaluated. Applying multivariable logistic regression, predictors associated with the utilization of IGeL, MuPaP, and overall individual health services were analyzed. RESULTS After validating the data and osteoarthritis diagnosis, 2363 persons were enrolled (mean age: 65.5 years, 72% female). In the last 12 months, 39% of patients had used at least one IGeL (MuPaP: 76%), with 86% being primarily performed by orthopedists (MuPaP: 88% patient self-motivated). Knee osteoarthritis was associated with increased utilization of IGeL. Having female gender, higher income, residence in Western Germany, higher disease burden, and lower satisfaction with the healthcare system were influences on the use of overall individual health services. CONCLUSIONS Since patients with high disease burden in particular tend to use these therapies with varying treatment success, detailed information, especially about the risks and existing evidence, should be a prerequisite for trustworthy doctor-patient relationships.
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Affiliation(s)
- Hannes Jacobs
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Deutschland.
| | - Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Deutschland
| | - Johanna Callhoff
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - Anne Postler
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - Joachim Saam
- Abteilung Medizin & Versorgungsforschung, BARMER, Wuppertal, Deutschland
| | - Angela Zink
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland.,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - Jens Goronzy
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
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160
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Lauche R, Hunter DJ, Adams J, Cramer H. Yoga for Osteoarthritis: a Systematic Review and Meta-analysis. Curr Rheumatol Rep 2019; 21:47. [PMID: 31338685 DOI: 10.1007/s11926-019-0846-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW This study aims to systematically review and summarise the efficacy and safety of yoga for osteoarthritis. Medline (through PubMed), Scopus, and the Cochrane Library were searched through April 2018 for randomised controlled trials of yoga for osteoarthritis. Primary outcomes were pain intensity, function, and quality of life; secondary outcomes were mental health and safety. Risk of bias was assessed using the Cochrane tool and quality of evidence through GRADE. RECENT FINDINGS Nine trials including 640 individuals with mainly lower extremity osteoarthritis aged 50-80 years were identified, with 80.3% female participants (median). Meta-analyses revealed very low-quality evidence for the effects of yoga on pain (vs. exercise: standardised mean difference (SMD) = - 1.07; 95%CI - 1.92, - 0.21; p = 0.01; vs. non-exercise: SMD = - 0.75; 95%CI - 1.18, - 0.31; p < 0.001), physical function (vs. exercise: SMD = 0.80; 95%CI 0.36; 1.24; p < 0.001; vs. non-exercise: SMD = 0.60; 95%CI 0.30, 0.98; p < 0.001), and stiffness (vs. exercise: SMD = - 0.92; 95%CI - 1.69, - 0.14; p = 0.008; vs. non-exercise: SMD = - 0.76; 95%CI - 1.26, - 0.26; p = 0.003) in individuals with knee osteoarthritis. Effects were not robust against potential methodological bias. No effects were found for quality of life, and depression, or for hand osteoarthritis. Safety was rarely reported. The findings of this meta-analysis indicate that yoga may be effective for improving pain, function, and stiffness in individuals with osteoarthritis of the knee, compared to exercise and non-exercise control groups. Due to the low methodological quality and potential risk of bias, only a weak recommendation can be made at this time for the use of yoga in adults with osteoarthritis of the knee.
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Affiliation(s)
- Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia. .,Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Buger Str. 80, Bamberg, 96049, Germany.
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Holger Cramer
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.,Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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161
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Acupuncture of different treatment frequency in knee osteoarthritis: a protocol for a pilot randomized clinical trial. Trials 2019; 20:423. [PMID: 31296249 PMCID: PMC6625113 DOI: 10.1186/s13063-019-3528-8] [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] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to determine whether 3 sessions per week of acupuncture treatment is superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Methods/design This is a two parallel-group, assessor-blinded, randomized controlled trial. Sixty patients with knee osteoarthritis (Kellgren–Lawrence grade II or III) will be recruited and randomly allocated to receive 24 or 8 sessions (group M or group L) of acupuncture treatment in a 1:1 ratio. Patients in group M will receive 3 sessions per week of acupuncture for 8 weeks. Patients in group L will receive acupuncture once per week for 8 weeks. The primary outcome is the response rate—the percentage of patients achieving a decrease ≥ 2 points on a numerical rating pain scale and a decrease ≥ 6 points in the Western Ontario and McMaster Universities Osteoarthritis Index function score at 8 weeks compared with baseline. Secondary outcomes include pain, function, overall effect, quality of life, and treatment credibility and expectancy. Discussion Three sessions per week of acupuncture treatment may be superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Results of the study will be of great importance for the guidelines of clinical therapy. Trial registration Clinicaltrials.gov, NCT03359603. Registered on 1 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3528-8) contains supplementary material, which is available to authorized users.
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Willett M, Duda J, Fenton S, Gautrey C, Greig C, Rushton A. Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review. PLoS One 2019; 14:e0219482. [PMID: 31291326 PMCID: PMC6619772 DOI: 10.1371/journal.pone.0219482] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms. Objective To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA. Design A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively. Data sources A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2nd, 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science. Eligibility criteria for selecting studies RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis. Results Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence. Conclusions BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.
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Affiliation(s)
- Matthew Willett
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Charlotte Gautrey
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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163
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Silisteanu SC, Antonescu E, Totan M. Study on the importance of medical treatment and physical methods in recovering patients with knee osteoarthritis. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Intrduction.Etoricoxibum belongs to the group of non-steroidal anti-inflammatory inhibitors selective of cyclooxygenase-2. The non-steroidal anti-inflammatory drugs are used to treat acute musculoskeletal disorders as they result in pain-relieving therapeutical effect. Etoricoxibum intervenes by blocking cyclooxygenase-2 and by reducing the painful and inflammatory phenomena. Material and method. The trial focused on the evolution of patients diagnosed with knee osteoarthritis after making the treatment by etoricoxibum. This study was conducted in the ambulatory regime for a period of 6 months and included 77 patients. Results and discussions It was assessed the efficacy of the complex recovery treatment for the patients diagnosed by knee osteoarthritis wich use of Etoricoxibum, in a dose of 60 mg /day, in order to improve the pain and the inflammation. The pursued objectives were: the assessment of the effects by using Etoricoxibum for the reduction of the pain and inflammation, the increase of the articular mobility and stability, the recovery of the walk and motor control, the decrease of the body weight, the increase of the quality of life. Conclusions. This trial show that, by making a combined treatment of medication and recovery, there was an reducing the pain and the inflammation as well as increasing the articular mobility. Key words: osteoarthritis, pain, ultrasound, recovery, disability,
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Affiliation(s)
- Sinziana Calina Silisteanu
- 1, 2 Railway Hospital Iasi - Specialty Ambulatory of Suceava - "Stefan cel Mare" University of Suceava FEFS-DSDU
| | - Elisabeta Antonescu
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania 4County Clinical Emergency Hospital, Sibiu, Romania
| | - Maria Totan
- 4County Clinical Emergency Hospital, Sibiu, Romania
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Jeong HS, Lee SC, Jee H, Song JB, Chang HS, Lee SY. Proprioceptive Training and Outcomes of Patients With Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. J Athl Train 2019; 54:418-428. [PMID: 30995119 DOI: 10.4085/1062-6050-329-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the effects of proprioceptive training on pain, stiffness, function, and functional test outcomes among patients with knee osteoarthritis (OA). DATA SOURCES All studies completed from 1946 to 2017 were obtained from 4 databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus). STUDY SELECTION Three reviewers independently identified appropriate studies and extracted data. DATA EXTRACTION Methodologic quality and level of evidence were assessed using the Physiotherapy Evidence Database scale and Oxford Centre for Evidence-Based Medicine guidelines. The standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pain, stiffness, function, and functional test outcomes. DATA SYNTHESIS Seven randomized controlled trials involving 558 patients with knee OA met the inclusion criteria. The selected studies had Physiotherapy Evidence Database scores of 6 to 8. All randomized controlled trials had an Oxford Centre for Evidence-Based Medicine level of evidence of 2. Meta-analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (SMD = -0.56; 95% CI = -1.06, -0.07; P = .026), function subscale (SMD = -0.40; 95% CI = -0.59, -0.21; P < .001), and non-WOMAC walking speed test (SMD = -1.07; 95% CI = -2.12, -0.01; P = .048) revealed that proprioceptive training had significant treatment effects. Proprioceptive training was not associated with reductions in WOMAC stiffness subscale scores and did not improve non-WOMAC get-up-and-go scores. CONCLUSIONS Proprioceptive training effectively promoted pain relief and completion of functional daily activity among patients with knee OA and should be included in rehabilitation programs. Stiffness and other mobility measures were unchanged after proprioceptive training. Modified proprioceptive training programs are needed to target stiffness and improve additional physical function domains.
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Affiliation(s)
- Hee Seong Jeong
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, Republic of Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea
| | - Sung-Cheol Lee
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, Republic of Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea
| | - Hyunseok Jee
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea.,Department of Sports Science, Hannam University, Daejeon, Republic of Korea
| | - Jun Bom Song
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea
| | - Hyun Sik Chang
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, Republic of Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea
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Iijima H, Aoyama T, Eguchi R, Takahashi M, Matsuda S. Effects of interaction between varus thrust and ambulatory physical activity on knee pain in individuals with knee osteoarthritis: an exploratory study with 12-month follow-up. Clin Rheumatol 2019; 38:1721-1729. [PMID: 30847687 DOI: 10.1007/s10067-019-04472-x] [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: 10/25/2018] [Revised: 01/05/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aimed to examine the interaction effect between ambulatory physical activity (PA) and varus thrust on knee pain in individuals with knee osteoarthritis (OA). METHOD Subjects (n = 207; mean age: 73.1 years, 71.5% women) in orthopedic clinics with diagnosed knee OA (Kellgren/Lawrence grade ≥ 1) were enrolled in this 12-month observational cohort study. Participants underwent gait observation for varus thrust assessment and pedometer-based ambulatory PA measurements at baseline and 12-month follow-up. Knee pain intensity was assessed using the Japanese Knee Osteoarthritis Measure pain subscale as a primary outcome measure. Multiple linear regression analyses were performed to evaluate ambulatory PA-thrust interaction on knee pain intensity. RESULTS Ninety-two subjects (mean age, 73.4 years; 68.5% women) completed the 12-month follow-up assessment. Baseline ambulatory PA-thrust interaction was significant (P = 0.017) in the cross-sectional analysis, adjusting for covariates, which yielded R2 = 0.310. Subgroup analysis showed that varus thrust was significantly associated with worse knee pain in subjects walking ≥ 5000 steps/day adjusting for covariates (beta: 7.94; 95% CI: 3.82, 12.1; P < 0.001) with a higher predictive ability (R2 = 0.664). In contrast, ambulatory PA-thrust interaction in the longitudinal analysis showed no significant association with knee pain changes. CONCLUSIONS Ambulatory PA interacted with varus thrust in the association with knee pain, as coexisting high ambulatory PA and varus thrust had the strongest association with higher knee pain. Maximal pain relief effects might be achieved when both ambulatory PA and varus thrust are treated simultaneously, rather than treating each separately.
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Affiliation(s)
- Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Hirotaka Iijima, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, 223-8522, Japan. .,Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryo Eguchi
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Yokohama, Japan
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Hirotaka Iijima, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, 223-8522, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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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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168
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Gilmartin-Thomas JFM, Bell JS, Liew D, Arnold CA, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson SJ, Giummarra MJ, Gowan J, Katz B, Lubman DI, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil J. Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice. Res Social Adm Pharm 2019; 15:207-213. [DOI: 10.1016/j.sapharm.2018.03.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/01/2018] [Accepted: 03/18/2018] [Indexed: 01/20/2023]
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Beukenhorst AL, Parkes MJ, Cook L, Barnard R, van der Veer SN, Little MA, Howells K, Sanders C, Sergeant JC, O'Neill TW, McBeth J, Dixon WG. Collecting Symptoms and Sensor Data With Consumer Smartwatches (the Knee OsteoArthritis, Linking Activity and Pain Study): Protocol for a Longitudinal, Observational Feasibility Study. JMIR Res Protoc 2019; 8:e10238. [PMID: 30672745 PMCID: PMC6366393 DOI: 10.2196/10238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/19/2018] [Accepted: 06/11/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Knee OsteoArthritis, Linking Activity and Pain (KOALAP) study is the first to test the feasibility of using consumer-grade cellular smartwatches for health care research. OBJECTIVE The overall aim was to investigate the feasibility of using consumer-grade cellular smartwatches as a novel tool to capture data on pain (multiple times a day) and physical activity (continuously) in patients with knee osteoarthritis. Additionally, KOALAP aimed to investigate smartwatch sensor data quality and assess whether engagement, acceptability, and user experience are sufficient for future large-scale observational and interventional studies. METHODS A total of 26 participants with self-diagnosed knee osteoarthritis were recruited in September 2017. All participants were aged 50 years or over and either lived in or were willing to travel to the Greater Manchester area. Participants received a smartwatch (Huawei Watch 2) with a bespoke app that collected patient-reported outcomes via questionnaires and continuous watch sensor data. All data were collected daily for 90 days. Additional data were collected through interviews (at baseline and follow-up) and baseline and end-of-study questionnaires. This study underwent full review by the University of Manchester Research Ethics Committee (#0165) and University Information Governance (#IGRR000060). For qualitative data analysis, a system-level security policy was developed in collaboration with the University Information Governance Office. Additionally, the project underwent an internal review process at Google, including separate reviews of accessibility, product engineering, privacy, security, legal, and protection regulation compliance. RESULTS Participants were recruited in September 2017. Data collection via the watches was completed in January 2018. Collection of qualitative data through patient interviews is still ongoing. Data analysis will commence when all data are collected; results are expected in 2019. CONCLUSIONS KOALAP is the first health study to use consumer cellular smartwatches to collect self-reported symptoms alongside sensor data for musculoskeletal disorders. The results of this study will be used to inform the design of future mobile health studies. Results for feasibility and participant motivations will inform future researchers whether or under which conditions cellular smartwatches are a useful tool to collect patient-reported outcomes alongside passively measured patient behavior. The exploration of associations between self-reported symptoms at different moments will contribute to our understanding of whether it may be valuable to collect symptom data more frequently. Sensor data-quality measurements will indicate whether cellular smartwatch usage is feasible for obtaining sensor data. Methods for data-quality assessment and data-processing methods may be reusable, although generalizability to other clinical areas should be further investigated. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10238.
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Affiliation(s)
- Anna L Beukenhorst
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthew J Parkes
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Louise Cook
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rebecca Barnard
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sabine N van der Veer
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
- Health eResearch Centre, The United Kingdom Farr Institute of Health Informatics Research, Manchester, United Kingdom
| | - Max A Little
- Mathematics Group, Aston University, Birmingham, United Kingdom
- Human Dynamics Group, Massachusetts Institute of Technology Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kelly Howells
- The National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Primary Care, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- The National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Terence W O'Neill
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - John McBeth
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - William G Dixon
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Health eResearch Centre, The United Kingdom Farr Institute of Health Informatics Research, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
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Kwok AK, O’Hara NN, Pollak AN, O’Hara LM, Herman A, Welsh CJ, Slobogean GP. Are injured workers with higher rehabilitation service utilization less likely to be persistent opioid users? A cross-sectional study. BMC Health Serv Res 2019; 19:32. [PMID: 30642319 PMCID: PMC6332665 DOI: 10.1186/s12913-019-3879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Given its role in treating musculoskeletal conditions, rehabilitation medicine may be an important factor in decreasing the use of opioids among injured workers. The primary objective was to determine if increased utilization of rehabilitation services was associated with decreased persistent opioid use among workers' compensation claimants. The secondary objective was to determine the combined association of rehabilitation service utilization and persistent opioid use with days of work lost due to injury. METHODS Using Chesapeake Employers' Insurance Company claims data from 2008 to 2016, claimants with at least one filled opioid prescription within 90 days of injury were eligible for inclusion. The primary outcome was persistent opioid use, defined as at least one filled opioid prescription more than 90 days from injury. The secondary outcome was days lost due to injury. The primary variable of interest, rehabilitation service utilization, was quantified based on the number of rehabilitation service claims and grouped into five levels (no utilization, and four quartiles - low, medium, high, very high). RESULTS Of the 9596 claimants included, 29% were persistent opioid users. Compared to claimants that did not utilize rehabilitation services, patients with very high rehabilitation utilization were nearly three times more likely (OR: 2.71, 95% CI: 2.28-3.23, p < 0.001) to be persistent opioid users and claimants with low and medium levels of rehabilitation utilization were less likely to be persistent opioid users (low OR: 0.20, 95%: 0.14-0.27, p < 0.001) (medium OR: 0.26, 95% CI: 0.21-0.32, p < 0.001). Compared to claimants that did not utilize rehabilitation services, very high rehabilitation utilization was associated with a 27% increase in days lost due to the injury (95% CI: 21.9-32.3, p < 0.001), while low (- 16.4, 95% CI: -21.3 - -11.5, p < 0.001) and medium (- 11.5, 95% CI: -21.6 - -13.8, p < 0.001) levels of rehabilitation utilization were associated with a decrease in days lost due to injury, adjusting for persistent opioid use. CONCLUSION Our analysis of insurance claims data revealed that low to moderate levels of rehabilitation was associated with reduced persistent opioid use and days lost to injury. Very high rehabilitation utilization was associated with increased persistent opioid use and increased time from work.
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Feasibility of a Home-Based Therapeutic Exercise Program in Individuals With Knee Osteoarthritis. Arch Rheumatol 2019; 33:295-301. [PMID: 30632538 DOI: 10.5606/archrheumatol.2018.6633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the feasibility and potential benefits of a four-week home-based therapeutic exercise program for individuals with osteoarthritis (OA) of the knee. Patients and methods Feasibility outcomes, namely the recruitment rate, retention rate, exercise adherence and adverse events, as well as pain, knee muscle strength, range of motion, functional mobility, physical function, and postural sway were assessed on 15 individuals (4 males, 11 females; mean age 62.8±2.5 years; range 55 to 83 years) with knee OA before and after a four-week home-based therapeutic exercise program. Results The main results indicated that this program was feasible, as indicated by recruitment, adherence, and safety outcomes. The retention rate was 80% and the overall exercise adherence for those completing the program was 93%. The exercise program improved significantly pain intensity (visual analog scale: 5.8±2.8 to 3.8±2.4 cm, p=0.006), functional mobility, muscle strength, and physical function (Knee injury and OA Outcome Score-Physical Function Short-form: 53.8±21.0 to 41.3±13.9 points, p=0.011). Conclusion This home-based therapeutic exercise program is feasible for individuals with OA of the knee and seems to improve pain intensity, functional mobility, muscle strength, and physical function.
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Polaski AM, Phelps AL, Kostek MC, Szucs KA, Kolber BJ. Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain. PLoS One 2019; 14:e0210418. [PMID: 30625201 PMCID: PMC6326521 DOI: 10.1371/journal.pone.0210418] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Increasing evidence purports exercise as a first-line therapeutic for the treatment of nearly all forms of chronic pain. However, knowledge of efficacious dosing respective to treatment modality and pain condition is virtually absent in the literature. The purpose of this analysis was to calculate the extent to which exercise treatment shows dose-dependent effects similar to what is seen with pharmacological treatments. METHODS A recently published comprehensive review of exercise and physical activity for chronic pain in adults was identified in May 2017. This report reviewed different physical activity and exercise interventions and their effectiveness in reducing pain severity and found overall modest effects of exercise in the treatment of pain. We analyzed this existing data set, focusing specifically on the dose of exercise intervention in these studies. We re-analyzed data from 75 studies looking at benefits of time of exercising per week, frequency of exercise per week, duration of intervention (in weeks), and estimated intensity of exercise. RESULTS Analysis revealed a significant positive correlation with exercise duration and analgesic effect on neck pain. Multiple linear regression modeling of these data predicted that increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients. DISCUSSION Modest effects were observed with one significant correlation between duration and pain effect for neck pain. Overall, these results provide insufficient evidence to conclude the presence of a strong dose effect of exercise in pain, but our modeling data provide tes predictions that can be used to design future studies to explicitly test the question of dose in specific patient populations.
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Affiliation(s)
- Anna M. Polaski
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Amy L. Phelps
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Palumbo Donahue School of Business, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Matthew C. Kostek
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Kimberly A. Szucs
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Department of Occupational Therapy, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Benedict J. Kolber
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
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Losina E. Why past research successes do not translate to clinical reality: gaps in evidence on exercise program efficacy. Osteoarthritis Cartilage 2019; 27:1-2. [PMID: 30248501 PMCID: PMC6309741 DOI: 10.1016/j.joca.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Affiliation(s)
- E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
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Eisele A, Schagg D, Krämer LV, Bengel J, Göhner W. Behaviour change techniques applied in interventions to enhance physical activity adherence in patients with chronic musculoskeletal conditions: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2019; 102:25-36. [PMID: 30279029 DOI: 10.1016/j.pec.2018.09.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify Behaviour Change Techniques (BCTs) applied in interventions to enhance physical activity (PA) adherence in patients with chronic musculoskeletal conditions and to investigate the effectiveness of these interventions in increasing PA adherence. METHODS A systematic search of seven databases was conducted. We included (cluster/quasi-) randomised controlled trials comparing behaviour change interventions to no/placebo/minimal interventions or usual care and involving at least a three-month post-intervention follow-up. Methodological quality was assessed, study characteristics and BCTs were narratively summarised and a meta-analysis was conducted. RESULTS Across 22 included studies, we coded 8-18 BCTs (mean = 11.2) in intervention and 0-12 (mean = 3.5) in control groups. Common BCTs were "graded tasks", "goal setting", "self-monitoring", "problem solving" and "feedback". Meta-analyses of 17 studies revealed a small medium-term effect (3-6 months post-intervention, standardised mean difference (SMD) = 0.20, 95% CI 0.08-0.33) and no long-term effect (7-12 months post-intervention, SMD = 0.13, 95% CI -0.02 to 0.28). Subgroup analysis yielded a higher effect (SMD = 0.29, 95% CI 0.19-0.40) for interventions using a greater number of BCTs. CONCLUSION There is moderate quality evidence that interventions using BCTs are effective to enhance medium-term physical activity adherence. PRACTICE IMPLICATION While superiority of single BCTs was not shown, it is likely that using more BCTs results in better adherence.
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Affiliation(s)
- Angelika Eisele
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany.
| | - Daniela Schagg
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | | | - Jürgen Bengel
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Wiebke Göhner
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
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175
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Gillman T, Schmidtke KA, Manning V, Vlaev I. General Practitioners' recommendations of self-directed-exercises for musculoskeletal problems and perceived barriers and facilitators to doing so: a mixed methods study. BMC Health Serv Res 2018; 18:998. [PMID: 30587183 PMCID: PMC6307153 DOI: 10.1186/s12913-018-3799-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal problems substantially impact the demand for and the finances of the United Kingdom's National Health Service. Some of this demand and cost could be alleviated if patients use self-directed-exercises. The present study aims first to establish whether general practitioners already recommend self-directed-exercises and second to describe barriers and facilitators to making such recommendations. METHOD The design of the current study included surveys and interviews. The surveys were designed to draw out participants' tendency to recommend self-directed-exercises and their behavioral drivers to do so. The drivers investigated include 14 domains described by the Theoretical Domains Framework. The surveys were completed online and the responses were analyzed using descriptive reports and regression analyses. The interviews were designed to more fully understand participants' experiences recommending self-directed-exercises according to the same framework. The interviews were audio-taped, transcribed, and thematically analyzed. RESULTS The survey found that the following domains significantly predicted participants' tendency to recommend self-directed-exercises: Environmental contexts and resources, Goals, Intentions, Knowledge, Memory attention and decision processes, and Social/professional role. The interviews brought out four themes that could be leveraged to increase general practitioners' tendency to recommend self-directed-exercises: (1) Practitioners' beliefs about self-directed-exercises being effective, (2) Patients' motivations to engage in self-directed-exercises, (3) Time constraints, and (4) The ease with which practitioners can recommend self-directed-exercises. CONCLUSIONS Most general practitioners already recommend self-directed-exercises, though they note significant barriers that may prevent them from doing so. General practitioners' tendency to recommend self-directed-exercises would be bolstered by creating a respected central resource of exercise pamphlets. These pamphlets should clearly describe how different self-directed-exercises should be performed and evidence supporting their effectiveness.
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Affiliation(s)
- Toby Gillman
- Centre for Health Policy, Imperial College London, London, UK
| | | | - Victoria Manning
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
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176
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Kigozi J, Jowett S, Nicholls E, Tooth S, Hay EM, Foster NE. Cost-utility analysis of interventions to improve effectiveness of exercise therapy for adults with knee osteoarthritis: the BEEP trial. Rheumatol Adv Pract 2018; 2:rky018. [PMID: 30506022 PMCID: PMC6251481 DOI: 10.1093/rap/rky018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives Evidence regarding the cost-effectiveness of enhancing physical therapy exercise programmes in order to improve outcomes for patients with knee OA remains unclear. This study investigates the cost-effectiveness of two enhanced physical therapy interventions compared with usual physical therapy care (UC) for adults with knee OA. Methods A trial-based cost–utility analysis of individually tailored exercise (ITE) or targeted exercise adherence (TEA) compared with UC was undertaken over a period of 18 months. Patient-level costs were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a base-case UK health-care perspective. Results The UC group was associated with lower National Health Service (NHS) costs [ITE-UC: £273.30, 95% CI: £−62.10 to £562.60; TEA-UC: £141.80, 95% CI: £−135.60 to £408.10)] and slightly higher QALY gains (ITE-UC: −0.015, 95% CI: −0.057 to 0.026; TEA-UC: −0.003, 95% CI: −0.045 to 0.038). In the base case, UC was the most likely cost-effective option (probability <40% of ITE or TEA cost-effective at £20 000/QALY). Differences in total costs were attributable to intervention costs, number of visits to NHS consultants and knee surgery, which were higher in both ITE and TEA groups. Conclusion This is the first economic evaluation comparing usual physical therapy care vs enhanced exercise interventions for knee OA that involves greater exercise individualization, supervision and progression or that focuses on exercise and physical activity adherence over the longer term. Our findings show that UC is likely to be the most cost-effective option. Trial registration Current Controlled Trials ISRCTN 93634563. Trial protocol Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at http://www.biomedcentral.com/1471-2474/15/254 doi: 10.1186/1471-2474-15-254
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Affiliation(s)
- Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Stephanie Tooth
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
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177
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Dai Z, Jafarzadeh SR, Niu J, Felson DT, Jacques PF, Li S, Zhang Y. Body Mass Index Mediates the Association between Dietary Fiber and Symptomatic Knee Osteoarthritis in the Osteoarthritis Initiative and the Framingham Osteoarthritis Study. J Nutr 2018; 148:1961-1967. [PMID: 30517729 PMCID: PMC6857615 DOI: 10.1093/jn/nxy231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/17/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background Dietary fiber reduces body weight and inflammation in clinical trials. It is unclear whether body mass index (BMI) and inflammation might explain the observed association between higher fiber intake and the lower risk of symptomatic knee osteoarthritis (SXKOA). Objectives We quantified the extent to which BMI and inflammation influenced the relation between dietary fiber and SXKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI) and the Framingham Offspring Osteoarthritis Study. At baseline of each study, men and women (mean age: 61 y) with or at risk of knee osteoarthritis were followed for 48 mo in the OAI. Adults (mean age: 53 y) were followed for 9.5 y in the Framingham study. Dietary fiber intake was estimated using a validated food-frequency questionnaire. Measured weight and height were used to calculate BMI. Serum high-sensitivity C-reactive protein (CRP) was measured in the Framingham study only. Incident SXKOA was defined as new onset of a combination of knee pain and radiographic osteoarthritis. We applied marginal structural models to quantify the mediation through BMI in the OAI and the sequential mediation through BMI and CRP in the Framingham study. Results Incident SXKOA occurred in 861 knees among 2876 persons in the OAI and in 143 knees among 971 persons in the Framingham study. In persons whose fiber intake was ≥21 g/d compared with those with intakes <21 g/d, the OR (95% CI) was 0.70 (0.53, 0.91) for the overall association with SXKOA and was 0.93 (0.92, 0.95) for the mediation via BMI (per kg/m2) in the OAI. In the Framingham study, the overall association was 0.57 (0.30, 1.09), the mediation through BMI (via BMI and the influence of BMI on CRP) was 0.94 (0.85, 1.02), and the mediation through CRP (per milligram per liter) was 0.99 (0.84, 1.19). Conclusion Our findings suggest that the inverse association of fiber intake and the risk of incident symptomatic knee osteoarthritis is partially mediated by BMI.
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Affiliation(s)
- Zhaoli Dai
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - S Reza Jafarzadeh
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
| | - Jingbo Niu
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
| | - David T Felson
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
- National Institute for Health Research Biomedical Research Center, University of Manchester, Manchester, United Kingdom
| | - Paul F Jacques
- Jean Mayer USDA Human Nutrition Research Center on Aging and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Shanshan Li
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
| | - Yuqing Zhang
- Department of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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178
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de Almeida AC, Pedroso MG, Aily JB, Gonçalves GH, Pastre CM, Mattiello SM. Influence of a periodized circuit training protocol on intermuscular adipose tissue of patients with knee osteoarthritis: protocol for a randomized controlled trial. BMC Musculoskelet Disord 2018; 19:421. [PMID: 30497420 PMCID: PMC6267088 DOI: 10.1186/s12891-018-2325-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/26/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The objective of this study is to analyze the influence of a 14-week periodized circuit training protocol on patients with knee osteoarthritis (OA), in randomized intervention groups, on thigh intermuscular adipose tissue (interMAT), body composition, systemic inflammation, cartilage degradation, and its repercussion on pain, functional performance and quality of life. METHODS This study presents a protocol for a randomized controlled trial. Sixty selected participants diagnosed with knee OA grades II and III, 40-65 years old and BMI < 30 kg/m2, will be randomly divided into three groups:periodized circuit training, strength training, and educational protocol. The circuit training and strength training protocols consist of 14-week training protocols conducted 3 times a week. The circuit training group will perform selected exercises previously stratified as light, moderate, and intense, arranged progressively in a circuit model, the strength group will perform regular strength exercises, and the educational protocol group will participate in a 14-week protocol with lectures twice a month about healthy lifestyles. Baseline and follow-up evaluations will be conducted for thigh interMAT (computed tomography), body composition (DXA), inflammation (IL-1β, IL-6, IL-10, TNF-α, leptin, and adiponectin), and joint degradation biomarkers (uCTX-II and sCOMP), performance-based tests (30s Chair Stand Test, 40 m Fast-paced Walk Test and Stair Climb Test), quadriceps and hamstring maximal isometric voluntary contraction (MIVC), and questionnaires (WOMAC and pain catastrophizing scale). Repeated measures ANOVA will be used to compare differences between groups (circuit training X strength training X educational protocol) at the different times of assessment (baseline x follow-up or baseline x during protocol x follow-up) for each of the dependent variables. When significant main effects were found, the pots hoc Bonferroni test will be used to identify statistical differences. A significance level of 5% (p < 0.05) will be adopted. DISCUSSION This will be the first randomized controlled trial to assess the effects of a circuit training protocol on patients with knee OA on thigh intermuscular adipose tissue (interMAT). Given the prevalence and impact of OA and the widespread availability of this intervention, assessing the efficacy of a low-cost, non-pharmacological, and non-invasive treatment for knee OA patients has the potential for immediate and high clinical impact. TRIAL REGISTRATION ClinicalTrials.gov, NCT02761590 , registered in May 4, 2016.
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Affiliation(s)
- Aline Castilho de Almeida
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Km 235,Rod. Washington Luís–SP310, Postal code, São Carlos, (SP) 13565-905 Brazil
| | - Maria Gabriela Pedroso
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Km 235,Rod. Washington Luís–SP310, Postal code, São Carlos, (SP) 13565-905 Brazil
| | - Jessica Bianca Aily
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Km 235,Rod. Washington Luís–SP310, Postal code, São Carlos, (SP) 13565-905 Brazil
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Km 235,Rod. Washington Luís–SP310, Postal code, São Carlos, (SP) 13565-905 Brazil
| | - Carlos Marcelo Pastre
- Department of Physical Therapy, São Paulo State University (UNESP) - School of Sciences and Technology, 305, Roberto Simonsen St., Presidente Prudente, (SP) 19060-900 Brazil
| | - Stela Marcia Mattiello
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), Km 235,Rod. Washington Luís–SP310, Postal code, São Carlos, (SP) 13565-905 Brazil
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179
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MacKay C, Hawker GA, Jaglal SB. Qualitative study exploring the factors influencing physical therapy management of early knee osteoarthritis in Canada. BMJ Open 2018; 8:e023457. [PMID: 30498043 PMCID: PMC6278797 DOI: 10.1136/bmjopen-2018-023457] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Increasingly, there is emphasis on identifying and initiating treatment of osteoarthritis (OA) in the early phases of the disease. This study aimed to identify the perceived barriers and facilitators to managing clients with early knee OA and the contextual factors affecting implementation of care by physical therapists (PTs). DESIGN Qualitative study using in-depth semistructured interviews with 33 PTs. The interviews were audio-recorded, transcribed verbatim and analysed inductively using thematic analysis. SETTING Canada. PARTICIPANTS A purposive sample of PTs who managed clients with knee symptoms and/or diagnosed knee OA in community/outpatient settings in three provinces in Canada (Ontario, Alberta, British Columbia). RESULTS Factors that affected physical therapy management of early knee OA were identified at four levels: the community, healthcare system, healthcare provider and client level. Some healthcare provider factors acted primarily as enablers of management, such as PTs' confidence in their ability to manage perceived early knee OA, PTs' beliefs about consequences of OA and the PT scope of practice. However, the study illuminated a range of modifiable factors that can act as barriers to management. These factors included access to services in the community and healthcare system; healthcare provider factors such as time, access to evidence and physician's role in referrals and messaging; and client factors related to client characteristics (eg, general health, socioeconomic status), engagement in management and beliefs about OA. CONCLUSION These findings provide us with a basis to begin to address specific barriers and to optimise care for early knee OA.
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Affiliation(s)
- Crystal MacKay
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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180
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Galindo T, Reyna J, Weyer A. Evidence for Transient Receptor Potential (TRP) Channel Contribution to Arthritis Pain and Pathogenesis. Pharmaceuticals (Basel) 2018; 11:E105. [PMID: 30326593 PMCID: PMC6315622 DOI: 10.3390/ph11040105] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023] Open
Abstract
Based on clinical and preclinical evidence, Transient Receptor Potential (TRP) channels have emerged as potential drug targets for the treatment of osteoarthritis, rheumatoid arthritis, and gout. This review summarizes the relevant data supporting a role for various TRP channels in arthritis pain and pathogenesis, as well as the current state of pharmacological efforts to ameliorate arthritis symptoms in patient populations.
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Affiliation(s)
- Tabitha Galindo
- School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, OR 97116, USA.
| | - Jose Reyna
- School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, OR 97116, USA.
| | - Andy Weyer
- Biological Sciences Department, City College of San Francisco, San Francisco, CA 94112, USA.
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181
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What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada? PLoS One 2018; 13:e0204872. [PMID: 30273410 PMCID: PMC6166953 DOI: 10.1371/journal.pone.0204872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/14/2018] [Indexed: 12/28/2022] Open
Abstract
Objectives To evaluate the perceptions of the general public and healthcare practitioners (HCP) in Canada about the relationship between running and knee joint health, and to explore HCP`s usual recommendations to runners with knee osteoarthritis (KOA). Methods Non-runners and runners (with and without KOA) and HCP completed an online survey regarding the safety of running for knee joint health. HCP also provided information related to usual clinical recommendations. Proportions of agreement were compared between non-runners and runners. Results A total of 114 non-runners, 388 runners and 329 HCP completed the survey. Overall, running was perceived as detrimental for the knee joint by 13.1% of the general public, while 25.9% were uncertain. More uncertainty was reported regarding frequent (33.9%) and long-distance (43.6%) running. Statistical analyses revealed greater proportions of non-runners perceiving running negatively compared with runners. Overall, 48.4% believed that running in the presence of KOA would lead to disease progression, while 53.1% believed running would lead to premature arthroplasty. In HCP, 8.2%, 9.1% and 22.2% perceived that running in general, running frequently, or running long-distances are risk factors for KOA, respectively. 37.1% and 2.7% of HCP typically recommended patients with KOA to modify their running training or to quit running, respectively. Conclusion High rates of uncertainty among the general public and HCP in Canada outline the need for further studies about running and knee joint health. Filling knowledge gaps will help inform knowledge translation strategies to better orientate the general public and HCP about the safety of running for knee joint health.
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van de Graaf VA, Noorduyn JCA, Willigenburg NW, Butter IK, de Gast A, Mol BW, Saris DBF, Twisk JWR, Poolman RW. Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial. JAMA 2018; 320:1328-1337. [PMID: 30285177 PMCID: PMC6583004 DOI: 10.1001/jama.2018.13308] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Despite recent studies suggesting arthroscopic partial meniscectomy (APM) is not more effective than physical therapy (PT), the procedure is still frequently performed in patients with meniscal tears. OBJECTIVE To assess whether PT is noninferior to APM for improving patient-reported knee function in patients with meniscal tears. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, multicenter, randomized clinical trial conducted in 9 hospitals in the Netherlands. Participants were aged 45 to 70 years with nonobstructive meniscal tears (ie, no locking of the knee joint). Patients with knee instability, severe osteoarthritis, and body mass index greater than 35 were excluded. Recruitment took place between July 17, 2013, and November 4, 2015. Participants were followed up for 24 months (final participant follow-up, October 11, 2017). INTERVENTIONS Three hundred twenty-one participants were randomly assigned to APM (n = 159) or a predefined PT protocol (n = 162). The PT protocol consisted of 16 sessions of exercise therapy over 8 weeks focused on coordination and closed kinetic chain strength exercises. MAIN OUTCOMES AND MEASURES The primary outcome was change in patient-reported knee function on the International Knee Documentation Committee Subjective Knee Form (range, 0 to 100; from worse to best) from baseline over a 24-month follow-up period. The noninferiority margin was defined as a difference between treatment groups of 8 points and was assessed with a 1-sided α of .025. The primary analysis followed the intention-to-treat principle. RESULTS Among 321 patients who were randomized (mean [SD] age, 58 [6.6] years; 161 women [50%]), 289 (90%) completed the trial (161 women and 158 men). In the PT group, 47 participants (29%) had APM during the 24-month follow-up period, and 8 participants randomized to APM (5%) did not have APM. Over a 24-month follow-up period, knee function improved in the APM group by 26.2 points (from 44.8 to 71.5) and in the PT group by 20.4 points (from 46.5 to 67.7). The overall between-group difference was 3.6 points (97.5% CI, -∞ to 6.5; P value for noninferiority = .001). Adverse events occurred in 18 participants in the APM group and 12 in the PT group. Repeat surgery (3 in the APM group and 1 in the PT group) and additional outpatient visits for knee pain (6 in the APM group and 2 in the PT group) were the most frequent adverse events. CONCLUSIONS AND RELEVANCE Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01850719.
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Affiliation(s)
| | - Julia C. A. Noorduyn
- Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | | | - Ise K. Butter
- Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Arthur de Gast
- Department of Orthopedic Surgery, Clinical Orthopedic Research Center–mN, Diakonessenhuis, Utrecht, the Netherlands
| | - Ben W. Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel B. F. Saris
- Department of Orthopedic Surgery, UMC Utrecht, Utrecht, the Netherlands
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jos W. R. Twisk
- currently with Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, the Netherlands
- Institute of Health Science of the Vrije Universiteit, Amsterdam, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
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183
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Nussbaumer-Streit B, Klerings I, Wagner G, Heise TL, Dobrescu AI, Armijo-Olivo S, Stratil JM, Persad E, Lhachimi SK, Van Noord MG, Mittermayr T, Zeeb H, Hemkens L, Gartlehner G. Abbreviated literature searches were viable alternatives to comprehensive searches: a meta-epidemiological study. J Clin Epidemiol 2018; 102:1-11. [DOI: 10.1016/j.jclinepi.2018.05.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
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184
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Brooks JM, Deiches J, Xiang X, Batsis JA, Chan F, DiMilia P, Chiu C, Thompson K, Bartels S. Differences in Self-Reported Physical Activity, Exercise Self-Efficacy and Outcome Expectancies, and Health Status by Body Mass Index Groups in People with Chronic Pain. JOURNAL OF REHABILITATION 2018; 84:46-52. [PMID: 32089565 PMCID: PMC7034931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The study purpose was to determine how self-reported lifestyle physical activity levels, exercise self-efficacy and outcome expectancies, and health status differ by body mass index for persons with chronic pain. From U.S. clinics and community networks, 209 adults reporting chronic musculoskeletal pain were recruited for the cross-sectional survey. Data were analyzed using analysis of variance. Participants with self-described obesity reported the lowest physical activity, reduced exercise self-efficacy and positive outcome expectancies, and poorer health status. Promoting graded activity while addressing motivational factors from health behavior theory for people with chronic pain and obesity should be encouraged in rehabilitation programs.
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185
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Lin YH, Lee SY, Su WR, Kao CC, Tai TW, Chen TB. Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement. J Clin Nurs 2018; 27:1836-1845. [PMID: 29603823 DOI: 10.1111/jocn.14368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. BACKGROUND Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. DESIGN A experimental and longitudinal study design. METHODS The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge. RESULTS The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. CONCLUSIONS This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. RELEVANCE TO CLINICAL PRACTICE When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.
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Affiliation(s)
- Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Su-Ying Lee
- Nursing Department, National Cheung Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheung Kung University, Tainan, Taiwan
| | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Ta-Wei Tai
- Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan
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186
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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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187
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Kloek CJJ, van Dongen JM, de Bakker DH, Bossen D, Dekker J, Veenhof C. Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomized controlled trial. BMC Public Health 2018; 18:1082. [PMID: 30170586 PMCID: PMC6119267 DOI: 10.1186/s12889-018-5975-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 08/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective. Methods This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty. Results Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective. Conclusions E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist. Trial registration NTR4224 (25 October 2013). Electronic supplementary material The online version of this article (10.1186/s12889-018-5975-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Corelien J J Kloek
- Tranzo, Tilburg University, Tilburg, the Netherlands. .,Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands. .,Department of Rehabilitation, Physiotherapy Sciences and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands. .,Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences and EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Dinny H de Bakker
- Tranzo, Tilburg University, Tilburg, the Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Daniël Bossen
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.,Department of Psychiatry Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Sciences and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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188
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Home exercise therapy to improve muscle strength and joint flexibility effectively treats pre-radiographic knee OA in community-dwelling elderly: a randomized controlled trial. Clin Rheumatol 2018; 38:133-141. [PMID: 30167975 PMCID: PMC6342874 DOI: 10.1007/s10067-018-4263-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 01/07/2023]
Abstract
To compare the efficacy and adherence rates of two parallel home exercise therapy programs—multiple exercise (training and stretching the knee and hip muscles) and control (training the quadriceps muscles)—on knee pain, physical function, and knee extension strength in community-dwelling elderly individuals with pre-radiographic knee osteoarthritis (OA). One hundred patients with medial knee pain were randomly allocated to one of two 4-week home exercise programs. Individuals with a Kellgren/Lawrence (K/L) grade 0 or 1 OA (pre-radiographic knee OA) in the medial compartment were enrolled. Primary outcomes were knee pain (visual analog scale), self-reported physical function (Japanese Knee Osteoarthritis Measure [JKOM]), and isometric maximum muscle strength of the knee extensor measured using a hand-held dynamometer. A total of 52 patients (28 [53.8%] in the multiple exercise group, 24 [46.2%] in the control group) completed the trial. The JKOM activities of daily living and general health conditions outcomes improved significantly in the multiple exercise group compared to the control group (JKOM activities of daily living, beta = − 0.76; 95% confidence interval [CI], − 1.39 to − 0.13; p = 0.01; JKOM general health conditions, beta = − 0.25; 95% CI, − 0.48 to − 0.01; p = 0.03). The home exercise compliance rates of the multiple exercise and control groups were 96.6 and 100%, respectively. When targeting pre-radiographic knee OA in community-dwelling elderly, it is important to implement home exercise programs that aim to improve muscle strength and joint flexibility rather than knee extension muscle power only.
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189
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Tanaka R, Hirohama K, Ozawa J. Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study. Braz J Phys Ther 2018; 23:266-272. [PMID: 30193850 DOI: 10.1016/j.bjpt.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis. METHODS This was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). RESULTS The chi-square values were not significant (chi-square=0.283, p=0.594), and the indices of goodness of fit were high, implying a valid model (GFI=1.000; AGFI=0.997; CFI=1.000; RMSEA=0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing. CONCLUSION The relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.
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Affiliation(s)
- Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
| | - Kenta Hirohama
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan
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190
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Mahmoudian A, Van Assche D, Herzog W, Luyten FP. Towards secondary prevention of early knee osteoarthritis. RMD Open 2018; 4:e000468. [PMID: 30167325 PMCID: PMC6109947 DOI: 10.1136/rmdopen-2017-000468] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 01/09/2023] Open
Abstract
Osteoarthritis (OA) of the knee is the most common arthritic disease, yet a convincing drug treatment is not available. The current narrative review focuses on integration of scientific evidence and professional experience to illustrate which management approaches can be taken for prototypical individual patient profiles with early knee OA. Animal models suggest that: (1) OA can progress even in the presence of fully recovered movement kinetics, kinematics and muscle activation patterns; (2) muscle weakness is an independent risk factor for the onset and possibly the rate of progression of knee OA; (3) onset and progression of OA are not related to body weight but appear to depend on the percentage of body fat. From studies in the human model, one could postulate that risk factors associated with progression of knee OA include genetic traits, preceding traumatic events, obesity, intensity of pain at baseline, static and dynamic joint malalignment and reduced muscle strength. Taken this into account, an individual can be identified as early knee OA at high risk for disease progression. A holistic patient-tailored management including education, supportive medication, weight loss, exercise therapy (aerobic, strengthening and neuromuscular) and behavioural approaches to improve self-management of early knee OA is discussed in individual prototypic patients. Secondary prevention of early knee OA provides a window of opportunity to slow down or even reverse the disease process. Yet, as the sheer number of patients early in the OA disease process is probably large, a more structured approach is needed to provide appropriate care depending on the patient's individual risk profile.
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Affiliation(s)
- Armaghan Mahmoudian
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Walter Herzog
- Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada
| | - Frank P Luyten
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
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191
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Suzuki Y, Iijima H, Tashiro Y, Kajiwara Y, Zeidan H, Shimoura K, Nishida Y, Bito T, Nakai K, Tatsumi M, Yoshimi S, Tsuboyama T, Aoyama T. Development of a questionnaire survey to evaluate lower limb function of patients with knee osteoarthritis. Clin Rheumatol 2018; 37:3115-3123. [PMID: 30091087 DOI: 10.1007/s10067-018-4229-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/12/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
This study aimed to develop a self-questionnaire index relevant to lower limb functional assessment reflecting clinical symptoms and activity restrictions associated with activities of daily living (ADL) for patients with knee osteoarthritis. This cross-sectional study enrolled patients with knee osteoarthritis (Kellgren/Lawrence grade ≥ 1). Participants evaluated clinical symptoms and activity restrictions using self-reported questionnaires. Radiographic evaluation, knee joint range of motion (ROM), and lower limb muscle strength were assessed. Associations between clinical symptoms, activity restrictions, and knee and hip joint function were evaluated using multiple and logistic regression analysis. Overall, 142 participants were included in the final analysis. Patients with knee pain while rising from a chair had lower knee and hip extension strength (knee extension β = - 0.28; 95% confidence interval (CI), - 0.41 to - 0.14; P < 0.0001; hip extension β = - 0.26; 95% CI, - 0.42 to - 0.08; P = 0.0034), and restricted knee extension ROM (odds ratio [OR] = 2.17; 95% CI, 1.02-4.63; P = 0.041). Patients with knee pain during stair climbing, turning or who were unable to stand on one leg without external support had reduced hip abduction muscle strength (β = - 0.17; 95% CI, - 0.27 to - 0.07; P = 0.0008). Patients with knee pain while rising from a chair or stepping showed more severe knee joint degeneration on radiographic evaluation (OR = 3.26; 95% CI, 1.11-10.91; P = 0.03). The self-questionnaire index reflected clinical symptoms and activity restrictions associated with ADL and was significantly associated with lower limb function in individuals with knee osteoarthritis.
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Affiliation(s)
- Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hala Zeidan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuichi Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsubasa Bito
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kengo Nakai
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masataka Tatsumi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Soyoka Yoshimi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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192
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Parsons TL, Bohm C, Poser K. "A Learned Soul to Guide Me": The Voices of Those Living with Kidney Disease Inform Physical Activity Programming. Physiother Can 2018; 70:289-295. [PMID: 30275654 DOI: 10.3138/ptc.2017-01.ep] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to (a) confirm the barriers to and facilitators of physical activity (PA) among persons living with chronic kidney disease (CKD) in Ontario and (b) inform the design of a Kidney Foundation of Canada Active Living for Life programme for persons living with CKD. Method: Adults living with CKD in Ontario were invited to participate in a cross-sectional survey investigating opinions about and needs for PA programming. The 32-item survey contained four sections: programme delivery preferences, current PA behaviour, determinants of PA, and demographics. Data were summarized using descriptive statistics and thematic coding. Results: A total of 63 respondents participated. They had a mean age of 56 (SD 16) years, were 50% female, and were 54% Caucasian; 66% had some post-secondary education. The most commonly reported total weekly PA was 90 minutes (range 0-1,050 minutes). Most respondents (84%) did not regularly perform strength training, and 73% reported having an interest in participating in a PA programme. Conclusion: Individuals living with CKD require resources to support and maintain a physically active lifestyle. We identified a diversity of needs, and they require a flexible and individualized inter-professional strategy that is responsive to the episodic changes in health status common in this population.
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Affiliation(s)
- Trisha L Parsons
- School of Rehabilitation Therapy, Queen's University, Kingston, Ont
| | - Clara Bohm
- Health Sciences Centre-Nephrology, Winnipeg, Man
| | - Katherine Poser
- School of Rehabilitation Therapy, Queen's University, Kingston, Ont
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Paterson KL, Hunter DJ, Metcalf BR, Eyles J, Duong V, Kazsa J, Wang Y, Buchbinder R, Cicuttini F, Forbes A, Harris A, Yu SP, Wang BH, Connell D, Linklater J, Bennell KL. Efficacy of intra-articular injections of platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis - the RESTORE trial protocol. BMC Musculoskelet Disord 2018; 19:272. [PMID: 30055602 PMCID: PMC6064619 DOI: 10.1186/s12891-018-2205-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background Knee osteoarthritis (OA) causes substantial pain, physical dysfunction and impaired quality of life. There is no cure for knee OA, and for some people, the disease may involve progressive symptomatic and structural deterioration over time. Platelet-rich plasma (PRP) is a therapeutic agent that aims to address underlying biological processes responsible for OA pathogenesis. As such, it has the potential to improve both symptoms and joint structure. The aim of this clinical trial is to determine whether a series of injections of PRP into the knee joint will lead to a significantly greater reduction in knee pain, and less loss of medial tibial cartilage volume over 12 months when compared to a series of placebo saline injections in people with knee OA. Methods This will be a two-group, superiority, randomised, participant-, interventionist- and assessor-blinded, placebo-controlled trial. Two hundred and eighty-eight participants aged over 50 years with painful knee OA and mild to moderate structural change on x-ray (Kellgren and Lawrence grade 2 and 3) will be randomly allocated to receive either three PRP injections or three normal saline injections into the knee joint at weekly intervals. The primary outcomes will be 12-month change in average overall knee pain severity (numeric rating scale) and medial tibial cartilage volume (magnetic resonance imaging (MRI)). Secondary outcomes include additional measures of knee pain and other symptoms, function in daily living and sport and recreation, quality of life, participant-perceived global ratings of change, and other MRI structural outcomes including meniscal and cartilage morphology, synovitis, effusion, bone marrow lesions and cartilage defects. A range of additional measures will be recorded, and a separate health economic evaluation will be performed. Discussion The findings from this study will help determine whether PRP improves both clinical and structural knee OA outcomes over 12 months when compared to a series of placebo saline injections. Trial registration Australian New Zealand Clinical Trials Registry reference: ACTRN12617000853347. Prospectively registered 9th of June 2017. Electronic supplementary material The online version of this article (10.1186/s12891-018-2205-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital Australia and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Ben R Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jillian Eyles
- Rheumatology Department, Royal North Shore Hospital Australia and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital Australia and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Jessica Kazsa
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Flavia Cicuttini
- Musculoskeletal Unit, Department of Epidemiology and Preventive Medicine, Monash University and Rheumatology Unit, Alfred Hospital, Melbourne, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Shirley P Yu
- Rheumatology Department, Royal North Shore Hospital Australia and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Bing Hui Wang
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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Kloek CJJ, Bossen D, Spreeuwenberg PM, Dekker J, de Bakker DH, Veenhof C. Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial. Phys Ther 2018; 98:560-570. [PMID: 29788253 PMCID: PMC6016690 DOI: 10.1093/ptj/pzy045] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. OBJECTIVE The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. DESIGN The design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial. SETTING The setting included 143 primary care physical therapist practices. PARTICIPANTS The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. INTERVENTION e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. MEASUREMENTS Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. RESULTS The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. LIMITATIONS The response rate at 12 months was 65%. CONCLUSIONS The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.
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Affiliation(s)
- Corelien J J Kloek
- Tranzo, Tilburg University, Tilburg, the Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands; Department of Rehabilitation, Physiotherapy Sciences and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht; and Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht,Address all correspondence to Ms Kloek at:
| | - Daniël Bossen
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | | | - Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam
| | - Dinny H de Bakker
- Tranzo, Tilburg University; and Netherlands Institute for Health Services Research (NIVEL)
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Sciences and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht; and Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht
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Darlow B, Brown M, Thompson B, Hudson B, Grainger R, McKinlay E, Abbott JH. Living with osteoarthritis is a balancing act: an exploration of patients' beliefs about knee pain. BMC Rheumatol 2018; 2:15. [PMID: 30886966 PMCID: PMC6390552 DOI: 10.1186/s41927-018-0023-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/24/2018] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to explore the beliefs of people with knee osteoarthritis (OA) about the disease, and how these beliefs had formed and what impact these beliefs had on activity participation, health behaviour, and self-management. Methods Semi-structured interviews were conducted with 13 people with knee OA recruited from general practices, community physiotherapy clinics, and public advertisements in two provinces of New Zealand. Data were analysed using Interpretive Description. Results Two key themes emerged. 1) Knowledge: certainty and uncertainty described participants’ strong beliefs about anatomical changes in their knee. Participants’ beliefs in a biomechanical model of progressive joint degradation often appeared to originate within clinical encounters and from literal interpretation of the term ‘wear and tear’. These beliefs led to uncertainty regarding interpretation of daily symptoms and participants’ ability to influence the rate of decline and certainty that joint replacement surgery represented the only effective solution to fix the damaged knee. 2) Living with OA described broader perspectives of living with OA and the perceived need to balance competing values and risks when making decisions about activity participation, medication, attentional focus, accessing care, and making the most of today without sabotaging tomorrow. Misunderstandings about knee OA negatively impacted on activity participation, health behaviours, and self-management decisions. Conclusion Biomechanical models of OA reduced participant exploration of management options and underpinned a perceived need to balance competing values. Improved information provision to people with knee OA could help guide positive health behaviour and self-management decisions and ensure these decisions are grounded in current evidence. Electronic supplementary material The online version of this article (10.1186/s41927-018-0023-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Darlow
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - Melanie Brown
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - Bronwyn Thompson
- 2Department Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Ben Hudson
- 3Department of General Practice, University of Otago - Christchurch, Christchurch, New Zealand
| | - Rebecca Grainger
- 4Department of Medicine, University of Otago - Wellington, Wellington, New Zealand
| | - Eileen McKinlay
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - J Haxby Abbott
- 5Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Abstract
Older adults 65 years of age and older compose a great portion of the US population. Physiologic changes of aging that limit function and general quality of life occur at a faster rate as we get older. There is high-quality evidence that exercise activity has many favorable benefits for older adults. The ideal exercise program in older adults should include aerobic, resistance, flexibility, and balance training. The exercise recommendations should be individually tailored to the abilities, precautions, and goals of each person. They also should be of sufficient intensity, volume, and duration in order to achieve maximal benefits.
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Affiliation(s)
- Juan Galloza
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 770030, USA
| | - Brenda Castillo
- Department of Physical Medicine and Rehabilitation, VA Caribbean Healthcare System, 10, Calle Casia, San Juan, PR 00921, USA
| | - William Micheo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, School of Medicine, University of Puerto Rico, Office A-204, PO Box 365067, San Juan, PR 00926, USA.
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198
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Dziedzic KS, Allen KD. Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care. Rheumatology (Oxford) 2018; 57:iv88-iv98. [PMID: 29684219 PMCID: PMC5905599 DOI: 10.1093/rheumatology/key062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Indexed: 12/20/2022] Open
Abstract
A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health management, complex interventions and outcomes. It sets this in the context of competing health priorities and multimorbidity, access to high quality conservative care, non-pharmacological therapies, resource limitations and models of care. The overuse of some therapies and neglect of others are discussed, as well as the potential for self-management. The roles of patient and public involvement and the healthcare team are highlighted in enhancing best care for OA and providing solutions for closing the evidence-to-practice gap. Implementation of models of care offer one solution to the challenges and progress of such implementation is described. Areas for further research are highlighted.
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Affiliation(s)
- Krysia S Dziedzic
- Institute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Veterans Affairs Health Care System, Center for Health Services Research in Primary Care, Durham, NC, USA
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Tuncer T, Cay FH, Altan L, Gurer G, Kacar C, Ozcakir S, Atik S, Ayhan F, Durmaz B, Eskiyurt N, Genc H, GokceKutsal Y, Gunaydin R, Hepguler S, Hizmetli S, Kaya T, Kurtais Y, Saridogan M, Sindel D, Sutbeyaz S, Sendur OF, Ugurlu H, Unlu Z. 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis. Rheumatol Int 2018; 38:1315-1331. [PMID: 29777340 DOI: 10.1007/s00296-018-4044-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/05/2018] [Indexed: 12/19/2022]
Abstract
In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.
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Affiliation(s)
- Tiraje Tuncer
- School Of Medicine, Physical Medicine Rehabilitation, Akdeniz University, Antalya, Turkey
| | - Fatih Hasan Cay
- Antalya Training and Research Hospital, Physical Medicine Rehabilitation and Rheumatology, University of Health Sciences, Antalya, Turkey.
| | - Lale Altan
- School of Medicine, Physical Medicine Rehabilitation, Uludağ University, Bursa, Turkey
| | - Gulcan Gurer
- School of Medicine, Physical Medicine Rehabilitation and Rheumatology, Adnan Menderes University, Aydın, Turkey
| | - Cahit Kacar
- School Of Medicine, Physical Medicine Rehabilitation and Rheumatology, Akdeniz University, Antalya, Turkey
| | - Suheda Ozcakir
- School of Medicine, Physical Medicine Rehabilitation, Uludağ University, Bursa, Turkey
| | - Sahap Atik
- School of Medicine, Orthopaedics and Traumatology, Gazi University, Ankara, Turkey
| | - Figen Ayhan
- Ankara Training and Research Hospital, Physical Medicine Rehabilitation, University Of Health Sciences, Ankara, Turkey
| | - Berrin Durmaz
- School of Medicine, Physical Medicine Rehabilitation, Ege University, Izmir, Turkey
| | - Nurten Eskiyurt
- Istanbul School of Medicine, Physical Medicine Rehabilitation (Retired), İstanbul University, Istanbul, Turkey
| | - Hakan Genc
- Ankara Training and Research Hospital, Physical Medicine Rehabilitation, University Of Health Sciences, Ankara, Turkey
| | - Yesim GokceKutsal
- School of Medicine, Physical Medicine Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Rezzan Gunaydin
- Physical Medicine Rehabilitation, Medical Park İzmir Hospital, Izmir, Turkey
| | - Simin Hepguler
- School of Medicine, Physical Medicine Rehabilitation, Ege University, Izmir, Turkey
| | - Sami Hizmetli
- School of Medicine, Physical Medicine Rehabilitation and Rheumatology Physical Medicine Rehabilitation, Cumhuriyet University, Sivas, Turkey
| | - Taciser Kaya
- Bozyaka Training and Research Hospital, Physical Medicine Rehabilitation, University of Health Sciences, Izmir, Turkey
| | - Yesim Kurtais
- School of Medicine, Physical Medicine Rehabilitation, Ankara University, Ankara, Turkey
| | - Merih Saridogan
- Cerrahpaşa School of Medicine, Physical Medicine Rehabilitation, İstanbul University, Istanbul, Turkey
| | - Dilsad Sindel
- İstanbul School of Medicine, Physical Medicine Rehabilitation, İstanbul University, Istanbul, Turkey
| | - Serap Sutbeyaz
- Kayseri Training and Research Hospital, Physical Medicine Rehabilitation, University of Health Sciences, Kayseri, Turkey
| | - Omer Faruk Sendur
- School of Medicine, Physical Medicine Rehabilitation, Adnan Menderes University, Aydın, Turkey
| | - Hatice Ugurlu
- School of Medicine, Physical Medicine Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Zeliha Unlu
- School of Medicine, Physical Medicine Rehabilitation, Celal Bayar University, Manisa, Turkey
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Keogh JW, Grigg J, Vertullo CJ. Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial. PeerJ 2018; 6:e4738. [PMID: 29761054 PMCID: PMC5949056 DOI: 10.7717/peerj.4738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA. Methods Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass). Results Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group. Discussion An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.
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Affiliation(s)
- Justin W Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Human Potential Centre, Auckland University of Technology, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Josephine Grigg
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Christopher J Vertullo
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Knee Research Australia, Gold Coast, QLD, Australia
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