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Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:439-447. [PMID: 29669488 DOI: 10.2519/jospt.2018.7877] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Osteoarthritis (OA) of the hip and knee is among the leading causes of global disability, highlighting the need for early, targeted, and effective treatment. The benefits of exercise therapy in people with hip and knee OA are substantial and supported by high-quality evidence, underlining that it should be part of first-line treatment in clinical practice. Furthermore, unlike other treatments for OA, such as analgesia and surgery, exercise therapy is not associated with risk of serious harm. Helping people with OA become more physically active, along with structured exercise therapy targeting symptoms and impairments, is crucial, considering that the majority of people with hip and knee OA do not meet physical activity recommendations. Osteoarthritis is associated with a range of chronic comorbidities, including type 2 diabetes, cardiovascular disease, and dementia, all of which are associated with chronic low-grade inflammation. Physical activity and exercise therapy not only improve symptoms and impairments of OA, but are also effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Patient education may be crucial to ensure long-term adherence and sustained positive effects on symptoms, impairments, physical activity levels, and comorbidities. J Orthop Sports Phys Ther 2018;48(6):439-447. Epub 18 Apr 2018. doi:10.2519/jospt.2018.7877.
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152
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Iijima H, Aoyama T, Fukutani N, Isho T, Yamamoto Y, Hiraoka M, Miyanobu K, Jinnouchi M, Kaneda E, Kuroki H, Matsuda S. Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study. BMC Psychol 2018; 6:19. [PMID: 29716654 PMCID: PMC5930799 DOI: 10.1186/s40359-018-0234-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 04/19/2018] [Indexed: 12/27/2022] Open
Abstract
Background Depressive symptoms are a major comorbidity in older adults with knee osteoarthritis (OA). However, the type of activity-induced knee pain associated with depression has not been examined. Furthermore, there is conflicting evidence regarding the association between depression and performance-based physical function. This study aimed to examine (i) the association between depressive symptoms and knee pain intensity, particularly task-specific knee pain during daily living, and (ii) the association between depressive symptoms and performance-based physical function, while considering other potential risk factors, including bilateral knee pain and ambulatory physical activity. Methods Patients in orthopaedic clinics (n = 95; age, 61–91 years; 67.4% female) who were diagnosed with radiographic knee OA (Kellgren/Lawrence [K/L] grade ≥ 1) underwent evaluation of psychological health using the Geriatric Depression Scale (GDS). Knee pain and physical function were assessed using the Japanese Knee Osteoarthritis Measure (JKOM), 10-m walk, timed up and go (TUG), and five-repetition chair stand tests. Results Ordinal logistic regression analysis showed that depression, defined as a GDS score ≥ 5 points, was significantly associated with a worse score on the JKOM pain-subcategory and a higher level of task-specific knee pain intensity during daily living, after being adjusted for age, sex, body mass index (BMI), K/L grade, and ambulatory physical activity. Furthermore, depression was significantly associated with a slower gait velocity and a longer TUG time, after adjusting for age, sex, BMI, K/L grade, presence of bilateral knee pain, and ambulatory physical activity. Conclusions These findings indicate that depression may be associated with increased knee pain intensity during daily living in a non-task-specific manner and is associated with functional limitation in patients with knee OA, even after controlling for covariates, including bilateral knee pain and ambulatory physical activity. Electronic supplementary material The online version of this article (10.1186/s40359-018-0234-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Japan Society for the Promotion of Science, Tokyo, Japan. .,Department of System Design Engineering, Keio University, Yokohama, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoto Fukutani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuya Isho
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Rehabilitation Center, Fujioka General Hospital, Gunma, Japan
| | | | | | | | | | - Eishi Kaneda
- Nozomi Orthopaedic Clinic, Hiroshima, Japan.,Nozomi Orthopaedic Clinic Studium, Hiroshima, Japan.,Nozomi Orthopaedic Clinic Hiroshima, Hiroshima, Japan
| | - Hiroshi Kuroki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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153
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Biomechanical characteristics of stair ambulation in patients with knee OA: A systematic review with meta-analysis toward a better definition of clinical hallmarks. Gait Posture 2018; 62:191-201. [PMID: 29558710 DOI: 10.1016/j.gaitpost.2018.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stair climbing was suggested to be the first affected task in individuals with knee osteoarthritis (OA). RESEARCH QUESTION This review aimed to identify consistent kinematic, kinetic, and spatiotemporal alterations of stair climbing exhibited by individuals with knee OA. METHODS A literature search published until September 2017 was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL. Reviewer extracted data in accordance with the Cochrane Handbook. Where possible, data were combined into a meta-analysis; the pooled standardized mean differences between individuals with knee OA and healthy adults were calculated using the random-effect model. RESULTS In total, 585 potentially relevant articles were selected, of which 12 (695 participants, mean age: 58.4 years) met the inclusion criteria. Meta-analysis revealed that kinematic and kinetic alterations during stair climbing associated with knee OA were lower external knee flexion moment in conjunction with a larger trunk/hip flexion angles and smaller knee flexion/ankle dorsiflexion angles. Individuals with knee OA showed a delayed quadriceps activation during stair ascent. A lack of evidence was detected for alterations in external knee adduction moment during stair climbing. Effect estimate in each meta-analysis was judged "very low" on the GRADE approach. SIGNIFICANCE No strong conclusion can be drawn because of the low quality of evidence; however, individuals with knee OA may exhibit altered kinematics and kinetics changes in sagittal plane during stair climbing, and have delayed quadriceps muscle activity. Further studies with adequate adjustment for confounders are warranted to facilitate clinical hallmarks of the knee OA, particularly in early stages of the disease.
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154
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Li LC, Sayre EC, Xie H, Falck RS, Best JR, Liu-Ambrose T, Grewal N, Hoens AM, Noonan G, Feehan LM. Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study. J Med Internet Res 2018; 20:e159. [PMID: 29712630 PMCID: PMC5952118 DOI: 10.2196/jmir.8514] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive. Objective We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis. Methods We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes. Results We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m2; delayed: mean 29.2, SD 4.8 kg/m2). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention. Conclusions Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management. Trial Registration ClinicalTrials.gov NCT02315664; https://clinicaltrials.gov/ct2/show/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC)
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Affiliation(s)
- Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | | | - Hui Xie
- Arthritis Research Canada, Richmond, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan S Falck
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - John R Best
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Navi Grewal
- Arthritis Research Canada, Richmond, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Greg Noonan
- Mary Pack Arthritis Program, Vancouver General Hospital, Vancouver, BC, Canada
| | - Lynne M Feehan
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
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155
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Valdes AM, Stocks J. Osteoarthritis and Ageing. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10313855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ageing is a complex process of accumulation of molecular, cellular, and organ damage, leading to loss of function and increased vulnerability to disease and death, the rate and extent of which varies among individuals. Osteoarthritis (OA) is not only the most common joint disease, but is also one of the major causes of disability in people aged >65 years and is accompanied by comorbid conditions, increased mortality, and decreased quality of life. One of the major risk factors for OA is ageing. However, OA itself may be involved in the biological ageing process. This is likely to be in part a direct involvement, by contributing levels of systemic inflammation and sharing molecular pathways with biological ageing, such as mitochondrial damage leading to cell senescence. Although OA is not considered an inflammatory form of arthritis, there is evidence of subclinical low-grade inflammation in the whole joint and inflammatory processes play a key role in the disease pathogenesis. For instance, there is synovial inflammation (e.g., following injury), mechanically derived inflammation present due to biomechanical overloading of a joint, and systemic inflammation resulting from obesity. Systemic inflammation is often associated with frailty, and having a high concentration of inflammatory markers is predictive of incident frailty, some of which are known to increase with age and correlate with pain. In addition, OA may also contribute indirectly to biological ageing via the disability and pain resulting from it. Further research into the exact process linking OA and biological ageing, including frailty, is needed.
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Affiliation(s)
- Ana M. Valdes
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joanne Stocks
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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156
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Sliepen M, Mauricio E, Lipperts M, Grimm B, Rosenbaum D. Objective assessment of physical activity and sedentary behaviour in knee osteoarthritis patients - beyond daily steps and total sedentary time. BMC Musculoskelet Disord 2018; 19:64. [PMID: 29471878 PMCID: PMC5824451 DOI: 10.1186/s12891-018-1980-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/15/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Knee osteoarthritis patients may become physically inactive due to pain and functional limitations. Whether physical activity exerts a protective or harmful effect depends on the frequency, intensity, time and type (F.I.T.T.). The F.I.T.T. dimensions should therefore be assessed during daily life, which so far has hardly been feasible. Furthermore, physical activity should be assessed within subgroups of patients, as they might experience different activity limitations. Therefore, this study aimed to objectively describe physical activity, by assessing the F.I.T.T. dimensions, and sedentary behaviour of knee osteoarthritis patients during daily life. An additional goal was to determine whether activity events, based on different types and durations of physical activity, were able to discriminate between subgroups of KOA patients based on risk factors. METHODS Clinically diagnosed knee osteoarthritis patients (according to American College of Rheumatology criteria) were monitored for 1 week with a tri-axial accelerometer. Furthermore, they performed three functional tests and completed the Knee Osteoarthritis Outcome Score. Physical activity levels were described for knee osteoarthritis patients and compared between subgroups. RESULTS Sixty-one patients performed 7303 mean level steps, 319 ascending and 312 descending steps and 601 bicycle crank revolutions per day. Most waking hours were spent sedentary (61%), with 4.6 bouts of long duration (> 30 min). Specific events, particularly ascending and descending stairs/slopes, brief walking and sedentary bouts and prolonged walking bouts, varied between subgroups. CONCLUSIONS From this sample of KOA patients, the most common form of activity was level walking, although cycling and stair climbing activities occurred frequently, highlighting the relevance of distinguishing between these types of PA. The total active time encompassed a small portion of their waking hours, as they spent most of their time sedentary, which was exacerbated by frequently occurring prolonged bouts. In this study, event-based parameters, such as stair climbing or short bouts of walking or sedentary time, were found more capable of discriminating between subgroups of KOA patients compared to overall levels of PA and sedentary time. Thereby, subtle limitations in physical behaviour of KOA-subgroups were revealed, which might ultimately be targeted in rehabilitation programs. TRIAL REGISTRATION German Clinical Trials Registry under ' DRKS00008735 ' at 02.12.2015.
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Affiliation(s)
- Maik Sliepen
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany
| | - Elsa Mauricio
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany
| | - Matthijs Lipperts
- AHORSE, Department of Orthopaedics, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - Bernd Grimm
- AHORSE, Department of Orthopaedics, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - Dieter Rosenbaum
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany
- Otto Bock Healthcare GmbH, Hermann-Rein-Str. 2a, 37075 Göttingen, Germany
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157
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial. Osteoarthritis Cartilage 2017; 25:1969-1979. [PMID: 28011099 DOI: 10.1016/j.joca.2016.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim was to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Secondary aims evaluated the effects on cardiovascular health, function and quality of life. DESIGN Participants with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity, or to usual care. The primary outcome was knee pain (0-10). Secondary outcomes were of cardiovascular risk including physical activity, blood pressure, blood lipid and glucose levels, body mass index and waist circumference; WOMAC Index scores; physical function; and quality of life. RESULTS Forty-six participants (23 each group) were recruited. Sixteen participants (70%) adhered to the walking program. Intention to treat analysis showed no between-group difference in knee pain. The walking group had increased odds of achieving a healthy systolic blood pressure (OR = 5.7, 95% CI 1.2-26.9), and a faster walking speed (Mean Difference (MD) = 0.12 m/s, 95% CI 0.02-0.23). Per protocol analysis based on participant adherence showed the walking group had more daily steps (MD = 1345 steps, 95% CI 365-2325); more time walking (MD = 18 min/day, 95% CI 5-31); reduced waist circumference (MD = -5.3 cm, 95% CI -10.5 to -0.03); and increased knee stiffness (MD = 0.9 units, 95% CI 0.07-1.8). CONCLUSIONS Patients with severe knee OA prescribed a 12-week walking program of 70 min/week may have had cardiovascular benefits without decreasing knee pain. Australian New Zealand Clinical Trials Registry ACTRN12615000015549.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Monash and Deakin University, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Monash University, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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158
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. Perceptions about participation in a 12-week walking program for people with severe knee osteoarthritis: a qualitative analysis. Disabil Rehabil 2017; 41:779-785. [DOI: 10.1080/09638288.2017.1408710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jason A. Wallis
- School of Allied Health, La Trobe University, Melbourne, Australia
- Department of Physiotherapy, Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Pazit Levinger
- School of Allied Health, La Trobe University, Melbourne, Australia
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Parminder J. Singh
- Department of Orthopaedics, Eastern Health and Monash University, Melbourne, Australia
| | - Chris Fong
- Department of Rheumatology, Eastern Health and Monash University, Melbourne, Australia
| | - Nicholas F. Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia
- Department of Physiotherapy, Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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159
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Veronese N, Stubbs B, Solmi M, Smith TO, Noale M, Schofield P, Maggi S. Knee Osteoarthritis and Risk of Hypertension: A Longitudinal Cohort Study. Rejuvenation Res 2017. [PMID: 28648126 DOI: 10.1089/rej.2017.1917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although previous research has indicated an association between osteoarthritis (OA) and cardiovascular disease, it remains unclear whether people with OA are at greater risk of developing hypertension. The aim of this study was to answer this uncertainity. We used the data of the Osteoarthritis Initiative, an ongoing public and private longitudinal study including people at higher risk of OA or having knee OA. Knee OA was defined through radiological and clinical assessment. Incident hypertension was defined as a systolic blood pressure ≥140 mmHg and/or a diastolic value ≥90 mmHg. Multivariate Cox's regression analyses were constructed considering the presence of knee OA as the exposure and incident hypertension as the outcome during a 96-month follow-up interval. A total of 3558 people with normative blood pressure values at baseline were analyzed (1930 OA/1628 controls). Incidence of hypertension within the follow-up interval was significantly higher in people with knee OA than in those without (60/[1000 person-years] vs. 55/[1000 person-years]; p < 0.0001). After adjusting for 13 confounders, people with knee OA had a 13% higher chance of developing hypertension (hazard ratio = 1.13; 95% confidence interval: 1.01-1.26; p = 0.03). Propensity score analysis did not alter these conclusions. In conclusion, this is the first longitudinal data analysis to demonstrate that people with knee OA have a higher chance of developing hypertension than those without OA. Our data suggest that monitoring blood pressure and prescribing health promotion interventions may be warranted among people with OA to mitigate the potential onset and adverse consequences of hypertension.
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Affiliation(s)
- Nicola Veronese
- 1 National Research Council, Neuroscience Institute , Aging Branch, Padova, Italy .,2 Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, National Relevance and High Specialization Hospital , Genova, Italy
| | - Brendon Stubbs
- 3 Physiotherapy Department, South London and Maudsley NHS Foundation Trust , London, United Kingdom .,4 Health Service and Population Research Department, Institute of Psychiatry , King's College London, London, United Kingdom .,5 Faculty of Health, Social Care and Education, Anglia Ruskin University , Chelmsford, United Kingdom
| | - Marco Solmi
- 2 Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, National Relevance and High Specialization Hospital , Genova, Italy .,6 Department of Neurosciences, University of Padova , Padova, Italy .,7 National Health Care System , Padua, Italy
| | - Toby O Smith
- 8 Faculty of Medicine and Health Sciences, University of East Anglia , Norwich Research Park, Norwich, United Kingdom
| | - Marianna Noale
- 1 National Research Council, Neuroscience Institute , Aging Branch, Padova, Italy
| | - Patricia Schofield
- 5 Faculty of Health, Social Care and Education, Anglia Ruskin University , Chelmsford, United Kingdom
| | - Stefania Maggi
- 1 National Research Council, Neuroscience Institute , Aging Branch, Padova, Italy
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160
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Duarte N, Rodrigues AM, Branco JDC, Canhão H, Hughes SL, Paúl C. Health and Lifestyles Factors Associated With Osteoarthritis among Older Adults in Portugal. Front Med (Lausanne) 2017; 4:192. [PMID: 29167793 PMCID: PMC5682311 DOI: 10.3389/fmed.2017.00192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health, and osteoarthritis (OA), among older adults. METHODS A sample of 1,645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population-based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease, and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. OA (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria. RESULTS 1,059 participants (64.9%) met the OA classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression, and anxiety. In the unadjusted logistic regression models, all variables were associated with OA. The final adjusted model explained 32% of the variance. Those who are female with higher age, have more than five comorbidities, and lower levels of function and physical activity were more likely to meet the criteria for a diagnosis of OA. DISCUSSION We have analyzed data from a population-based study and found that a diagnosis of OA was independently associated with age, female gender, higher number of comorbidities, physical disability, and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.
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Affiliation(s)
- Natália Duarte
- Research Unit on Ageing, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Porto, Porto, Portugal
| | - Ana Maria Rodrigues
- EpiReumaPt Study Group—Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
- EpiDoc Unit—Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jaime Da Cunha Branco
- EpiReumaPt Study Group—Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Helena Canhão
- EpiReumaPt Study Group—Centro de Estudos de Doenças Crónicas (CEDOC), EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Escola Nacional de Saúde Publica, Universidade Nova de Lisboa, Sociedade Portuguesa de Reumatologia, Serviço de Reumatologia do Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN-EPE), Lisboa, Portugal
| | - Susan L. Hughes
- Community Health Sciences, School of Public Health, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL, United States
| | - Constança Paúl
- Research Unit on Ageing, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Porto, Porto, Portugal
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Sliepen M, Brandes M, Rosenbaum D. Current Physical Activity Monitors in Hip and Knee Osteoarthritis: A Review. Arthritis Care Res (Hoboken) 2017; 69:1460-1466. [PMID: 27998033 PMCID: PMC5656924 DOI: 10.1002/acr.23170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/13/2022]
Affiliation(s)
| | - Mirko Brandes
- Leibniz-Institut fur Praventionsforschung und Epidemiologie, Bremen, Germany
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162
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Quicke JG, Foster NE, Ogollah RO, Croft PR, Holden MA. Relationship Between Attitudes and Beliefs and Physical Activity in Older Adults With Knee Pain: Secondary Analysis of a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 69:1192-1200. [PMID: 27696795 PMCID: PMC5601293 DOI: 10.1002/acr.23104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/19/2016] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate how attitudes and beliefs about exercise relate to physical activity behavior in older adults with knee pain attributable to osteoarthritis (OA). METHODS We conducted secondary data analyses of a randomized controlled trial of exercise interventions (ISRCTN: 93634563). Participants were adults ≥45 years old with knee pain attributable to OA (n = 514). Crude and adjusted cross-sectional and longitudinal associations between baseline Self-Efficacy for Exercise (SEE), Positive Outcome Expectations for Exercise (POEE), Negative Outcome Expectations for Exercise scores, and physical activity level, at baseline, 3 months, and 6 months (measured by self-report using the Physical Activity Scale for the Elderly [PASE]), and important increases in physical activity level (from baseline to 6-month followup) were investigated using multiple linear and logistic regression. RESULTS Cross-sectional associations were found between SEE and PASE scores (β = 4.14 [95% confidence interval (95% CI) 0.26, 8.03]) and POEE and PASE scores (β = 16.71 [95% CI 1.87, 31.55]), adjusted for sociodemographic and clinical covariates. Longitudinal associations were found between baseline SEE and PASE scores at 3 months (β = 4.95 [95% CI 1.02, 8.87]) and 6 months β = 3.71 (0.26, 7.16), and baseline POEE and PASE at 3 months (β = 34.55 [95% CI 20.13, 48.97]) and 6 months (β = 25.74 [95% CI 11.99, 39.49]), adjusted for baseline PASE score and intervention arm. However, no significant associations with important increases in physical activity level were found. CONCLUSION Greater exercise self-efficacy and more positive exercise outcome expectations were associated with higher current and future physical activity levels. These may be targets for interventions aimed at increasing physical activity.
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Affiliation(s)
- Jonathan G Quicke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Reuben O Ogollah
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Peter R Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Melanie A Holden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
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163
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Mantoani LC, Dell'Era S, MacNee W, Rabinovich RA. Physical activity in patients with COPD: the impact of comorbidities. Expert Rev Respir Med 2017; 11:685-698. [PMID: 28699821 DOI: 10.1080/17476348.2017.1354699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD) and it plays an important role on physical activity (PA) in this population. Since low PA levels have been described as a key factor to predict morbi-mortality in COPD, it seems crucial to review the current literature available on this topic. Areas covered: This review covers the most common comorbidities found in COPD, their prevalence and prognostic implications. We explore the differences in PA between COPD patients with and without comorbidities, as well as the impact of the number or type of comorbidities on activity levels of this population. The effect of different comorbidities on activities of daily living in patients with COPD is also reviewed. Finally, we discuss options for the treatment of inactivity in COPD patients considering their comorbidities and limitations. Expert commentary: Comorbidities are highly prevalent in patients with COPD and further deteriorate PA levels in this population. Despite the wide range of interventions available in COPD, the evidence in the field seems to point at PA coaching with feedback on individual goals and longer lasting PR programmes with more than 12 weeks of duration when attempting to raise the activity levels of this population.
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Affiliation(s)
- Leandro Cruz Mantoani
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Silvina Dell'Era
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK.,b Sección de Rehabilitación y Cuidados Respiratorios, Servicio de Kinesiología, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - William MacNee
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Roberto A Rabinovich
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
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164
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Relationship Between Pedometer-Based Physical Activity and Physical Function in Patients With Osteoarthritis of the Knee: A Cross-Sectional Study. Arch Phys Med Rehabil 2017; 98:1382-1388.e4. [DOI: 10.1016/j.apmr.2016.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 11/20/2022]
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165
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Li LC, Sayre EC, Xie H, Clayton C, Feehan LM. A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study. JMIR Mhealth Uhealth 2017; 5:e86. [PMID: 28652228 PMCID: PMC5504340 DOI: 10.2196/mhealth.7863] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 01/02/2023] Open
Abstract
Background Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA. Methods We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. Results We identified 46 eligible individuals; of those, 34 (74%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. Conclusions This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA. Trial Registration ClinicalTrials.gov NCT02313506; https://clinicaltrials.gov/ct2/show/NCT02313506 (Archived by WebCite at http://www.webcitation.org/6r4P3Bub0)
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Affiliation(s)
- Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | | | - Hui Xie
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Cam Clayton
- Arthritis Research Canada, Richmond, BC, Canada
| | - Lynne M Feehan
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Program, Fraser Health, Surrey, BC, Canada
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166
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Zadro JR, Shirley D, Amorim A, Pérez-Riquelme F, Ordoñana JR, Ferreira PH. Are people with chronic low back pain meeting the physical activity guidelines? A co-twin control study. Spine J 2017; 17:845-854. [PMID: 28163210 DOI: 10.1016/j.spinee.2017.01.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/20/2016] [Accepted: 01/30/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite a large amount of research investigating physical activity (PA) levels in people with chronic low back pain (LBP), no study has investigated whether people with chronic LBP are meeting the World Health Organization (WHO) PA guidelines. Furthermore, with genetics and the early shared environment substantially influencing the presence of LBP and PA engagement, these factors could confound the association between LBP and PA and need to be controlled for. PURPOSE This study aimed to investigate the association between chronic LBP and meeting the PA guidelines, while controlling for the effects of genetics and early shared environment. DESIGN This is a cross-sectional co-twin control study. PATIENT SAMPLE A cross-sectional analysis was performed on 1,588 twins from the Murcia Twin Registry in Spain with available data on LBP and PA from the 2013 data collection wave. OUTCOME MEASURES The exposure and outcome variables in our study were self-reported. Twins reporting a history of chronic LBP were asked follow-up questions to inform on the presence of recent LBP (within the past 4 weeks), previous LBP (no pain within the past 4 weeks), and persistent LBP (no pain-free month in the last 6 months). These were our exposure variables. Our outcome variable was meeting the WHO PA guidelines, which involved at least 75 minutes of vigorous-intensity PA, or at least 150 minutes of moderate-intensity PA per week. METHODS To investigate the association between chronic LBP and meeting the PA guidelines, we first performed a multivariate logistic regression on the total sample of twins. Co-variables entered the model if the univariate association between the co-variable, and both the exposure and the outcome reached a significance of p<.2. Second, to adjust for the influence of genetics and early shared environment, we performed a conditional multivariate logistic regression on complete twin pairs discordant for LBP. The Murcia Twin Registry is supported by Fundación Séneca, Regional Agency for Science and Technology, Murcia, Spain (08633/PHCS/08 and 15302/PHCS/10) and the Ministry of Science and Innovation, Spain (PSI11560-2009). Funding for this project has also been received from Fundación MAPFRE (2012). The authors declare that there are no conflicts of interest. RESULTS There was a significant inverse association between recent LBP and meeting the PA guidelines (odds ratio [OR]=0.71, p=.034). When controlling for genetics and early shared environment, this association disappeared. There was no association between previous (OR=0.95, p=.779) or persistent LBP (OR=0.78, p=.192) and meeting the PA guidelines. CONCLUSION Twins with recent LBP are less likely to meet the PA guidelines than those with no history of chronic LBP, highlighting the importance of incorporating PA promotion in the treatment of these individuals. Genetics and early shared environment appear to be confounding the association between LBP and PA, although this needs to be further tested in larger twin samples.
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Affiliation(s)
- Joshua Robert Zadro
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, New South Wales, 2141, Australia.
| | - Debra Shirley
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, New South Wales, 2141, Australia
| | - Anita Amorim
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, New South Wales, 2141, Australia
| | - Francisco Pérez-Riquelme
- Murcia Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; Murcia Institute for Biomedical Research, IMIB-Arrixaca, HCUVA Virgen de la Arrixaca, 30120, Murcia, Spain
| | - Juan R Ordoñana
- Murcia Institute for Biomedical Research, IMIB-Arrixaca, HCUVA Virgen de la Arrixaca, 30120, Murcia, Spain; Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, New South Wales, 2141, Australia
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167
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Pinto AJ, Roschel H, de Sá Pinto AL, Lima FR, Pereira RMR, Silva CA, Bonfá E, Gualano B. Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases? Autoimmun Rev 2017; 16:667-674. [PMID: 28479487 DOI: 10.1016/j.autrev.2017.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/17/2022]
Abstract
This review aims to (1) summarize the estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases; (2) describe the relationship between physical (in)activity levels and disease-related outcomes; (3) contextualize the estimates and impact of physical inactivity and sedentary behavior in autoimmune diseases compared to other rheumatic diseases and chronic conditions; and (4) discuss scientific perspectives around this theme and potential clinical interventions to attenuate these preventable risk factors. We compiled evidence to show that estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases are generally comparable to other rheumatic diseases as well as to other chronic conditions (e.g., type 2 diabetes, cardiovascular diseases, and obesity), in which a lack of physical activity and excess of sedentary behavior are well-known predictors of morbimortality. In addition, we also showed evidence that both physical inactivity and sedentary behavior may be associated with poor health-related outcomes (e.g., worse disease symptoms and low functionality) in autoimmune rheumatic diseases. Thus, putting into practice interventions to make the patients "sit less and move more", particularly light-intensity activities and/or breaking-up sedentary time, is a simple and prudent therapeutic approach to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases.
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Affiliation(s)
- Ana Jéssica Pinto
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Ana Lúcia de Sá Pinto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Fernanda Rodrigues Lima
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Clovis Artur Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Eloisa Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
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168
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Veronese N, Stubbs B, Solmi M, Smith TO, Noale M, Cooper C, Maggi S. Association between lower limb osteoarthritis and incidence of depressive symptoms: data from the osteoarthritis initiative. Age Ageing 2017; 46:470-476. [PMID: 27932358 DOI: 10.1093/ageing/afw216] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 01/08/2023] Open
Abstract
Background osteoarthritis (OA) is associated with a number of medical morbidities. Although the prevalence of depression and depressive symptoms is presumed to be high in people with OA, no prospective comparative study has analyzed its incidence. Objective to determine whether OA was associated with an increased odds of developing depressive symptoms. Design longitudinal cohort study (follow-up: 4.2 years). Setting data were gathered from the North American Osteoarthritis Initiative (OAI) dataset. Subjects people at higher risk developing OA. Methods OA diagnosis was defined as the presence of OA at hand, knee, hip, back/neck or other sites at baseline. Depressive symptoms were defined using the 20-item Center for Epidemiologic Studies-Depression (cut-off 16 points) after 4 years. Results a total of 3,491 people without depressive symptoms at baseline were analyzed (1,506 with OA/1,985 without). Using an adjusted logistic regression analysis for 12 potential confounders, people with OA had a similar odds of depressive symptoms at follow-up compared to those without OA (odds ratio (OR): 1.26; 95% confidence of interval (CI): 0.95-1.67). However, multi-site OA (i.e. OA ≥2 sites; OR: 1.48, 95% CI: 1.07-2.05) and the specific presence of hip (OR: 1.72; 95% CI: 1.08-2.73) or knee OA (OR: 1.43; 95% CI: 1.03-1.98) were associated with a greater odds of developing depressive symptoms compared to people without OA. Conclusions this is the first study of longitudinal data to demonstrate people with multi-site, hip or knee OA have a greater odds of developing depressive symptoms compared to people without OA. This suggests that OA may be associated with future mental health burden.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8 AF, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK
| | - Marco Solmi
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
- Department of Neurosciences, University of Padova, Padova, Italy
- National Health Care System, Padua Local Unit ULSS 17, Italy
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Cyrus Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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169
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Hinman RS, Lawford BJ, Campbell PK, Briggs AM, Gale J, Bills C, French SD, Kasza J, Forbes A, Harris A, Bunker SJ, Delany CM, Bennell KL. Telephone-Delivered Exercise Advice and Behavior Change Support by Physical Therapists for People with Knee Osteoarthritis: Protocol for the Telecare Randomized Controlled Trial. Phys Ther 2017; 97:524-536. [PMID: 28339847 DOI: 10.1093/ptj/pzx021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/26/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Exercise and physical activity are a core component of knee osteoarthritis (OA) care, yet access to physical therapists is limited for many people. Telephone service delivery models may increase access. OBJECTIVE Determine the effectiveness of incorporating exercise advice and behavior change support by physical therapists into an existing Australian nurse-led musculoskeletal telephone service for adults with knee OA. DESIGN Randomized controlled trial with nested qualitative studies. SETTING Community, Australia-wide. PARTICIPANTS One hundred seventy-five people ≥45 years of age with knee symptoms consistent with a clinical diagnosis of knee OA. Eight musculoskeletal physical therapists will provide exercise advice and support. INTERVENTION Random allocation to receive existing care or exercise advice in addition to existing care. Existing care is a minimum of one phone call from a nurse for advice on OA self-management. Exercise advice involves 5-10 calls over 6 months from a physical therapist trained in behavior change support to prescribe, monitor, and progress a strengthening exercise program and physical activity plan. MEASUREMENTS Outcomes will be measured at baseline and at 6 and 12 months. Primary outcomes are knee pain and physical function. Secondary outcomes include other measures of knee pain, self-efficacy, physical activity and its mediators, kinesiophobia, health service usage, work productivity, participant-perceived change, and satisfaction. Additional measures include adherence, adverse events, therapeutic alliance, satisfaction with telephone-delivered therapy, and expectation of outcome. Semi-structured interviews with participants with knee OA and therapists will be conducted. LIMITATIONS Physical therapists cannot be blinded. CONCLUSIONS This study will determine if incorporating exercise advice and behavior change support by physical therapists into a nurse-led musculoskeletal telephone service improves outcomes for people with knee OA. Findings will inform development and implementation of telerehabilitation services.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Carlton, Victoria 3010, Australia
| | - Belinda J Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne
| | - Penny K Campbell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Janette Gale
- HealthChange Australia, Sydney, North South Wales, Australia
| | | | - Simon D French
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health
| | | | - Stephen J Bunker
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and Medibank, Melbourne, Victoria, Australia
| | - Clare M Delany
- Department of Medical Education, The University of Melbourne
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne
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170
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Marszalek J, Price LL, Harvey WF, Driban JB, Wang C. Outcome Expectations and Osteoarthritis: Association of Perceived Benefits of Exercise With Self-Efficacy and Depression. Arthritis Care Res (Hoboken) 2017; 69:491-498. [PMID: 27390257 PMCID: PMC5219866 DOI: 10.1002/acr.22969] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/31/2016] [Accepted: 06/21/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Outcome expectancy is recognized as a determinant of exercise engagement and adherence. However, little is known about which factors influence outcome expectations for exercise among people with knee osteoarthritis (OA). This is the first study to examine the association of outcome expectations for exercise with demographic, physical, and psychosocial outcomes in individuals with knee OA. METHODS We performed a cross-sectional analysis of the baseline data from a randomized trial of tai chi versus physical therapy in participants with symptomatic knee OA. Knee pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome expectations for exercise, self-efficacy, depression, anxiety, stress, and social support were measured using standard instruments. Logistic regression models were utilized to determine associations with outcome expectations. RESULTS There were 262 participants, with a mean age of 59.8 years and a mean body mass index of 32.1 kg/m2 ; 69.1% of the participants were female, 51.5% were white, the mean disease duration was 8.6 years, and the mean WOMAC knee pain and function scores were 260.8 and 906.8, respectively. Higher outcome expectations for exercise were associated with greater self-efficacy (odds ratio [OR] 1.25 [95% confidence interval (95% CI) 1.11-1.41]; P = 0.0004), as well as with fewer depressive symptoms (OR 0.84 for each 5-point increase [95% CI 0.73-0.97]; P = 0.01). Outcome expectancy was not significantly associated with sex, race, education, pain, function, radiographic severity, social support, anxiety, or stress. CONCLUSION Our results suggest significant associations between outcome expectations for exercise and self-efficacy and depression. Future studies should examine how these relationships longitudinally affect long-term clinical outcomes of exercise-based treatment for knee OA.
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Affiliation(s)
- Jolanta Marszalek
- Center for Integrative Medicine & Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, United States
| | - William F. Harvey
- Center for Integrative Medicine & Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Jeffrey B. Driban
- Center for Integrative Medicine & Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Chenchen Wang
- Center for Integrative Medicine & Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
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Abstract
Wearable sensors, in particular inertial measurement units (IMUs) allow the objective, valid, discriminative and responsive assessment of physical function during functional tests such as gait, stair climbing or sit-to-stand. Applied to various body segments, precise capture of time-to-task achievement, spatiotemporal gait and kinematic parameters of demanding tests or specific to an affected limb are the most used measures. In activity monitoring (AM), accelerometry has mainly been used to derive energy expenditure or general health related parameters such as total step counts. In orthopaedics and the elderly, counting specific events such as stairs or high intensity activities were clinimetrically most powerful; as were qualitative parameters at the ‘micro-level’ of activity such as step frequency or sit-stand duration. Low cost and ease of use allow routine clinical application but with many options for sensors, algorithms, test and parameter definitions, choice and comparability remain difficult, calling for consensus or standardisation.
Cite this article: Grimm B, Bolink S. Evaluating physical function and activity in the elderly patient using wearable motion sensors. EFORT Open Rev 2016;1:112–120. DOI: 10.1302/2058-5241.1.160022.
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Affiliation(s)
- Bernd Grimm
- AHORSE Research Foundation, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Stijn Bolink
- AHORSE Research Foundation, Zuyderland Medical Center, Heerlen, The Netherlands
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172
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Zhaoyang R, Martire LM, Sliwinski MJ. Morning self-efficacy predicts physical activity throughout the day in knee osteoarthritis. Health Psychol 2017; 36:568-576. [PMID: 28277696 DOI: 10.1037/hea0000479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the within-day and cross-day prospective effects of knee osteoarthritis (OA) patients' self-efficacy to engage in physical activity despite the pain on their subsequent physical activity assessed objectively in their natural environment. METHOD Over 22 days, 135 older adults with knee OA reported their morning self-efficacy for being physically active throughout the day using a handheld computer and wore an accelerometer to measure moderate activity and steps. RESULTS Morning self-efficacy had a significant positive effect on steps and moderate-intensity activity throughout that day, above and beyond the effects of demographic background and other psychosocial factors as well as spouses' support and social control. The lagged effect of morning self-efficacy on the next day's physical activity and the reciprocal lagged effect of physical activity on the next day's self-efficacy were not significant. Positive between-person effects of self-efficacy on physical activity were found. CONCLUSIONS Future research should aim to better understand the mechanisms underlying fluctuations in patients' daily self-efficacy, and target patients' daily self-efficacy as a modifiable psychological mechanism for promoting physical activity. (PsycINFO Database Record
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173
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Birch S, Lee MS, Robinson N, Alraek T. The U.K. NICE 2014 Guidelines for Osteoarthritis of the Knee: Lessons Learned in a Narrative Review Addressing Inadvertent Limitations and Bias. J Altern Complement Med 2017; 23:242-246. [PMID: 28394671 DOI: 10.1089/acm.2016.0385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several systematic reviews suggest that acupuncture is effective for knee osteoarthritis (OA), and furthermore a safe and cost-effective treatment for this condition. A recent clinical practice guideline (CPG) from the National Institute for Health and Care Excellence (NICE), in the United Kingdom, recommended against the use of acupuncture on the grounds that the effect size (ES) in comparison with sham acupuncture is too small. Safety data were not considered in the review, in addition the levels of evidence for acupuncture against other recommended therapies were not compared. Consequently, it is argued that this NICE guideline has limitations that lead to several potential biases in its evaluation of acupuncture, which were not addressed correctly: (1) NICE's prior scoping process limited its review. (2) NICE introduced the method of developing recommendations based on the consideration of which interventions make "minimal important differences" of an ES of 0.5 or greater, rather than the statistical significance of the effect of an intervention when compared with an appropriate comparison. (3) Evidence that sham acupuncture is not physiologically inert and has some level of beneficial effect, hence artificially reducing the magnitude of the ES in comparison with sham. (4) The low adverse effects profile of acupuncture. (5) Evidence from trials comparing acupuncture with usual or standard care was not considered, nor was cost-effectiveness data. (6) Lack of the usual CPG "head-to-head" comparisons between interventions. If the same criteria and methods that have been applied to acupuncture were applied to other NICE-recommended therapies for knee OA, including patient centeredness, patient education, self-management and weight loss, nonsteroidal anti-inflammatory drug (NSAIDs), and cyclooxygenase-2 inhibitor (COX-2 inhibitors), these too would no longer be recommended and opiates would become the first line of drug prescription. Given the problems with sham acupuncture, perhaps now is the time to embrace pragmatic studies and employ comparative effectiveness studies instead.
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Affiliation(s)
- Stephen Birch
- 1 Kristiania University College , Institute of Health Sciences, Oslo, Norway
| | - Myeong Soo Lee
- 2 Korea Institute of Oriental Medicine , Daejeon, Republic of Korea.,3 Allied Health Sciences, London South Bank University , London, United Kingdom
| | - Nicola Robinson
- 3 Allied Health Sciences, London South Bank University , London, United Kingdom
| | - Terje Alraek
- 1 Kristiania University College , Institute of Health Sciences, Oslo, Norway .,4 National Research Centre in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Medicine, UiT The Arctic University of Norway , Tromso, Norway
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174
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Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord 2017; 18:72. [PMID: 28173795 PMCID: PMC5297181 DOI: 10.1186/s12891-017-1439-y] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/31/2017] [Indexed: 02/04/2023] Open
Abstract
Background The uptake of evidence-based guidelines in clinical practice is suboptimal in osteoarthritis (OA) and other chronic diseases. Good Life with osteoArthritis in Denmark (GLA:D) was launched in 2013 with the aim of implementing guidelines for the treatment of knee and hip OA in clinical care nationwide. The purpose of this report was to evaluate the effects of the GLA:D intervention from 2013 to 2015, using data from the national GLA:D registry. Methods Patients undergo education and supervised exercise delivered by trained physiotherapists. Outcomes evaluated at baseline, 3 and 12 months are pain intensity (0 to 100, best to worst), objective physical function (30-s chair-stand test and 40-m fast-paced walk test), physical activity (number of days per week being physically active for at least 30 min), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale, 0–100, worst to best), number of patients on painkillers and sick leave, and access to care according to guidelines. Results Data from 9,825 participants from the GLA:D registry were utilised in the analyses. It was demonstrated that GLA:D improved pain intensity and quality of life by 12.4 points and 5.4 points at 3 months, and 13.7 points and 9.4 points at 12 months, respectively. Furthermore, physical function and physical activity improved (only at 3 months), fewer patients took painkillers following the treatment, and fewer patients were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D. GLA:D is offered in all five health care regions in Denmark via 286 active GLA:D units, but the uptake in the Danish municipalities is still low with only 20% of the municipalities offering GLA:D. Conclusion Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave. The lifestyle changes introduced by education and supervised exercise were largely maintained at 1 year and may have the potential to also improve general health and reduce societal costs.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, DK-5230, Odense M, Denmark. .,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, 4200, Slagelse, Region Zealand, Denmark.
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, DK-5230, Odense M, Denmark
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175
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Abstract
Synopsis Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. J Orthop Sports Phys Ther 2017;47(2):67-79. doi:10.2519/jospt.2017.7286.
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Kanavaki AM, Rushton A, Klocke R, Abhishek A, Duda JL. Barriers and facilitators to physical activity in people with hip or knee osteoarthritis: protocol for a systematic review of qualitative evidence. BMJ Open 2016; 6:e012049. [PMID: 27810971 PMCID: PMC5128852 DOI: 10.1136/bmjopen-2016-012049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION This protocol aims to describe the objective and methods to be followed in a systematic review of qualitative studies on barriers and facilitators to physical activity (PA) in people with hip or knee osteoarthritis (OA). METHODS AND ANALYSIS MEDLINE, EMBASE, PhychINFO, Web of Science, CINAHL, SPORTDiscus, Scopus and grey literature sources will be electronically searched. Hand search of qualitative research-centred journals, reference screening of relevant reviews and inquiries to researchers active in the field will complement the search. Studies will be selected if they apply qualitative or mixed-methods designs to directly explore factors that correspond to engagement in PA/exercise or, the perceptions regarding PA/exercise in people with hip or knee OA. The Critical Appraisal Skills Programme Qualitative Checklist and the evaluative criteria of credibility, transferability, dependability and confirmability will be applied for the study appraisal. 2 independent reviewers will perform the search, study selection and study appraisal. Thematic synthesis will be used for synthesising the findings of the primary studies and the process and product of the synthesis will be checked by a second researcher. ConQual approach will be used for assessing the confidence in the qualitative findings. ETHICS AND DISSEMINATION This systematic review will inform our understanding of the PA determinants and how to optimise behaviour change in people living with hip or knee OA. The review findings will be reported in a peer-reviewed journal and presented at national or international conferences. The study raises no ethical issues. TRIAL REGISTRATION NUMBER CRD42016030024.
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Affiliation(s)
- Archontissa M Kanavaki
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Rainer Klocke
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Abhishek Abhishek
- Faculty of Medicine and Health Sciences, Academic Rheumatology Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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177
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Luna IE, Peterson B, Kehlet H, Aasvang EK. Individualized assessment of post-arthroplasty recovery by actigraphy: a methodology study. J Clin Monit Comput 2016; 31:1283-1287. [DOI: 10.1007/s10877-016-9952-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/26/2016] [Indexed: 01/25/2023]
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178
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Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2016; 46:629-39. [PMID: 27374011 DOI: 10.2519/jospt.2016.6618] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review with meta-analysis. Background A complete understanding of impairments associated with knee osteoarthritis would optimize exercise interventions for people with knee osteoarthritis. Our current understanding of hip strength deficits in this population is based on studies with conflicting findings and small samples. There is a need to systematically review and pool current evidence. Objectives To determine whether hip strength deficits exist in people with symptomatic knee osteoarthritis. Methods Electronic databases (MEDLINE, CINAHL, Embase, the Cochrane Library, and PsycINFO) were searched through February 2016. Studies comparing hip strength in people diagnosed with symptomatic knee osteoarthritis to healthy control participants were included in the review. A meta-analysis with random effects was applied to relevant data from included studies and a modified Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the quality of evidence for each pooled analysis. Results Five studies were included in the review. Meta-analysis revealed moderate-quality evidence of weaker isometric and isokinetic hip abduction strength in people with knee osteoarthritis (moderate difference: 7% to 24% weaker) and very low-quality evidence of no difference in isometric hip adduction strength. There was very low- to moderate-quality evidence of weaker isokinetic hip strength in the remaining planes of motion (moderate to large differences: 14% to 55% weaker). Conclusion Significant hip strength deficits exist in people with knee osteoarthritis. Hip strength assessment should be considered in clinical practice and may assist with directing targeted management strategies. Level of Evidence Symptom prevalence, level 1a-. J Orthop Sports PhysTher 2016;46(8):629-639. Epub3 Jul 2016. doi:10.2519/jospt.2016.6618.
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Khoja SS, Almeida GJ, Chester Wasko M, Terhorst L, Piva SR. Association of Light-Intensity Physical Activity With Lower Cardiovascular Disease Risk Burden in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:424-31. [PMID: 26314559 DOI: 10.1002/acr.22711] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/29/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize physical activity (PA) in individuals with rheumatoid arthritis (RA) and to determine the associations between PA participation at light to moderate intensities and cardiovascular disease risk factors, disability, and disease activity. METHODS The cross-sectional study used data from 2 RA cohorts. PA was measured using an accelerometry-based activity monitor, recording minutes/day spent in sedentary (≤1 metabolic equivalent [MET]), very light (1.1-1.9 METs), light (2-2.9 METs), and moderate activities (≥3 METs). Cardiovascular markers included body mass index, blood pressure, insulin resistance, and lipid profile. Disability and disease activity were measured using the Health Assessment Questionnaire (HAQ) and the Disease Activity Score in 28 joints (DAS28), respectively. Associations between PA at each intensity level and health markers were assessed by multiple linear regression models, adjusted for age, sex, and cohort. RESULTS Ninety-eight subjects (mean ± SD age 58 ± 9 years, 85% female) were included. Subjects spent 9.8 hours/day being sedentary, 3.5 hours/day engaged in very light PA, 2.1 hours/day engaged in light PA, and 35 minutes/day engaged in moderate PA. Only 17% were physically active (≥150 minutes/week of moderate PA in 10-minute bouts). Regression models showed that very light, light, and moderate PA were inversely associated with most cardiovascular disease risk factors and HAQ and DAS28 scores (R(2) Δ range 0.04-0.52, P < 0.05). The associations between PA and cardiovascular disease markers were either equivalent or stronger at very light and light intensities, as compared to moderate intensity. CONCLUSION Individuals with RA are mostly active at very light and light intensities. PA at these intensity levels associates favorably with cardiovascular markers and lower disability and disease activity in RA.
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Affiliation(s)
| | | | | | | | - Sara R Piva
- University of Pittsburgh, Pittsburgh, Pennsylvania
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180
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Liu SH, Eaton CB, Driban JB, McAlindon TE, Lapane KL. Comparison of self-report and objective measures of physical activity in US adults with osteoarthritis. Rheumatol Int 2016; 36:1355-64. [DOI: 10.1007/s00296-016-3537-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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181
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Macera CA, Cavanaugh A, Bellettiere J. State of the Art Review: Physical Activity and Older Adults. Am J Lifestyle Med 2016; 11:42-57. [PMID: 30202313 DOI: 10.1177/1559827615571897] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/18/2014] [Accepted: 01/12/2015] [Indexed: 12/31/2022] Open
Abstract
Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.
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Affiliation(s)
- Caroline A Macera
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - Alyson Cavanaugh
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - John Bellettiere
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
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182
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Freke M, Kemp JL, Svege I, Risberg MA, Semciw AI, Crossley KM. Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence. Br J Sports Med 2016; 50:1180. [DOI: 10.1136/bjsports-2016-096152] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 01/16/2023]
Abstract
BackgroundFemoroacetabular impingement (FAI) and associated pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of rehabilitation programmes in this patient group. Knowledge regarding physical impairments in people with symptomatic FAI is limited.HypothesisIn adults aged 18–50 years with symptomatic FAI: (1) to identify physical impairments in range of motion (ROM), hip muscle function and functional tasks; (2) to compare physical impairments with healthy controls; and (3) to evaluate the effects of interventions targeting physical impairments.Study designSystematic review.MethodsA systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined ROM, hip muscle function and functional tasks were included. Standardised mean differences were calculated where possible or best evidence synthesis and study conclusions were presented.ResultsTwenty-two studies fulfilled all inclusion criteria. Methodological quality was varied. Results for hip joint ROM differences between people with symptomatic FAI compared and control subjects were varied. People with symptomatic FAI demonstrated some deficits in hip muscle strength and reduced balance on one leg when compared with control subjects. For hip joint ROM and hip muscle strength results for within-group differences between preintervention and postintervention time points were limited and inconclusive. No randomised controlled trials evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI.ConclusionsPeople with symptomatic FAI demonstrate impairments in some hip muscle strength and single leg balance. This information may assist therapists in providing targeted rehabilitation programmes for people with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted interventions are effective in symptomatic FAI.Clinical relevanceThis information may assist therapists in providing targeted rehabilitation programmes for people with symptomatic FAI.
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183
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Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review. J Orthop Sports Phys Ther 2016; 46:431-42. [PMID: 27117726 DOI: 10.2519/jospt.2016.6449] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPERO (registration number CRD42014010155). Level of Evidence Therapy, level 2a. J Orthop Sports Phys Ther 2016;46(6):431-442. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6449.
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Veronese N, Cereda E, Maggi S, Luchini C, Solmi M, Smith T, Denkinger M, Hurley M, Thompson T, Manzato E, Sergi G, Stubbs B. Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis. Semin Arthritis Rheum 2016; 46:160-167. [PMID: 27179749 DOI: 10.1016/j.semarthrit.2016.04.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/15/2016] [Accepted: 04/11/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD). METHODS Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA. Risk of all-cause and CVD mortality were summarized using adjusted hazard ratios (HRs) for joint specific (hand, hip, and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included. RESULTS From the PRO.V.A. study (N = 2927), there was no significant increase in mortality risk for participants with any joint OA (N = 1858) compared to non-OA (all-cause, HR = 0.95, 95% CI: 0.77-1.15 and CVD, HR = 1.12, 95% CI: 0.82-1.54). On meta-analysis, seven studies (OA = 10,018/non-OA = 18,541), with a median 12-year follow-up, reported no increased risk of any-cause mortality in those with OA (HR = 1.10, 95% CI: 0.97-1.25). After removing data on hand OA, a significant association between OA and mortality was observed (HR = 1.18, 95% CI: 1.08-1.28). There was a significant higher risk of overall mortality for (1) studies conducted in Europe, (2) patients with multi-joint OA; and (3) a radiological diagnosis of OA. OA was associated with significantly higher CVD mortality (HR = 1.21, 95% CI: 1.10-1.34). CONCLUSIONS People with OA are at increased risk of death due to CVD. The relationship with overall mortality is less clear and may be moderated by the presence of hand OA.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Maggi
- Aging Branch, Institute of Neuroscience, National Research Council-CNR, Padova, Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy; Local Health Unit 17, Mental Health Department, Padova, Italy
| | - Toby Smith
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, University of Ulm, Ulm, Germany; Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Michael Hurley
- Faculty of Health and Social Care Sciences, St Georges University of London, London, UK
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, UK
| | - Enzo Manzato
- Geriatrics Section, Department of Medicine (DIMED), University of Padova, Padova, Italy; Aging Branch, Institute of Neuroscience, National Research Council-CNR, Padova, Italy
| | - Giuseppe Sergi
- Geriatrics Section, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
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Arnold JB, Mackintosh S, Olds TS, Jones S, Thewlis D. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty. J Orthop Res 2015; 33:1818-25. [PMID: 26135207 DOI: 10.1002/jor.22969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/16/2015] [Indexed: 02/04/2023]
Abstract
Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity.
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Affiliation(s)
- John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Shylie Mackintosh
- International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Timothy S Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sara Jones
- International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Dominic Thewlis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
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186
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Paxton RJ, Melanson EL, Stevens-Lapsley JE, Christiansen CL. Physical activity after total knee arthroplasty: A critical review. World J Orthop 2015; 6:614-622. [PMID: 26396937 PMCID: PMC4573505 DOI: 10.5312/wjo.v6.i8.614] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/07/2015] [Accepted: 07/02/2015] [Indexed: 02/06/2023] Open
Abstract
Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points.
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187
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Clayton C, Feehan L, Goldsmith CH, Miller WC, Grewal N, Ye J, Yoo JY, Li LC. Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol. Pilot Feasibility Stud 2015; 1:30. [PMID: 27965808 PMCID: PMC5153859 DOI: 10.1186/s40814-015-0027-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/13/2015] [Indexed: 01/13/2023] Open
Abstract
Background Physical activity (PA) reduces pain and improves functioning in people with knee osteoarthritis (OA), but few people with the condition meet recommended PA guidelines. Successful intervention strategies to increase PA include goal setting, action planning, self-monitoring, and follow-up feedback from a healthcare professional. Recently developed consumer wearable activity trackers allow users to set activity goals, self-monitor daily goal-progress, and provide feedback on goal attainment. It is hypothesized that a multi-component physiotherapist-led intervention that includes a short (40-min) education module, guided goal-setting and action planning, the use of a wristband activity tracker, and weekly follow-up phone calls will lead to increased PA outcomes. Methods/design Thirty-six participants will be recruited from the community for a two-group pilot randomized controlled trial with a stepped-wedge design using an intention-to-treat analysis. Computer-generated block randomization will be performed using varying block sizes and a 1:1 allocation ratio. The 4-week intervention will be delivered immediately (immediate-intervention group) or after a 5-week delay (delayed-intervention group). Outcome measures of pain and disability (Knee Injury and OA Outcome Score), disease self-management ability (Partners in Health Scale), and objective bouted moderate-to-vigorous PA and sedentary time (BodyMedia SenseWear Mini Armband) will be collected at baseline (week 0) and two follow-ups (weeks 5 and 10), for a total study duration of 11 weeks. Feasibility data relating to process, resource, management, and scientific elements of the trial will be collected. Outcome measure and feasibility data will be summarized, and an estimate of intervention efficacy will be obtained by regression model with planned comparisons. The trial began recruiting in February 2015. To date, 34 subjects have been recruited. Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote PA in people living with knee OA. The results will provide valuable information to inform a larger randomized trial to assess intervention effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT02313506 (registration date 8 December 2014). First participant randomized 20 February 2015.
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Affiliation(s)
- Cam Clayton
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada ; Department of Physical Therapy, University of British Columbia, Friedman Building, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Lynne Feehan
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada ; Department of Physical Therapy, University of British Columbia, Friedman Building, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada ; Rehabilitation Program, Fraser Health, Central City Office, 400-13450 102nd Avenue, Surrey, BC V3T 0H1 Canada
| | - Charlie H Goldsmith
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada ; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 9510, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - William C Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Navi Grewal
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Joanna Ye
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Ju Young Yoo
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Linda C Li
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada ; Department of Physical Therapy, University of British Columbia, Friedman Building, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
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188
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial. Osteoarthritis Cartilage 2015; 23:1285-93. [PMID: 25882926 DOI: 10.1016/j.joca.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/10/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). DESIGN Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS Twenty-four participants (13 women) aged 53-83 years, and average body mass index (BMI) of 34 kg/m(2) (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R(2) = 0.31, cubic R(2) = 0.69) and reduced stiffness (linear R(2) = 0.20, cubic R(2) = 0.52), with increased benefits at moderate to higher doses. CONCLUSIONS There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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189
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Verlaan L, Bolink SAAN, Van Laarhoven SN, Lipperts M, Heyligers IC, Grimm B, Senden R. Accelerometer-based Physical Activity Monitoring in Patients with Knee Osteoarthritis: Objective and Ambulatory Assessment of Actual Physical Activity During Daily Life Circumstances. Open Biomed Eng J 2015; 9:157-63. [PMID: 26312077 PMCID: PMC4541405 DOI: 10.2174/1874120701509010157] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/21/2014] [Accepted: 12/19/2014] [Indexed: 12/27/2022] Open
Abstract
Background: It is important to assess physical activity objectively during daily life circumstances, to understand the association between physical activity and diseases and to determine the effectiveness of interventions. Accelerometer-based physical activity monitoring seems a promising method and could potentially capture all four FITT (i.e. Frequency, Intensity, Time, Type) components of physical activity considered by the World Health Organization (WHO). Aim: To assess the four FITT components of physical activity with an accelerometer during daily life circumstances and compare with self-reported levels of physical activity in patients with knee osteoarthritis (OA) and a healthy control group. Methods: Patients (n=30) with end-stage knee OA and age-matched healthy subjects (n=30) were measured. An ambulant tri-axial accelerometer was placed onto the lateral side of the upper leg. Physical activity was measured during four consecutive days. Using algorithm-based peak detection methods in Matlab, parameters covering the four FITT components were assessed. Self-reported physical activity was assessed using the Short questionnaire to assess health enhancing physical activity (SQUASH). Results: Knee OA patients demonstrated fewer walking bouts (154 ±79 versus 215 ±65 resp.; p=0.002), step counts (4402 ±2960 steps/day versus 6943 ±2581 steps/day; p=0.001) and sit-to-stand (STS) transfers (37 ±14 versus 44 ±12; p=0.031) compared to controls. Knee OA patients demonstrated more time sitting (65 ±15% versus 57 ±10% resp.; p=0.029), less time walking (8 ±4% versus 11 ±4% resp.; p=0.014) and lower walking cadence (87 ±11steps/min versus 99 ± 8steps/min resp.; p<0.001). Accelerometer-based parameters of physical activity were moderately-strong (Pearsons’s r= 0.28-0.49) correlated to self-reported SQUASH scores. Conclusion: A single ambulant accelerometer-based physical activity monitor feasibly captures the four FITT components of physical activity and provides more insight into the actual physical activity behavior and limitations of knee OA patients in their daily life.
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Affiliation(s)
- L Verlaan
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - S A A N Bolink
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - S N Van Laarhoven
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - M Lipperts
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - I C Heyligers
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - B Grimm
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
| | - R Senden
- AHORSE Foundation, Department of Orthopaedics, Atrium Medical Center Heerlen, The Netherlands
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190
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Holden MA, Nicholls EE, Young J, Hay EM, Foster NE. Exercise and physical activity in older adults with knee pain: a mixed methods study. Rheumatology (Oxford) 2015; 54:413-23. [PMID: 25187640 PMCID: PMC4334683 DOI: 10.1093/rheumatology/keu333] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/25/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe and explore current exercise and physical activity behaviour in older adults with knee pain in the UK. METHODS A survey was mailed to 2234 adults ≥50 years of age registered with one general practice within the UK to determine the presence and severity of knee pain and levels of physical activity. Semi-structured interviews were conducted with 22 questionnaire responders with knee pain. RESULTS The questionnaire response rate was 59% (n = 1276) and 611 respondents reported knee pain. Only ∼40% of individuals with knee pain were sufficiently active to meet physical activity recommendations. Interviews revealed individual differences in the type and setting of physical activity completed and some self-monitored their symptoms in response to physical activity in order to guide future behaviour. CONCLUSION Innovative interventions that can be adapted to suit individual needs and preferences are required to help older adults with knee pain become more physically active.
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Affiliation(s)
- Melanie A Holden
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
| | - Elaine E Nicholls
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Julie Young
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
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191
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Allen KD, Bosworth HB, Chatterjee R, Coffman CJ, Corsino L, Jeffreys AS, Oddone EZ, Stanwyck C, Yancy WS, Dolor RJ. Clinic variation in recruitment metrics, patient characteristics and treatment use in a randomized clinical trial of osteoarthritis management. BMC Musculoskelet Disord 2014; 15:413. [PMID: 25481809 PMCID: PMC4295303 DOI: 10.1186/1471-2474-15-413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/25/2014] [Indexed: 01/02/2023] Open
Abstract
Background The Patient and PRovider Interventions for Managing Osteoarthritis (OA) in Primary Care (PRIMO) study is one of the first health services trials targeting OA in a multi-site, primary care network. This multi-site approach is important for assessing generalizability of the interventions. These analyses describe heterogeneity in clinic and patient characteristics, as well as recruitment metrics, across PRIMO study clinics. Methods Baseline data were obtained from the PRIMO study, which enrolled n = 537 patients from ten Duke Primary Care practices. The following items were examined across clinics with descriptive statistics: (1) Practice Characteristics, including primary care specialty, numbers and specialties of providers, numbers of patients age 55+, urban/rural location and county poverty level; (2) Recruitment Metrics, including rates of eligibility, refusal and randomization; (3) Participants’ Characteristics, including demographic and clinical data (general and OA-related); and (4) Participants’ Self-Reported OA Treatment Use, including pharmacological and non-pharmacological therapies. Intraclass correlation coefficients (ICCs) were computed for participant characteristics and OA treatment use to describe between-clinic variation. Results Study clinics varied considerably across all measures, with notable differences in numbers of patients age 55+ (1,507-5,400), urban/rural location (ranging from “rural” to “small city”), and proportion of county households below poverty level (12%-26%). Among all medical records reviewed, 19% of patients were initially eligible (10%-31% across clinics), and among these, 17% were randomized into the study (13%-21% across clinics). There was considerable between-clinic variation, as measured by the ICC (>0.01), for the following patient characteristics and OA treatment use variables: age (means: 60.4-66.1 years), gender (66%-88% female), race (16%-61% non-white), low income status (5%-27%), presence of hip OA (26%-68%), presence both knee and hip OA (23%-61%), physical therapy for knee OA (24%-61%) and hip OA (0%-71%), and use of knee brace with metal supports (0%-18%). Conclusions Although PRIMO study sites were part of one primary care practice network in one health care system, clinic and patient characteristics varied considerably, as did OA treatment use. This heterogeneity illustrates the importance of including multiple, diverse sites in trials for knee and hip OA, to enhance the generalizability and evaluate potential for real-world implementation. Trial registration Clinical Trial Registration Number: NCT 01435109 Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-413) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelli D Allen
- Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
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192
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Patient activity after TKA depends on patient-specific parameters. Clin Orthop Relat Res 2014; 472:3933-40. [PMID: 25053290 PMCID: PMC4397766 DOI: 10.1007/s11999-014-3813-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 07/09/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients expect an improvement of walking ability and an increase in activity levels after TKA. Unfortunately, few studies report qualitative and quantitative activity improvements after TKA. QUESTIONS/PURPOSES The aims of this study were (1) to evaluate quantity and quality of physical activity before and after TKA with an accelerometer, and to compare activity level with that of an age-matched control group without lower-extremity disorders. (2) Improvement in measured steps per day after TKA and the ability to meet physical activity guidelines were evaluated. (3) The influence of patient-specific and implant parameters were assessed. PATIENTS AND METHODS An accelerometer was used to measure activity in 97 patients who were assessed before TKA and 1 year after TKA. The measurements included the total number of steps, moderate to vigorous activity defined as at least 100 steps per minute, and time spent lying, sitting/standing, or walking. We then calculated the proportion of patients who met the 10,000 steps per day guideline recommendation and determined factors that predicted failure to meet that goal. Thirty-nine age-matched control subjects without lower-extremity disorders were selected and underwent the same assessments using the accelerometer for comparison with patients 1 year after TKA. RESULTS Measured steps per day improved from a mean of 5278 (SD, 2999) preoperatively to 6473 (SD, 3654) postoperatively (effect size, 1.23; 95% CI, 1.10-1.35; p < 0.001). Moderate to vigorous steps per day improved from a mean of 1150 (SD, 982) to 1935 (SD, 1728; p < 0.001). Times spent in lying, sitting, or standing position or during walking did not change after TKA. For all measured parameters, activity of the patients after TKA was considerably less than that of the age-matched control subjects, who walked a mean of 13,375 (SD, 4614) steps per day (p < 0.001), performed a mean of 6562 (SD, 3401) vigorous steps per day (p < 0.001), and spent a mean of 2.9 hours (SD, 1.1) per day walking (p < 0.001). Only 16 patients (16.5%) met physical activity guidelines after TKA. BMI (p = 0.017), sex (p = 0.027), and comorbidities (American Society of Anesthesiologists Grade, p = 0.042) were independent factors associated with steps per day after TKA. CONCLUSIONS One year after TKA, patients had increased walking and moderate to vigorous steps. However, only 16.5% achieved the guideline recommendations for walking activity. BMI, sex, and comorbidities are patient factors that are associated with activity after TKA. Even with improvements in walking, activity level after TKA remains less than that seen for age-matched control subjects. Surgeons should be aware of this when counseling patients undergoing TKA. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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193
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Ezzat AM, MacPherson K, Leese J, Li LC. The effects of interventions to increase exercise adherence in people with arthritis: a systematic review. Musculoskeletal Care 2014; 13:1-18. [PMID: 25752931 DOI: 10.1002/msc.1084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Allison M Ezzat
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, BC, Canada; Child and Family Research Institute, Vancouver, BC, Canada
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194
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Wallis J. Commentary to: light intensity physical activity is associated with lower disability in adults with or at risk of knee osteoarthritis. J Physiother 2014; 60:163. [PMID: 25104211 DOI: 10.1016/j.jphys.2014.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jason Wallis
- Department of Physiotherapy, Eastern Health, Melbourne, Australia
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195
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Peeters GMEEG, Brown WJ, Burton NW. Psychosocial factors associated with increased physical activity in insufficiently active adults with arthritis. J Sci Med Sport 2014; 18:558-64. [PMID: 25174532 DOI: 10.1016/j.jsams.2014.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 06/30/2014] [Accepted: 08/08/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although physical activity can potentially reduce symptoms of arthritis, 50% of people with arthritis are insufficiently active. The aim was to identify psychosocial factors associated with increased physical activity in mid-age adults with arthritis who did not meet recommended physical activity levels. DESIGN Longitudinal cohort study. METHODS Data were from 692 insufficiently active men and women (mean age 55 ± 6.6 years) with arthritis, who answered mailed surveys in 2007 and 2009 in the HABITAT study. Increased physical activity was defined as a change of ≥ 200 MET min/week in walking, moderate and vigorous activities from 2007 to 2009. Scale scores were used to measure psychosocial factors including intention, experiences, attitudes, efficacy, barriers, motivation, social support, and health professional advice. Associations between (1) 2007 psychosocial factors and (2) 2007-2009 improvement (≥ +1 standard deviation) in psychosocial factors and increased physical activity were examined with logistic regression models. Results were adjusted for education, body mass index, and self-rated health. RESULTS Between 2007 and 2009, 296 participants (42.8%) increased their physical activity. Engagement, mastery and physical activity intention in 2007 were associated with this increase in physical activity (engagement OR = 1.11, 99% confidence interval (CI) = 1.05-1.17; mastery OR = 1.12, 99%CI = 1.02-1.22; physical activity intention OR = 1.29, 99%CI = 1.06-1.56). Improved scores for encouragement (OR = 2.07, CI = 1.07-4.01) and self-efficacy (OR =2 .27, CI = 1.30-3.97) were also significantly associated with increased physical activity. CONCLUSIONS Positive physical activity experiences and intentions were predictors of increased physical activity among people with arthritis. Improved physical activity confidence and social support were associated with increased physical activity. It is important to consider these psychosocial factors when planning physical activity interventions for people with arthritis.
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Affiliation(s)
- G M E E Geeske Peeters
- The University of Queensland, School of Human Movement Studies, Australia; The University of Queensland, School of Population Health, Australia.
| | - Wendy J Brown
- The University of Queensland, School of Human Movement Studies, Australia
| | - Nicola W Burton
- The University of Queensland, School of Human Movement Studies, Australia
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196
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Stubbs B, Hurley M, Smith T. What are the factors that influence physical activity participation in adults with knee and hip osteoarthritis? A systematic review of physical activity correlates. Clin Rehabil 2014; 29:80-94. [DOI: 10.1177/0269215514538069] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To determine the factors associated with physical activity participation in adults with hip or knee osteoarthritis. Methods: A systematic review was conducted including searches of AMED, PsycINFO, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library from inception until October 2013. Studies presenting quantitative correlates of physical activity in adults with hip and/or knee osteoarthritis were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment. Correlates were analysed using the summary code approach within the socio-ecological model. Results: A total of 170 correlates were identified from 29 publications analysing 8076 individual people with hip or knee osteoarthritis. Methodological quality was generally good. For knee osteoarthritis, factors consistently negatively associated with physical activity (reported more than four studies) were increasing age (number of participants in studies supporting association = 4558), non-white ethnicity ( n = 3232), increased osteoarthritis symptoms ( n = 2374) and female gender ( n = 4816). Greater lower limb function ( n = 1671) and faster gait speed were ( n = 4098) positively associated with physical activity. Social (e.g. support from spouse ( n = 141)) and environment (outdoor temperature ( n = 38)) factors were identified as possible factors that influence physical activity. For hip osteoarthritis, higher body mass index ( n = 99), increased comorbidities ( n = 1021), lower mental health ( n = 189) and unemployment ( n = 65) were negatively associated with physical activity; while better social functioning ( n = 1055) and health-related quality of life were positively associated with physical activity ( n = 34). Conclusion: Demographic, physical, social, psychological and environmental factors are all important correlates for physical activity for people with knee or hip osteoarthritis. Clinicians should consider these in clinical practice.
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Affiliation(s)
- Brendon Stubbs
- School of Health and Social Care, University of Greenwich, London, UK
| | - Michael Hurley
- School of Rehabilitation Sciences, St Georges University of London and Kingston University, London, UK
| | - Toby Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Hermann A, Ried-Larsen M, Jensen AK, Holst R, Andersen LB, Overgaard S, Holsgaard-Larsen A. Low validity of the Sensewear Pro3 activity monitor compared to indirect calorimetry during simulated free living in patients with osteoarthritis of the hip. BMC Musculoskelet Disord 2014; 15:43. [PMID: 24552503 PMCID: PMC3938645 DOI: 10.1186/1471-2474-15-43] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/11/2014] [Indexed: 12/02/2022] Open
Abstract
Background To validate physical activity estimates by the Sensewear Pro3 activity monitor compared with indirect calorimetry during simulated free living in patients diagnosed with osteoarthritis of the hip pre or post total hip arthroplasty. Methods Twenty patients diagnosed with hip osteoarthritis (10 pre- and 10 post total hip arthroplasty; 40% female; age: 63.3 ± 9.0; BMI: 23.7 ± 3.7). All patients completed a 2 hour protocol of simulated free living with 8 different typical physical activity types. Energy consumption (kcal/min) was estimated by the Sense Wear pro3 Armband activity monitor and validated against indirect calorimetry (criterion method) by means of a portable unit (Cosmed K4b2). Bias and variance was analyzed using functional ANOVA. Results Mean bias during all activities was 1.5 Kcal/min 95%CI [1.3; 1.8] corresponding to 72% (overestimation). Normal gait speed showed an overestimation of 2.8 Kcal/min, 95%CI [2.3; 3.3] (93%) while an underestimation of -1.1 Kcal/min, 95%CI [-1.8; -0.3] (-25%) was recorded during stair climb. Activities dominated by upper body movements showed large overestimation with 4.37 Kcal/min, 95%CI [3.8; 5.1] (170%) being recorded during gardening. Both bias and variance appeared to be dependent on activity type. Conclusion The activity monitor generally overestimated the energy consumption during common activities of low to medium intensity in the patient group. The size and direction of the bias was highly dependent on the activity type which indicates the activity monitor is of limited value in patients with hip osteoarthritis and that the results do not express the real energy expenditure.
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Affiliation(s)
- Andreas Hermann
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
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