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Lawrence LM, Singleton JF. What Do We Mean by Older Adult and Physical Activity? Reviewing the Use of These Terms in Recent Research. ACTIVITIES, ADAPTATION & AGING 2017. [DOI: 10.1080/01924788.2016.1272391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim SR, Choi KH, Jung GU, Shin D, Kim K, Park SM. Associations Between Fat Mass, Lean Mass, and Knee Osteoarthritis: The Fifth Korean National Health and Nutrition Examination Survey (KNHANES V). Calcif Tissue Int 2016; 99:598-607. [PMID: 27590619 DOI: 10.1007/s00223-016-0190-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
As little is known about the associations between body composition (fat mass and lean mass) and knee OA, especially regarding body parts (upper body and lower limbs), the purpose of this study was to identify the association between the former and the prevalence of the latter according to body parts. This study was designed as a cross-sectional analysis, with 4194 people (1801 men and 2393 women) from the fifth Korean National Health and Nutrition Examination Survey (KNHANES V, 2010-2011) included. Body composition (fat mass and lean mass) was measured by using dual-energy X-ray absorptiometry, and knee OA was diagnosed based on the level of Kellgren-Lawrence grade. In multivariate logistic regression analysis, upper body composition was not significantly correlated with radiographic knee OA (P > 0.05), while participants with higher lean mass of lower limbs were less likely to have radiographic knee OA (aOR 0.57; 95 % CI 0.32-0.99). In stratified analysis, participants with higher lean mass of lower limbs were less likely to have a radiographic knee OA in 40-54 kg (P for trend = 0.05) and 55-70 kg stratum (P for trend = 0.03), while this trend slightly attenuated in 70-85 kg stratum (P for trend = 0.15). In conclusion, the increase in lean mass of lower limbs is inversely related to the prevalence of knee OA while upper body composition is not. This study suggests that the lean mass of lower limbs might be associated with reduction in the risk of knee OA.
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Affiliation(s)
- Seong Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Industrial Engineering, Seoul National University College of Engineering, Seoul, South Korea
| | - Kyung-Hyun Choi
- Center for Health Promotion and Cancer Prevention, Dongnam Institute of Radiological and Medical Sciences, Busan, South Korea
| | - Go-Un Jung
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Doosup Shin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yunkeon-dong, Jongro-gu, Seoul, 110-744, South Korea.
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The contribution of leg press and knee extension strength and power to physical function in people with knee osteoarthritis: A cross-sectional study. Knee 2016; 23:942-949. [PMID: 27817980 DOI: 10.1016/j.knee.2016.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 08/08/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED The purposes of this study were to 1) determine the additional contributions of leg press and knee extensor power, over and above that of strength, to the performance of physical function tasks in people with knee osteoarthritis, and 2) compare the ability of bilateral leg press to unilateral knee extensor strength and power to predict functional task performance. METHODS A cross-sectional, exploratory study of 40 individuals with tibiofemoral knee osteoarthritis resulting in moderate impairments in physical function was conducted. Physical function (Get-up and Go, timed stair climb and descent, and five time chair rise) and muscle performance (leg press and knee extension strength and power) were assessed. RESULTS After controlling for covariates and strength, leg press, but not knee extensor, power explained additional variance in physical function (11% and 21%). Conversely, adding strength to regression models including covariates and power did not consistently improve the prediction of physical function. Additionally, leg press power consistently explained more variance in physical function (44 to 57%) than involved (24 to 34%) or uninvolved (28 to 48%) knee extension power. CONCLUSIONS Leg press power may be a more functionally relevant measure of muscle performance than knee extension strength in this population. Future studies should investigate the effectiveness of interventions specifically designed to improve leg press power in people with knee osteoarthritis.
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Jones MD, Taylor JL, Booth J, Barry BK. Exploring the Mechanisms of Exercise-Induced Hypoalgesia Using Somatosensory and Laser Evoked Potentials. Front Physiol 2016; 7:581. [PMID: 27965587 PMCID: PMC5126702 DOI: 10.3389/fphys.2016.00581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/11/2016] [Indexed: 01/10/2023] Open
Abstract
Exercise-induced hypoalgesia is well described, but the underlying mechanisms are unclear. The aim of this study was to examine the effect of exercise on somatosensory evoked potentials, laser evoked potentials, pressure pain thresholds and heat pain thresholds. These were recorded before and after 3-min of isometric elbow flexion exercise at 40% of the participant's maximal voluntary force, or an equivalent period of rest. Exercise-induced hypoalgesia was confirmed in two experiments (Experiment 1–SEPs; Experiment 2–LEPs) by increased pressure pain thresholds at biceps brachii (24.3 and 20.6% increase in Experiment 1 and 2, respectively; both d > 0.84 and p < 0.001) and first dorsal interosseous (18.8 and 21.5% increase in Experiment 1 and 2, respectively; both d > 0.57 and p < 0.001). In contrast, heat pain thresholds were not significantly different after exercise (forearm: 10.8% increase, d = 0.35, p = 0.10; hand: 3.6% increase, d = 0.06, p = 0.74). Contrasting effects of exercise on the amplitude of laser evoked potentials (14.6% decrease, d = −0.42, p = 0.004) and somatosensory evoked potentials (10.9% increase, d = −0.02, p = 1) were also observed, while an equivalent period of rest showed similar habituation (laser evoked potential: 7.3% decrease, d = −0.25, p = 0.14; somatosensory evoked potential: 20.7% decrease, d = −0.32, p = 0.006). The differential response of pressure pain thresholds and heat pain thresholds to exercise is consistent with relative insensitivity of thermal nociception to the acute hypoalgesic effects of exercise. Conflicting effects of exercise on somatosensory evoked potentials and laser evoked potentials were observed. This may reflect non-nociceptive contributions to the somatosensory evoked potential, but could also indicate that peripheral nociceptors contribute to exercise-induced hypoalgesia.
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Affiliation(s)
- Matthew D Jones
- School of Medical Sciences, University of New South WalesSydney, NSW, Australia; Neuroscience Research AustraliaSydney, NSW, Australia
| | - Janet L Taylor
- School of Medical Sciences, University of New South WalesSydney, NSW, Australia; Neuroscience Research AustraliaSydney, NSW, Australia
| | - John Booth
- School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| | - Benjamin K Barry
- School of Medical Sciences, University of New South WalesSydney, NSW, Australia; Neuroscience Research AustraliaSydney, NSW, Australia
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Kjeken I, Eide REM, Klokkeide Å, Matre KH, Olsen M, Mowinckel P, Andreassen Ø, Darre S, Nossum R. Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:473. [PMID: 27842579 PMCID: PMC5109819 DOI: 10.1186/s12891-016-1321-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/01/2016] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA? METHODS/DESIGN All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years. DISCUSSION The findings will improve the evidence-based management of HOA. TRIAL REGISTRATION IDENTIFIER NCT01794754 . First registrated February 15th 2013.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | | | | | - Karin Hoegh Matre
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Monika Olsen
- Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Petter Mowinckel
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Øyvor Andreassen
- Patient research panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Darre
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Nossum
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Crane DM, Oliver KS, Bayes MC. Orthobiologics and Knee Osteoarthritis. Phys Med Rehabil Clin N Am 2016; 27:985-1002. [DOI: 10.1016/j.pmr.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther 2016; 33:1921-1946. [PMID: 27671326 PMCID: PMC5083776 DOI: 10.1007/s12325-016-0409-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 01/05/2023]
Abstract
Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition’s etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.
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Affiliation(s)
- Nicholas J Murphy
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - Jillian P Eyles
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
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The Effects of Yoga on Pain, Mobility, and Quality of Life in Patients with Knee Osteoarthritis: A Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6016532. [PMID: 27777597 PMCID: PMC5061981 DOI: 10.1155/2016/6016532] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 02/05/2023]
Abstract
Objective. To systematically assess the effects of yoga on pain, mobility, and quality of life in patients with knee osteoarthritis. Methods. Pubmed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), and other sources were searched systematically in this study. Two reviewers identified eligible studies and extracted data independently. Downs and Black's Quality Index were used to evaluate the methodological quality of the included studies. Results. A total of 9 articles (6 studies) involving 372 patients with knee osteoarthritis met the inclusion criteria. The most common yoga protocol is 40~90 minutes/session, lasting for at least 8 weeks. The effect of yoga on pain relief and function improvement could be seen after two-week intervention. Conclusion. This systematic review showed that yoga might have positive effects in relieving pain and mobility on patients with KOA, but the effects on quality of life (QOL) are unclear. Besides, more outcome measure related to mental health of yoga effects on people with KOA should be conducted.
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Goh SL, Persson MSM, Bhattacharya A, Hall M, Doherty M, Zhang W. Relative efficacy of different types of exercise for treatment of knee and hip osteoarthritis: protocol for network meta-analysis of randomised controlled trials. Syst Rev 2016; 5:147. [PMID: 27590834 PMCID: PMC5010721 DOI: 10.1186/s13643-016-0321-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/18/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND 'Exercise' is universally recommended as a core treatment for knee and hip osteoarthritis (OA). However, there are very few head-to-head comparative trials to determine the relative efficacy between different types of exercise. The aim of this study is to benchmark different types of exercises against each other through the use of a common comparator in a network meta-analysis of randomised controlled trials (RCTs). METHODS This study will include only RCTs published in peer-reviewed journals. A systematic search will be conducted in several electronic databases and other relevant online resources. No limitations are imposed on language or publication date. Participants must be explicitly identified by authors as having OA. Interventions that involved exercise or comparators in any form will be included. Pain is the primary outcome of interest; secondary outcomes will include function and quality of life measures. Quality assessment of studies will be based on the modified Cochrane's risk of bias assessment tool. At least two investigators will be involved throughout all stages of screening and data acquisition. Conflicts will be resolved through discussion. Conventional meta-analysis will be performed based on random effects model and network meta-analysis on a Bayesian model. Subgroup analysis will also be conducted based on study, patient and disease characteristics. DISCUSSION This study will provide for the first time comprehensive research evidence for the relative efficacy of different exercise regimens for treatment of OA. We will use network meta-analysis of existing RCT data to answer this question. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033865.
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Affiliation(s)
- Siew-Li Goh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | - Monica S. M. Persson
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Archan Bhattacharya
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | - Michelle Hall
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 2016; 17:372. [PMID: 27568007 PMCID: PMC5002319 DOI: 10.1186/s12891-016-1209-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022] Open
Abstract
Background Both increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action. Methods A cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects. Results Following AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait. Conclusions This is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening. Trial registration ISRCTN74086288, 4th January 2016, retrospectively registered.
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Duan-Porter W, Goldstein KM, McDuffie JR, Hughes JM, Clowse MEB, Klap RS, Masilamani V, Allen LaPointe NM, Nagi A, Gierisch JM, Williams JW. Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain. Ann Intern Med 2016; 165:184-93. [PMID: 27111355 PMCID: PMC6611166 DOI: 10.7326/m15-2877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed "sex effects"). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.
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Use non-pharmacological and pharmacological interventions before considering surgery in elderly patients with knee osteoarthritis. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hudson R, Richmond A, Sanchez B, Stevenson V, Baker RT, May J, Nasypany A, Reordan D. AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT "SQUEEZE" TECHNIQUE. Int J Sports Phys Ther 2016; 11:564-574. [PMID: 27525181 PMCID: PMC4970847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) "Squeeze" technique in physically active participants who presented with clinical symptoms of meniscal tears. DESCRIPTION OF CASES The MC "Squeeze" technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population. The Numeric Pain Rating Scale (NRS), the Patient Specific Functional Scale (PSFS), the Disability in the Physically Active (DPA) Scale, and the Knee injury and Osteoarthritis Outcomes Score (KOOS) were administered to assess participant pain level and function. OUTCOMES Statistically significant improvements were found on cumulative NRS (p ≤ 0.001), current NRS (p ≤ 0.002), PSFS (p ≤ 0.003), DPA (p ≤ 0.019), and KOOS (p ≤ 0.002) scores across all five participants. All participants exceeded the minimal clinically important difference (MCID) on the first treatment and reported an NRS score and current pain score of one point or less at discharge. The MC "Squeeze" technique produced statistically and clinically significant changes across all outcome measures in all five participants. DISCUSSION The use of the MC "Squeeze" technique in this case series indicated positive outcomes in five participants who presented with meniscal tear symptoms. Of importance to the athletic population, each of the participants continued to engage in sport activity as tolerated unless otherwise required during the treatment period. The outcomes reported in this case series exceed those reported when using traditional conservative therapy and the return to play timelines for meniscal tears treated with partial meniscectomies. LEVELS OF EVIDENCE Level 4.
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Affiliation(s)
| | | | | | | | | | - James May
- The University of Idaho, Moscow, ID, USA
| | | | - Don Reordan
- Jacksonville Physical Therapy, Jacksonville, OR, USA
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265
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Deveza LA, Hunter DJ. Pain Relief for an Osteoarthritic Knee in the Elderly: A Practical Guide. Drugs Aging 2016; 33:11-20. [PMID: 26659733 DOI: 10.1007/s40266-015-0331-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In view of the increasing prevalence of knee osteoarthritis (OA) in the population worldwide, optimal management is critical to decrease the burden of this condition and minimize disability and personal suffering. Current care is based on a sequence of non-pharmacological, pharmacological, and surgical modalities, targeted to improving pain and function in the elderly population. The aim of this article is to provide a practical view of the efficacy of therapeutic options available along with clinically relevant considerations on the management of knee OA in this demographic group.
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Affiliation(s)
- Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia.
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266
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Wylde V, Artz N, Marques E, Lenguerrand E, Dixon S, Beswick AD, Burston A, Murray J, Parwez T, Blom AW, Gooberman-Hill R. Effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement for osteoarthritis: study protocol for a randomised controlled trial. Trials 2016; 17:289. [PMID: 27296366 PMCID: PMC4906683 DOI: 10.1186/s13063-016-1418-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/27/2016] [Indexed: 12/27/2022] Open
Abstract
Background Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency. Trial registration ISRCTN32087234, registered on 11 February 2015.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Neil Artz
- School of Health Professions, University of Plymouth, Peninsula Allied Health Centre, Derriford Road, Plymouth, Devon, PL6 8BH, UK
| | - Elsa Marques
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Samantha Dixon
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - James Murray
- North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Tarique Parwez
- Emersons Green Independent Treatment Centre, The Brooms, Emersons Green, Bristol, BS16 7FH, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
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267
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Marconcin P, Espanha M, Yázigi F, Campos P. The PLE(2)NO self-management and exercise program for knee osteoarthritis: Study Protocol for a Randomized Controlled Trial. BMC Musculoskelet Disord 2016; 17:250. [PMID: 27267755 PMCID: PMC4896008 DOI: 10.1186/s12891-016-1115-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/02/2016] [Indexed: 11/21/2022] Open
Abstract
Background International recommendations suggest exercise and self-management programs, including non-pharmacological treatments, for knee osteoarthritis (KOA) because they can benefit pain relief and improve function and exercise adherence. The implementation of a combined self-management and exercise program termed PLE2NO may be a good method for controlling KOA symptoms because it encourages the development of self-efficacy to manage the pathology. This study will assess the effects of a self-management and exercise program in comparison to an educational intervention (control program) on symptoms, physical fitness, health-related quality of life, self-management behaviors, self-efficacy, physical activity level and coping strategies. Methods/Design This PLE2NO study is a single-blinded, randomized controlled trial of elderly (aged above 60 yrs old) patients with clinical and radiographic KOA. The patients will be allocated into either an educational group (control) or a self-management and exercise group (experimental). All participants will receive a supplement of chondroitin and glucosamine sulfates. This paper describes the protocol that will be used in the PLE2NO program. Discussion This program has several strengths. First, it involves a combination of self-management and exercise approaches, is available in close proximity to the patients and occurs over a short period of time. The latter two characteristics are crucial for maintaining participant adherence. Exercise components will be implemented using low-cost resources that permit their widespread application. Moreover, the program will provide guidance regarding the effectiveness of using a self-management and exercise program to control KOA symptoms and improve self-efficacy and health-related quality of life. Trial registration NCT02562833 (09/23/2015)
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Affiliation(s)
- Priscila Marconcin
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal. .,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, 70040-020, Brazil.
| | - Margarida Espanha
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal
| | - Flávia Yázigi
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, Laboratório de Fisiologia eBioquímica do Exercício, P-1499-002, Estrada da Costa 1499-002 Cruz Quebrada, Dafundo, Portugal
| | - Pedro Campos
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal
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268
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Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1775-85. [PMID: 27043347 DOI: 10.1007/s00167-016-4089-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.
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269
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Egerton T, Diamond L, Buchbinder R, Bennell K, Slade SC. Barriers and enablers in primary care clinicians' management of osteoarthritis: protocol for a systematic review and qualitative evidence synthesis. BMJ Open 2016; 6:e011618. [PMID: 27235303 PMCID: PMC4885472 DOI: 10.1136/bmjopen-2016-011618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/20/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Osteoarthritis is a highly prevalent and disabling condition. Primary care management of osteoarthritis is generally suboptimal despite evidence for several modestly effective interventions and the availability of high-quality clinical practice guidelines. This report describes a planned study to synthesise the views of primary care clinicians on the barriers and enablers to following recommended management of osteoarthritis, with the aim of providing new interpretations that may facilitate the uptake of recommended treatments, and in turn improve patient care. METHODS AND ANALYSIS A systematic review and meta-synthesis of qualitative studies. 5 databases will be searched using key search terms for qualitative research, evidence-based practice, clinical practice guidelines, osteoarthritis, beliefs, perceptions, barriers, enablers and adherence. A priori inclusion/exclusion criteria include availability of data from primary care clinicians, reports on views regarding management of osteoarthritis, and studies using qualitative methods for both data collection and analysis. At least 2 independent reviewers will identify eligible reports, conduct a critical appraisal of study conduct, extract data and synthesise reported findings and interpretations. Synthesis will follow thematic analysis within a grounded theory framework of inductive coding and iterative theme identification. The reviewers plus co-authors will contribute to the meta-synthesis to find new themes and theories. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be used to determine a confidence profile of each finding from the meta-synthesis. The protocol has been registered on PROSPERO and is reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The results will help to inform policy and practice and assist in the optimisation of management for people with osteoarthritis. PROSPERO REGISTRATION NUMBER CRD42015027543.
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Affiliation(s)
- T Egerton
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - L Diamond
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - R Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Victoria, Australia
| | - K Bennell
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - S C Slade
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Victoria, Australia
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270
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Liu SH, Driban JB, Eaton CB, McAlindon TE, Harrold LR, Lapane KL. Objectively Measured Physical Activity and Symptoms Change in Knee Osteoarthritis. Am J Med 2016; 129:497-505.e1. [PMID: 26844633 PMCID: PMC6768827 DOI: 10.1016/j.amjmed.2015.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study objective was to quantify the association between daily physical activity measured by accelerometer and 1-year changes in symptoms among people with knee osteoarthritis. METHODS Participants from the Osteoarthritis Initiative had knee radiographs and physical activity assessed using GT1M ActiGraph (Pensacola, FL) uniaxial accelerometers at the 48-month visit. Physical activity was calculated and categorized as tertiles of average daily minutes in light and moderate-to-vigorous activity. Outcomes were 1-year change in symptoms measured by Western Ontario and McMaster Universities scales, including pain, stiffness, and physical function. Adjusted multivariable linear models estimated the relationship between tertiles of light or moderate-to-vigorous physical activity and changes in knee symptoms. RESULTS Among 1059 participants (55% were women; mean age, 66 ± 9 years), greater time in light activity was associated with a trend toward declined physical function (P = .01). Greater time in daily moderate-to-vigorous activity also was associated with declined physical function (P = .01) and increased pain (P = .08). None of these average changes in symptoms reached minimally important clinical differences. However, greater daily time in both activities was associated with a higher probability of worsening symptoms among persons with Kellgren-Lawrence grade 4 osteoarthritis. CONCLUSIONS Objectively measured daily activity was not associated with 1-year symptom improvements among community-dwelling adults with knee osteoarthritis. In those with advanced disease (Kellgren-Lawrence grade 4), greater daily minutes in physical activity were associated with worsening symptoms. How best to implement exercise regimens in persons with advanced knee osteoarthritis to reduce the deleterious impact on symptoms needs to be explored.
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Affiliation(s)
- Shao-Hsien Liu
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Mass.
| | | | - Charles B Eaton
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School, School of Public Health, Brown University, Providence, RI
| | | | - Leslie R Harrold
- Departments of Medicine and Orthopedics, University of Massachusetts Medical School, Worcester, Mass
| | - Kate L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
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271
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Efficacy of intra-articular hyaluronic acid injections and exercise-based rehabilitation programme, administered as isolated or integrated therapeutic regimens for the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1686-94. [PMID: 26685691 DOI: 10.1007/s00167-015-3917-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the efficacy of intra-articular hyaluronic acid (HA) injections and exercise-based rehabilitation (EBR) programme, administered as isolated or integrated for the treatment of knee osteoarthritis. METHODS One hundred sixty-five patients affected by moderate degrees of knee OA were randomly divided into three groups. Group 1 (HA) underwent three HA injections (one every 2 weeks); group 2 (EBR) underwent 20 treatment sessions in a month of an individualized programme; and group 3 (HA + EBR) received both treatments simultaneously. Primary outcome was the Italian version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; secondary outcome was the evaluation of active range of movement (AROM). All patients were evaluated before and 1, 3 and 6 months after treatment. Significance was set at p < 0.05. RESULTS Two patients in each group were lost to follow-up. No adverse events occurred. All groups experienced improvements at 1-month follow-up. No further improvements could be detected within groups over time. At 1-month follow-up, WOMAC pain subscale showed significant improvement in group 3 compared to group 1 (p = 0.043). WOMAC pain, stiffness and function subscales showed that group 2 significantly worsened between 1 and 6 months after treatment (p = 0.004, p = 0.026 and p = 0.025, respectively). AROM revealed no significant differences between and within groups over time. CONCLUSIONS Intra-articular HA injections and individualized rehabilitation programmes administered in isolation or in combination are effective in improving knee function and pain relief. The combined treatment showed the greatest pain relief at 1-month follow-up compared to either in isolation. Compared to the previous studies, this is the first study, which proposed an EBR programme tailored to the compartment of the knee joint most involved in the degenerative process. LEVEL OF EVIDENCE I.
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272
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Walsh N, Jordan JL, Babatunde OO, Powell J, Healey EL. Community-based exercise and physical activity programmes led by exercise professionals for osteoarthritis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicola Walsh
- University of the West of England; Glenside Campus Bristol UK BS16 1DD
| | - Joanne L Jordan
- Keele University; Arthritis Research UK Primary Care Centre, Institute of Primary Care & Health Sciences; Keele Staffordshire UK ST5 5BG
| | - Opeyemi O Babatunde
- Keele University; Arthritis Research UK Primary Care Centre, Institute of Primary Care & Health Sciences; Keele Staffordshire UK ST5 5BG
| | - Jane Powell
- University of the West of England; Faculty of Life Sciences; Bristol UK
| | - Emma L Healey
- Keele University; Arthritis Research UK Primary Care Centre, Institute of Primary Care & Health Sciences; Keele Staffordshire UK ST5 5BG
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273
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Affiliation(s)
- Jenna R Lyttle
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; The Alfred Centre Alfred Hospital, Commercial Road Melbourne 3004 Australia
| | - Donna M Urquhart
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; The Alfred Centre Alfred Hospital, Commercial Road Melbourne 3004 Australia
| | - Flavia M Cicuttini
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; The Alfred Centre Alfred Hospital, Commercial Road Melbourne 3004 Australia
| | - Anita E Wluka
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; The Alfred Centre Alfred Hospital, Commercial Road Melbourne 3004 Australia
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274
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Abstract
IMPORTANCE Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. EVIDENCE SYNTHESIS Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects. RECOMMENDATIONS There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. CONCLUSIONS AND RELEVANCE The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
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Affiliation(s)
- Deborah Dowell
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tamara M Haegerich
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roger Chou
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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275
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Li X, Yang J, Liu D, Li J, Niu K, Feng S, Yokota H, Zhang P. Knee loading inhibits osteoclast lineage in a mouse model of osteoarthritis. Sci Rep 2016; 6:24668. [PMID: 27087498 PMCID: PMC4834538 DOI: 10.1038/srep24668] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/04/2016] [Indexed: 11/08/2022] Open
Abstract
Osteoarthritis (OA) is a whole joint disorder that involves cartilage degradation and periarticular bone response. Changes of cartilage and subchondral bone are associated with development and activity of osteoclasts from subchondral bone. Knee loading promotes bone formation, but its effects on OA have not been well investigated. Here, we hypothesized that knee loading regulates subchondral bone remodeling by suppressing osteoclast development, and prevents degradation of cartilage through crosstalk of bone-cartilage in osteoarthritic mice. Surgery-induced mouse model of OA was used. Two weeks application of daily dynamic knee loading significantly reduced OARSI scores and CC/TAC (calcified cartilage to total articular cartilage), but increased SBP (subchondral bone plate) and B.Ar/T.Ar (trabecular bone area to total tissue area). Bone resorption of osteoclasts from subchondral bone and the differentiation of osteoclasts from bone marrow-derived cells were completely suppressed by knee loading. The osteoclast activity was positively correlated with OARSI scores and negatively correlated with SBP and B.Ar/T.Ar. Furthermore, knee loading exerted protective effects by suppressing osteoclastogenesis through Wnt signaling. Overall, osteoclast lineage is the hyper responsiveness of knee loading in osteoarthritic mice. Mechanical stimulation prevents OA-induced cartilage degeneration through crosstalk with subchondral bone. Knee loading might be a new potential therapy for osteoarthritis patients.
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Affiliation(s)
- Xinle Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Jing Yang
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Daquan Liu
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
- Department of Pharmacology, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Jie Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hiroki Yokota
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, IN 46202, USA
| | - Ping Zhang
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, IN 46202, USA
- TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300457, China
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276
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Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain. Osteoarthritis Cartilage 2016; 24:589-92. [PMID: 26564575 DOI: 10.1016/j.joca.2015.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/25/2015] [Accepted: 11/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with acute exercise-induced pain flares in persons with knee or hip pain. DESIGN Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. RESULTS Joint pain was reduced from baseline (NRS 3.6; 95% CI 3.2-4.1) to 8-weeks follow-up (2.6; 95% CI 2.1-3.1), (P < 0.01). Pain decreased 0.04 NRS (95% CI 0.02-0.05, P < 0.01) on average per exercise session and pre- to post-exercise pain decreased 0.04 NRS (95% CI 0.03-0.05, P < 0.01) on average per session, approaching no acute exercise-induced pain in the last weeks. CONCLUSION This study found a clear decrease in size of acute exercise-induced pain flares with increasing number of exercise sessions. In parallel, pain ratings decreased over the 8 weeks exercise period. Our findings provide helpful information for clinicians, which can be used to educate and balance patient expectation when starting supervised neuromuscular exercise.
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Hoffmann TC, Maher CG, Briffa T, Sherrington C, Bennell K, Alison J, Singh MF, Glasziou PP. Prescribing exercise interventions for patients with chronic conditions. CMAJ 2016; 188:510-518. [PMID: 26976965 DOI: 10.1503/cmaj.150684] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Chris G Maher
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Tom Briffa
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kim Bennell
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jennifer Alison
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Maria Fiatarone Singh
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Paul P Glasziou
- Centre for Research in Evidence-Based Practice (Hoffmann, Glasziou), Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; School of Population Health (Briffa), University of Western Australia, Crawley, Australia; Centre for Health (Bennell), Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia; Discipline of Physiotherapy (Alison), Faculty of Health Sciences, The University of Sydney; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney; Exercise, Health and Performance Faculty Research Group (Singh), Faculty of Health Sciences, Charles Perkins Centre and Sydney Medical School, The University of Sydney, Sydney, Australia
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Rewald S, Mesters I, Lenssen AF, Emans PJ, Wijnen W, de Bie RA. Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial. BMC Musculoskelet Disord 2016; 17:88. [PMID: 26887576 PMCID: PMC4758142 DOI: 10.1186/s12891-016-0939-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/10/2016] [Indexed: 01/22/2023] Open
Abstract
Background Over the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only. Methods The study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. Inclusion criteria: knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. Exclusion criteria: any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection <3 months and/or hyaluronic acid injection <6 months; severe joint complaints (other than knee joint); symptomatic and radiological apparent hip OA; inflammatory joint diseases; inability to safely enter and exit the pool; fear of water. Participants will receive two 45-min moderate intense aqua-cycling sessions weekly over a period of 12 weeks in addition to usual care or usual care only. Usual care consists of an individual intervention plan comprising lifestyle recommendations, medication routine and referral to a physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self-reported disease severity, physical activity level, quality of life, self-efficacy and fear of movement. Daily diaries will collect information on knee pain, physical functioning, level of physical activity, pain medication routine and physical therapy (control group only) or exercise participation over two 30-day periods (during the intervention period). Discussion To our knowledge the present study is the first randomised controlled trial evaluating the effects of aqua-cycling in the pre-surgical stage of knee osteoarthritis. This trial will demonstrate if the newly designed aqua-cycling intervention, in supplement to usual care, can help to improve impairments due to knee osteoarthritis. Trial registration Netherlands Trial Register NTR3766 (21-12-2012). Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0939-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Rewald
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - Ilse Mesters
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - A F Lenssen
- Department of Physiotherapy, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Wiel Wijnen
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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279
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Johnsen MB, Hellevik AI, Baste V, Furnes O, Langhammer A, Flugsrud G, Nordsletten L, Zwart JA, Storheim K. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study). BMC Musculoskelet Disord 2016; 17:86. [PMID: 26879518 PMCID: PMC4754866 DOI: 10.1186/s12891-016-0937-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort. METHODS Participants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45-59 and ≥60 years) and sex. RESULTS A total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08-2.94) and men between 45-59 years (HR 1.53, 95 % CI 1.10-2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03-2.04). No measures of LPA were associated with TKR for men. CONCLUSION In this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.
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Affiliation(s)
- Marianne Bakke Johnsen
- Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alf Inge Hellevik
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway. .,The HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway.
| | - Valborg Baste
- Uni Research Health, Bergen, Norway. .,Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Ove Furnes
- Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. .,Departments of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Arnulf Langhammer
- The HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway.
| | - Gunnar Flugsrud
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Lars Nordsletten
- Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - John Anker Zwart
- Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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280
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Wood LRJ, Blagojevic-Bucknall M, Stynes S, D'Cruz D, Mullis R, Whittle R, Peat G, Foster NE. Impairment-targeted exercises for older adults with knee pain: a proof-of-principle study (TargET-Knee-Pain). BMC Musculoskelet Disord 2016; 17:47. [PMID: 26821917 PMCID: PMC4731955 DOI: 10.1186/s12891-016-0899-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Therapeutic exercise is an effective intervention for knee pain and osteoarthritis (OA) and should be individualised. In a preliminary, proof-of-principle study we sought to develop a home exercise programme targeted at specific physical impairments of weak quadriceps, reduced knee flexion range of motion (ROM) and poor balance, and evaluate whether receipt of this was associated with improvements in those impairments and in patient-reported outcomes among older adults with knee pain. METHODS This community-based study used a single group, before-after study design with 12-week follow-up. Participants were 58 adults aged over 56 years with knee pain and evidence of quadriceps weakness, loss of flexion ROM, or poor balance, recruited from an existing population-based, observational cohort. Participants received a 12-week home exercise programme, tailored to their physical impairments. The programme was led, monitored and progressed by a physiotherapist over six home visits, alternating with six telephone calls. Primary outcome measures were maximal isometric quadriceps strength, knee flexion ROM and timed single-leg standing balance, measured at baseline, 6 and 12 weeks by a research nurse blinded to the nature and content of participants' exercise programmes. Secondary outcome measures included the WOMAC. RESULTS At 12 weeks, participants receiving strengthening exercises demonstrated a statistically significant change in quadriceps isometric strength compared to participants not receiving strengthening exercises: 3.9 KgF (95 % CI 0.1, 7.8). Changes in knee flexion ROM (2.1° (-2.3, 6.5)) and single-leg balance time (-2.4 s (-4.5, 6.7)) after stretching and balance retraining exercises respectively, were not found to be statistically significant. There were significant improvements in mean WOMAC Pain and Physical Function scores: -2.2 (-3.1, -1.2) and -5.1 (-7.8, -2.5). CONCLUSIONS A 12-week impairment-targeted, home-based exercise programme for symptomatic knee OA appeared to be associated with modest improvements in self-reported pain and function but no strong evidence of greater improvement in the specific impairments targeted by each exercise package, with the possible exception of quadriceps strengthening. TRIAL REGISTRATION Clinical Trial Registration Number: ISRCTN 61638364 Date of registration: 24 June 2010.
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Affiliation(s)
- Laurence R J Wood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Milica Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Deborah D'Cruz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Ricky Mullis
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Rebecca Whittle
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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281
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Kobsar D, Osis ST, Hettinga BA, Ferber R. Gait Biomechanics and Patient-Reported Function as Predictors of Response to a Hip Strengthening Exercise Intervention in Patients with Knee Osteoarthritis. PLoS One 2015; 10:e0139923. [PMID: 26444426 PMCID: PMC4596804 DOI: 10.1371/journal.pone.0139923] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/19/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Muscle strengthening exercises have been shown to improve pain and function in adults with mild-to-moderate knee osteoarthritis, but individual response rates can vary greatly. Predicting individuals who respond and those who do not is important in developing a more efficient and effective model of care for knee osteoarthritis (OA). Therefore, the purpose of this study was to use pre-intervention gait kinematics and patient-reported outcome measures to predict post-intervention response to a 6-week hip strengthening exercise intervention in patients with mild-to-moderate knee OA. Methods Thirty-nine patients with mild-to-moderate knee osteoarthritis completed a 6-week hip-strengthening program and were subgrouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in Knee injury Osteoarthritis Outcome Score (KOOS). Predictors of responder subgroups were retrospectively determined from baseline patient-reported outcome measures and kinematic gait parameters in a discriminant analysis of principal components. A 3–4 year follow-up on 16 of the patients with knee OA was also done to examine long-term changes in these parameters. Results A unique combination of patient-reported outcome measures and kinematic factors was able to successfully subgroup patients with knee osteoarthritis with a cross-validated classification accuracy of 85.4%. Lower patient-reported function in daily living (ADL) scores and hip frontal plane kinematics during the loading response were most important in classifying High-Responders from other sub-groups, while a combination of hip, knee, ankle kinematics were used to classify Non-Responders from Low-Responders. Conclusion Patient-reported outcome measures and objective biomechanical gait data can be an effective method of predicting individual treatment success to an exercise intervention. Measuring gait kinematics, along with patient-reported outcome measures in a clinical setting can be useful in helping make evidence-based decisions regarding optimal treatment for patients with knee OA.
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Affiliation(s)
- Dylan Kobsar
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Sean T. Osis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Blayne A. Hettinga
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
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282
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Brenneman EC, Kuntz AB, Wiebenga EG, Maly MR. A Yoga Strengthening Program Designed to Minimize the Knee Adduction Moment for Women with Knee Osteoarthritis: A Proof-Of-Principle Cohort Study. PLoS One 2015; 10:e0136854. [PMID: 26367862 PMCID: PMC4569287 DOI: 10.1371/journal.pone.0136854] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED People with knee osteoarthritis may benefit from exercise prescriptions that minimize knee loads in the frontal plane. The primary objective of this study was to determine whether a novel 12-week strengthening program designed to minimize exposure to the knee adduction moment (KAM) could improve symptoms and knee strength in women with symptomatic knee osteoarthritis. A secondary objective was to determine whether the program could improve mobility and fitness, and decrease peak KAM during gait. The tertiary objective was to evaluate the biomechanical characteristics of this yoga program. In particular, we compared the peak KAM during gait with that during yoga postures at baseline. We also compared lower limb normalized mean electromyography (EMG) amplitudes during yoga postures between baseline and follow-up. Primary measures included self-reported pain and physical function (Knee injury and Osteoarthritis Outcome Score) and knee strength (extensor and flexor torques). Secondary measures included mobility (six-minute walk, 30-second chair stand, stair climbing), fitness (submaximal cycle ergometer test), and clinical gait analysis using motion capture synchronized with electromyography and force measurement. Also, KAM and normalized mean EMG amplitudes were collected during yoga postures. Forty-five women over age 50 with symptomatic knee osteoarthritis, consistent with the American College of Rheumatology criteria, enrolled in our 12-week (3 sessions per week) program. Data from 38 were analyzed (six drop-outs; one lost to co-intervention). Participants experienced reduced pain (mean improvement 10.1–20.1 normalized to 100; p<0.001), increased knee extensor strength (mean improvement 0.01 Nm/kg; p = 0.004), and increased flexor strength (mean improvement 0.01 Nm/kg; p = 0.001) at follow-up compared to baseline. Participants improved mobility on the six-minute walk (mean improvement 37.7 m; p<0.001) and 30-second chair stand (mean improvement 1.3; p = 0.006) at follow-up compared to baseline. Fitness and peak KAM during gait were unchanged between baseline and follow-up. Average KAM during the yoga postures were lower than that of normal gait. Normalized mean EMG amplitudes during yoga postures were up to 31.0% of maximum but did not change between baseline and follow-up. In this cohort study, the yoga-based strengthening postures that elicit low KAMs improved knee symptoms and strength in women with knee OA following a 12 week program (3 sessions per week). The program also improved mobility, but did not improve fitness or reduce peak KAM during gait. The KAM during the yoga postures were lower than that of normal gait. Overall, the proposed program may be useful in improving pain, strength, and mobility in women with knee osteoarthritis. Clinical efficacy needs to be assessed using a randomized controlled trial design. TRIAL REGISTRATION ClinicalTrials.gov NCT02146105.
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Affiliation(s)
- Elora C. Brenneman
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexander B. Kuntz
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emily G. Wiebenga
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Monica R. Maly
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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283
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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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284
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Chang WJ, Bennell KL, Hodges PW, Hinman RS, Liston MB, Schabrun SM. Combined exercise and transcranial direct current stimulation intervention for knee osteoarthritis: protocol for a pilot randomised controlled trial. BMJ Open 2015; 5:e008482. [PMID: 26297371 PMCID: PMC4550738 DOI: 10.1136/bmjopen-2015-008482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is a major health problem and a leading cause of disability. The knee joint is commonly affected, resulting in pain and physical dysfunction. Exercise is considered the cornerstone of conservative management, yet meta-analyses indicate, at best, moderate effect sizes. Treatments that bolster the effects of exercise, such as transcranial direct current stimulation (tDCS), may improve outcomes in knee OA. The aims of this pilot study are to (1) determine the feasibility, safety and perceived patient response to a combined tDCS and exercise intervention in knee OA, and (2) provide data to support a sample size calculation for a fully-powered trial should trends of effectiveness be present. METHODS AND ANALYSIS A pilot randomised, assessor-blind and participant-blind, sham-controlled trial. 20 individuals with knee OA who report a pain score of 40 or more on a 100 mm visual analogue scale on walking, and meet a priori selection criteria will be randomly allocated to receive either: (1) active tDCS plus exercise, or (2) sham tDCS plus exercise. All participants will receive 20 min of either active or sham tDCS immediately prior to 30 min of supervised muscle strengthening exercise twice a week for 8 weeks. Participants in both groups will also complete unsupervised home exercises twice per week. Outcome measures of feasibility, safety, pain, disability and pain system function will be assessed immediately before and after the 8-week intervention. Analyses of feasibility and safety will be performed using descriptive statistics. Statistical analyses will be used to determine trends of effectiveness and will be based on intention-to-treat as well as per protocol. ETHICS AND DISSEMINATION This study was approved by the institutional ethics committee (H10184). Written informed consent will be obtained from all participants. The results of this study will be submitted for peer-reviewed publication. TRIAL REGISTRATION NUMBER ANZCTR365331.
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Affiliation(s)
- Wei-Ju Chang
- University of Western Sydney, School of Science and Health, Penrith, New South Wales, Australia
| | - Kim L Bennell
- The University of Melbourne, School of Health Sciences, Parkville, Victoria, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Rana S Hinman
- The University of Melbourne, School of Health Sciences, Parkville, Victoria, Australia
| | - Matthew B Liston
- University of Western Sydney, School of Science and Health, Penrith, New South Wales, Australia
| | - Siobhan M Schabrun
- University of Western Sydney, School of Science and Health, Penrith, New South Wales, Australia
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285
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Hernandez HJ, McIntosh V, Leland A, Harris-Love MO. Progressive Resistance Exercise with Eccentric Loading for the Management of Knee Osteoarthritis. Front Med (Lausanne) 2015; 2:45. [PMID: 26217665 PMCID: PMC4497310 DOI: 10.3389/fmed.2015.00045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/26/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The patient was a 58-year-old African-American male with radiographic evidence of bilateral knee osteoarthritis (OA). He participated in a standardized 12-week eccentric strengthening program within a Veterans Affairs (VA) medical center. BACKGROUND The use of an eccentric training paradigm may prove to be beneficial for older adults with knee OA since eccentric muscle actions are involved in the energy absorption at the knee joint during gait and controlled movement during stair descent. Furthermore, in comparison to standard muscle actions, eccentric muscle actions result in higher torque generation and a lower rate of oxygen consumption at a given level of perceived exertion. Therefore, this mode of progressive resistance exercise may be ideal for older adults. DISCUSSION The patient completed an eccentric strengthening regimen for the knee flexors and extensors twice per week without an exacerbation of knee pain. Muscle morphology measures of the rectus femoris were measured using diagnostic ultrasound. Isokinetic measures of muscle peak torque were obtained at 60°/s and 180°/s. Functional performance was assessed using a physical performance battery and stair-step performance was assessed from the linear displacement of the center of gravity trajectories obtained with a force plate. Visual analog scale pain ratings and self-reported global disease status were also documented. Post-exercise assessments revealed improvements in sonographic muscle size and tissue composition estimates, peak knee extensor torque (ranging from 60 to 253%), functional performance, and global disease status. CONCLUDING REMARKS The patient exhibited improvements in muscle morphology, muscle strength, functional performance, pain, and global disease status after 12 weeks of an eccentric strengthening regimen. The intervention and outcomes featured in this case were feasible to implement within a VA medical center and merit further investigation.
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Affiliation(s)
- Haniel J. Hernandez
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC, USA
| | - Valerie McIntosh
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
| | - Azadeh Leland
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC, USA
| | - Michael O. Harris-Love
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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286
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Gignac MAM, Cao X, Ramanathan S, White LM, Hurtig M, Kunz M, Marks PH. Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2015; 7:4. [PMID: 25973208 PMCID: PMC4429315 DOI: 10.1186/2052-1847-7-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. METHODS Participants were athletes, 18-40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. RESULTS Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities was predicted by decreases in fears of re-injury and by greater personal importance of exercise. CONCLUSIONS This study highlights not only fears of re-injury, which has been documented in previous studies, but also the perceived personal importance of exercise in predicting activity levels following ACL reconstructive surgery. The findings can help in developing interventions to aid individuals make decisions about physical activities post knee injury and surgery.
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Affiliation(s)
- Monique AM Gignac
- />Institute for Work and Health; Division of Health Care & Outcomes Research, Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xingshan Cao
- />Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Canada
| | - Subha Ramanathan
- />Postdoctoral Fellow, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Lawrence M White
- />Joint Department of Medical Imaging, Faculty of Medicine, University Health Network, Mount Sinai Hospital, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Mark Hurtig
- />Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Monica Kunz
- />Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul H Marks
- />Division of Orthopaedic Surgery, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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