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Tak ECPM, Verweij LM, Chorus AMJ, Hopman-Rock M. What Are the Predictors of Self-Reported Change in Physical Activity in Older Adults with Knee or Hip Osteoarthritis? Int J Behav Med 2023; 30:199-210. [PMID: 35322346 PMCID: PMC10036423 DOI: 10.1007/s12529-022-10080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although physical activity (PA) has been shown to be beneficial in older adults with osteoarthritis (OA), most show low levels of PA. This study evaluated if self-efficacy, attitude, social norm, and coping styles predicted change in PA in older adults with OA in the knee and/or hip. METHODS Prospective study following 105 participants in a self-management intervention with baseline, post-test (6 weeks), and follow-up (6 months). Univariate associations and multivariate regression with self-reported change in PA as the dependent variable were measured. Potential predictors in the model: demographic, illness-related, and behavioral variables (attitude, self-efficacy, social norm, and intention), coping style, and pain coping. RESULTS Forty-eight percent of participants reported increased PA at 6 weeks and 37% at 6 months which corresponded with registered PA levels. At 6 weeks, use of the pain coping style "resting," intention, and participation in the intervention was univariately and multivariately, positively associated with more self-reported change, whereas being single and less use of the pain coping style "distraction" predicted less change. Higher pain severity only predicted less change multivariately. At 6 months, univariate associations for age, general coping style "seeking support," and participation in the intervention were found; higher age was associated multivariately with less self-reported change. CONCLUSION At short term, self-reported change of PA was predicted by the behavioral factors intention and several pain coping styles. Together with other predictors of self-reported change (pain severity, higher age, being single), these could be addressed in future interventions for enhancing PA in older adults with OA.
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Affiliation(s)
| | - Lisanne M Verweij
- Department of Quality and Patient Care, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - Marijke Hopman-Rock
- Department of Public and Occupational Health, AmsterdamUMC (Location Vumc), Van der Boechorststraat 7 1081BT, Amsterdam, the Netherlands.
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2
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Migliore A, Alekseeva L, Avasthi SR, Bannuru RR, Chevalier X, Conrozier T, Crimaldi S, de Campos GC, Diracoglu D, Gigliucci G, Herrero-Beaumont G, Iolascon G, Ionescu R, Jerosch J, Lains J, Maheu E, Makri S, Martusevich N, Matucci-Cerinic M, Pavelka K, Petrella RJ, Raman R, Tarantino U. Early Osteoarthritis Questionnaire (EOAQ): a tool to assess knee osteoarthritis at initial stage. Ther Adv Musculoskelet Dis 2023; 15:1759720X221131604. [PMID: 36860967 PMCID: PMC9969428 DOI: 10.1177/1759720x221131604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 09/22/2022] [Indexed: 02/27/2023] Open
Abstract
Background Early stage of osteoarthritis (OA) is characterized by joint stiffness and pain as well as by subclinical structural changes that may affect cartilage, synovium, and bone. At the moment, the lack of a validated definition of early osteoarthritis (EOA) does not allow to make an early diagnosis and adopt a therapeutic strategy to slow disease progression. Also, no questionnaires are available to evaluate the early stage, and therefore this remains an unmet need. Objective Therefore, the purpose of the technical experts panel (TEP) of 'International Symposium of intra-articular treatment' (ISIAT) was to create a specific questionnaire to evaluate and monitor the follow-up and clinical progress of patients affected by early knee OA. Design The items for the Early Osteoarthritis Questionnaire (EOAQ) were identified according to the following steps: items generation, items reduction, and pre-test submission. Methods During the first step, literature has been reviewed and a comprehensive list of items about pain and function in knee EOA was drafted. Then, during the ISIAT (5th edition 2019), the draft has been discussed by the board, which reformulated, deleted, or subdivided some of the items. After the ISIAT symposium, the draft was submitted to 24 subjects affected by knee OA. A score based on the importance and the frequency was created and the items with a score ⩾0.75 were selected. After intermediate evaluation made by a sample of patients, the second and final version of the questionnaire EOAQ was submitted to the whole board for final analysis and acceptance in a second meeting (29 January 2021). Results After an exhaustive elaboration, the final version of the questionnaire contains two domains (Clinical Features and Patients Reported Outcome) with respectively 2 and 9 questions, for a total of 11 questions. Questions mainly explored the fields of early symptoms and patients reported outcomes. Marginally, the need of the symptoms treatment and the use of painkillers were investigated. Conclusions Adoption of diagnostic criteria of early OA is strongly encouraged and a specific questionnaire for the whole management of the clinical features and patients' outcome might really improve the evolution of OA in the early stages of the disease, when the treatment is expected to be more effective.
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Affiliation(s)
| | - Liudmila Alekseeva
- Department of Metabolic Diseases of Bone and
Joints, VA Nasonova Research Institute of Rheumatology, Moscow, Russian
Federation
| | - Sachin R. Avasthi
- Department of Emergency Medicine, Dr Ram
Manohar Lohia Hospital, Lucknow, India
| | - Raveendhara R. Bannuru
- Centre for Treatment Comparison and Integrative
Analysis Division of Rheumatology, Tufts Medical Centre, Boston, MA,
USA
| | | | | | - Sergio Crimaldi
- Chirurgia Ortopedica Mininvasiva e Nuove
Tecnologie, Humanitas Research Hospital, Castellanza, Italy
| | - Gustavo C. de Campos
- Department of Orthopaedics and Traumatology,
University of Campinas, São Paulo, Brazil
| | - Demirhan Diracoglu
- Department of Physical Medicine and
Rehabilitation Division of Pain Medicine, Istanbul University, Istanbul,
Turkey
| | | | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties
and Dentistry, University of Campania ‘L Vanvitelli’, Caserta, Italy
| | - Ruxandra Ionescu
- Department of Internal Medicine and
Rheumatology Sf. Maria Hospital, University of Medicine and Pharmacy ‘Carol
Davila’, Bucharest, Romania
| | - Jörg Jerosch
- Orthopaedic Department, Johanna Etienne
Hospital, Neuss, Germany
| | - Jorge Lains
- Physical Rehabilitation Medicine Department,
Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, Saint-Antoine
Hospital, Paris, France
| | - Souz Makri
- EUPATI Graduate and Patient Advocate,
Brussels, Belgium
| | - Natalia Martusevich
- Department of Rheumatology, Belorussian State
Medical University, Minsk, Belarus
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical
Medicine, University of Florence, Florence, Italy
| | | | - Robert J. Petrella
- Department of Family Medicine, School of
Kinesiology University Western Ontario, Ontario, ON, Canada
| | - Raghu Raman
- Academic Department of Orthopaedics, Hull and
East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology,
‘Policlinico Tor Vergata’ Foundation, Rome, Italy
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3
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Yamashina S, Harada K, Tanaka R, Inoue Y. Abnormal Gait Pattern Examination Screening for Physical Activity Level after One Year in Patients with Knee Osteoarthritis. J Funct Morphol Kinesiol 2023; 8:jfmk8010024. [PMID: 36810508 PMCID: PMC9944103 DOI: 10.3390/jfmk8010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023] Open
Abstract
This study examined the relationship between abnormal gait pattern and physical activity level one year later in patients with knee osteoarthritis (KOA) and determined the clinical utility of the abnormal gait pattern examination. Initially, the patients' abnormal gait pattern was assessed using seven items, based on the scoring system reported in a previous study. The grading was based on a three-criteria system with 0: no abnormality, 1: moderately abnormal, and 2: severely abnormal. The patients were then classified into three groups according to physical activity level one year after gait pattern examination: low, intermediate, and high physical activity groups, respectively. Cut-off values for physical activity levels were calculated based on abnormal gait pattern examinations results. On follow-ups with 24 of the 46 subjects, age, abnormal gait pattern, and gait speed showed significant differences among the three groups according to the amount of physical activity. Effect size of abnormal gait pattern was higher than age and gait speed. Patients with KOA with physical activity < 2700 steps/day and <4400 steps/day at one year had abnormal gait pattern examination scores of ≥8 and ≥5, respectively. Abnormal gait pattern is associated with future physical activity. The results suggested that abnormal gait pattern examinations in patients with KOA could be used to screen for the possibility of physical activity being <4400 steps one year later.
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Affiliation(s)
- Shunsuke Yamashina
- Department of Rehabilitation, Taira Hospital, Okayama 709-0498, Japan
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima 739-0046, Japan
- Correspondence: ; Tel.: +81869-93-1155
| | - Kazuhiro Harada
- Graduate School of Health Sciences, Kibi International University, Okayama 716-0018, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima 739-0046, Japan
| | - Yu Inoue
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima 739-0046, Japan
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4
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Witkam R, Verstappen SMM, Gwinnutt JM, Cook MJ, O'Neill TW, Cooper R, Humphreys J. The association between lower socioeconomic position and functional limitations is partially mediated by obesity in older adults with symptomatic knee osteoarthritis: Findings from the English Longitudinal Study of Ageing. Front Public Health 2022; 10:1053304. [PMID: 36600944 PMCID: PMC9806847 DOI: 10.3389/fpubh.2022.1053304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the longitudinal associations of socioeconomic position (SEP) with functional limitations and knee joint replacement surgery (JRS) in people with symptomatic knee osteoarthritis (OA), and whether body mass index (BMI) mediated these relationships. Methods Data came from the English Longitudinal Study of Ageing, a national longitudinal panel study of adults aged ≥50 years. A total of 1,499 participants (62.3% female; mean age 66.5 (standard deviation (SD) 9.4) years; 47.4% obese) self-reporting an OA diagnosis and knee pain, with at least one BMI measurement were included. Mixed effect models estimated longitudinal associations of each SEP variable (education, occupation, income, wealth and deprivation index) and obesity (BMI ≥30.0 kg/m2) with repeated measures of functional limitations. Cox regression analyses estimated associations between SEP indicators and obesity at baseline and risk of knee JRS at follow-up. Structural equation modeling estimated any mediating effects of BMI on these relationships. Results Lower SEP and obesity at baseline were associated with increased odds of functional limitations in people with knee OA [e.g., difficulty walking 100 yards: no qualification vs. degree adjOR 4.33 (95% CI 2.20, 8.55) and obesity vs. no obesity adjOR 3.06 (95% CI 2.14, 4.37); similar associations were found for the other SEP indicators]. A small proportion of the association between lower SEP and functional limitations could be explained by BMI (6.2-12.5%). Those with lower income, lower wealth and higher deprivation were less likely to have knee JRS [e.g., adjHR most vs. least deprived 0.37 (95% CI 0.19, 0.73)]; however, no clear association was found for education and occupation. Obesity was associated with increased hazards of having knee JRS [adjHR 1.87 (95% CI 1.32, 2.66)]. As the direction of the associations for SEP and obesity with knee JRS were in opposite directions, no mediation analyses were performed. Conclusions Lower SEP was associated with increased odds of functional limitations but lower hazards of knee JRS among people with knee OA, potentially indicating underutilization of JRS in those with lower SEP. Obesity partially mediated the relationship between lower SEP and increased odds of functional limitations, suggesting adiposity as a potential interventional target.
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Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Suzanne M. M. Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom,*Correspondence: Suzanne M. M. Verstappen
| | - James M. Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael J. Cook
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Terence W. O'Neill
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom,AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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5
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Endoscopic Surgical Treatment of Osteoarthritis and Prognostic Model Construction. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1799177. [PMID: 36105246 PMCID: PMC9467768 DOI: 10.1155/2022/1799177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
Purpose Osteoarthritis (OA) is a degenerative disease of joints. Currently, there is still a lack of effective tools to predict the long-term efficacy of surgical treatment of OA. The purpose of this study was to explore the prognostic factors of endoscopic surgery for OA and to predict the long-term efficacy of this type of surgery for OA by establishing a prognostic model. Methods Baseline and follow-up data on 236 OA patients who underwent surgery in our hospital from January 2017 to December 2021 were selected and patients were randomly assigned to a training set (n = 165) and a test set (n = 71). The Pearson correlation coefficient was used to analyze the correlation between features. Feature selection was performed by recursive feature elimination (RFE) and linear regression. K-means clustering analysis was performed on the selected features to obtain the number of output layers. Finally, a single hidden layer error backpropagation (BP)-artificial neural network (ANN) model was established on the training set, and receiver operating characteristic (ROC) curve was drawn on the test set for verification. Results Correlation analysis revealed no redundancy among features. RFE and linear regression screened out the features associated with postoperative prognosis under endoscopic surgery: sex, age, BMI, region, morning stiffness time, step count, and osteophyte area. K-means clustering yielded that the optimal number of categories was three, the same as the number of categories for the outcome variable. Therefore, a 7-1-3 BP neural network model was established based on these 7 features, and this model could predict the postoperative situation within one year to a relatively accurate extent: area under curve values (AUC) were 0.814, 0.700, and 0.761 in patients with worse, unchanged, and improved conditions one year after surgery, respectively, higher than the multiclass AUC value (0.646). Conclusion The prognostic model of endoscopic surgery for OA constructed in this study can well predict the disease progression of patients within one year after surgery.
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6
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van Berkel AC, Schiphof D, Waarsing JH, Runhaar J, van Ochten JM, Bindels PJE, Bierma-Zeinstra SMA. 10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study. Ann Rheum Dis 2021; 80:487-493. [PMID: 33451999 PMCID: PMC7958083 DOI: 10.1136/annrheumdis-2020-218625] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/14/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To explore the natural course of hip osteoarthritis (OA) in a population of first-time presenters with hip complaints. METHODS Data were collected at baseline and after 2, 5, 8 and 10 years on participants from the Cohort Hip and Cohort Knee study with early symptomatic hip OA. Descriptive statistics were used to analyse the natural course of the hip complaints with respect to clinical signs and symptoms, physical functioning and radiographic osteoarthritis (ROA) features. RESULTS In total, 588 participants were included with hip complaints and 86% completed the 10-year follow-up. The 10-year follow-up showed that 12% (69 participants) underwent hip replacement (HR), an increase of ROA of the hip (Kellgren and Lawrence score≥2) from 19% to 49%, and an increase in clinical hip OA according to the American College of Rheumatology criteria from 27% to 43%. All Western Ontario and McMaster Osteoarthritis Index subscales and physical activity remained on average constant during the 10-year follow-up for those who did not undergo an HR. The use of pain medication increased from 43% at baseline to 50% after 10 years. CONCLUSION One out of nine participants with early hip problems received an HR during the 10-year follow-up. Prevalence of clinical hip OA and hip ROA increased steadily during the 10-year follow-up. Overall, we observed more hip OA, but fewer or stable complaints with respect to clinical signs and symptoms, and physical functioning. So it could be cautiously concluded that after 10 years, first-time presenters with hip complaints either received an HR or their symptoms remained stable.
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Affiliation(s)
- Annemaria C van Berkel
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John M van Ochten
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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7
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Tanaka S, Nishigami T, Wand BM, Stanton TR, Mibu A, Tokunaga M, Yoshimoto T, Ushida T. Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis-generating study. Eur J Pain 2020; 25:485-496. [PMID: 33108042 DOI: 10.1002/ejp.1687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this investigation was to undertake a hypothesis-generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise. METHODS One hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20-min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self-efficacy and knee self-perception. RESULTS Fifty-five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self-perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise. CONCLUSIONS Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise. SIGNIFICANCE Regardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self-efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants.
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Affiliation(s)
- So Tanaka
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, Fukuoka, Japan.,The Doctoral Course of Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Hiroshima, Japan
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Tasha R Stanton
- IIMPACT in Health, The University of South Australia, Adelaide, SA, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Akira Mibu
- Department of Nursing and Physical Therapy, Konan Women's University, Kobe, Japan
| | - Masami Tokunaga
- Department of Orthopaedic, Fukuoka Orthopaedic Hospital, Fukuoka, Japan
| | - Takaaki Yoshimoto
- Department of Orthopaedic, Fukuoka Orthopaedic Hospital, Fukuoka, Japan
| | - Takahiro Ushida
- The Doctoral Course of Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Center for Interdisciplinary, Aichi Medical University, Nagakute, Japan
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Price A, Smith J, Dakin H, Kang S, Eibich P, Cook J, Gray A, Harris K, Middleton R, Gibbons E, Benedetto E, Smith S, Dawson J, Fitzpatrick R, Sayers A, Miller L, Marques E, Gooberman-Hill R, Blom A, Judge A, Arden N, Murray D, Glyn-Jones S, Barker K, Carr A, Beard D. The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling. Health Technol Assess 2020; 23:1-216. [PMID: 31287051 DOI: 10.3310/hta23320] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. OBJECTIVES/RESEARCH QUESTIONS Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? METHODS A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. RESULTS From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. LIMITATIONS The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. CONCLUSION The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. FUTURE WORK Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sujin Kang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Eibich
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Kristina Harris
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elena Benedetto
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jill Dawson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Adrian Sayers
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Laura Miller
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Elsa Marques
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Ashley Blom
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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9
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Bell K, Hendry G, Steultjens M. Physical activity and sedentary behaviour in people with inflammatory joint disease: a cross sectional study. Arthritis Care Res (Hoboken) 2020; 74:493-500. [DOI: 10.1002/acr.24438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kirsty Bell
- Physiotherapy Department Crieff Community Hospital PH7 3HR Crieff Scotland UK
| | - Gordon Hendry
- Physiotherapy Department Crieff Community Hospital PH7 3HR Crieff Scotland UK
| | - Martijn Steultjens
- Physiotherapy Department Crieff Community Hospital PH7 3HR Crieff Scotland UK
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10
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Xu C, Marchand NE, Driban JB, McAlindon T, Eaton CB, Lu B. Dietary Patterns and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Am J Clin Nutr 2020; 111:667-676. [PMID: 31912140 PMCID: PMC7049524 DOI: 10.1093/ajcn/nqz333] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While some individual foods and nutrients have been associated with knee osteoarthritis (KOA) progression, the association between dietary patterns and KOA progression has received little research attention. OBJECTIVE The objective of this study was to determine whether dietary patterns, derived by principal components analysis (PCA), are associated with KOA progression. METHODS In the Osteoarthritis Initiative (OAI), a prospective cohort with clinical centers in Maryland, Ohio, Pennsylvania, and Rhode Island, 2757 participants with existing KOA (mean age 62 y) and diet assessed at baseline were followed for ≤72 mo. Using PCA, Western and prudent dietary patterns were derived. Radiographic KOA progression was assessed using 2 separate measures, 1 full Kellgren-Lawrence (KL) grade increase and loss in joint space width (JSW). Symptomatic KOA progression was defined as an increase in or remaining in 1 of the 2 highest classification categories of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). RESULTS Adherence to Western and prudent dietary patterns was significantly associated with radiographic and symptomatic progression of KOA. With increasing Western pattern score, there was increased KL-worsening risk (compared with quartile 1, HR for quartile 4: 1.30; 95% CI: 1.05, 1.61; P-trend < 0.01) and increased odds of progression to higher WOMAC score (compared with quartile 1, OR for quartile 4: 1.39; 95% CI: 1.18, 1.63; P-trend < 0.01) but no significant change in JSW loss. With increasing prudent pattern score there was decreased KL-worsening risk (compared with quartile 1, HR for quartile 4: 0.79; 95% CI: 0.64, 0.98; P-trend = 0.02), decreased JSW loss (quartile 1: 0.46 mm; quartile 4: 0.38 mm; P-trend < 0.01), and decreased odds of higher WOMAC progression (compared with quartile 1, OR for quartile 4 0.73; 95% CI: 0.62, 0.86; P-trend < 0.01) in multivariable adjusted models. CONCLUSIONS Adherence to a Western dietary pattern was associated with increased radiographic and symptomatic KOA progression, while following a prudent pattern was associated with reduced progression. In general, for people already diagnosed with KOA, eating a diet rich in fruits, vegetables, fish, whole grains, and legumes may be related to decreased radiographic and symptomatic disease progression.
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Affiliation(s)
- Chang Xu
- Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Nathalie E Marchand
- Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey B Driban
- Division of Rheumatology, Immunology and Allergy, Tufts Medical Center, Boston, MA
| | - Timothy McAlindon
- Division of Rheumatology, Immunology and Allergy, Tufts Medical Center, Boston, MA
| | - Charles B Eaton
- Brown University Center for Primary Care and Prevention, Pawtucket, RI,Departments of Family Medicine and Epidemiology, the Warren Alpert Medical School of Brown University, Providence, RI
| | - Bing Lu
- Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, MA,Address correspondence to BL (e-mail: )
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11
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Teirlinck CH, Dorleijn DMJ, Bos PK, Rijkels-Otters JBM, Bierma-Zeinstra SMA, Luijsterburg PAJ. Prognostic factors for progression of osteoarthritis of the hip: a systematic review. Arthritis Res Ther 2019; 21:192. [PMID: 31443685 PMCID: PMC6708123 DOI: 10.1186/s13075-019-1969-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Predicting which patients with hip osteoarthritis are more likely to show disease progression is important for healthcare professionals. Therefore, the aim of this review was to assess which factors are predictive of progression in patients with hip osteoarthritis. Methods A literature search was made up until 14 March 2019. Included were cohort and case-control studies evaluating the association between factors and progression (either clinical, radiological, or THR). Excluded were studies with a follow-up < 1 year or specific underlying pathologies of osteoarthritis. Risk of bias was assessed using the QUIPS tool. A best-evidence synthesis was conducted. Results We included 57 articles describing 154 different factors. Of these, a best-evidence synthesis was possible for 103 factors, separately for clinical and radiological progression, and progression to total hip replacement. We found strong evidence for more clinical progression in patients with comorbidity and more progression to total hip replacement for a higher Kellgren and Lawrence grade, superior or (supero) lateral femoral head migration, and subchondral sclerosis. Strong evidence for no association was found regarding clinical progression for gender, social support, pain medication, quality of life, and limited range of motion of internal rotation or external rotation. Also, strong evidence for no association was found regarding radiological progression for the markers CTX-I, COMP, NTX-I, PINP, and PIIINP and regarding progression to total hip replacement for body mass index. Conclusion Strong evidence suggested that 4 factors were predictive of progression of hip osteoarthritis, whereas 12 factors were not predictive of progression. Evidence for most of the reported factors was either limited or conflicting. Protocol registration PROSPERO, CRD42015010757 Electronic supplementary material The online version of this article (10.1186/s13075-019-1969-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C H Teirlinck
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - D M J Dorleijn
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P K Bos
- Department of Orthopedics, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - J B M Rijkels-Otters
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Orthopedics, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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12
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Chang AH, Chmiel JS, Almagor O, Hayes KW, Guermazi A, Prasad PV, Moisio KC, Zhang Y, Szymaszek J, Sharma L. Hip muscle strength and protection against structural worsening and poor function and disability outcomes in knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:885-894. [PMID: 30825608 PMCID: PMC6536333 DOI: 10.1016/j.joca.2019.02.795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Examine associations of hip abductor strength with (1) cartilage damage worsening in the tibiofemoral and patellofemoral compartments 2 years later, and (2) poor function and disability outcomes 5 years later. METHODS Participants had knee osteoarthritis (K/L ≥ 2) in at least one knee. Hip abductor strength was measured using Biodex Dynamometry. Participants underwent 3.0T MRI of both knees at baseline and 2 years later. Baseline-to-2-year cartilage damage progression, defined as any worsening of WORMS cartilage damage score, was assessed at each tibiofemoral and patellofemoral surface. LLFDI (Late-Life Function and Disability Instrument) and Chair-Stand-Rate were recorded at baseline and 5-year follow-up; outcomes analyzed using quintiles. Poor outcomes were defined as remaining in the same low-function quintiles or being in a worse quintile at 5-year follow-up. We analyzed associations of baseline hip abductor strength with cartilage damage worsening and function and disability outcomes using multivariable log-binomial models. RESULTS 275 knees from 164 persons [age = 63.7 (SD = 9.8) years, 79.3% women] comprised the structural outcome sample, and 187 persons [age = 64.2 (9.7), 78.6% women] the function and disability outcomes sample. Greater baseline hip abductor strength was associated with reduced risks of baseline-to-2-year medial patellofemoral and lateral tibiofemoral cartilage damage worsening [adjusted relative risks (RRs) range: 0.80-0.83) and with reduced risks of baseline-to-5-year poor outcomes for Chair-Stand-Rate and LLFDI Basic Lower-Extremity Function and Disability Limitation (adjusted RRs range: 0.91-0.94). CONCLUSION Findings support a beneficial role of hip abductor strength for disease modification and for function and disability outcomes, and as a potential therapeutic target in managing knee osteoarthritis.
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Affiliation(s)
- Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joan S. Chmiel
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, USA
| | - Orit Almagor
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Karen W. Hayes
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology,
Boston University School of Medicine, Boston, MA, USA
| | | | - Kirsten C. Moisio
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yunhui Zhang
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julie Szymaszek
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Leena Sharma
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
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13
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Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Gait- and Posture-Related Factors Associated With Changes in Hip Pain and Physical Function in Patients With Secondary Hip Osteoarthritis: A Prospective Cohort Study. Arch Phys Med Rehabil 2019; 100:2053-2062. [PMID: 31054296 DOI: 10.1016/j.apmr.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify gait- and posture-related factors associated with changes in hip pain and physical function in patients with hip osteoarthritis (OA). DESIGN Prospective cohort study. SETTING Clinical biomechanics laboratory of a university. PARTICIPANTS Consecutive sampling of female patients with mild-to-moderate secondary hip OA (N=30). MAIN OUTCOME MEASURES Hip pain (visual analog scale) and physical function (physical component summary of the Medical Outcomes Study 36-Item Short-Form Health Survey) were measured at baseline and 12 months later. With changes in hip pain and physical function as dependent variables, linear regression analyses were performed with gait- and posture-related factors as independent variables with and without adjustment for age, joint space width, and hip pain or physical function at baseline. Posture-related factors included angles of thoracic kyphosis, lumbar lordosis, sacral inclination, spinal inclination, and spinal mobility. Gait-related factors were walking speed, steps per day, joint angles, external hip joint moment impulses, and daily cumulative hip moments. RESULTS Multiple linear regression analyses showed that limited hip extension (adjusted standardized B coefficient [95% confidence interval]: -0.52 [-0.88 to -0.17]) and limited external rotation angles (-0.51 [-0.85 to -0.18]) during walking were associated with the worsening of hip pain. An increased thoracic kyphosis (-0.54 [-0.99 to -0.09]), less sacral anterior tilt (0.40 [0.01-0.79]), reduced thoracic spine mobility (0.59 [0.23-0.94]), less steps per day (0.53 [0.13-0.92]), and a slower walking speed (0.45 [0.04-0.86]) were associated with deterioration in physical function. CONCLUSIONS Gait- and posture-related factors should be considered when assessing risk and designing preventive interventions for the clinical progression of secondary hip OA.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 47:805-813. [DOI: 10.1016/j.semarthrit.2017.10.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
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15
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Nur H, Sertkaya BS, Tuncer T. Determinants of physical functioning in women with knee osteoarthritis. Aging Clin Exp Res 2018; 30:299-306. [PMID: 28608254 DOI: 10.1007/s40520-017-0784-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is an important health problem with its high prevalence and association with pain and functional disability in physical tasks and activities especially in women. AIMS To explore the impacts of widely seen demographic, pathological, psychological, and impairment factors on physical functioning in women with knee OA using the performance-based and self-reported measures. METHODS One hundred and ten women with knee OA participated in this study. Performance-based measures included the 10-m walk test, timed up and go (TUG) test, and a stair test. Self-reported physical functioning was measured using the Western Ontario and McMasters Universities OA Index. Knee muscle strength, pain intensity, flexion range of motion (ROM), body mass index (BMI), radiographic severity, and anxious and depressive symptoms were measured. Age, disease duration, and comorbidities were recorded. Correlation and linear regression analyses were used to assess the associations. RESULTS In the linear regression models, knee muscle weakness, limited knee flexion ROM, pain intensity, and older age contributed to 65% of variance in physical performance measures mostly explained by knee muscle weakness. Knee pain intensity, BMI, anxiety, and knee muscle weakness contributed to 60% of variance in WOMAC physical function score mostly explained by pain. Radiologic severity, depression, comorbidities, and disease duration did not have a significant association (P < 0.05). Performance-based measures had significant but moderate correlations with WOMAC physical function score (r range 0.51-0.57, P < 0.05). CONCLUSION In women with knee OA, knee muscle strength was the main determinant of performance-based physical functioning together with knee flexion ROM, knee pain, and age. Knee pain was the main determinant of self-reported physical functioning. BMI, anxiety, and knee muscle strength had some contributions as well. Performance-based and self-reported measures had moderate relations and evaluate different aspects of physical functioning. In the management of women with knee OA strengthening of weak knee muscles, improving limited flexion ROM, pain management, weight loss, and improving anxiety should be considered as a priority and performance-based and self-reported measures should be used together for a comprehensive evaluation of physical functioning.
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Affiliation(s)
- Hakan Nur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Akdeniz University, 07059, Antalya, Turkey.
| | - Bilge Saruhan Sertkaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Akdeniz University, 07059, Antalya, Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Akdeniz University, 07059, Antalya, Turkey
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16
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Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther 2017; 19:260. [PMID: 29191237 PMCID: PMC5709997 DOI: 10.1186/s13075-017-1456-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 01/12/2023] Open
Abstract
Background We aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA). Methods Forty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace. Results Wearing a soft brace significantly reduced pain during level walking (B − 0.60, P = 0.001) and perturbed walking (B − 0.80, P < 0.001), reduced the time to complete the 10-m walk (B − 0.23, P < 0.001) and the GUG tests (B − 0.23, P = 0.004), reduced self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P < 0.001), and reduced lack of confidence in the knees during level walking (OR 0.45, P < 0.001) and perturbed walking (OR 0.56, P < 0.001), compared with not wearing a soft brace. There was no difference in effects between a non-tight and tight brace, except for the 10-m walk test. Wearing a tight brace significantly reduced the time to complete the 10-m walk test in comparison with wearing a non-tight brace (B − 0.11, P = 0.03). Conclusion The results of this study indicate that a soft brace is an efficacious intervention targeting pain, activity limitations, self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life. Trial registration trialregister.nl, NTR6363. Retrospectively registered on 15 May 2017.
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Affiliation(s)
- Tomasz Cudejko
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center (MIQC), Academic Medical Center, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Willem Lems
- Amsterdam Rheumatology & Immunology Center, Amsterdam Medical Center, Reade, VU University Medical Center, Amsterdam, The Netherlands.,Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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17
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Iolascon G, Gimigliano F, Moretti A, de Sire A, Migliore A, Brandi M, Piscitelli P. Early osteoarthritis: How to define, diagnose, and manage. A systematic review. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Clinical Prediction Models for Patients With Nontraumatic Knee Pain in Primary Care: A Systematic Review and Internal Validation Study. J Orthop Sports Phys Ther 2017. [PMID: 28622751 DOI: 10.2519/jospt.2017.7142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review and validation study. Background Many prognostic models of knee pain outcomes have been developed for use in primary care. Variability among published studies with regard to patient population, outcome measures, and relevant prognostic factors hampers the generalizability and implementation of these models. Objectives To summarize existing prognostic models in patients with knee pain in a primary care setting and to develop and internally validate new summary prognostic models. Methods After a sensitive search strategy, 2 reviewers independently selected prognostic models for patients with nontraumatic knee pain and assessed the methodological quality of the included studies. All predictors of the included studies were evaluated, summarized, and classified. The predictors assessed in multiple studies of sufficient quality are presented in this review. Using data from the Musculoskeletal System Study (BAS) cohort of patients with a new episode of knee pain, recruited consecutively by Dutch general medical practitioners (n = 372), we used predictors with a strong level of evidence to develop new prognostic models for each outcome measure and internally validated these models. Results Sixteen studies were eligible for inclusion. We considered 11 studies to be of sufficient quality. None of these studies validated their models. Five predictors with strong evidence were related to function and 6 to recovery, and were used to compose 2 prognostic models for patients with knee pain at 1 year. Running these new models in another data set showed explained variances (R2) of 0.36 (function) and 0.33 (recovery). The area under the curve of the recovery model was 0.79. After internal validation, the adjusted R2 values of the models were 0.30 (function) and 0.20 (recovery), and the area under the curve was 0.73. Conclusion We developed 2 valid prognostic models for function and recovery for patients with nontraumatic knee pain, based on predictors with strong evidence. A longer duration of complaints predicted poorer function but did not adequately predict chance of recovery. Level of Evidence Prognosis, levels 1a and 1b. J Orthop Sports Phys Ther 2017;47(8):518-529. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7142.
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19
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Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage 2017; 25:647-653. [PMID: 27940216 DOI: 10.1016/j.joca.2016.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the proportion of isolated patellofemoral osteoarthritis (PFOA) compared to tibiofemoral osteoarthritis (TFOA) in middle-aged participants with early osteoarthritis (OA) symptoms of the knee; to describe the natural course of PFOA compared with that of TFOA and to identify whether patients with PFOA have a different phenotype compared to patients with TFOA, or with combined PFOA and TFOA (combined osteoarthritis (COA)). DESIGN Participants with early OA symptoms of the knee were selected, completed questionnaires, underwent physical examination, and had knee radiographs at baseline, and at 2 and 5 years follow-up. Based on radiographs, participants were classified as having isolated TFOA, isolated PFOA, COA, or no radiographic OA. Multivariate logistic regression was used to identify participant characteristics associated with a specific group of OA at 2 years follow-up. RESULTS The cohort comprised 845 participants (mean age 55.9 years). At baseline, 116 had PFOA, none had TFOA or COA. Of these 116 participants, 66.3% had developed COA at 5 years follow-up. At 2 years follow-up, PFOA, TFOA and COA were present in 77 (10.8%), 39 (5.5%) and 83 (11.6%) participants, respectively. Multivariate regression analyses at 2 years follow-up showed that participants with radiographic PFOA or TFOA were not significantly different from each other with respect to signs and symptoms. CONCLUSIONS These results suggest that OA is more likely to start in the patellofemoral joint and then progress to COA in individuals with symptoms of early knee OA. No differences in TFOA and PFOA phenotypes were determined with respect to signs and symptoms.
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20
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Migliore A, Scirè CA, Carmona L, Beaumont GH, Bizzi E, Branco J, Carrara G, Chevalier X, Collaku L, Aslanidis S, Denisov L, Di Matteo L, Bianchi G, Diracoglu D, Frediani B, Maheu E, Martusevich N, Bagnato GF, Scarpellini M, Minisola G, Akkoc N, Ramonda R, Barskova T, Babic-Naglic D, Muelas JVM, Ionescu R, Rashkov R, Damjanov N, Cerinic MM. The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology. Rheumatol Int 2017; 37:1227-1236. [DOI: 10.1007/s00296-017-3700-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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21
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Mahler E, den Broeder AA, Woodworth TG, Busch V, van den Hoogen FH, Bijlsma J, van den Ende C. How should worsening in osteoarthritis be defined? Development and initial validation of preliminary criteria for clinical worsening in knee and hip osteoarthritis. Scand J Rheumatol 2017; 46:396-406. [PMID: 28276959 DOI: 10.1080/03009742.2016.1235226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES There is a need to define and validate measures of clinical worsening in knee and hip osteoarthritis (OA). The objectives of this exploratory project were: (i) to characterize worsening criteria in knee and hip OA using psychometric methods; (ii) to estimate their sensitivity and specificity; and (iii) to validate and compare these criteria with worsening criteria previously described in the literature. METHOD An Expert Group reached consensus on 10 sets of worsening criteria to be tested in observational data sets of patients with knee or hip OA who received multimodal conservative treatment. These sets included 219 patients (derivation cohort) and 296 patients (validation cohort). We estimated minimal clinically important worsening (MCIW) values for pain, function, stiffness, and patient global assessment, and tested candidate worsening criteria in the derivation cohort. Finally, using patient judgement, we examined the sensitivity and specificity of literature-based as well as candidate worsening criteria in the validation cohort. RESULTS Literature-based worsening criteria were found to have high specificity (range 60-92%) but low sensitivity (range 22-59%). Two out of 10 candidate worsening criteria constructed by the Expert Group showed an acceptable combination of sensitivity and specificity in the derivation cohort, which was confirmed in the validation cohort (ranging from 54% to 65% and 67% to 74%, respectively). CONCLUSIONS This is the first study to describe symptomatic worsening criteria based on expert consensus after examining the performance of candidate criteria derived from the literature applied to data in an observational study. The newly proposed worsening criteria show an acceptable combination of sensitivity and specificity.
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Affiliation(s)
- Eam Mahler
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - A A den Broeder
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - T G Woodworth
- b Division of Rheumatology , Geffen School of Medicine UCLA , Los Angeles , CA , USA
| | - Vjjf Busch
- c Department of Orthopedics , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - F H van den Hoogen
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.,d Department of Rheumatology , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Jwj Bijlsma
- e Department of Rheumatology and Clinical Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Chm van den Ende
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
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22
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Riddle DL, Golladay GJ, Hayes A, Ghomrawi HM. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24:354-361. [PMID: 27914722 PMCID: PMC5359031 DOI: 10.1016/j.knee.2016.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/12/2016] [Accepted: 11/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. METHODS A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. RESULTS Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded 'yes'). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1). CONCLUSION A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.
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Affiliation(s)
- Daniel L. Riddle
- Department of Physical Therapy, School of Allied Health Professions,Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University,Corresponding author: Department of Physical Therapy, West Hospital, Room B-100, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA. Tel.: 804-828-0234; fax: 804-828-8111. (Daniel L. Riddle)
| | - Gregory J. Golladay
- Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University
| | - Amanda Hayes
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
| | - Hassan M.K. Ghomrawi
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
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23
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de Rooij M, van der Leeden M, Heymans MW, Holla JFM, Häkkinen A, Lems WF, Roorda LD, Veenhof C, Sanchez-Ramirez DC, de Vet HCW, Dekker J. Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016; 68:481-92. [PMID: 26316234 DOI: 10.1002/acr.22693] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/10/2015] [Accepted: 08/11/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA. METHODS A search was conducted in PubMed, CINAHL, Embase, Psych-INFO, and SPORTDiscus up to January 2014. A meta-analysis and a qualitative data synthesis were performed. RESULTS Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I(2) >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain and physical functioning was interpreted to be indistinct. We found strong evidence for a number of prognostic factors predicting deterioration in pain (e.g., higher knee pain at baseline, bilateral knee symptoms, and depressive symptoms). We also found strong evidence for a number of prognostic factors predicting deterioration in physical functioning (e.g., worsening in radiographic OA, worsening of knee pain, lower knee extension muscle strength, lower walking speed, and higher comorbidity count). CONCLUSION Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. These findings support current research efforts to define subgroups or phenotypes within knee OA populations. Strong evidence was found for knee characteristics, clinical factors, and psychosocial factors as prognostics of deterioration of pain and physical functioning.
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Affiliation(s)
- Mariëtte de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Centre, Reade, and VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Martijn W Heymans
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Jasmijn F M Holla
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Arja Häkkinen
- University of Jyväskylä and Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Willem F Lems
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Cindy Veenhof
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Henrica C W de Vet
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Joost Dekker
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
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24
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Øiestad BE, White DK, Booton R, Niu J, Zhang Y, Torner J, Lewis CE, Nevitt M, LaValley M, Felson DT. Longitudinal Course of Physical Function in People With Symptomatic Knee Osteoarthritis: Data From the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 68:325-31. [PMID: 26236919 DOI: 10.1002/acr.22674] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/27/2015] [Accepted: 07/21/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pain and functional decline are hallmarks of knee osteoarthritis (OA). Nevertheless, longitudinal studies unexpectedly reveal stable or improved physical function. The aim of this study was to impute missing and pre-total knee replacement (TKR) values to describe physical function over time among people with symptomatic knee OA. METHODS We included participants from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) with incident symptomatic knee OA, observed during the first 30 months in MOST and 36 months in OAI. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (WOMAC-PF), the 5-times sit-to-stand test, and the 20-meter-walk test were assessed at 4 and 5 years in MOST and at 6 years in OAI. We used a multiple imputation method for missing visits, and estimated pre-TKR values close to the time of TKR, using a fitted local regression smoothing curve. In mixed-effect models, we investigated the physical function change over time, using data before and after imputation and calculation of pre-TKR values. RESULTS In MOST, 225 (8%) had incident knee OA, with corresponding 577 (12.7%) in OAI. After adjusting for pre-TKR values and imputing missing values, we found that WOMAC-PF values remained stable or slightly declined over time, and the 20-meter-walk test results changed from stable in nonimputed analyses to worsening using imputed data. CONCLUSION Data from MOST and OAI showed stable to worsening physical function over time in people with incident symptomatic knee OA after imputing missing values and adjusting pre-TKR values.
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Affiliation(s)
| | - Daniel K White
- University of Delaware, Newark, and Boston University School of Medicine, Boston, Massachusetts
| | - Ross Booton
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | - Michael LaValley
- Boston University School of Medicine and School of Public Health, Boston, Massachusetts
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester, Manchester, UK
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25
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Riddle DL, Makowski M, Kong X. Knee Osteoarthritis Worsening Across the Disease Spectrum and Future Knee Pain, Symptoms, and Functioning: A Multisite Prospective Cohort Study. Arthritis Care Res (Hoboken) 2016. [PMID: 26212203 DOI: 10.1002/acr.22654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Prognostic estimates for knee osteoarthritis worsening over the full disease spectrum have not been reported. Osteoarthritis Initiative data were used to determine the association between knee radiographic osteoarthritis worsening and future knee pain and function. METHODS Yearly data over a 5-year period were analyzed. Outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index and the Knee Injury and Osteoarthritis Outcome Score pain and symptoms scales. Knees were grouped based on whether yearly Kellgren/Lawrence (K/L) grades worsened. Associations of yearly K/L worsening with knee pain, symptoms, or function scores at the end of the year and with lagged outcomes observed at least 1 year after worsening were assessed using linear models with generalized estimating equations. RESULTS A total of 25,932 knee-years of observations were examined in the primary analysis. For knees with yearly K/L worsening, all outcome scores were significantly worse (P values from 0.02 to <0.001) at the end of the index year, as compared to unchanged knees. All outcomes for knees with worsened versus unchanged K/L scores exceeded the minimal clinically important difference (MCID). For lagged effects, outcomes at 1 year following the index K/L year exceeded the MCID and were statistically significant (P ≤ 0.001) for knees with baseline K/L grades of 2 or 3. CONCLUSION K/L worsening over a 1-year period is prognostically important over the short term for all baseline K/L grades, and for knees with baseline K/L grades of 2 or 3 worsening continues over the following year.
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26
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Hamilton CB, Wong MK, Gignac MAM, Davis AM, Chesworth BM. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review. Pain Pract 2016; 17:99-114. [PMID: 26990402 DOI: 10.1111/papr.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. METHODS A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. RESULTS Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. CONCLUSIONS Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.
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Affiliation(s)
- Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Ming-Kin Wong
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Monique A M Gignac
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Aileen M Davis
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation, Rehabilitation Science Institute, Toronto, Ontario, Canada.,Departments of Physical Therapy and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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27
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Bastick AN, Runhaar J, Belo JN, Bierma-Zeinstra SMA. Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies. Arthritis Res Ther 2015; 17:152. [PMID: 26050740 PMCID: PMC4483213 DOI: 10.1186/s13075-015-0670-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We performed a systematic review of prognostic factors for the progression of symptomatic knee osteoarthritis (OA), defined as increase in pain, decline in physical function or total joint replacement. METHOD We searched for available observational studies up to January 2015 in Medline and Embase according to a specified search strategy. Studies that fulfilled our initial inclusion criteria were assessed for methodological quality. Data were extracted and the results were pooled, or if necessary summarized according to a best evidence synthesis. RESULTS Of 1,392 articles identified, 30 met the inclusion criteria and 38 determinants were investigated. Pooling was not possible due to large heterogeneity between studies. The best evidence synthesis showed strong evidence that age, ethnicity, body mass index, co-morbidity count, magnetic resonance imaging (MRI)-detected infrapatellar synovitis, joint effusion and baseline OA severity (both radiographic and clinical) are associated with clinical knee OA progression. There was moderate evidence showing that education level, vitality, pain-coping subscale resting, MRI-detected medial femorotibial cartilage loss and general bone marrow lesions are associated with clinical knee OA progression. However, evidence for the majority of determinants was limited (including knee range of motion or markers) or conflicting (including age, gender and joint line tenderness). CONCLUSION Strong evidence was found for multiple prognostic factors for progression of clinical knee OA. A large variety in definitions of clinical knee OA (progression) remains, which makes it impossible to summarize the evidence through meta-analyses. More research on prognostic factors for knee OA is needed using symptom progression as an outcome measure. Remarkably, only few studies have been performed using pain progression as an outcome measure. The pathophysiology of radiographic factors and their relation with symptoms should be further explored.
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Affiliation(s)
- Alex N Bastick
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - Janneke N Belo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
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28
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Holla JFM, van der Leeden M, Knol DL, Roorda LD, Hilberdink WKHA, Lems WF, Steultjens MPM, Dekker J. Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study. Arthritis Care Res (Hoboken) 2015; 67:48-57. [PMID: 24905958 DOI: 10.1002/acr.22381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/03/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE It has been hypothesized that pain and low vitality lead to an increase in avoidance of activities in persons with early symptomatic knee osteoarthritis (OA), and that avoidance of activities leads to an increase in activity limitations. The present study aimed to evaluate these hypotheses. METHODS Baseline, 2-year, and 5-year followup data of 828 participants from the Cohort Hip and Cohort Knee Study with early symptomatic knee OA were used. Autoregressive generalized estimating equations and linear regression models were used to analyze the longitudinal and cross-sectional associations between self-reported knee pain, vitality, pain-related avoidance of activities, and activity limitations. The models were adjusted for the covariates age, sex, education level, body mass index, comorbidity, radiographic severity, and hip pain. RESULTS In longitudinal analyses, knee pain and vitality predicted a subsequent increase in avoidance of activities. Pain-related avoidance of activities predicted a subsequent increase in activity limitations; however, this relationship lost statistical significance (P = 0.089) after adjustment for covariates. Cross-sectional analyses showed strong relationships between knee pain, low vitality, pain-related avoidance of activities, and activity limitations at all time points. CONCLUSIONS In persons with early symptomatic knee OA, knee pain and low vitality lead to a subsequent increase in avoidance of activities. Pain-related avoidance of activities is related to activity limitations at inception of symptoms, but also years later. Therefore, it can be recommended to monitor and target avoidance of activities at various stages of the disease.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
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29
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Wesseling J, Boers M, Viergever MA, Hilberdink WKHA, Lafeber FPJG, Dekker J, Bijlsma JWJ. Cohort Profile: Cohort Hip and Cohort Knee (CHECK) study. Int J Epidemiol 2014; 45:36-44. [DOI: 10.1093/ije/dyu177] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Hermsen LA, Leone SS, Smalbrugge M, Dekker J, van der Horst HE. Frequency, severity and determinants of functional limitations in older adults with joint pain and comorbidity: Results of a cross-sectional study. Arch Gerontol Geriatr 2014; 59:98-106. [DOI: 10.1016/j.archger.2014.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
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31
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van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil 2014; 95:1962-8. [PMID: 24977932 DOI: 10.1016/j.apmr.2014.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/29/2014] [Accepted: 06/09/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity. DESIGN A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders. SETTING A rehabilitation and rheumatology center. PARTICIPANTS Subjects (N=146) with early symptomatic knee OA from the CHECK study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test. RESULTS A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=-1.12, B=-5.83, and B=-1.25, respectively). Proprioception and laxity did not moderate this association. CONCLUSIONS In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations.
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Affiliation(s)
- Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
| | - Jasmijn F Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirk L Knol
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem F Lems
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Joost Dekker
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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32
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Holla JFM, Sanchez-Ramirez DC, van der Leeden M, Ket JCF, Roorda LD, Lems WF, Steultjens MPM, Dekker J. The avoidance model in knee and hip osteoarthritis: a systematic review of the evidence. J Behav Med 2014; 37:1226-41. [PMID: 24841177 DOI: 10.1007/s10865-014-9571-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/07/2014] [Indexed: 01/01/2023]
Abstract
The avoidance model in patients with knee and hip osteoarthritis (OA) hypothesizes that pain and psychological distress lead to avoidance of activities, and thereby to muscle weakness and activity limitations. This paper systematically reviews the scientific evidence for the validity of this avoidance model. A qualitative data synthesis was used to identify levels of evidence. Sixty studies were included. In knee OA, strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness (mediation by muscle weakness), strong evidence was found for an association between muscle weakness and activity limitations, and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance of activities (mediation by avoidance). In hip OA, weak evidence was found for mediation by muscle weakness; and strong evidence was found for an association between muscle weakness and activity limitations. More research is needed on the consecutive associations between pain or psychological distress, avoidance of activities and muscle weakness, and to confirm causal relationships.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center, Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands,
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Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol 2013; 1:1943-2008. [PMID: 23733694 DOI: 10.1002/cphy.c100057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.
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Affiliation(s)
- Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Holla JFM, van der Leeden M, Knol DL, Roorda LD, van der Esch M, Voorneman RE, Lems WF, Dekker J. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort. BMC Musculoskelet Disord 2013; 14:296. [PMID: 24131757 PMCID: PMC3852795 DOI: 10.1186/1471-2474-14-296] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/14/2013] [Indexed: 11/16/2022] Open
Abstract
Background Body-mass index (BMI) and depressed mood are both positively associated with pain and activity limitations in knee osteoarthritis (OA), and are interrelated. The aims of the present study were: 1) to assess whether BMI and depressed mood are independently associated with knee pain and activity limitations; and 2) to compare the relative contributions of BMI and depressed mood to knee pain and activity limitations. Methods A cross-sectional study in 294 patients with clinical knee OA. Regression analyses were performed with knee pain or activity limitations (self-reported and performance-based) as dependent variables, and BMI and depressed mood as independent variables. All analyses were adjusted for age, gender, marital status, education level, radiographic OA and comorbidity. Dominance analyses were performed to examine the relative contributions of BMI and depressed mood to knee pain and activity limitations. Results BMI and depressed mood were positively and independently associated with knee pain and activity limitations. BMI and depressed mood explained small parts (3.0% and 2.3%, respectively) of variance in knee pain. BMI explained a substantial part of variance in both self-reported (9.8%) and performance-based (20.4%) activity limitations, while depressed mood explained a small part of variance (3.1% in self-reported and 2.6% in performance-based activity limitations). Conclusions In patients with knee OA both BMI and depressed mood seem to be independently associated with knee pain and activity limitations. The contribution of BMI to activity limitations is most substantial, thereby offering a relevant target for interventions.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Centre
- Reade, PO Box 58271, 1040 HG Amsterdam, The Netherlands.
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Hoogeboom TJ, van Meeteren NLU, Kim RH, Stevens-Lapsley JE. Linear and Curvilinear Relationship between Knee Range of Motion and Physical Functioning in People with Knee Osteoarthritis: A Cross-Sectional Study. PLoS One 2013; 8:e76173. [PMID: 24086704 PMCID: PMC3784410 DOI: 10.1371/journal.pone.0076173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/25/2013] [Indexed: 11/19/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Thomas J. Hoogeboom
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, United States of America
- Caphri Research School, Maastricht University Medical Centre, Maastricht, The Netherlands
- Center for Care Technology Research (CCTR), Maastricht, The Netherlands
- * E-mail:
| | - Nico L. U. van Meeteren
- Caphri Research School, Maastricht University Medical Centre, Maastricht, The Netherlands
- Center for Care Technology Research (CCTR), Maastricht, The Netherlands
- TNO Healthy Living, Leiden, The Netherlands
| | - Raymond H. Kim
- Department of Orthopedics, Porter Adventist Hospital, Denver, Colorado, United States of America
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, United States of America
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Alschuler KN, Molton IR, Jensen MP, Riddle DL. Prognostic value of coping strategies in a community-based sample of persons with chronic symptomatic knee osteoarthritis. Pain 2013; 154:2775-2781. [PMID: 23969326 DOI: 10.1016/j.pain.2013.08.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Abstract
Radiographic knee osteoarthritis (OA) is a highly prevalent condition that has been the focus of a number of studies identifying factors that are prognostic of continued or worsening pain and function. Although prior prognostic studies have identified a number of demographic, physical, and psychological factors that are predictive of outcome, minimal focus has been placed on pain coping skills as prognostic factors, despite cross-sectional evidence suggesting that pain coping skills are associated with pain and function in knee OA. The present study reports on the use of pain coping skills as prognostic factors for changes in pain and/or function over a 1-year period. Participants were drawn from the Osteoarthritis Initiative, a prospective longitudinal cohort study of persons recruited from the community who either had knee OA or were at high risk for developing knee OA. Data from the Coping Strategies Questionnaire were compared against 1-year change in pain, function, or both, using established criteria for defining whether the patient got better, worse, or stayed the same over the 1-year period. Results revealed a significant effect for praying/hoping, increased behavioral activities, and pain catastrophizing as prognostic of pain outcomes; ignoring pain and praying/hoping were prognostic of function outcomes; and increased behavioral activities and pain catastrophizing were prognostic of a combined pain and function outcome. The findings provide important new evidence regarding the potential clinical relevance of a number of pain coping responses hypothesized to influence future pain and function in persons with arthritis.
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Affiliation(s)
- Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
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Holla JFM, van der Leeden M, Heymans MW, Roorda LD, Bierma-Zeinstra SMA, Boers M, Lems WF, Steultjens MPM, Dekker J. Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study. Ann Rheum Dis 2013; 73:1369-75. [DOI: 10.1136/annrheumdis-2012-202984] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Riddle DL, Dumenci L. Self-rated health and symptomatic knee osteoarthritis over three years: data from a multicenter observational cohort study. Arthritis Care Res (Hoboken) 2013; 65:169-76. [PMID: 22392799 DOI: 10.1002/acr.21661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/27/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if a previously published model of the influence of self-rated health on physical, mental, and social health among patients with joint replacement surgery could be generalized to persons with symptomatic knee osteoarthritis (OA). Our second purpose was to determine if self-rated health mediated changes in physical, mental, and social health. METHODS Persons with symptomatic knee OA (n = 1,127) who participated in the Osteoarthritis Initiative study completed the required measures at baseline and at 1-, 2-, and 3-year intervals. The key variable of interest was a single-item self-rated health measure. In addition, measures of physical, mental, and social health and a set of covariate measures over the 3-year period were analyzed. Structural equation modeling was used to test interrelationships among variables, as well as predictive and mediational relationships among self-rated health and mental, physical, and social health after adjusting for baseline covariates. RESULTS The full model demonstrated good statistical fit. Prior self-rated health consistently predicted current mental health and social health. Prior social health predicted current self-rated health. Self-rated health also mediated changes in mental health and social health. Only social health changes were mediated by self-rated health over all time periods. CONCLUSION Self-rated health predicts a variety of outcomes of symptomatic knee OA. In addition, self-rated health mediates changes in social health and mental health. The use of self-rated health as a simple and efficient clinical assessment has potential for clinical utility because of its predictive capability and association with multiple health domains.
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Affiliation(s)
- Daniel L Riddle
- Virginia Commonwealth University, Richmond, VA 23298-0224, USA.
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Sasaki E, Ishibashi Y, Tsuda E, Ono A, Yamamoto Y, Inoue R, Takahashi I, Umeda T, Nakaji S. Evaluation of locomotive disability using loco-check: a cross-sectional study in the Japanese general population. J Orthop Sci 2013; 18:121-9. [PMID: 23114857 DOI: 10.1007/s00776-012-0329-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/12/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purposes of this study were to reveal the prevalence of locomotive syndrome (LS) evaluated by loco-check in the Japanese general population and to analyze the relationship between radiographic knee osteoarthritis (OA) and lumbar spondylosis, metabolic syndrome and LS. Furthermore, we evaluated LS according to functional examinations. METHODS Seven hundred twenty-two volunteers aged 56.6 ± 13.6 years participated in the Iwaki Health Promotion Project in 2010 and were classified into two groups: LS (one or more disabilities) or non-LS (no disability) according to the criteria of LS proposed by the Japanese Orthopaedic Association. Radiographic knee OA and lumbar spondylosis were defined according to the Kellgren-Lawrence grade. Metabolic syndrome was defined as the presence of two or more risk factors in addition to visceral obesity. The prevalence of LS associated with knee OA, lumbar spondylosis and metabolic syndrome was compared statistically. Also, data of six functional examinations were compared between the non-LS and LS groups. RESULTS The prevalence of LS was 21.2 % in males and 35.6 % in females and increased with aging regardless of gender. The prevalence of LS with knee OA was 48.7 %, with lumbar spondylosis was 33.8 %, and with metabolic syndrome was 43.4 %. The non-LS group had significantly better performance in the functional reach and sit and reach tests than the LS group in males and females by age-adjusted comparison. CONCLUSION The prevalence of LS in the general population was higher in females than in males. A strong risk factor for LS was radiographic knee OA. Also, those with LS had loss of skeletal muscle mass, balancing and flexibility. This study showed that evaluation by loco-check was an acceptable tool to detect the early stage of locomotive disability for LS, and interventional prevention for strength, balancing and flexibility would be helpful for those with LS.
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Affiliation(s)
- Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
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Suri P, Morgenroth DC, Hunter DJ. Epidemiology of osteoarthritis and associated comorbidities. PM R 2012; 4:S10-9. [PMID: 22632687 DOI: 10.1016/j.pmrj.2012.01.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA) is the most common cause of walking-related disability among older adults in the United States, and the prevalence and incidence of OA are increasing rapidly. Systemic and local risk factors for knee OA have been identified, and obesity and joint injury appear to be the strongest risk factors that are both modifiable and have the potential for substantial impact on a population level. The risk factors for functional decline and disability in persons with symptomatic OA have been examined in relatively few studies. The course of functional decline in persons with symptomatic OA on a population level is generally one of stable to slowly deteriorating function, but on an individual level, many patients maintain function or improve during the first 3 years of follow-up. Obesity stands out as one of few modifiable risk factors of OA that also is a potentially modifiable predictor of functional decline. Physical activity also appears to have a substantial protective impact on future OA-related disability. Further epidemiologic studies and randomized controlled trials are needed to prioritize prevention through targeting these modifiable risk factors for OA and related disability.
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Affiliation(s)
- Pradeep Suri
- Division of PM&R, VA Boston Healthcare System-JP Campus, 150 S Huntington Ave, Boston, MA 02130, USA.
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Holla JFM, van der Leeden M, Roorda LD, Bierma-Zeinstra SMA, Damen J, Dekker J, Steultjens MPM. Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis. Arthritis Care Res (Hoboken) 2011; 64:59-65. [DOI: 10.1002/acr.20645] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hermsen LAH, Leone SS, van der Windt DAWM, Smalbrugge M, Dekker J, van der Horst HE. Functional outcome in older adults with joint pain and comorbidity: design of a prospective cohort study. BMC Musculoskelet Disord 2011; 12:241. [PMID: 22024146 PMCID: PMC3214164 DOI: 10.1186/1471-2474-12-241] [Citation(s) in RCA: 14] [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: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 11/21/2022] Open
Abstract
Background Joint pain is a highly prevalent condition in the older population. Only a minority of the older adults consult the general practitioner for joint pain, and during consultation joint pain is often poorly recognized and treated, especially when other co-existing chronic conditions are involved. Therefore, older adults with joint pain and comorbidity may have a higher risk of poor functional outcome and decreased quality of life (QoL), and possibly need more attention in primary care. The main purpose of the study is to explore functioning in older adults with joint pain and comorbidity, in terms of mobility, functional independence and participation and to identify possible predictors of poor functional outcome. The study will also identify predictors of decreased QoL. The results will be used to develop prediction models for the early identification of subgroups at high risk of poor functional outcome and decreased QoL. This may contribute to better targeting of treatment and to more effective health care in this population. Methods/Design The study has been designed as a prospective cohort study, with measurements at baseline and after 6, 12 and 18 months. For the recruitment of 450 patients, 25 general practices will be approached. Patients are eligible for participation if they are 65 years or older, have at least two chronic conditions and report joint pain on most days. Data will be collected using various methods (i.e. questionnaires, physical tests, patient interviews and focus groups). We will measure different aspects of functioning (e.g. mobility, functional independence and participation) and QoL. Other measurements concern possible predictors of functioning and QoL (e.g. pain, co-existing chronic conditions, markers for frailty, physical performance, psychological factors, environmental factors and individual factors). Furthermore, health care utilization, health care needs and the meaning and impact of joint pain will be investigated from an older person's perspective. Discussion In this paper, we describe the protocol of a prospective cohort study in Dutch older adults with joint pain and comorbidity and discuss the potential strengths and limitations of the study.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Riddle DL, Kong X, Fitzgerald GK. Psychological health impact on 2-year changes in pain and function in persons with knee pain: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2011; 19:1095-101. [PMID: 21723400 PMCID: PMC3159740 DOI: 10.1016/j.joca.2011.06.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/27/2011] [Accepted: 06/06/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We determined whether baseline depressive symptoms, knee-related confidence and general psychological distress influenced changes in pain and function during 2 years of follow-up. DESIGN We included persons in the Osteoarthritis Initiative (OAI) dataset with baseline pain of 1 or greater on a 0-10 scale in at least one knee and no knee or hip surgery during the 2-year follow-up (n=3407). The four outcome variables were repeated chair standing, 20 m walk and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Disability. Linear mixed effects models assessed the association of each mental health variable with the yearly change in each baseline adjusted outcome measure after controlling for covariates. RESULTS Depressive symptoms were significantly predictive of worsening in most outcomes. The magnitude of worsening predicted for each year was small. For example, the dichotomized WOMAC Pain model indicated that depressed persons experience more rapid worsening than non-depressed persons at an average rate of 0.59 WOMAC points per year (95% CI 0.176, 1.013, P=0.005). Similar significant but very small effects of depressive symptoms on other outcomes were observed. Knee confidence was not predictive of change. General psychological distress was predictive of change in 20-m walk and WOMAC Pain. CONCLUSIONS The most consistent psychological predictor of yearly worsening was baseline depressive symptoms. Although a statistically robust predictor of outcome, given that change was very small and highly dependent on baseline status, our results indicate that a considerable degree of persistent depressive symptoms would be required to have a meaningful effect on future self-reported outcome.
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Affiliation(s)
- Daniel L. Riddle
- Departments of Physical Therapy and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0224, Phone: 804-828-0234, Fax: 804-828-8111,
| | - Xiangrong Kong
- Department of Family Population and Reproductive Health and Department of Biostatistics, The Johns Hopkins University, Baltimore, MD, USA
| | - G. Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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