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Giaretta S, Magni A, Migliore A, Natoli S, Puntillo F, Ronconi G, Santoiemma L, Sconza C, Viapiana O, Zanoli G. A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape. J Clin Med 2024; 13:5176. [PMID: 39274389 PMCID: PMC11396710 DOI: 10.3390/jcm13175176] [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] [Received: 06/17/2024] [Revised: 07/24/2024] [Accepted: 08/11/2024] [Indexed: 09/16/2024] Open
Abstract
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.
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Affiliation(s)
- Stefano Giaretta
- UOC Ortopedia e Traumatologia OC San Bortolo di Vicenza (AULSS 8 Berica), 36100 Vicenza, Italy
| | - Alberto Magni
- Local Health Department, Desenzano sul Garda, 25015 Brescia, Italy
| | - Alberto Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
| | - Silvia Natoli
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pain Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Filomena Puntillo
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | | | | | - Ombretta Viapiana
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, 37126 Verona, Italy
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Occhiobello, 45030 Rovigo, Italy
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Tanpure S, Phadnis A, Nagda T, Rathod C, Kothurkar R, Chavan A, Lekurwale R. Unraveling the gait dynamics - A comparative study of iASSIST and conventional total knee replacement techniques in osteoarthritic elderly patients. J Clin Orthop Trauma 2024; 55:102524. [PMID: 39290645 PMCID: PMC11402551 DOI: 10.1016/j.jcot.2024.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 07/04/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Background Osteoarthritis (OA) stands as the most prevalent disability among the elderly population. Assessing functional outcomes after Total Knee Replacement (TKR) typically involves Gait analysis along with other evaluation methods. The objective of this study was to compare Gait results, including temporospatial parameters, joint angles, gait profile score (GPS), and movement analysis profiles (MAP), between conventional and iASSIST TKR techniques. Method The study involved 21 participants (mean age 68.4 ± 4.2 years), with 16 females and 5 males. Among them, 11 patients had traditional surgery (15 TKR), and 10 patients had iASSIST surgery (13 TKR), totaling 28 knees (7 bilateral). The pre-operative Gait analysis was conducted one day before the surgical procedure, whereas the postoperative Gait analysis was performed, on average, 210 ± 20 days after surgery. Gait analysis was conducted using the Qualisys Motion capture system, operating at a rate of 120 Hz. The data were thoroughly analyzed using Visual 3D C-Motion Software. Results An analysis of gait biomechanics metrics, encompassing temporospatial parameters, joint angles, GPS, and MAP, was undertaken. Significant differences were observed in sagittal plane joint angles of the pelvis and hip, transverse plane joint angles of the knee, cadence, and MAP of foot internal/external rotation. However, there were no statistically significant differences between the two TKR techniques in the remaining temporospatial variables, joint angles, GPS, or MAP. Conclusion This study revealed a significant difference between iASSIST-guided TKR and conventional TKR, demonstrating that the iASSIST procedure led to improvements in walking biomechanics. Findings hold potential utility for orthopedic surgeons in their decision-making processes, ultimately contributing to the improvement of functional outcomes following TKR.
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Affiliation(s)
- Sanket Tanpure
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Ashish Phadnis
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Taral Nagda
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Chasanal Rathod
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Rohan Kothurkar
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Ajay Chavan
- Jupiter Gait Lab, Jupiter Lifeline Hospital, Thane, India
| | - Ramesh Lekurwale
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
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Ohmi T, Katagiri H, Amemiya M, Ikematsu K, Miyazaki M, Koga H, Yagishita K. Gait analysis of patients with knee osteoarthiritis who can run versus cannot run. Gait Posture 2024; 112:67-72. [PMID: 38744023 DOI: 10.1016/j.gaitpost.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Many middle-aged and older adults participate in running to maintain their health and fitness; however, some have to stop running due to osteoarthritis-attributed knee pain. It was unclear whether gait biomechanics and knee physical findings differ between those who can and cannot run. RESEARCH QUESTION What are the gait and knee physical findings of patients with knee osteoarthritis who remain capable of running in comparison to those who are not capable of running? METHODS This was a cross-sectional study, which recruited 23 patients over the age of 40 who had been diagnosed with knee osteoarthritis. Their knee joint ranges of motion and muscle strength, knee pain, and the maximum gait speed (walk as fast as possible) were measured. Knee alignment was calculated from X-ray images, and the knee joint extension angle and adduction moment during a self-selected gait speed were determined using motion analysis. Participants were divided into two groups-those able to run (n=11) and those unable to run (n=12). The measured and calculated outcomes were compared between groups, and logistic regression analyses of significantly different outcomes were performed. RESULTS There were significant group differences in the maximum knee extension angle during stance phase (p = 0.027), maximum gait speed during the 10-m walk test (p = 0.014), knee pain during gait (p = 0.039) and medial proximal tibial angle by X-ray (p = 0.035). Logistic regression analyses revealed that the maximum knee extension angle during stance phase (OR: 1.44, 95%CI: 1.06¬1.94, p = 0.02) was a significant factor. SIGNIFICANCE The ability to extend the knee during gait is an important contributing factor in whether participants with knee osteoarthritis are capable of running.
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Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Masaki Amemiya
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Ikematsu
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Midori Miyazaki
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Smith SL, Walsh DA. Osteoarthritis pain phenotypes: How best to cut the cake? Osteoarthritis Cartilage 2024; 32:124-127. [PMID: 38006965 DOI: 10.1016/j.joca.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Stephanie L Smith
- Research Fellow, Pain Centre Versus Arthritis and Advanced Pain Discovery Platform, Academic Rheumatology, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham, UK
| | - David A Walsh
- Honorary Consultant, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK; Professor of Rheumatology, co-director Pain Centre Versus Arthritis, and Programme Director Advanced Pain Discovery Platform, NIHR Biomedical Research Centre, Academic Rheumatology, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, UK, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK.
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Cai G, Zhang Y, Wang Y, Li X, Xu S, Shuai Z, Pan F, Peng X. Frailty predicts knee pain trajectory over 9 years: results from the Osteoarthritis Initiative. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1364-1371. [PMID: 37428156 PMCID: PMC10690856 DOI: 10.1093/pm/pnad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Frailty is a multisystem syndrome and its relationship with symptomatic osteoarthritis has been reported. We aimed to identify trajectories of knee pain in a large prospective cohort and to describe the effect of frailty status at baseline on the pain trajectories over 9 years. METHODS We included 4419 participants (mean age 61.3 years, 58% female) from the Osteoarthritis Initiative cohort. Participants were classified as "no frailty," "pre-frailty," or "frailty" at baseline, based on 5 characteristics (ie, unintentional weight loss, exhaustion, weak energy, slow gait speed, and low physical activity). Knee pain was evaluated annually using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (0-20) from baseline to 9 years. RESULTS Of the participants included, 38.4%, 55.4%, and 6.3% were classified as "no frailty," "pre-frailty," and "frailty," respectively. Five pain trajectories were identified: "No pain" (n = 1010, 22.8%), "Mild pain" (n = 1656, 37.3%), "Moderate pain" (n = 1149, 26.0%), "Severe pain" (n = 477, 10.9%), and "Very Severe pain" (n = 127, 3.0%). Compared to participants with no frailty, those with pre-frailty and frailty were more likely to have more severe pain trajectories (pre-frailty: odds ratios [ORs] 1.5 to 2.1; frailty: ORs 1.5 to 5.0), after adjusting for potential confounders. Further analyses indicated that the associations between frailty and pain were mainly driven by exhaustion, slow gait speed, and weak energy. CONCLUSIONS Approximately two-thirds of middle-aged and older adults were frail or pre-frail. The role of frailty in predicting pain trajectories suggests that frailty may be an important treatment target for knee pain.
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Affiliation(s)
- Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Youyou Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoxi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shengqian Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoqing Peng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Pharmacology, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, Anhui, China
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Chen L, Zhao L, Cheng K, Lin L, Wu F, Shen X. Effect of 10.6-μm CO 2 laser moxibustion on the fastest 15-m walking time in patients with knee osteoarthritis: a double-blind, sham-controlled, multi-site randomized trial. J Orthop Surg Res 2023; 18:891. [PMID: 37993959 PMCID: PMC10666435 DOI: 10.1186/s13018-023-04380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND In this study, we investigated the impact of 10.6-μm CO2 laser moxibustion (LM) on the fastest 15-m walking time in individuals suffering from knee osteoarthritis (KOA). METHODS A total of 392 individuals diagnosed with KOA and meeting the specified eligibility criteria were assigned randomly into two groups: the LM treatment group and the sham LM control group (ratio 1:1). Both groups received either LM therapy or simulated LM therapy to address the affected area of the knee joint. This treatment was administered three times a week for a duration of 4 weeks. RESULTS In the LM group, the fastest 15-m walking times at both Week 4 and Week 12 were significantly reduced compared to the times before treatment (all P < 0.05). However, in the sham LM group, there were no notable differences in the fastest 15-m walking times after treatment (all P > 0.05). Moreover, the LM group exhibited shorter 15-m walking times than the sham LM group at both Week 4 and Week 12 (all P < 0.05). CONCLUSION The use of CO2 LM can lead to a substantial enhancement in the fastest 15-m walking time of individuals suffering from KOA, and its therapeutic impact can last for a minimum of 8 weeks post-treatment. The fastest 15-m walking time serves as an indicator of alterations in the walking capacity of patients with KOA.
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Affiliation(s)
- Lusheng Chen
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, 201433, China
| | - Ling Zhao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, No. 1200 of Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Ke Cheng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, No. 1200 of Cailun Road, Pudong New District, Shanghai, 201203, China
- Shanghai Research Center of Acupuncture and Meridian, 421 Niudun Road, Shanghai, 201203, China
| | - Lin Lin
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, No. 1200 of Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Fan Wu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, No. 1200 of Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, No. 1200 of Cailun Road, Pudong New District, Shanghai, 201203, China.
- Shanghai Research Center of Acupuncture and Meridian, 421 Niudun Road, Shanghai, 201203, China.
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Winnock de Grave P, Van Criekinge T, Luyckx T, Moreels R, Gunst P, Claeys K. Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments. Knee Surg Sports Traumatol Arthrosc 2023; 31:4692-4704. [PMID: 37311955 DOI: 10.1007/s00167-023-07464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Patient-specific alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical effects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-specific alignment TKA cohort (inverse kinematic alignment-iKA). METHODS At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). RESULTS During walking, the maximum knee flexion did not differ between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002. CONCLUSION At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Philip Winnock de Grave
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium.
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium.
| | | | - Thomas Luyckx
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Louvain, Belgium
| | - Robin Moreels
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Gent, Ghent, Belgium
| | - Paul Gunst
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
| | - Kurt Claeys
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium
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Carvalho C, Helena Gonçalves G, Fernando Approbato Selistre L, Petrella M, De Oliveira Sato T, Da Silva Serrão PRM, Márcia Mattiello S. Association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis. Arch Rheumatol 2023; 38:387-396. [PMID: 38046241 PMCID: PMC10689021 DOI: 10.46497/archrheumatol.2023.9386] [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: 11/27/2021] [Accepted: 12/09/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives This study aimed to investigate the association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis (OA). Patients and methods The cross-sectional study was conducted with 39 individuals (24 females, 15 males; mean age: 57.3±6.2 years; range, 40 to 65 years) with knee OA between January 2014 and July 2015. Ankle torque was determined using an isokinetic dynamometer. The 40-m fast-paced walk test and a stair climb test were used to assess functional performance. Self-reported pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pearson's correlation coefficients were calculated to test correlations between the dependent variables (40-m fast-paced walk test, stair climb test, WOMAC pain and physical function domains, sex, age, body mass index, and radiologic evidence of OA) and the independent variables (mean plantar flexor torque and dorsiflexor peak torque). A multiple linear regression analysis was applied to quantify the association between the dependent and independent variables. Results Dorsiflexor and plantar flexor peak torques in the concentric and eccentric modes were negatively correlated with the 40-m fast-paced walk and stair climb tests (r=-0.33 to -0.51, p≤0.05). A negative correlation was found between concentric plantar flexor torque and the WOMAC physical function score (r=-0.35, p=0.03). No correlation was found between ankle torques and the WOMAC pain score (p>0.05). The multiple linear regression analysis showed that the eccentric plantar flexor and dorsiflexor torques were significantly associated with the stair climb test (β=-0.001, 95% confidence interval [CI]: -0.001 to 0.000, p=0.03, and β=-0.002, 95% CI: -0.004 to 0.000, p=0.05, respectively). No significant associations were found between concentric plantar flexor and dorsiflexor torques and the stair climb test (p>0.05). No significant associations were found between the ankle torques and the 40-m fast-paced walk test and WOMAC physical function (p>0.05). Conclusion Ankle torque plays an important role in functional performance. Thus, ankle torque deficit, especially eccentric plantar flexor and dorsiflexor torques, may exert a negative influence on stair climbing performance in patients with knee osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Marina Petrella
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Lee HY, Park YM, Hwang HM, Shin DY, Jeong HN, Kim JG, Park HY, Kim DS, Yoo JJ, Kim MS, Kim MJ, Yang HJ, Choi SC, Lee IA. The Effect of the Mixed Extract of Kalopanax pictus Nakai and Achyranthes japonica Nakai on the Improvement of Degenerative Osteoarthritis through Inflammation Inhibition in the Monosodium Iodoacetate-Induced Mouse Model. Curr Issues Mol Biol 2023; 45:6395-6414. [PMID: 37623223 PMCID: PMC10453891 DOI: 10.3390/cimb45080404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
Osteoarthritis is a chronic inflammatory disease, and, due to the lack of fundamental treatment, the main objective is to alleviate pain and prevent cartilage damage. Kalopanax pictus Nakai and Achyranthes japonica Nakai are herbal plants known for their excellent anti-inflammatory properties. The objective of this study is to confirm the potential of a mixture extract of Kalopanax pictus Nakai and Achyranthes japonica Nakai as a functional raw material for improving osteoarthritis through anti-inflammatory effects in macrophages and MIA-induced arthritis experimental animals. In macrophages inflamed by lipopolysaccharide (LPS), treatment of Kalopanax pictus Nakai and Achyranthes japonica Nakai mixture inhibits NF-κB and mitogen-activated protein kinase (MAPK) activities, thereby inhibiting inflammatory cytokine tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6), inflammatory factors PGE2, MMP-2, and MMP-9, and nitric oxide (NO) was reduced. In addition, in an animal model of arthritis induced by MIA (monosodium iodoacetate), administration of Kalopanax pictus Nakai and Achyranthes japonica Nakai mixture reduced blood levels of inflammatory cytokines TNF-α and IL-6, inflammatory factors prostaglandin E2(PGE2), matrix metalloproteinase-2(MMP-2), and NO. Through these anti-inflammatory effects, MIA-induced pain reduction (recovery of clinical index, increase in weight bearing, and increase in area and width of the foot), recovery of meniscus damage, loss of cartilage tissue or inflammatory cells in tissue infiltration reduction, and recovery of the proteglycan layer were confirmed. Therefore, it is considered that Kalopanax pictus Nakai and Achyranthes japonica Nakai mixture has the potential as a functional raw material that promotes joint health.
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Affiliation(s)
- Hak-Yong Lee
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Young-Mi Park
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Hai-Min Hwang
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Dong-Yeop Shin
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Han-Na Jeong
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Jae-Gon Kim
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Hyo-Yeon Park
- INVIVO Co., Ltd., Nonsan 32992, Republic of Korea; (H.-Y.L.); (Y.-M.P.); (H.-M.H.); (D.-Y.S.); (H.-N.J.); (J.-G.K.); (H.-Y.P.)
| | - Dae-Sung Kim
- Central Research and Development, Hanpoong Pharm & Foods, Wanju 55314, Republic of Korea; (D.-S.K.); (J.-J.Y.)
| | - Jin-Joo Yoo
- Central Research and Development, Hanpoong Pharm & Foods, Wanju 55314, Republic of Korea; (D.-S.K.); (J.-J.Y.)
| | - Myung-Sunny Kim
- Korea Food Research Institute, Wanju 55365, Republic of Korea; (M.-S.K.); (M.-J.K.); (H.-J.Y.)
| | - Min-Jung Kim
- Korea Food Research Institute, Wanju 55365, Republic of Korea; (M.-S.K.); (M.-J.K.); (H.-J.Y.)
| | - Hye-Jeong Yang
- Korea Food Research Institute, Wanju 55365, Republic of Korea; (M.-S.K.); (M.-J.K.); (H.-J.Y.)
| | - Soo-Cheol Choi
- Department of Chemistry, Kunsan National University, Gunsan 54150, Republic of Korea
| | - In-Ah Lee
- Department of Chemistry, Kunsan National University, Gunsan 54150, Republic of Korea
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10
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Liu P, Wang C, Chen H, Shang S. Development of a nomogram prediction model for gait speed trajectories in persons with knee osteoarthritis. Sci Rep 2023; 13:11291. [PMID: 37438394 DOI: 10.1038/s41598-023-37193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/17/2023] [Indexed: 07/14/2023] Open
Abstract
To examine heterogeneous trajectories of 8-year gait speed among patients with symptomatic knee osteoarthritis (KOA) and to develop a nomogram prediction model. We analyzed data from the Osteoarthritis Initiative (OAI) assessed at baseline and follow-up over 8 years (n = 1289). Gait speed was measured by the 20-m walk test. The gait speed trajectories among patients with KOA were explored by latent class growth analysis. A nomogram prediction model was created based on multivariable logistic regression. Three gait speed trajectories were identified: the fast gait speed group (30.4%), moderate gait speed group (50.5%) and slow gait speed group (19.1%). Age ≥ 60 years, female, non-white, nonmarried, annual income < $50,000, obesity, depressive symptoms, comorbidity and WOMAC pain score ≥ 5 were risk factors for the slow gait trajectory. The area under the ROC curve of the prediction model was 0.775 (95% CI 0.742-0.808). In the external validation cohort, the AUC was 0.773 (95% CI 0.697-0.848). Heterogeneous trajectories existed in the gait speed of patients with KOA and could be predicted by multiple factors. Risk factors should be earlier identified, and targeted intervention should be carried out to improve physical function of KOA patients.
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Affiliation(s)
- Peiyuan Liu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Cui Wang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Hongbo Chen
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Shaomei Shang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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11
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Christensen JC, Blackburn BE, Anderson LA, Gililland JM, Peters CL, Archibeck MJ, Pelt CE. Recovery Curve for Patient Reported Outcomes and Objective Physical Activity After Primary Total Knee Arthroplasty - A Multicenter Study Using Wearable Technology. J Arthroplasty 2023; 38:S94-S102. [PMID: 36996947 DOI: 10.1016/j.arth.2023.03.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND This study aimed to describe the trajectory of recovery based on patient reported outcomes (PROs) and objective metrics of physical activity measures over the first 12 months post-total knee arthroplasty (TKA). METHODS In total, 1,005 participants who underwent a primary unilateral TKA surgery between November 2018 and September 2021 from a multi-site prospective study were analyzed. Generalized estimating equations were used to evaluate PROs and objective physical activity measures over time. RESULTS All Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), EuroQol-5D (EQ-5D) and steps per day scores were greater than pre-operative scores (P<0.05). The flights of stairs per day, gait speed and walking asymmetry all declined at 1-month (all, P<0.001). However, all subsequent scores improved by 6 months (all, P<0.01). The greatest clinically important differences from previous visit in KOOS JR (β=18.1; 95% Confidence Interval (CI)=17.2, 19.0), EQ-5D (β=0.11; 95% CI=0.10, 0.12), steps per day (β=1169.3; 95% CI=1012.7, 1325.9), gait speed (β=-0.05; 95% CI=-0.06, -0.03), and walking asymmetry (β=0.00; 95% CI=-0.03, 0.03) were observed at 3 months. CONCLUSION The KOOS JR, EQ-5D, and steps per day measures showed earlier improvements than other physical activity metrics, with the greatest magnitude of improvement within the first 3 months post-TKA. The greatest magnitude of improvement in walking asymmetry was not observed until 6 months, while gait speed and flights of stairs per day were not observed until 12 months. This data may further help provide expectation setting information to patients prior to surgery, and may aid in identifying outliers to the normal recovery curve who may benefit from targeted interventions.
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Affiliation(s)
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
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12
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Liao CD, Huang SW, Chen HC, Huang YY, Liou TH, Lin CL. Effects of Protein Supplementation Combined with Resistance Exercise Training on Walking Speed Recovery in Older Adults with Knee Osteoarthritis and Sarcopenia. Nutrients 2023; 15:nu15071552. [PMID: 37049391 PMCID: PMC10096553 DOI: 10.3390/nu15071552] [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] [Received: 03/03/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Knee osteoarthritis (KOA) is closely associated with sarcopenia, sharing the common characteristics of muscle weakness and low physical performance. Resistance exercise training (RET), protein supplementation (PS), and PS+RET have promise as treatments for both sarcopenia and KOA. However, whether PS+RET exerts any effect on time to recovery to normal walking speed (WS) in older adults with sarcopenia and KOA remains unclear. This study investigated the treatment efficiency of PS+RET on WS recovery among individuals with KOA and sarcopenia. A total of 108 older adults aged ≥ 60 years who had a diagnosis of radiographic KOA and sarcopenia were enrolled in this prospective cohort study. Sarcopenia was defined on the basis of the cutoff values of the appendicular skeletal muscle mass index for Asian people and a slow WS less than 1.0 m/s. The patients were equally distributed to three groups: PS+RET, RET alone, and usual care. The weekly assessment was performed during a 12-week intervention and a subsequent 36-week follow-up period. A cutoff of 1.0 m/s was used to identify successful recovery to normal WS. Kaplan-Meier analysis was performed to measure the survival time to normal WS among the study groups. Multivariate Cox proportional-hazards regression (CPHR) models were established to calculate the hazard ratios (HRs) of successful WS recovery and determine its potential moderators. After the 3-month intervention, PS+RET as well as RET obtained greater changes in WS by an adjusted mean difference of 0.18 m/s (p < 0.0001) and 0.08 (p < 0.05) m/s, respectively, compared to usual care. Kaplan-Meier analysis results showed both RET and PS+RET interventions yielded high probabilities of achieving normal WS over the 12-month follow-up period. Multivariate CPHR results revealed that PS+RET (adjusted HR = 5.48; p < 0.001), as well as RET (adjusted HR = 2.21; p < 0.05), independently exerted significant effects on WS recovery. PS+RET may accelerate normal WS recovery by approximately 3 months compared with RET. Sex and initial WS may influence the treatment efficiency. For patients with KOA who suffer sarcopenia, 12-week RET alone exerts significant effects on WS recovery, whereas additional PS further augments the treatment effects of RET by speeding up the recovery time of WS toward a level ≥ 1.0 m/s, which facilitates the patients to diminish the disease severity or even free from sarcopenia.
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Affiliation(s)
- Chun-De Liao
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Yu-Yun Huang
- Department of Pediatrics, New York University Langone Medical Center, New York City, NY 10016, USA
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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13
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Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
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Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
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14
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Collins K, Fajardo R, Harkey M, Knake J, Lisee C, Wilcox L, Tasco J, Kuenze C. Knee symptoms do not affect walking biomechanics among women 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2240-2247. [PMID: 35001419 DOI: 10.1002/jor.25265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Women with anterior cruciate ligament reconstruction report worse pain and knee-related symptoms, and also exhibit biomechanical changes that may be related to knee osteoarthritis (OA) development. This is particularly concerning as symptom state has been previously associated with knee OA development. The purpose of this study was to compare lower extremity walking biomechanics between women (age: 21.40 ± 8.54 years) experiencing clinically significant knee-related symptoms and women with acceptable symptoms 6 months following surgery. Twenty-eight women with history of primary, unilateral anterior cruciate ligament reconstruction who completed a lower extremity walking biomechanics assessment 6 months following surgery were included in this analysis. Women were dichotomized as experiencing acceptable or clinically significant knee symptoms according to Knee injury and OA Outcomes Score cut-offs described by Englund et al. Walking biomechanics were compared between women with clinically significant and acceptable symptoms using one-way analysis of covariances for involved limb biomechanics. Biomechanical variables of interest were: peak vertical ground reaction forces (vGRFs), vGRF loading rates, knee flexion angles, knee extension moments, knee adduction angles, and knee adduction moments, and gait speed. Nearly 60% of women reported clinically significant knee symptoms 6 months postoperative. There were no statistically significant differences between symptom groups for walking biomechanics and gait speed outcomes. These findings suggest patient reported knee symptoms may not be a primary influence on walking biomechanics 6 months following anterior cruciate ligament reconstruction. Though, longitudinal assessment of changes in symptom state and walking biomechanics may be warranted as poorer walking biomechanics and symptoms are indicators of knee OA.
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Affiliation(s)
- Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Ryan Fajardo
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jeffrey Knake
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luke Wilcox
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Jamie Tasco
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.,Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
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15
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Physical activity thresholds for predicting longitudinal gait decline in adults with knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:965-972. [PMID: 33865966 DOI: 10.1016/j.joca.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the longitudinal relationship between physical performance (via real-life accelerometry) and physical capacity (laboratory measurement of gait speed) in patients with knee osteoarthritis (KOA), and to derive accelerometry measured thresholds associated with gait speed decline in KOA that may provide targets for disease-specific physical activity guidelines. DESIGN Longitudinal data from the Osteoarthritis Initiative (OAI) accelerometer sub-study was extracted from 1,229 participants assessed 2 years apart. Extracted data include functional capacity, demographic and anthropometric characteristics, patient-reported outcome measures, and accelerometry-based physical activity measures. A "poor capacity" group was defined based on the gait speed quintile decline between baseline and the 2-yr follow-up. A Random Forest classifier was trained to classify individuals' capacity status, and the impact of each extracted factor on the prediction outcome was analyzed using a novel machine learning interpretation algorithm. RESULTS The most impactful predicting feature for gait decline is low minutes in the performance of moderate-vigorous activity (count per min 2,500+). Slower sit-to-stand performance, higher age and self-reported knee pain, and lower minutes in performance light activities (count per min 350-2499) also contributed to the model prediction. The overall classification accuracy is 76.3% (75.4% sensitivity, 76.5% specificity). CONCLUSIONS We investigated the impact magnitude and direction of each predicting feature on the longitudinal capacity status among KOA patients. Using novel data interpretation method, we established feature thresholds that may increase the probability of gait decline. These identified thresholds may provide meaningful information for establishing specific physical activity guidelines for KOA.
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16
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A D, A T, T J, O R, LE D, M E. The role of pain and walking difficulties in shaping willingness to undergo joint surgery for osteoarthritis: Data from the Swedish BOA register. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100157. [PMID: 36474994 PMCID: PMC9718157 DOI: 10.1016/j.ocarto.2021.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To investigate whether the association between pain intensity and willingness to undergo surgery is explained by walking difficulties, in patients with knee or hip osteoarthritis (OA). Methods This is an observational study using data from the Better management of patients with Osteoarthritis (BOA) register, which collects data from a publicly financed self-management programme for people with OA in Sweden. We included all patients with knee or hip OA who attended the baseline visit between 2008 and 2016. We conducted separate mediation analyses within a counterfactual framework to estimate the mediation effect of walking difficulties (yes/no) on willingness to undergo surgery (yes/no) for each one-point increase in pain (0-10 on a numeric rating scale), adjusted for relevant confounders. Results We included 72,131 patients (69% women, mean age 66, mean pain 5.4, 81% had walking difficulties, 27% was willing to undergo surgery). A one-point increase in pain intensity was associated with 1.53 (95% CI: 1.51; 1.55) higher odds of being willing to undergo surgery. Walking difficulties mediated 10%-25% of the effect of one-point increase in pain when pain was <8/10, while at pain ≥8/10 this percentage decreased to 3%. Conclusions More than 80% of the BOA patients have mild to moderate pain (<8/10) and walking difficulties can mediate up to a quarter of the total effect of pain on the willingness to undergo surgery in these patients. Trials to evaluate the potential to lower surgery demand by reducing walking difficulties in people with these characteristics are needed.
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Affiliation(s)
- Dell’Isola A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Turkiewicz A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jönsson T
- Department of Health Sciences, Division of Physiotherapy, Sport Sciences, Lund University, Sweden
| | - Rolfson O
- Department of Orthopedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Dahlberg LE
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Englund M
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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17
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Alenazi AM, Alqahtani BA, Vennu V, Alshehri MM, Alanazi AD, Alrawaili SM, Khunti K, Segal NA, Bindawas SM. Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4414. [PMID: 33919455 PMCID: PMC8122394 DOI: 10.3390/ijerph18094414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. MATERIALS AND METHODS Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed. RESULTS Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p < 0.001). CONCLUSIONS Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.
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Affiliation(s)
- Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
| | - Ahmad D. Alanazi
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia;
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK;
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
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18
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Ylinen J, Pennanen A, Weir A, Häkkinen A, Multanen J. Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking. J Electromyogr Kinesiol 2021; 57:102528. [PMID: 33647872 DOI: 10.1016/j.jelekin.2021.102528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/27/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®). METHODS Seventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF). RESULTS Averaged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities. CONCLUSION BF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.
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Affiliation(s)
- Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Antti Pennanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Doha, Qatar; Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, the Netherlands
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
| | - Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
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19
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Figgins E, Choi YH, Speechley M, Montero-Odasso M. Associations Between Potentially Modifiable and Nonmodifiable Risk Factors and Gait Speed in Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging. J Gerontol A Biol Sci Med Sci 2021; 76:e253-e263. [PMID: 33420785 DOI: 10.1093/gerona/glab008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Gait speed is a strong predictor of morbidity and mortality in older adults. Understanding the factors associated with gait speed and the associated adverse outcomes will inform mitigation strategies. We assessed the potentially modifiable and nonmodifiable factors associated with gait speed in a large national cohort of middle and older-aged Canadian adults. METHODS We examined cross-sectional baseline data from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort. The study sample included 20 201 community-dwelling adults aged 45-85 years. The associations between sociodemographic and anthropometric factors, chronic conditions, and cognitive, clinical, and lifestyle factors and 4-m usual gait speed (m/s) were estimated using hierarchical multivariable linear regression. RESULTS The coefficient of determination, R 2, of the final regression model was 19.7%, with 12.9% of gait speed variability explained by sociodemographic and anthropometric factors, and nonmodifiable chronic conditions and 6.8% explained by potentially modifiable chronic conditions, cognitive, clinical, and lifestyle factors. Potentially modifiable factors significantly associated with gait speed include cardiovascular conditions (unstandardized regression coefficient, B = -0.018; p < .001), stroke (B = -0.025; p = .003), hypertension (B = -0.007; p = .026), serum Vitamin D (B = 0.004; p < .001), C-reactive protein (B = -0.005; p = .005), depressive symptoms (B = -0.003; p < .001), physical activity (B = 0.0001; p < .001), grip strength (B = 0.003; p < .001), current smoking (B = -0.026; p < .001), severe obesity (B = -0.086; p < .001), and chronic pain (B = -0.008; p = .018). CONCLUSIONS The correlates of gait speed in adulthood are multifactorial, with many being potentially modifiable through interventions and education. Our results provide a life-course-perspective framework for future longitudinal assessments risk factors affecting gait speed.
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Affiliation(s)
- Erica Figgins
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Mark Speechley
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.,Schulich Interfaculty Program in Public Health, University of Western Ontario, London, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.,Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Canada
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Oliveira RCS, Inocêncio AVM, Shirahige L, Rodrigues MAB, Vasconcelos CR, Pedrosa MAC. Gait speed and functional performance in elderly women with knee osteoarthritis. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Knee osteoarthritis is a degenerative and inflammatory disease that causes skeletal muscle dysfunction and induces limitation of functional activities, such as gait. Objective: To assess the relationship between gait speed and functional performance in elderly women with knee osteoarthritis. Methods: 38 elderly women were divided into two groups: knee osteoarthritis group (KOAG) (n = 24, 68 ± 4.42) and control group (CG) (n = 14, 66.35 ± 3.54). Gait speed data was assessed through Qualisys system and functional performance through a checklist of the International Classification of Functioning, Disability and Health (ICF). Results: Comparing with CG (p < 0.05), KOAG patients had lower gait speed (p = 0.004) and worse functional performance in d4500 (walking short distances), d4501 (walking long distances), d4502 (walking on different surfaces), and d4503 (walking around obstacles) ICF categories. By associating gait speed and functional performance in KOAG, significant differences were found in the d4500 (p = 0.019) and d4501 (p = 0.035) categories, but none for either the d4502 (p = 0.511) or d4503 (p = 0.076) categories. Gait speed was negatively correlated with d4500 (rho = -0.585, p = 0.003), d4501 (rho= -0.552, p = 0.005), and d4502 (rho = -0,548, p = 0,006). Conclusion: Gait speed is related to functional performance in elderly women with knee osteoarthritis for the activities of walking short distances, walking long distances, and walking on different surfaces. However, it seems that gait speed is not related to walking around obstacles.
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Wolf R, Pereira G, Mattos FD, Lodovico A, Bento PCB. Muscle function, physical function, and gait in older women with and without knee osteoarthritis. MOTRIZ: REVISTA DE EDUCACAO FISICA 2021. [DOI: 10.1590/s1980-657420210015020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Vogel M, Meyer F, Frommer J, Walter M, Lohmann CH, Croner R. Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation? Scand J Pain 2020; 21:238-246. [PMID: 34387954 DOI: 10.1515/sjpain-2020-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized. METHOD The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery. CONCLUSION Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core. IMPLICATIONS Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Meyer
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörg Frommer
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena Friedrich Schiller University, Jena, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Croner
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Charlton JM, Esculier JF, Kobsar D, Thatcher D, Hunt MA. Symptomatic knee osteoarthritis is associated with worse but stable quality of life and physical function regardless of the compartmental involvement: Data from the OAI. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100117. [DOI: 10.1016/j.ocarto.2020.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
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Li C, Kang B, Zhang T, Gu H, Man Q, Song P, Liu Z, Chen J, Wang X, Xu B, Zhao W, Zhang J. High Visceral Fat Area Attenuated the Negative Association between High Body Mass Index and Sarcopenia in Community-Dwelling Older Chinese People. Healthcare (Basel) 2020; 8:healthcare8040479. [PMID: 33198340 PMCID: PMC7712146 DOI: 10.3390/healthcare8040479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/05/2023] Open
Abstract
The association between obesity and sarcopenia remains controversial. The present study was conducted to explore the associations among body mass index (BMI), visceral fat area (VFA), and sarcopenia in older people and analyze their potential mechanisms. This cross-sectional study included 861 community-dwelling older Chinese people from three regions of China. BMI, VFA, muscle mass, muscle strength, physical performance, body composition, and metabolic markers were measured. Muscle mass and muscle strength were positively correlated with BMI, but were negatively correlated with VFA. Simple overweight/obesity was negatively associated with sarcopenia (OR = 0.07, 95% CI = 0.03~0.18), and the OR value was lower than combined obesity (OR = 0.16, 95% CI = 0.09~0.28). Fat free mass and total body protein were positively associated with high BMI but negatively associated with high VFA. Furthermore, high VFA was adversely associated with some metabolic risk factors of sarcopenia. Combination of BMI and VFA increased diagnostic efficiency of low muscle mass and sarcopenia. In conclusion, high BMI was negatively associated with sarcopenia, while high VFA attenuated the negative association between high BMI and sarcopenia. The opposite association may partially be attributed to their different associations with body composition and metabolic risk factors of sarcopenia. Therefore, bedsides BMI, VFA and its interaction with BMI should be considered in sarcopenia prevention.
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Affiliation(s)
- Cheng Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Bingxian Kang
- Wuyuan County Center for Disease Control and Prevention, 105 Shiji Road, Wuyuan, Inner Mongolia 015100, China; (B.K.); (X.W.)
| | - Ting Zhang
- Yuexiu District Center for Disease Control and Prevention, 23 Jiaochang West Road, Guangzhou 510030, China; (T.Z.); (B.X.)
| | - Hongru Gu
- Taicang City Center for Disease Control and Prevention, 36 Xianfu West Street, Taicang 215400, China;
| | - Qingqing Man
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Pengkun Song
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Zhen Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Jingyi Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Xile Wang
- Wuyuan County Center for Disease Control and Prevention, 105 Shiji Road, Wuyuan, Inner Mongolia 015100, China; (B.K.); (X.W.)
| | - Bin Xu
- Yuexiu District Center for Disease Control and Prevention, 23 Jiaochang West Road, Guangzhou 510030, China; (T.Z.); (B.X.)
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
- Correspondence: ; Tel.: +86-10-6623-7174
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d'Errico A, Ricceri F, Descatha A, Leclerc A, Roquelaure Y, Goldberg M. Lifetime Duration of Exposure to Biomechanical Factors at Work as a Mediator of the Relationship Between Socioeconomic Position and Walking Speed. Front Public Health 2020; 8:412. [PMID: 33282805 PMCID: PMC7689267 DOI: 10.3389/fpubh.2020.00412] [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: 11/04/2019] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
The study aimed to assess the proportion mediated by the duration of exposure to ergonomic factors at work on the relationship between socioeconomic position (SEP) and low walking speed. This cross-sectional study was performed on data collected at baseline on 19,704 men and 20,273 women 45-70 years old, currently or previously employed, enrolled in the Constances cohort. SEP was assigned through current or last occupation, categorized in three classes, based on the European Socioeconomic Classification. Walking speed was assessed through one measurement of normal walking for 3 m and dichotomized at the lowest quintile of the sex- and age- (5-year) specific distribution. Self-reported workplace exposure throughout working life to repetitive work, intense physical work, and lifting/carrying heavy loads was used to assess the duration of exposure to each factor, categorized in four classes. Through Poisson regression models, adjusted for BMI, smoking, alcohol intake, hypertension, physical activity, diabetes, cardiovascular diseases, and a cognitive score, the attenuation in the prevalence ratio (PR) of low walking speed by SEP produced by the inclusion of duration of exposure to each factor was evaluated. The mediating effect of work ergonomic exposures on the relationship between SEP and low walking speed was assessed using the weighted method by Vanderweele. In the fully adjusted model without ergonomic exposures, both men and women in the middle and the lowest SEP had a significantly increased risk of low walking speed compared with those in the highest SEP (men: PR = 1.30 and PR = 1.46, respectively; women: PR = 1.24 and PR = 1.45, respectively). The inclusion in separate regression models of exposure duration to repetitive work, intense physical work, and handling of heavy loads produced modest risk attenuations in both men and women, all smaller or around 10%. Mediation analysis revealed in both sexes significant mediation effects for most ergonomic exposures considered, although also with low mediation effects. Significant differences in walking speed by SEP were observed in this large sample, but the proportion of such differences explained by the duration of exposure to ergonomic factors at work was low using either the risk attenuation or the mediation analysis methods.
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Affiliation(s)
- Angelo d'Errico
- Local Health Unit TO3, Epidemiology Department, Turin, Italy
| | - Fulvio Ricceri
- Local Health Unit TO3, Epidemiology Department, Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alexis Descatha
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,University of Angers, Angers, France
| | - Annette Leclerc
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,Paris Descartes University, Paris, France
| | | | - Marcel Goldberg
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,Paris Descartes University, Paris, France
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Wieczorek M, Rotonda C, Guillemin F, Rat AC. What Have We Learned From Trajectory Analysis of Clinical Outcomes in Knee and Hip Osteoarthritis Before Surgery? Arthritis Care Res (Hoboken) 2020; 72:1693-1702. [PMID: 31529685 DOI: 10.1002/acr.24069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/10/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The past decade has seen a rapid increase in the publication of studies using trajectory analysis to describe the course of osteoarthritis (OA) symptoms. The aim of this systematic review was to describe the distinct trajectories for OA outcomes and the predictors of these trajectories. METHODS Medline and PsycInfo databases were searched for relevant studies. Selection criteria were 1) patients ≥18 years of age, 2) patients at high risk of or diagnosed with knee or hip OA, 3) studies aiming to identify homogeneous subgroups with distinct trajectories of clinical outcomes, and 4) methodology and analysis designed to identify trajectories (longitudinal design and repeated measures). The search was limited to publications in English or French. RESULTS Of the 5,177 abstracts retrieved, 44 studies met the inclusion criteria; 21 described the disease progression before surgery. The most frequent outcomes were pain and physical function. Up to 6 trajectories of pain were found for hip and knee OA. For function, between 1 and 5 trajectories were identified for knee OA. Low educational level, high body mass index, and high number of comorbidities were the most reported predictors of bad evolution. CONCLUSION Although studies were heterogeneous (outcome, subgroup number, and composition), they revealed stable OA trajectories over time. This finding suggests that OA is a chronic disease that does not inevitably worsen in terms of patient-reported symptoms.
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Affiliation(s)
| | | | - Francis Guillemin
- Université de Lorraine, EA 4360 Apemac, and Inserm, CHRU Nancy, Université de Lorraine, CIC-1433 Epidémiologie Clinique, Nancy, France
| | - Anne-Christine Rat
- Université de Lorraine, EA 4360 Apemac, Nancy, and, University of Caen Normandy, Rheumatology Department, Caen, France
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27
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Karim HT, Rosso A, Aizenstein HJ, Bohnen NI, Studenski S, Rosano C. Resting state connectivity within the basal ganglia and gait speed in older adults with cerebral small vessel disease and locomotor risk factors. Neuroimage Clin 2020; 28:102401. [PMID: 32932053 PMCID: PMC7495101 DOI: 10.1016/j.nicl.2020.102401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM The basal ganglia are critical for planned locomotion, but their role in age-related gait slowing is not well known. Spontaneous regional co-activation of brain activity at rest, known as resting state connectivity, is emerging as a biomarker of functional neural specialization of varying human processes, including gait. We hypothesized that greater connectivity amongst regions of the basal ganglia would be associated with faster gait speed in the elderly. We further investigated whether this association was similar in strength to that of other risk factors for gait slowing, specifically white matter hyperintensities (WMH). METHODS A cohort of 269 adults (79-90 years, 146 females, 164 White) were assessed for gait speed (m/sec) via stopwatch; brain activation during resting state functional magnetic resonance imaging, WMH, and gray matter volume (GMV) normalized by intracranial volume via 3T neuroimaging; and risk factors of poorer locomotion via clinical exams (body mass index (BMI), muscle strength, vision, musculoskeletal pain, cardiometabolic conditions, depressive symptoms, and cognitive function). To understand whether basal ganglia connectivity shows distinct clusters of connectivity, we conducted a k-means clustering analysis of regional co-activation among the substantia nigra, nucleus accumbens, subthalamic nucleus, putamen, pallidum, and caudate. We conducted two multivariable linear regression models: (1) with gait speed as the dependent variable and connectivity, demographics, WMH, GMV, and locomotor risk factors as independent variables and (2) with basal ganglia connectivity as the dependent variable and demographics, WMH, GMV, and locomotor risk factors as independent variables. RESULTS We identified two clusters of basal ganglia connectivity: high and low without a distinct spatial distribution allowing us to compute an average connectivity index of the entire basal ganglia regional connectivity (representing a continuous measure). Lower connectivity was associated with slower gait, independent of other locomotor risk factors, including WMH; the coefficient of this association was similar to those of other locomotor risk factors. Lower connectivity was significantly associated with lower BMI and greater WMH. CONCLUSIONS Lower resting state basal ganglia connectivity is associated with slower gait speed. Its contribution appears comparable to WMH and other locomotor risk factors. Future studies should assess whether promoting higher basal ganglia connectivity in older adults may reduce age-related gait slowing.
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Affiliation(s)
- H T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
| | - A Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - H J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - N I Bohnen
- Departments of Radiology & Neurology, University of Michigan, Ann Arbor, MI, United States; Neurology Service & Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - S Studenski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - C Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
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Driban JB, Harkey MS, Price LL, Lo GH, McAlindon TE. The Inverse OARSI-OMERACT Criteria Is a Valid Indicator of the Clinical Worsening of Knee Osteoarthritis: Data From the Osteoarthritis Initiative. J Rheumatol 2020; 48:442-446. [PMID: 32541081 DOI: 10.3899/jrheum.200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We assessed if the inverse Osteoarthritis Research Society International (OARSI) and Outcome Measures in Rheumatology (OMERACT) criteria relate to concurrent radiographic knee osteoarthritis (KOA) progression and decline in walking speed, as well as future knee replacement. METHODS We conducted knee-based analyses of data from the Osteoarthritis Initiative. All knees had symptomatic OA: at least doubtful radiographic KOA (Kellgren-Lawrence grade ≥ 1) and knee pain ≥ 10/100 (Western Ontario and McMaster Universities Osteoarthritis Index pain) at the 12-month visit. The inverse of the OARSI-OMERACT responder criteria depended on knee pain and function, and global assessment of knee impact. We used generalized linear mixed models to assess the relationship of the inverse OARSI-OMERACT criteria over 2 years (i.e., 12-month and 36-month visits) with worsening radiographic severity (any increase in Kellgren-Lawrence grade from 12 months to 36 months) and decline in self-selected 20-m walking speed of ≥ 0.1m/s (from 12 months to 36 months). We used a Cox model to assess time to knee replacement during the 6 years after the 36-month visit as an outcome. RESULTS Among the 1746 analyzed, 19% met the inverse OARSI-OMERACT criteria. Meeting the inverse OARSI-OMERACT criteria was associated with almost double the odds of experiencing concurrent worsening in radiographic KOA severity (OR 1.89, 95% CI 1.32-2.70) or decline in walking speed (OR 1.82, 95% CI 1.37-2.40). A knee meeting the inverse OARSI-OMERACT criteria was more likely to receive a knee replacement after the 36-month visit (23%) compared with a nonresponder (10%; HR 2.54, 95% CI 1.89-3.41). CONCLUSION The inverse OARSI-OMERACT criteria for worsening among people with KOA had good construct validity in relation to clinically relevant outcomes.
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Affiliation(s)
- Jeffrey B Driban
- J.B. Driban, PhD, ATC, CSCS, Associate Professor, T.E. McAlindon, MD, Chief of Rheumatology, Allergy, and Immunology, Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston;
| | - Matthew S Harkey
- M.S. Harkey, PhD, Postdoctoral Research Fellow, Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, and Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Lori Lyn Price
- L.L. Price, MAS, Statistician, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Grace H Lo
- G.H. Lo, MD, Assistant Professor, Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, and Section of Immunology, Allergy, and Rheumatology Baylor College of Medicine, Houston, Texas, USA
| | - Timothy E McAlindon
- J.B. Driban, PhD, ATC, CSCS, Associate Professor, T.E. McAlindon, MD, Chief of Rheumatology, Allergy, and Immunology, Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston
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Hyodo K, Kanamori A, Kadone H, Takahashi T, Kajiwara M, Yamazaki M. Gait Analysis Comparing Kinematic, Kinetic, and Muscle Activation Data of Modern and Conventional Total Knee Arthroplasty. Arthroplast Today 2020; 6:338-342. [PMID: 32529016 PMCID: PMC7280752 DOI: 10.1016/j.artd.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background To provide normal knee function, a total knee arthroplasty (TKA) implant with an anatomic surface shape and an adequate sagittal position has been developed. However, it is unclear how this modern implant influences knee joint kinetics and muscle activation during a gait. Therefore, we evaluated this modern TKA prosthesis and compared it with a conventional TKA prosthesis for gait analysis in terms of kinetics and muscle activation. Methods Subjects were patients (>60 years of age) with knee osteoarthritis who had undergone unilateral TKA. Twelve patients received the modern TKA prosthesis (group modern), and the other 12 patients received a conventional TKA prosthesis (group conventional). The subjects underwent motion capture analyses with a force plate, and kinematic and kinetic data were acquired from a 10-m gait test. Electromyography data of 6 lower limb muscles were simultaneously collected during the gait test. The 2 groups were compared using unpaired t-tests. Results In group modern, gait speed was faster, step length was longer, and the knee flexion angle during the initial stance phase was larger. Furthermore, in group modern, the maximum knee extension moment was higher; however, the quadriceps muscle activity tended to be lower than that in group conventional. Conclusions Gait characteristics of group modern were more like a normal gait, and knee joint extension moments were greater. This finding indicates that the quadriceps muscles can be more effectively activated, and the anterior stability function of the anterior cruciate ligament may be reproduced with the shape of the modern implant.
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Affiliation(s)
- Kojiro Hyodo
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Tatsuya Takahashi
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaya Kajiwara
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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30
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Harkey MS, Price LL, Reid KF, Lo GH, Liu SH, Lapane KL, Dantas LO, McAlindon TE, Driban JB. Patient-specific reference values for objective physical function tests: data from the Osteoarthritis Initiative. Clin Rheumatol 2020; 39:1961-1970. [PMID: 32030634 PMCID: PMC7372536 DOI: 10.1007/s10067-020-04972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVE We aimed to establish sex-specific reference values of objective physical function tests among individuals with or at risk for knee osteoarthritis (KOA) across subsets of age, radiographic KOA severity, and body mass index (BMI). METHOD We included Osteoarthritis Initiative participants with data for objective physical function tests, sex, age, BMI, and radiographic KOA severity (Kellgren-Lawrence [KL] grade) at baseline. Objective physical function was quantified with 20-m walk speed, chair-stand speed, 400-m walk time, and knee extension and flexion strength. We created participant characteristic subsets for sex, age, KL grade, and BMI. Reference values were created as percentiles from minimum to maximum in 10% increments for each combination of participant characteristic subsets. Previously established clinically important differences for 20-m walk speed and knee extension strength were used to highlight clinically relevant differences. RESULTS Objective physical function reference values tables and an interactive reference value table were created across all combinations of sex, age, KL grade, and BMI among 3860 individuals with or at risk for KOA. Clinically relevant differences exist for 20-m walk speed and knee extension strength between males and females across age groups, KL grades, and BMI categories. CONCLUSIONS Establishing an individual's relative level of objective physical function by comparing their performance to individuals with similar sex, age, KL grade, or BMI may help improve interpretation of physical function performance. The interactive reference value table will provide clinicians and researchers a clinically accessible avenue to use these reference values.Key Points• Since greater age, radiographic knee osteoarthritis severity, and body mass index are all associated with worse objective physical function, reference values should consider the complex inter-play among these patient characteristics.• This study provides objective physical function reference values among subsets of individuals across the spectrum of sex, age groups, radiographic knee osteoarthritis severity, and body mass index categories.• These reference values offer a more patient-centered approach for interpreting an individual's relative level of objective physical function by comparing them to a more homogeneous group of individuals with similar participant characteristics.• We have provided a clinically accessible interactive table that will enable clinicians and researchers to input their patient's data to quickly and efficiently determine a patient's relative objective physical function compared to individual's with similar characteristics.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA.
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Kieran F Reid
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Shao-Hsien Liu
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lucas Ogura Dantas
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
- Physical Therapy Department, Neuromuscular Plasticity Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
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Fawole HO, Riskowski JL, Dell'Isola A, Steultjens MP, Nevitt MC, Torner JC, Lewis CE, Felson DT, Chastin SFM. Determinants of generalized fatigue in individuals with symptomatic knee osteoarthritis: The MOST Study. Int J Rheum Dis 2020; 23:559-568. [PMID: 31991526 PMCID: PMC7160026 DOI: 10.1111/1756-185x.13797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
AIM The aim of the study was to identify sociodemographic, disease-related, physical and mental health-related determinants of fatigue at 2-year follow-up in individuals with symptomatic knee osteoarthritis (OA). METHODS A longitudinal analysis of participants with symptomatic knee OA from the Multicenter Osteoarthritis Study (MOST) was conducted to identify predictors of fatigue at 2-year follow-up. Participants self-reported fatigue at baseline for the first time in the MOST cohort and at follow-up using a 0-10 visual analog scale. At baseline, questionnaires on sociodemographics, disease-related symptoms, physical and mental health factors were completed. Data were analyzed using linear regressions with a backwards elimination approach. RESULTS Of the 2330 individuals in the MOST cohort at baseline, 576 had symptomatic knee OA and of these, 449 with complete fatigue values at baseline and follow-up were included in this analysis. Minimally important fatigue change (ie, worsening [≥1.13], no change [<0.82 or <1.13] and improvement [≥-0.82]) from baseline to follow-up were unequal within the population (34.5%, 26.9%, 38.5%; χ2 [2, N = 449] = 9.32, P = .009). The multiple linear regression showed that baseline fatigue (unstandardized coefficient [Β] = 0.435; 95% confidence interval [CI] 0.348-0.523, P < .001), slow gait speed (Β = -1.124; 95% CI -1.962 to -0.285, P = .009), depressive symptoms (Β = 0.049; 95% CI 0.024-0.075, P < .001) and higher numbers of comorbidities (Β = 0.242; 95% CI 0.045-0.439, P = .016) were significant predictors of greater fatigue at follow-up. CONCLUSION Fatigue is strongly associated with physical- and mental-related health factors. Individualized treatments that include combined psychological and physical function rehabilitation might be modalities for fatigue management.
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Affiliation(s)
- Henrietta O Fawole
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Physiotherapy, College of Medical Sciences, University of Benin, Edo State, Nigeria
| | - Jody L Riskowski
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Andrea Dell'Isola
- Department of Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Martijn P Steultjens
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | | | - Sebastien F M Chastin
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Science, Ghent University, Ghent, Belgium
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Effect of Shoes Reducing Varus Instability of the Knee on Gait Parameters, Knee Pain, and Health-Related Quality of Life in Females With Medial Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harkey MS, Price LL, McAlindon TE, Davis JE, Stout AC, Lu B, Zhang M, Eaton CB, Barbe MF, Lo GH, Driban JB. Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:259-270. [PMID: 29882630 DOI: 10.1002/acr.23613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/05/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a decline in walking speed during the year prior to disease onset is associated with concurrent changes in cartilage, bone marrow lesions (BMLs), or effusion in adults who develop common knee osteoarthritis (OA), accelerated knee OA, or no knee OA. METHODS We identified 3 groups from the Osteoarthritis Initiative based on annual radiographs from baseline to 48 months: accelerated knee OA, common knee OA, and no knee OA. We used the cartilage damage index (CDI) to assess tibiofemoral cartilage damage and used a semiautomated program to measure BML and effusion volume. Walking speed was assessed as an individual's habitual walking speed over 20 meters. One-year change in walking speed and structural measures were calculated as index visit measurements minus measurements from the year prior visit. Logistic regression models were used to determine whether change in walking speed (exposure) was associated with change in each structural measure (outcome) for the overall group and then separately for the accelerated knee OA, common knee OA, and no knee OA groups. RESULTS Adults who slowed their walking speed were almost twice as likely to present with increased BML volume, with a significant association (odds ratio 3.04 [95% confidence interval (95% CI) 1.03-8.95]) among adults with accelerated knee OA. Adults with accelerated knee OA who slowed their walking speed were approximately 3.4 times (95% CI 1.10-10.49) more likely to present with increased effusion volume. Walking speed change was not significantly associated with CDI change. CONCLUSION A change in an easily assessable clinical examination (i.e., 20-meter walk test) was associated with concurrent worsening in BML and effusion volume in adults who developed accelerated knee OA.
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Affiliation(s)
| | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | | | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ming Zhang
- Tufts Medical Center, Boston, Massachusetts
| | - Charles B Eaton
- Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Mary F Barbe
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Grace H Lo
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston Texas
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Guedes RDC, Dias RC, Neri AL, Ferriolli E, Lourenço RA, Lustosa LP. Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18036026032019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.
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Trajectories of Quality of Life and Associated Risk Factors in Patients With Knee Osteoarthritis: Findings From the Osteoarthritis Initiative. Am J Phys Med Rehabil 2019; 97:620-627. [PMID: 29547449 DOI: 10.1097/phm.0000000000000926] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) has a significant impact on quality of life (QOL). Although QOL is generally thought to diminish over time, it is unknown whether different patient groups demonstrate unique patterns of change in QOL. We sought to identify and characterize QOL trajectories in knee OA. DESIGN This prospective cohort study included 1013 individuals with symptomatic knee OA from the osteoarthritis initiative. We used group-based trajectory modeling to identify distinct temporal patterns of change in the Knee Injury and Osteoarthritis Outcome Score QOL subscale for 8 yrs. Baseline covariates included age, sex, ethnicity, education, co-morbidities, body mass index, substance use, depression, knee pain, and functional tests. RESULTS Group-based trajectory modeling revealed the following three distinct QOL trajectories: a high QOL trajectory (32% of the cohort) experiencing improvement for 8 yrs as well as moderate (49%) and low QOL (20%) trajectories maintaining similar levels over time. Low QOL trajectory membership was significantly associated with younger age (P < 0.001), nonwhite race (P < 0.001), less education (P < 0.001), more co-morbidities (P < 0.001), higher body mass index (P < 0.001), and more depressive symptoms (P < 0.001). Higher QOL trajectory members were less likely to undergo knee replacement surgery (P < 0.001). CONCLUSIONS Distinct QOL trajectories exist in knee OA and are associated with modifiable factors, with a subset of patients showing potential to improve their QOL over time.
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Li C, Chen Y, Lin T, Hsiao Y, Fu JC, Chen C, Lee C. Immediate responses of multi‐focal low level laser therapy on quadriceps in knee osteoarthritis patients. Kaohsiung J Med Sci 2019; 35:702-707. [DOI: 10.1002/kjm2.12113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Cyuan‐Fong Li
- Department of Physical Medicine and RehabilitationKaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Yi‐Jen Chen
- Department of Physical Medicine and RehabilitationKaohsiung Medical University Hospital Kaohsiung Taiwan
- Graduate Institute of Clinical Medicine, College of MedicineKaohsiung Medical University Kaohsiung Taiwan
| | - Tz‐Yan Lin
- Department of Physical Medicine and RehabilitationKaohsiung Municipal Ta‐Tung Hospital Kaohsiung Taiwan
| | - Yu‐Hsuan Hsiao
- Department of Physical Medicine and RehabilitationKaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Jimmy Chun‐Ming Fu
- Department of Physical Medicine and RehabilitationKaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Chia‐Hsin Chen
- Department of Physical Medicine and RehabilitationKaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Physical Medicine and RehabilitationSchool of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
- Orthopaedic Research CenterKaohsiung Medical University Kaohsiung Taiwan
| | - Chia‐Ling Lee
- Department of Physical Medicine and RehabilitationKaohsiung Municipal Siaogang Hospital Kaohsiung Taiwan
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Vogel M, Krippl M, Frenzel L, Riediger C, Frommer J, Lohmann C, Illiger S. Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA). J Clin Med 2019; 8:E697. [PMID: 31100954 PMCID: PMC6571957 DOI: 10.3390/jcm8050697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022] Open
Abstract
Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: 1) PC factor, 2) absorptive detachment, and 3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC.
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Affiliation(s)
- Matthias Vogel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Martin Krippl
- Institut für Psychologie der Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, Geb. 24, 39106 Magdeburg, Germany.
| | - Lydia Frenzel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christian Riediger
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Jörg Frommer
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christoph Lohmann
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Sebastian Illiger
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
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Coyle PC, Pugliese JM, Sions JM, Eskander MS, Schrack JA, Hicks GE. Pain Provocation and the Energy Cost of Walking: A Matched Comparison Study of Older Adults With and Without Chronic Low Back Pain With Radiculopathy. J Geriatr Phys Ther 2019; 42:E97-E104. [PMID: 30998562 DOI: 10.1519/jpt.0000000000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Chronic low back pain with radiculopathy (CLBPR) is common among older adults and can lead to walking difficulty. Energy cost of walking strongly predicts changes in walking speed, which is predictive of mortality in older adults. The purposes of this study were to examine (1) the impact of pain provocation on the energy cost of walking and (2) the relationship between pain intensity and change in energy cost of walking. METHODS Older adults (60-85 years) with (n = 20) and without (n = 20) CLBPR were matched on age, sex, and diabetes presence/absence. Energy cost of walking was measured with a portable metabolic gas analyzer, as participants walked for 20 minutes or less. Energy cost and pain measurements occurred during early and late stages of walking. Percent change in energy cost was calculated. Participants were grouped by their pain response during walking: increased pain (n = 13); consistent pain (n = 7); no pain, matched to individuals with increased pain (n = 13); and no pain, matched to individuals with consistent pain (n = 7). We examined the within-groups change in energy cost for all groups, as well as the relationship between late-stage pain intensity and percent change of energy cost for individuals whose pain increased. RESULTS AND DISCUSSION Within the increased pain group, energy cost of walking significantly increased from early to late stages (median change = 0.003 mL/kg/m, P = .006), and late-stage pain intensity explained 41.2% (p = 0.040) of the variance in percent change. Since pain appears to be linked to energy cost, effective pain management with walking may be an important factor in preventing mobility decline. CONCLUSIONS Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Delaware, Newark
| | | | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark
| | | | - Jennifer A Schrack
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark
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Negative Affect, Type D Personality, Quality of Life, and Dysfunctional Outcomes of Total Knee Arthroplasty. Pain Res Manag 2019; 2019:6393101. [PMID: 30719200 PMCID: PMC6335857 DOI: 10.1155/2019/6393101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
Background Type D personality (TDP) is a sign of tapered stress and compromises treatment outcomes including those of hip arthroplasty. The common dissatisfaction with total knee arthroplasty (TKA) is predicted by fear avoidance, pain catastrophizing and emotional lability, with poor quality of life (QoL) reflecting these strains. This study is the first to investigate the influence of TDP on TKA assuming (1) negative affect (NA) to be linked to fear avoidance and to increased dissatisfaction with TKA and (2) the expression of NA and social inhibition (SI) to not be stable over time. Method We studied 79 participants using the brief symptom inventory-18, the pain-catastrophizing scale, the Tampa scale of kinesiophobia, the SF-36, and the WOMAC preoperatively and 12 months postoperatively. T-test and regression were used to compare the variables of interest between groups built based upon outcome severity. Result NA at follow-up predicted knee pain (p=0.02) and knee function (p < 0.01) at follow-up. Contrarily, increased expressions of NA/SI at follow-up were predicted by NA (p=0.04) and rumination (p=0.05) at the baseline. Conclusion The present results suggest the postoperative increase of NA to be linked to dysfunctional outcomes of TKA due to an interaction with pain catastrophizing. Baseline self-rated physical health did not connect to the dissatisfaction with TKA 1-year postoperatively.
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de Matos Brunelli Braghin R, Libardi EC, Junqueira C, Rodrigues NC, Nogueira-Barbosa MH, Renno ACM, Carvalho de Abreu DC. The effect of low-level laser therapy and physical exercise on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis: a blind randomized clinical trial. Disabil Rehabil 2018; 41:3165-3172. [PMID: 30324827 DOI: 10.1080/09638288.2018.1493160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis (OA).Methods: Subjects with knee OA (Grades 1-3) were evaluated and randomized into four groups: Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. The treatment was carried out twice a week for 2 months. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was applied for evaluation and reevaluation; evaluation of spatiotemporal gait variables was performed using GAITRite equipment.Results: The EG showed significant improvement in pain (p = 0.006) and function (p = 0.01) according to WOMAC. Regarding gait variables, in intergroup analysis after 8 weeks all groups receiving intervention showed a significant increase in gait speed: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005). Only the group treated with laser + exercise showed a significant increase (p = 0.009) in the cadence and duration of single right limb support (p = 0.04), and only the groups treated with exercise and laser + exercise showed significant decreases in the duration of right limb support (p = 0.035 and p = 0.003, respectively), compared to the CG.Conclusions: The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support).Implications for rehabilitationThere are differences in gait patterns in patients with knee OA, including decreased gait speed, cadence, and step length.The results shown in the present study provide additional information about the physical therapy approaches that should be chosen during clinical practical to improve gait performance in individuals with knee osteoarthritis.The improvement in gait performance is a relevant issue due to the fact that is associated to physical independence and better quality of life.
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Affiliation(s)
- Roberta de Matos Brunelli Braghin
- Physiotherapy Course, Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Elisa Cavalheiro Libardi
- Physiotherapy Course, Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carina Junqueira
- Physiotherapy Course, Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Natalia Camargo Rodrigues
- Physiotherapy Course, Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Division of Radiology of the Internal Medicine Department, Ribeirao Preto Medical School University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Milner CE, Meardon SA, Hawkins JL, Willson JD. Walking velocity and step length adjustments affect knee joint contact forces in healthy weight and obese adults. J Orthop Res 2018; 36:2679-2686. [PMID: 29704285 DOI: 10.1002/jor.24031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/19/2018] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis is a major public health problem and adults with obesity are particularly at risk. One approach to alleviating this problem is to reduce the mechanical load at the joint during daily activity. Adjusting temporospatial parameters of walking could mitigate cumulative knee joint mechanical loads. The purpose of this study was to determine how adjustments to velocity and step length affects knee joint loading in healthy weight adults and adults with obesity. We collected three-dimensional gait analysis data on 10 adults with a normal body mass index and 10 adults with obesity during over ground walking in nine different conditions. In addition to preferred velocity and step length, we also conducted combinations of 15% increased and decreased velocity and step length. Peak tibiofemoral joint impulse and knee adduction angular impulse were reduced in the decreased step length conditions in both healthy weight adults (main effect) and those with obesity (interaction effect). Peak knee joint adduction moment was also reduced with decreased step length, and with decreased velocity in both groups. We conclude from these results that adopting shorter step lengths during daily activity and when walking for exercise can reduce mechanical stimuli associated with articular cartilage degenerative processes in adults with and without obesity. Thus, walking with reduced step length may benefit adults at risk for disability due to knee osteoarthritis. Clinical Significance: Adopting a shorter step length during daily walking activity may reduce knee joint loading and thus benefit those at risk for knee cartilage degeneration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2679-2686, 2018.
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Affiliation(s)
- Clare E Milner
- ReHAB Group, Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, Pennsylvania, 19102
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, 27834
| | - Jillian L Hawkins
- ReHAB Group, Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, Pennsylvania, 19102
| | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, 27834
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Fenton SAM, Neogi T, Dunlop D, Nevitt M, Doherty M, Duda JL, Klocke R, Abhishek A, Rushton A, Zhang W, Lewis CE, Torner J, Kitas G, White DK. Does the intensity of daily walking matter for protecting against the development of a slow gait speed in people with or at high risk of knee osteoarthritis? An observational study. Osteoarthritis Cartilage 2018; 26:1181-1189. [PMID: 29729332 PMCID: PMC6098720 DOI: 10.1016/j.joca.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a risk factor for a decline in gait speed. Daily walking reduces the risk of developing slow gait speed and future persistent functional limitation. However, the protective role of walking intensity is unclear. We investigated the association of substituting time spent not walking, with walking at light and moderate-to-vigorous intensities for incident slow gait over 2-years, among people with or at high risk of knee OA. METHOD We used baseline and 2-year follow-up data from the Multicenter Osteoarthritis (MOST) study (n = 1731) and the Osteoarthritis Initiative (OAI, n = 1925). Daily walking intensity was objectively assessed using accelerometer-enabled devices, and classified as; not walking (<1 steps/min), very-light (1-49 steps/min), light (50-100 steps/min), and moderate-to-vigorous (>100 steps/min). We defined slow gait during a 20-m walk, as <1 m/s and <1.2 m/s. Isotemporal substitution evaluated time-substitution effects on incident slow gait outcomes at 2-years. RESULTS Replacing 20 min/day of not walking with walking at a moderate-to-vigorous intensity, demonstrated small to moderate reductions in the risk of developing a gait speed <1.0 m/s (Relative Risk [95% confidence interval (CI)]; MOST = 0.51 [0.27, 0.98], OAI = 0.21 [0.04, 0.98]), and <1.2 m/s (MOST = 0.73 [0.53, 1.00], OAI = 0.65 [0.36, 1.18]). However, only risk reductions for <1.0 m/s met statistical significance. Replacing not walking with very-light or light intensity walking was not associated with the risk of developing slow gait outcomes. CONCLUSION When possible, walking at a moderate-to-vigorous intensity (>100 steps/min) may be best recommended in order to reduce the risk of developing critical slow gait speed among people with, or at high risk of knee OA.
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Affiliation(s)
- Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK,Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University Medical Center, Boston, MA, USA
| | - Dorothy Dunlop
- Center for Healthcare Studies and Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | - Michael Doherty
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK
| | - Rainer Klocke
- Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Abhishek Abhishek
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK
| | - Weiya Zhang
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - George Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK,Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Coyle PC, Schrack JA, Hicks GE. Pain Energy Model of Mobility Limitation in the Older Adult. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:1559-1569. [PMID: 28531299 PMCID: PMC6084583 DOI: 10.1093/pm/pnx089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Chronic pain is prevalent, costly, and disabling among older adults. Although mobility decline is inevitable with aging, it is clear, from current evidence, that older adults with chronic pain experience a greater rate of functional mobility decline than their pain-free peers. Past studies suggest that pain expedites the age-related decline in functional mobility; however, the pathways through which pain affects mobility remain unclear. Gerontological experts hypothesize that the age-related decline in mobility may be driven by alterations in energy expenditure; these concepts are outlined in a model known as the Energetic Pathway of Mobility Loss. Pain may play a critical role in this process through a pathway of energetic inefficiency, physical inactivity, and decreased capacity. Purpose The purposes of this article are to 1) summarize the current literature that supports the Energetic Pathway of Mobility Loss model and 2) propose a new framework, known as the Pain Energy Model, to clarify how the disablement process may be amplified among older adults with painful conditions. Conclusion This new framework is designed to generate new clinical research and to suggest new clinical implications for older adults with painful conditions by identifying key steps and potential treatment targets in the pathway to functional mobility decline.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jennifer A Schrack
- Johns Hopkins Bloomberg School of Public Health, Center on Aging and Health, Baltimore, Maryland
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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Shea MK, Loeser RF, McAlindon TE, Houston DK, Kritchevsky SB, Booth SL. Association of Vitamin K Status Combined With Vitamin D Status and Lower-Extremity Function: A Prospective Analysis of Two Knee Osteoarthritis Cohorts. Arthritis Care Res (Hoboken) 2018; 70:1150-1159. [PMID: 29045002 PMCID: PMC5904020 DOI: 10.1002/acr.23451] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/10/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Vitamins K and D are important for the function of vitamin K-dependent proteins in joint tissues. It is unclear whether these nutrients are mutually important to functional outcomes related to knee osteoarthritis (OA). We evaluated the association of vitamin K and D sufficiency with lower-extremity function in the Health, Aging and Body Composition knee OA substudy (Health ABC) and conducted a replication analysis in an independent cohort, the Osteoarthritis Initiative (OAI). METHODS In Health ABC (60% female, mean ± SD age 75 ± 3 years) baseline nutrient status was measured using circulating vitamin K and 25-hydroxyvitamin D (25[OH]D). Lower-extremity function was assessed using the Short Physical Performance Battery (SPPB) and usual 20-meter gait speed. In the OAI (58% female, mean ± SD age 61 ± 9 years), baseline nutrient intake was estimated by food frequency questionnaire. Lower-extremity function was assessed using usual 20-meter gait speed and chair stand completion time. Multivariate mixed models were used to evaluate the association of vitamin K and D status and intake with lower-extremity function over 4-5 years. RESULTS Health ABC participants with sufficient plasma vitamin K (≥1.0 nmoles/liter) and serum 25(OH)D (≥50 nmoles/liter) generally had better SPPB scores and faster usual gait speed over followup (P ≤ 0.002). In the OAI, sufficient vitamin K and vitamin D intake combined was associated with overall faster usual gait speed and chair stand completion time over followup (P ≤ 0.029). CONCLUSION Sufficient vitamin K status combined with sufficient vitamin D status was associated with better lower-extremity function in 2 knee OA cohorts. These findings merit confirmation in vitamin K and D co-supplementation trials.
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Ismail A, Moore C, Alshishani N, Yaseen K, Alshehri MA. Cognitive behavioural therapy and pain coping skills training for osteoarthritis knee pain management: a systematic review. J Phys Ther Sci 2017; 29:2228-2235. [PMID: 29643612 PMCID: PMC5890238 DOI: 10.1589/jpts.29.2228] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022] Open
Abstract
[Purpose] To investigate the effectiveness of cognitive-behavioural therapy (CBT) and
pain coping skills training (PCST) on pain level in adults with osteoarthritis of the knee
(KOA) in comparison with usual care. [Subjects and Methods] Five databases were
systematically searched for relevant randomised controlled trials (RCTs) according to the
selected eligibility criteria (inception to June 7, 2016). PEDro scale was used to assess
the validity of included studies. [Results] Four studies met the inclusion criteria and
all studies had high methodological quality. The total number of participants was 665
across the four included studies. All participants had been diagnosed with KOA (clinical
and radiographic evaluation). The majority of the population were female (71.13%). The
interventions utilised were: CBT, CBT for insomnia (CBT-I), PCST, and PCST combined with
behavioral weight management (BWM) in one study and with exercise in another study. The
outcome measure for pain in KOA was the WOMAC scale. Overall, three studies have reported
clinical improvement in KOA pain perception after 12-month follow-up time point.
[Conclusion] This review has recognised the need for future studies that have rigorous
methodological quality, and investigate the effect of mutual CBT and PCST protocols on KOA
pain and pain-related functional and psychological abilities.
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Affiliation(s)
- Ayah Ismail
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Catherine Moore
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Natasha Alshishani
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Khalid Yaseen
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Mansour Abdullah Alshehri
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
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Dai Z, Felson DT, Zhang Y. Reply. Arthritis Care Res (Hoboken) 2017; 69:1932-1933. [PMID: 28085230 PMCID: PMC5509525 DOI: 10.1002/acr.23186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zhaoli Dai
- Boston University School of Medicine, Boston, MA
| | - David T Felson
- Boston University School of Medicine, Boston, MA
- University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, MA
- Massachusetts General Hospital, Boston, MA
- Harvard School of Medicine, Boston, MA
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Fonseca Alves DJ, Bartholomeu-Neto J, Júnior ER, Ribeiro Zarricueta BS, Nóbrega OT, Córdova C. Walking Speed, Risk Factors, and Cardiovascular Events in Older Adults—Systematic Review. J Strength Cond Res 2017; 31:3235-3244. [DOI: 10.1519/jsc.0000000000002182] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Rosso AL, Studenski SA, Longstreth WT, Brach JS, Boudreau RM, Rosano C. Contributors to Poor Mobility in Older Adults: Integrating White Matter Hyperintensities and Conditions Affecting Other Systems. J Gerontol A Biol Sci Med Sci 2017; 72:1246-1251. [PMID: 27816937 PMCID: PMC5861865 DOI: 10.1093/gerona/glw224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/18/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Age-related mobility limitations are debilitating and common. Cerebral white matter hyperintensities (WMH) and conditions affecting other systems are known contributors, but have been studied in isolation. METHODS In 2,703 adults aged 65 years or older, we assessed cross-sectional and longitudinal gait speed and mobility disability (self-reported difficulty walking half mile) in those with and without high burden of MRI-defined WMH along with six other conditions (OCs) affecting mobility: gender-specific weak grip; poor self-reported vision; gender-specific lowest quartile of forced vital capacity; self-reported joint pain; ankle-arm index less than 0.9; and body mass index (BMI) greater than 30 kg/m2. Separate regression models adjusted for age, gender, and race were repeated for each OC and based on a 4-level predictor: -WMH/-OC; -WMH/+OC; +WMH/-OC; and +WMH/+OC. RESULTS Gait speed was fastest in those with -WMH/-OC and slowest for those with +WMH/+OC. Gait speed was similar for either WMH or one of the OC (p range: .07-.9), except for BMI. Those with a high BMI had slower gait speed than those with WMH (p = .01). Declines in gait speed over 6 years were similar for all groups. Results for both prevalent and incident mobility disability showed that associations for WMH and OC were similar for weak grip, poor vision, and low forced vital capacity (p range: .1-.7). Having joint pain, low ankle-arm index, or high BMI was associated with higher prevalent and incident mobility disability compared with having WMH (p range: <.001-.02). CONCLUSIONS Cerebral WMH should be considered along with conditions affecting mobility from other systems when considering risk and treatment for mobility limitations.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | | | - W T Longstreth
- Department of Neurology
- Department of Epidemiology, University of Washington, Seattle
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
| | | | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
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Dai Z, Lu N, Niu J, Felson DT, Zhang Y. Dietary Fiber Intake in Relation to Knee Pain Trajectory. Arthritis Care Res (Hoboken) 2017; 69:1331-1339. [PMID: 27899003 DOI: 10.1002/acr.23158] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/13/2016] [Accepted: 11/22/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Dietary fiber may reduce knee pain, in part by lowering body weight and reducing inflammation. In this study, we assessed whether fiber intake was associated with patterns of knee pain development. METHODS In a prospective, multicenter cohort of 4,796 men and women ages 45-79 years with or at risk of knee osteoarthritis, participants underwent annual followups for 8 years. Dietary fiber intake was estimated using a validated food frequency questionnaire at baseline. Group-based trajectory modeling was used to identify Western Ontario and McMaster Universities Osteoarthritis Index pain trajectories, which were assessed for associations with dietary fiber intake using polytomous regression models. RESULTS Of the eligible participants (4,470 persons and 8,940 knees, mean ± SD age 61.3 ± 9.1 years, 58% women), 4.9% underwent knee replacement and were censored at the time of surgery. Four distinct knee pain patterns were identified: no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%). Dietary total fiber was inversely related to membership in the moderate or severe pain groups (P ≤ 0.006 for trend for both). Subjects in the highest versus those in the lowest quartile of total fiber intake had a lower risk of belonging to the moderate pain pattern group (odds ratio [OR] 0.76 [95% confidence interval (95% CI) 0.61-0.93]) and severe pain pattern group (OR 0.56 [95% CI 0.41-0.78]). Similar results were found with grain fiber and these 2 pain pattern groups. CONCLUSION Our findings suggest that a high intake of dietary total or grain fiber, particularly the recommended daily fiber average intake of 25 gm per day, is associated with a lower risk of developing moderate or severe knee pain over time.
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Affiliation(s)
- Zhaoli Dai
- Boston University School of Medicine, Boston, Massachusetts
| | - Na Lu
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
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Herzog MM, Driban JB, Cattano NM, Cameron KL, Tourville TW, Marshall SW, Pietrosimone B. Risk of Knee Osteoarthritis Over 24 Months in Individuals Who Decrease Walking Speed During a 12-Month Period: Data from the Osteoarthritis Initiative. J Rheumatol 2017; 44:1265-1270. [PMID: 28572470 PMCID: PMC6061917 DOI: 10.3899/jrheum.170093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the association between change in walking speed over a 12-month period and risk of developing radiographic knee osteoarthritis (rKOA) over a 24-month period. METHODS We included participants without rKOA from the Osteoarthritis Initiative. Change in walking speed was determined from a 20-m walk assessment, calculated using walking speed at 12-month followup minus baseline speed and/or 24-month followup walking speed minus 12-month speed. Incident rKOA was defined as progressing to Kellgren-Lawrence arthritis grading scale ≥ 2 within 24 months (i.e., incidence between 12 and 36 mos or 24 and 48 mos). Self-reported significant knee injury during the exposure period, age, body mass index (BMI), and Physical Activity Scale for the Elderly (PASE) score were adjusted for analytically. RESULTS We included 2638 observations among 1460 unique participants (58% women; aged 59 ± 9 yrs, range 45-79). The mean change in walking speed over 12 months was 0.001 ± 0.13 m/s (range -0.6271 to 1.4968). About 5% of the sample (n = 122) developed rKOA over a 24-month period. After controlling for significant knee injury, age, BMI, and PASE score, we found an 8% relative increase in risk of developing rKOA for every 0.1 m/s decrease in walking speed over a 12-month period (risk ratio 1.08, 95% CI 1.00-1.15, p = 0.05). CONCLUSION Evaluating change in speed over a 12-month period using a 20-m walk test may be useful in identifying individuals at increased risk of developing rKOA over the subsequent 24 months. Identification of patients at high risk for developing rKOA would allow medical providers to implement early interventions to maximize joint health.
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Affiliation(s)
- Mackenzie M Herzog
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA.
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
| | - Jeffrey B Driban
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Nicole M Cattano
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Kenneth L Cameron
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Timothy W Tourville
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Stephen W Marshall
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- From the Department of Epidemiology, Gillings School of Global Public Health, and the Injury Prevention Research Center, and the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts; Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; Keller Army Community Hospital, West Point, New York; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
- M.M. Herzog, MPH, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; N.M. Cattano, PhD, Department of Sports Medicine, West Chester University; K.L. Cameron, PhD, Keller Army Community Hospital; T.W. Tourville, PhD, Department of Rehabilitation and Movement Science, University of Vermont; S.W. Marshall, PhD, Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; B. Pietrosimone, PhD, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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