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Ninneman JV, Roberge GA, Stegner AJ, Cook DB. Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms. Curr Top Behav Neurosci 2024. [PMID: 39120812 DOI: 10.1007/7854_2024_504] [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: 08/10/2024]
Abstract
Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.
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Affiliation(s)
- Jacob V Ninneman
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gunnar A Roberge
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron J Stegner
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
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Bendrik R, Sundström B, Bröms K, Emtner M, Kallings LV, Peterson M. One leg testing in hip and knee osteoarthritis: A comparison with a two-leg oriented functional outcome measure and self-reported functional measures. Osteoarthritis Cartilage 2024; 32:937-942. [PMID: 38552834 DOI: 10.1016/j.joca.2024.03.111] [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: 10/30/2023] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments. METHOD Data was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen's standardised mean difference for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests. RESULTS The maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI 0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor (r = 0.188 to 0.226) (p = 0.018 to 0.048). CONCLUSION The unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs.
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Affiliation(s)
- R Bendrik
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
| | - B Sundström
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; Department of Public health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.
| | - K Bröms
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden.
| | - M Emtner
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - L V Kallings
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
| | - M Peterson
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; Academic Primary Health Care, Region Uppsala, Sweden.
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Alyousef YS, Johnston V, Smith MD. Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists. Musculoskelet Sci Pract 2024; 71:102942. [PMID: 38507868 DOI: 10.1016/j.msksp.2024.102942] [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: 07/06/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Lower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. OBJECTIVES To explore Australian physiotherapists' use of work-related interventions in managing patients with lower limb OA, and identify current management practices. METHODS Physiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. RESULTS A total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers' compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. CONCLUSION Many physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; Majmaah University, College of Applied Medical Sciences, Al Majma'ah, Saudi Arabia
| | - Venerina Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; University of Southern Queensland, School of Health and Medical Sciences, Ipswich, QLD, Australia
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia.
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Marriott KA, Hall M, Maciukiewicz JM, Almaw RD, Wiebenga EG, Ivanochko NK, Rinaldi D, Tung EV, Bennell KL, Maly MR. Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2024; 76:821-830. [PMID: 38317328 DOI: 10.1002/acr.25313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence. METHODS We searched six databases, from inception to January 28, 2023, for randomized controlled trials comparing land-based, resistance exercise-only interventions with no intervention, or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3 to 6 months, >6 to <12 months, ≥12 months. The between-group effect was calculated for immediate postintervention pain and physical function (activities of daily living [ADL] and sports/recreation [SPORT]). RESULTS For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. CONCLUSION In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose.
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Affiliation(s)
| | - Michelle Hall
- The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | - Emma V Tung
- The University of Waterloo, Waterloo, Ontario, Canada
| | - Kim L Bennell
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Monica R Maly
- The University of Waterloo, Waterloo, Ontario, Canada
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White DK, Thoma LM. Progress in rehabilitation-related exercise for knee OA at OARSI over the past 30 years. Osteoarthritis Cartilage 2024; 32:411-413. [PMID: 38360266 DOI: 10.1016/j.joca.2024.02.005] [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: 08/29/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Daniel K White
- Department of Physical Therapy, University of Delaware, 540 S. College Dr., 210L, Newark 19716, DE, USA.
| | - Louise M Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Krauss I, Roesel I, Martus P, Giurgiu M, Mueller G. Effectiveness of an 11-week exercise intervention for patients with hip or knee osteoarthritis: results of a quasi-experimental pragmatic trial. BMC Sports Sci Med Rehabil 2024; 16:24. [PMID: 38245801 PMCID: PMC10799538 DOI: 10.1186/s13102-023-00779-0] [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: 05/30/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To assess the effectiveness of exercise and education in addition to standard care (SC) compared to SC alone in patients with hip or knee osteoarthritis (OA) during 24 months follow-up. DESIGN We conducted a quasi-experimental pragmatic clinical trial in care centers of a health insurance company. Overall, 1,030 subjects with hip and/or knee OA were included. The intervention group was recruited from clients participating in a hip/knee training (HKT, n = 515) in addition to SC. The control group (CO, n = 515) receiving SC only was recruited from the insurance database. HKT comprised 8 group sessions (1/week) of exercise and education, complemented by a 11-week structured home-exercise program (2/week). Primary endpoints were change of joint-related pain and function (WOMAC Index, score 0-10) after 3 months. Secondary endpoints related to follow-ups at 6, 12 and 24 months. All patient reported outcome measures were analyzed using linear mixed models (LMMs) investigating a time x treatment effect. A multivariable cox proportional hazards regression model was used to identify differences of joint replacement during follow-up between groups. RESULTS LMMs revealed statistically significant differences in favor of HKT for the primary outcomes WOMAC pain = 0.47 (CI 0.27-0.66; Effect Size (ES) = 0.22, p < 0.001) and WOMAC function = 0.27 (CI 0.11-0.44; ES = 0.13, p < 0.001). HKT was superior to CO for 6, 12, and 24 months as well (ES < 0.2, p ≤ 0.006). HKT was inferior regarding the first incidence of hip or knee AJR during follow-up in comparison to CO (adjusted hazard ratio, HR = 1.57; CI 1.08-2.30; p = 0.020). CONCLUSIONS This trial demonstrated short-, mid- and long-term superiority of exercise versus control. However, differences were smaller than those reported in previous efficacy trials, raising questions regarding clinical importance. Responder analysis will follow to identify possible predictors for patient responsiveness on an individual level. Further studies should investigate the frequency and reasons for joint replacement following exercise therapy. TRIAL REGISTRATION German Clinical Trial Register (DRKS00009251). Registered 10 September 2015.
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Affiliation(s)
- Inga Krauss
- Department of Sports Medicine, University Hospital and Faculty of Medicine Tuebingen, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany.
- Interfaculty Research Institute for Sports and Physical Activity Tuebingen, Tuebingen, Germany.
| | - Inka Roesel
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital and Faculty of Medicine, Tuebingen, Germany
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital and Faculty of Medicine, Tuebingen, Germany
| | - Marco Giurgiu
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Gerhard Mueller
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Allgemeine Ortskrankenkasse AOK Baden-Wuerttemberg, Stuttgart, Germany
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Li X, Wang S, Liu W, Wu H, Zhu Y. Causal effect of physical activity and sedentary behaviors on the risk of osteoarthritis: a univariate and multivariate Mendelian randomization study. Sci Rep 2023; 13:19410. [PMID: 37938609 PMCID: PMC10632381 DOI: 10.1038/s41598-023-46984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023] Open
Abstract
There is still a lot of ambiguity about the link between physical activity (PA), sedentary behaviors (SBs) and osteoarthritis (OA). This study aimed to investigate the causal relationship of PA/SBs on the risk of OA. A univariate and multivariate Mendelian randomization (MR) analysis was conducted to investigate the causal effect of five PA phenotypes and three SB phenotypes on overall OA, knee OA, hip OA, total hip arthroplasty, and total knee arthroplasty (TKA). MR methods used were inverse-variance weighting, MR-Egger regressions, and weighted median. Sensitivity analysis examined horizontal pleiotropy and heterogeneity, and confirmed the reliability of the results. After false discovery rate, light do-it-yourself (DIY) activities decreased the risk for overall OA (OR: 0.32, 95% CI 0.16-0.65), and knee OA (OR: 0.26, 95% CI 0.12-0.51). Resulting in a decreased risk of walking for pleasure on overall OA (OR: 0.87, 95% CI 0.70-1.04) and knee OA (OR: 0.14, 95% CI 0.06-0.32) was also observed. Television viewing, however, significantly increased the risk of OA, knee OA, hip OA, and TKA. MVMR findings revealed independent causal impacts of walking for pleasure and watching television on overall and knee OA, taking into account BMI, smoking, and education. This study suggested that light DIY and walking for pleasure were beneficial for preventing OA, and the risk of OA and TKA increased with prolonged television watching.
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Affiliation(s)
- Xingzhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Sibo Wang
- Department of Neurology, Center for Neuroscience, The First Hospital of Jilin University, Changchun, China
| | - Wanguo Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Yuhang Zhu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
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Hinman RS, Jones SE, Nelligan RK, Campbell PK, Hall M, Foster NE, Russell T, Bennell KL. Absence of Improvement With Exercise in Some Patients With Knee Osteoarthritis: A Qualitative Study of Responders and Nonresponders. Arthritis Care Res (Hoboken) 2023; 75:1925-1938. [PMID: 36594402 DOI: 10.1002/acr.25085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/20/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the perceptions of patients about why they did, or did not, respond to a physical therapist-supported exercise and physical activity program. METHODS This was a qualitative study within a randomized controlled trial. Twenty-six participants (of 40 invited) with knee osteoarthritis sampled according to response (n = 12 responders, and 14 nonresponders based on changes in both pain and physical function at 3 and 9 months after baseline) to an exercise and physical activity intervention. Semistructured individual interviews were conducted. Inductive thematic analysis was undertaken within each subgroup using grounded theory principles. A deductive approach compared themes and subthemes across subgroups. Findings were triangulated with quantitative data. RESULTS (Sub)themes common to responders and nonresponders included the intervention components that facilitated engagement, personal attitudes and expectations, beliefs about osteoarthritis and exercise role, importance of adherence, and perceived strength gains with exercise. In contrast to responders who felt empowered to self-manage, nonresponders accepted responsibility for lack of improvement in pain and function with exercise, acknowledging that their adherence to the intervention was suboptimal (confirmed by quantitative adherence data). Nonresponders believed that their excess body weight (supported by quantitative data) contributed to their outcomes, encountered exercise barriers (comorbidities, stressors, and life events), and perceived that the trial measurement tools did not adequately capture their response to exercise. CONCLUSION Responders and nonresponders shared some similar perceptions of exercise. However, along with perceived limitations in trial outcome measurements, nonresponders encountered challenges with excess weight, comorbidities, stressors, and life events that led to suboptimal adherence and collectively were perceived to contribute to nonresponse.
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Affiliation(s)
- Rana S Hinman
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah E Jones
- The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Michelle Hall
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Nadine E Foster
- The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | - Trevor Russell
- The University of Queensland, Brisbane, Queensland, Australia
| | - Kim L Bennell
- The University of Melbourne, Melbourne, Victoria, Australia
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Holden MA, Hattle M, Runhaar J, Riley RD, Healey EL, Quicke J, van der Windt DA, Dziedzic K, van Middelkoop M, Burke D, Corp N, Legha A, Bierma-Zeinstra S, Foster NE. Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. THE LANCET. RHEUMATOLOGY 2023; 5:e386-e400. [PMID: 38251550 DOI: 10.1016/s2665-9913(23)00122-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. METHODS We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). FINDINGS Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0-100 scale (with 100 corresponding to worst pain), with a difference of -6·36 points (95% CI -8·45 to -4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, -3·77 points (-5·97 to -1·57, BoS 30·0%, τ2 14·4) in the medium term, and -3·43 points (-5·18 to -1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0-100 scale (with 100 corresponding to worst physical function), with a difference of -4·46 points in the short term (95% CI -5·95 to -2·98, BoS 10·5%, τ2 10·1), -2·71 points in the medium term (-4·63 to -0·78, BoS 33·6%, τ2 11·9), and -3·39 points in the long term (-4·97 to -1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). INTERPRETATION There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. FUNDING Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.
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Affiliation(s)
- Melanie A Holden
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
| | - Miriam Hattle
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jos Runhaar
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Erasmus MC University, Medical Center, Rotterdam, Netherlands
| | - Richard D Riley
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Chartered Society of Physiotherapy, London, UK
| | | | - Krysia Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Danielle Burke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Nadia Corp
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Amardeep Legha
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Nadine E Foster
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Herston, Brisbane, QLD, Australia
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Creasey J, Masterman J, Turpin G, Stanley R, Immins T, Burgess L, Wainwright TW. A 1RM Strengthening and Exercise Programme for the Treatment of Knee Osteoarthritis: A Quality-Improvement Study. J Clin Med 2023; 12:jcm12093156. [PMID: 37176597 PMCID: PMC10179632 DOI: 10.3390/jcm12093156] [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: 03/08/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Background: The Kneefit programme is a 12-week strengthening and exercise programme, personalised using body-weight ratios, for people with knee osteoarthritis. Objectives and Design: This quality-improvement study was conducted to evaluate the effectiveness of the programme for managing symptomatic knee osteoarthritis. Methods: The Kneefit programme was delivered between 20 August 2013 and 7 January 2014 and included six weeks of supervised strengthening, balance, and cardiovascular exercise in a group at the local hospital, followed by six weeks of unsupervised exercise. Leg-press and knee-extension 1RM scores were assessed at baseline, six weeks, and twelve weeks. In addition, patient-reported outcome measures (Oxford Knee Score, EQ5D, Patient Specific Function Score (PSFS)) were assessed. Wilcoxon Signed Rank tests were used to evaluate the changes from week 1 to week 6 and week 12. Results: Thirty-six patients were included at baseline and at six weeks, and 31 patients completed their twelve-week assessment. Statistically significant improvements were found at 6 and 12 weeks for change for the Oxford Knee Score (median change: 4.0, IQR 4.0 to 9.0, p < 0.001 and 4.0, IQR 0 to 8.0, p < 0.001), EQ5D-5L (median change: 0.078, IQR 0.03 to 0.20, p < 0.001 and 0.071, IQR 0.02 to 0.25, p < 0.001) and the PSFS (median change: 1.3 IQR 0 to 2.6, p = 0.005 and 2.3 IQR -0.3 to 3.3, p = 0.016). In addition, significant improvements were found for 1RM leg-press and knee-extension scores on both the affected and unaffected legs. Conclusion: The Kneefit programme was successful at improving both functional and strength-related outcome measures in patients with knee osteoarthritis. Our findings suggest that tailoring strength exercises based on the 1RM strength-training principles is feasible in this population.
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Affiliation(s)
- James Creasey
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
- Orthopaedic Research Institute, Bournemouth University, Poole BH12 5BB, UK
| | - Jo Masterman
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Gregory Turpin
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Richard Stanley
- Clinical & Rehabilitation Services Department, AECC University College, Bournemouth BH5 2DF, UK
| | - Tikki Immins
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
- Orthopaedic Research Institute, Bournemouth University, Poole BH12 5BB, UK
| | - Louise Burgess
- Orthopaedic Research Institute, Bournemouth University, Poole BH12 5BB, UK
| | - Thomas W Wainwright
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
- Orthopaedic Research Institute, Bournemouth University, Poole BH12 5BB, UK
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Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
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Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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12
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Abbott JH. Delivering exercise therapy in practice: a lot to consider, and much still to work out. Osteoarthritis Cartilage 2023; 31:292-294. [PMID: 36509331 DOI: 10.1016/j.joca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Affiliation(s)
- J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand.
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13
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Lawford BJ, Master H, Larsen JB, Bartholdy C, Corrigan P, Ginnerup-Nielsen E, Le C, Teoli A, Bennell KL, Metcalf B, Hinman RS, Button K, Collins NJ, Cottrell E, Henrotin Y, Skou ST, Thoma LM, Wellsandt E, White DK, Holden MA. What should a toolkit to aid the delivery of therapeutic exercise for hip and knee osteoarthritis look like? Qualitative analysis of an international survey of 318 researchers, clinicians, and consumers by the OARSI Rehabilitation Discussion Group. Musculoskeletal Care 2023. [PMID: 36631968 DOI: 10.1002/msc.1732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to identify important components of, and practical resources relevant for inclusion in, a toolkit to aid exercise delivery for people with hip/knee osteoarthritis. METHOD An online international multi-disciplinary survey was conducted across 43 countries (139 clinicians, 44 people with hip/knee osteoarthritis and 135 osteoarthritis researchers). Participants were presented with the seeding statement 'Practical resources to aid the implementation of exercise for people with hip/knee osteoarthritis should…' and asked to provide up to 10 open text responses. Responses underwent refinement and qualitative content analysis to create domains and categories. RESULTS Refinement of 551 open text responses yielded 72 unique statements relevant for analysis. Statements were organised into nine broad domains, suggesting that resources to aid exercise delivery should: (1) be easily accessible; (2) be of high quality; (3) be developed by, and for, stakeholders; (4) include different ways of delivering information; (5) include different types of resources to support exercise and non-exercise components of self-management; (6) include resources on recommended exercises and how to perform/progress them; (7) include tools to support motivation and track progress; (8) include resources to enable tailoring of the programme to the individual and; (9) facilitate access to professional and peer support. CONCLUSION Our findings identified important components of, and practical resources to include within, a toolkit to aid delivery of exercise for people with hip/knee osteoarthritis. These findings have implications for exercise providers and lay the foundation for the development of a toolkit to help ensure exercise provision aligns with current international recommendations.
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Affiliation(s)
- Belinda J Lawford
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesper B Larsen
- Department of Health Science and Technology, Musculoskeletal Health and Implementation, Aalborg University, Aalborg, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | | | - Christina Le
- University of Alberta in Edmonton, Edmonton, Alberta, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Ben Metcalf
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Kate Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
| | - Yves Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium.,Motricity Sciences Department, musculoSKeletal Innovative Research Lab (mSKIL), Institute of Pathology, University of Liège, Liège, Belgium.,Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Liège, Belgium.,The Osteoarthritis Foundation, Boncelles, Belgium
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Louise M Thoma
- Division of Physical Therapy, Department of Health Sciences, School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
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14
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Derue H, Ribeiro-da-Silva A. Therapeutic exercise interventions in rat models of arthritis. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100130. [PMID: 37179770 PMCID: PMC10172998 DOI: 10.1016/j.ynpai.2023.100130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Arthritis is the leading cause of musculoskeletal pain and disability worldwide. Nearly 50% of individuals over the age of 65 have arthritis, which contributes to limited function, articular pain, physical inactivity, and diminished quality of life. Therapeutic exercise is often recommended in clinical settings for patients experiencing arthritic pain, however, there is little practical guidance regarding the use of therapeutic exercise to alleviate arthritic musculoskeletal pain. Rodent models of arthritis allow researchers to control experimental variables, which cannot be done with human participants, providing an opportunity to test therapeutic approaches in preclinical models. This literature review provides a summary of published findings in therapeutic exercise interventions in rat models of arthritis as well as gaps in the existing literature. We reveal that preclinical research in this field has yet to adequately investigate the impact of experimental variables in therapeutic exercise including their modality, intensity, duration, and frequency on joint pathophysiology and pain outcomes.
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Affiliation(s)
- Hannah Derue
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Alfredo Ribeiro-da-Silva
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
- Corresponding author at: Department of Pharmacology and Therapeutics, McGill University, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada.
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15
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Hinman RS, Hall M, Comensoli S, Bennell KL. Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis. J Sci Med Sport 2023; 26:37-45. [PMID: 36463000 DOI: 10.1016/j.jsams.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management. Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.
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Affiliation(s)
- Rana S Hinman
- Department of Physiotherapy, The University of Melbourne, Australia.
| | - Michelle Hall
- Department of Physiotherapy, The University of Melbourne, Australia
| | | | - Kim L Bennell
- Department of Physiotherapy, The University of Melbourne, Australia
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16
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Roesel I, Krauss I, Martus P, Steinhilber B, Mueller G. Comparison of a Group-/Home-Based and a Weight-Machine-Based Exercise Training for Patients with Hip or Knee Osteoarthritis-A Secondary Analysis of Two Trial Interventions in a Real-World Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17088. [PMID: 36554968 PMCID: PMC9779110 DOI: 10.3390/ijerph192417088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to compare an individual weight-machine-based strengthening program (MbT) with a group-/homebased training offering strengthening/functional exercises (GHT) in a general health care setting. A total of 657 participants (GHT = 521, MbT = 136) suffering from hip/knee OA were included and analysed with a pre-post design (baseline (T0)/3-months (T1)). Primary outcomes were pain and physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-10). Additionally, adherence and perceived patient benefit were measured (T1). Data were analysed with linear mixed models (time, treatment, baseline pain/physical impairment severity) adjusted for patient characteristics. No significant between-group differences in pain reduction/functional improvements (time*treatment*baseline pain/physical impairment severity, pain/function: n.s.; time*treatment, pain: p = 0.884, function: p = 0.067). Within-group improvements were dependent on baseline severity: Higher severity levels demonstrated larger changes from baseline. Perceived patient-benefit (very high to high, GHT: 78%, MbT: 92%) and exercise adherence (Dropouts T1: GHT: 27.8%, MbT: 16.2%; adherence to supervised sessions: GHT: 89%, MbT: 92%) was slightly better in the MbT. In summary, both MbT and GHT, showed positive results for patients with at least moderate disease symptoms. Findings for physical functioning, perceived patient-benefit, exercise adherence hint towards a superiority of MbT. Individual preferences should be considered when prescribing exercise therapy. Trial registration: (1) German Clinical Trial Register DRKS00009251. Registered 10 September 2015. (2) German Clinical Trial Register DRKS00009257. Registered 11 September 2015.
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Affiliation(s)
- Inka Roesel
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, 72076 Tuebingen, Germany
- Department of Sports Medicine, University Hospital, Medical Clinic, 72076 Tuebingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, University Hospital, Medical Clinic, 72076 Tuebingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity Tuebingen, 72074 Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, 72076 Tuebingen, Germany
| | - Benjamin Steinhilber
- Institute for Occupational and Social Medicine and Health Services Research, University Hospital of Tuebingen, 72074 Tuebingen, Germany
| | - Gerhard Mueller
- Allgemeine Ortskrankenkasse AOK Baden-Wuerttemberg, 70191 Stuttgart, Germany
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17
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Hinman RS, Nelligan RK, Campbell PK, Kimp AJ, Graham B, Merolli M, McManus F, Lamb KE, Bennell KL. Exercise adherence Mobile app for Knee Osteoarthritis: protocol for the MappKO randomised controlled trial. BMC Musculoskelet Disord 2022; 23:874. [PMID: 36127677 PMCID: PMC9487056 DOI: 10.1186/s12891-022-05816-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background In people with knee osteoarthritis (OA), ongoing exercise participation, particularly with strengthening exercises, is central to management. Patient adherence to prescribed exercise typically declines once consultations with a clinician have ceased. Mobile applications (apps) can incorporate behaviour change techniques that may assist adherence, potentially optimising clinical outcomes. Methods This is a two-arm, pragmatic, superiority randomised trial. One hundred and eighty two Australians with chronic knee pain (clinical knee OA) and who have at least a mild level of physical dysfunction are being recruited. Participants are randomly allocated i) exercise (physiotherapist-prescribed exercise) or; ii) exercise plus app (physiotherapist-prescribed exercise plus access to the ‘My Exercise Messages’ mobile app). Exercise care comprises two videoconferencing consultations with a physiotherapist over two weeks (30 min each) for a strengthening exercise program, which is then conducted independently at home for 24 weeks without any further physiotherapist consultations. Participants are also provided with exercise resources to facilitate home-based exercise. Those randomised to exercise plus app will download the app after completing the two weeks of physiotherapy consultations and will be instructed by research staff to use the app for the 24 weeks of unsupervised home-based exercises. The app works by tracking completion of weekly exercise sessions, providing regular messages to facilitate weekly exercise and providing personalised messages to help overcome individual barriers to exercise participation. The two primary outcomes are i) self-reported physical function; and ii) number of days strengthening exercises were performed (previous fortnight), with a primary endpoint of 26 weeks and a secondary endpoint of 14 weeks. Secondary outcomes include knee pain severity; knee-related quality of life; global change; exercise program satisfaction; exercise self-efficacy; physical activity; sport and recreation function; another measure of exercise adherence; and willingness to undergo joint replacement. Process measures are also included. Discussion Findings will determine if a theory-informed mobile app improves exercise adherence and physical function in people with knee OA who have received a home-based strengthening program. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12621000724875. Prospectively registered 9/06/2021.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Rachel K Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Penny K Campbell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Alexander J Kimp
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Bridget Graham
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Mark Merolli
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Biostatistics Unit, The University of Melbourne, Melbourne, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Biostatistics Unit, The University of Melbourne, Melbourne, Australia.,Methods and Implementation Support for Clinical Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
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18
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People With Knee Osteoarthritis Attending Physical Therapy Have Broad Education Needs and Prioritize Information About Surgery and Exercise: A Concept Mapping Study. J Orthop Sports Phys Ther 2022; 52:595-606. [PMID: 35712751 DOI: 10.2519/jospt.2022.11089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To (1) identify the education priorities of people with knee osteoarthritis, including perceived importance and confidence that a health care professional can address each, and (2) match priorities to education-specific content recommendations in knee osteoarthritis management guidelines. DESIGN Concept mapping methodology. METHODS Participants generated, sorted (based on themes), and rated (5-point Likert scales: importance and confidence) education priorities. Multidimensional scaling and hierarchical cluster analysis of sorting data produced a cluster map with overarching domains. Priorities were matched against education-specific content recommendations in knee osteoarthritis guidelines. RESULTS Participants (brainstorming, n = 43; sorting and rating, n = 24) generated 76 priorities. A 4-domain, 11-cluster map was the most useful representation of sorting data: (i) understanding treatment options (relationship of education and exercise with surgery, adjunct options, treatment decision making); (ii) exercise therapy (how to exercise, why exercise); (iii) understanding and managing the condition (symptom management, understanding symptoms, understanding the condition); and (4) surgical, medical, and dietary management (surgery, medications, diet and supplements). The "relationship of education and exercise with surgery" (3.88/5), "surgery" (3.86/5), and "how to exercise" (3.78/5) clusters were rated highest for importance. Few priorities identified by participants were clearly recommended as education-specific content recommendations in the American College of Rheumatology (3%, n = 2/76), European Alliance of Associations for Rheumatology (12%, n = 9/76), National Institute for Health and Care Excellence (16%, n = 12/76), and Osteoarthritis Research Society International (1%, n = 1/76) guidelines. CONCLUSION People with knee osteoarthritis presenting to physical therapists have broad education needs and prioritize information about surgery and exercise. J Orthop Sports Phys Ther 2022;52(9):595-606. Epub: 17 June 2022. doi:10.2519/jospt.2022.11089.
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19
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Physical Therapists Prioritize Providing Education About Exercise Therapy and to Dispel Misconceptions About Radiology for People With Knee Osteoarthritis: A Concept Mapping Study. J Orthop Sports Phys Ther 2022; 52:607-619. [PMID: 35712752 DOI: 10.2519/jospt.2022.11090] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To (1) identify the education priorities that physical therapists have for people with knee osteoarthritis, including perceived importance and capability to provide, and (2) match priorities to education-specific content recommendations in knee osteoarthritis guidelines. DESIGN Concept mapping methodology. METHODS Physical therapists generated, sorted (based on themes), and rated (5-point Likert scales: importance and capability) patient education priorities. Priorities were matched against education-specific content recommendations in knee osteoarthritis guidelines. Additional education-specific content recommendations were added from guidelines and expert opinion if necessary. Multidimensional scaling and hierarchical cluster analysis produced a cluster map with overarching domains. RESULTS Physical therapists (brainstorming, n = 41; sorting, n = 20; rating, n = 22) generated 56 priorities, with 13 added (n = 2 from guidelines, n = 11 from expert opinion). Few priorities were clearly included as education-specific content recommendations in guidelines (ACR [2%, n = 1/56], EULAR [14%, 8/56], NICE [11%, 6/56], and OARSI [0%, 0/56]). An 8-cluster map emerged with 3 overarching domains: (i) first-line care (exercise therapy, lifestyle modification and general health, and weight management), (ii) knowledge formation and countering misconceptions (radiology misconceptions, understanding and managing pain and disability, and general beliefs and understanding about osteoarthritis), and (iii) decision making for medical management (surgery and medications). The exercise therapy cluster was rated the highest for both importance (3.84/5) and capability (4.00). The medications and weight management clusters were rated the lowest for importance (2.54) and capability (2.82), respectively. CONCLUSION Physical therapists prioritize a range of education topics for people with knee osteoarthritis, focusing on exercise therapy. Physical therapists feel least capable of providing weight management education. J Orthop Sports Phys Ther 2022;52(9):607-619. Epub: 17 June 2022. doi:10.2519/jospt.2022.11090.
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20
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Mazzei D, Whittaker J, Kania-Richmond A, Faris P, Wasylak T, Robert J, Hawker G, Marshall D. Do people with knee osteoarthritis use guideline-consistent treatments after an orthopaedic surgeon recommends nonsurgical care? A cross-sectional survey with long-term follow-up. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100256. [DOI: 10.1016/j.ocarto.2022.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
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21
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Kuwabara A, Cinque M, Ray T, Sherman SL. Treatment Options for Patellofemoral Arthritis. Curr Rev Musculoskelet Med 2022; 15:90-106. [PMID: 35118631 PMCID: PMC9083346 DOI: 10.1007/s12178-022-09740-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To present a synthesis of recent literature regarding the treatment of patellofemoral arthritis RECENT FINDINGS: Risk factors of PFJ OA include patella malalignment or maltracking, injury to supportive structures including the MPFL, dysfunction of hamstring and quadriceps coordination, lower limb alignment, trochlear dysplasia, patellar trauma, or ACL surgery. Special physical exam maneuvers include patellar grind test, apprehension test, and lateral patellar tilt angle. Radiographs that should be obtained first-line include weight bearing bilateral AP, lateral, and Merchant views. CT and MRI are used to assess trochlear dysplasia, excessive patellar height, and TT-TG distance. Non-operative management options discussed include non-pharmacologic treatment (patient education, self-management, physical therapy, weight loss), ESWT, cold therapy, taping, bracing, and orthotics. Pharmacologic management options discussed include NSAIDs, acetaminophen, oral narcotics, and duloxetine. Injection therapies include glucocorticoids, hyaluronic acid, PRP, and other regenerative therapies (BMAC, adipose, or mesenchymal stem cells). Other treatment options include radiofrequency ablation and botulinum toxin. The algorithm for the surgical treatment of PFJ OA can begin with arthroscopic assessment of the PF articular cartilage to address mechanical symptoms and to evaluate/treat lateral soft tissue with or without overhanging lateral osteophytes. If patients fail to have symptomatic improvement, a TTO can be considered in those patients less than 50 years of age or active patients >50 years old. In patients with severe PFJ OA, refractory to the above treatments, PFA should be considered. While early PFA design and technique were less than encouraging, more recent implant design and surgical technique have demonstrated robust results in the literature. Patellofemoral osteoarthritis is a challenging orthopedic problem to treat, in that it can often affect younger patients, with otherwise well-functioning knees. It is a unique entity compared to TF OA with distinct epidemiology, biomechanics and risk factors and treatment options.
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Affiliation(s)
- Anne Kuwabara
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Mark Cinque
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Taylor Ray
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Seth Lawrence Sherman
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
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Dzakpasu FQS, Carver A, Brakenridge CJ, Cicuttini F, Urquhart DM, Owen N, Dunstan DW. Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. Int J Behav Nutr Phys Act 2021; 18:159. [PMID: 34895248 PMCID: PMC8666269 DOI: 10.1186/s12966-021-01191-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions. METHODS Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review. RESULTS Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting. CONCLUSIONS We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases. PROTOCOL REGISTRATION PROSPERO ID # CRD42020166412 (Amended to limit the scope).
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Affiliation(s)
- Francis Q S Dzakpasu
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia.
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Alison Carver
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Christian J Brakenridge
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Flavia Cicuttini
- Central Clinical School/Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Donna M Urquhart
- Central Clinical School/Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Neville Owen
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
| | - David W Dunstan
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Hsu YI, Chen YC, Lee CL, Chang NJ. Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157744. [PMID: 34360036 PMCID: PMC8345675 DOI: 10.3390/ijerph18157744] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/23/2022]
Abstract
This study investigated the effects of home-based nutritional and telemedicine-based resistance exercise interventions on improving body composition, blood biochemistry, and lower-limb functional performance. In total, 66 obese patients with mild-to-moderate knee osteoarthritis were randomly divided into a diet control group (D), elastic band resistance exercise group (E), and diet control plus elastic band exercise group (D + E). Each group was supervised by a clinical dietitian and follow-up was conducted via telephone calls or a communication application to track the participants’ progress. After 12 weeks of intervention, the D (p < 0.001) and D + E (p < 0.001) groups achieved significant weight loss. The D + E group exhibited a significant reduction in body fat relative to the D (p = 0.019) and E (p = 0.012) groups. Compared with the D (p = 0.002) and E (p = 0.019) groups, the D + E group achieved significant improvements in the timed up-and-go test and Western Ontario and McMaster Universities Osteoarthritis total scale. The D + E group experienced significant improvements in total cholesterol (p = 0.001), low-density lipoprotein cholesterol (p = 0.01), and triglyceride levels (p = 0.007) relative to other groups. In conclusion, individual diet control intervention combined with telemedicine-based resistance exercise intervention significantly improved the body composition, blood biochemistry, and lower-limb functional performance of the investigated population with comorbid conditions.
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Affiliation(s)
- Yen-I Hsu
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Nutritional Therapy, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ying-Chou Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang-Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Chia-Lun Lee
- Center for Physical and Health Education, National Sun Yat-Sen University, Kaohsiung 804, Taiwan;
| | - Nai-Jen Chang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.:+886-7-312-1101 (ext. 2646); Fax: +886-7-313-8359
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