Factors influencing adherence among older people with osteoarthritis

Efficacy of home-based exercise in the treatment of pain and disability at the hip and knee in patients with osteoarthritis: a systematic review and meta-analysis

BACKGROUND

An increasing body of evidence suggests that home-based exercise (HBE) therapy has significant therapeutic effects on knee osteoarthritis (KOA) and hip osteoarthritis (HipOA), and it has advantages such as cost savings, strong operability, and good compliance compared with hospitalization and exercise courses.

OBJECTIVE

To evaluate the efficacy of HBE in the treatment of KOA and HipOA.

METHODS

A systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase to collect randomized controlled trials. The retrieval time was from database establishment until March 6, 2024. Stata 15.1 software was used for data analysis.

RESULTS

A total of 16 randomized controlled trials involving 3,015participants were included, with 1,519 participants in the intervention group and 1,496 in the control group. The meta-analysis showed that, compared to the control group, HBE can significantly improve pain [SMD=-0.38, 95% CI (-0.58, -0.18); P = 0.001], joint function      [SMD=-0.60, 95% CI (-1.01, -0.19); P = 0.004], balance ability [SMD=-0.67, 95% CI (-1.00, -0.34); P = 0.001], mobility (ADL) [SMD = 0.51, 95% CI (0.19, 0.82); P = 0.002] in patients with KOA and HipOA. There is no statistical difference in the improvement of joint stiffness [WMD = -0.80, 95% CI (-1.61, 0.01); P = 0.052]. In addition, subgroup analysis showed that HBE significantly improved pain, joint function, and balance ability in KOA patients compared with the control group. HipOA patients showed significant improvement in pain and joint function; However, HBE only improved activity ability in patients with comorbidities of KOA and HipOA.

CONCLUSION

HBE can effectively alleviate pain, improve joint function, and enhance physical function in patients with KOA and HipOA. However, more high-quality randomized controlled trials (RCTs) with large sample sizes and long-term interventions are needed to validate the efficacy of HBE due to limitations in the methodology and consistency of indicator outcomes in the included RCTs.

REGISTRATION NUMBER

We've registered with PROSPERO, and the number is CRD42023443085.

PaiNEd app. Assessing central sensitization in survivors of breast cancer: A reliability study

Introduction

Pain is a common adverse event in survivors of breast cancer (sBCs). As there is no gold standard to assess pain experience predominantly related to central sensitization (CS) symptoms, we designed the PaiNEd app, which includes an algorithm to report whether patients are under predominant CS pain mechanisms.

Objective

We aimed to assess the reliability of the PaiNEd app to estimate whether sBC pain experience is predominantly related to CS symptoms.

Methods

An observational, descriptive reliability design was employed to assess the inter- and intrarater reliability of the PaiNEd app. This app includes an algorithm that considers the number of painful body parts and some questionnaires related to pain, such as the Numeric Pain-Rating Scale, the Brief Pain Inventory, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Central Sensitization Inventory (CSI).

Results

A total of 21 sBCs with persistent pain were recruited. We observe a general trend of close agreement between the paper-based and app-based formats (ICCs ranged between 0.802 and 0.972; Cronbach's alpha ranged between 0.797 and 0.971). Test-retest reliabilities were moderate to excellent (ICCs ranged between 0.510 and 0.941; Cronbach's alpha ranged between 0.499 and 0.938). The agreement between the categorization of the CS algorithm and the CSI (cut-off point ≥ 40 for CS symptoms) was 95.24%.

Conclusion

The PaiNEd app emerges as a robust tool for evaluating pain experience predominantly related to CS and pain-related symptoms in sBCs. Its demonstrated reliability not only bolsters its utility but also signifies its potential as a valuable asset for healthcare professionals engaged in pain education programs.

Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review

Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis

Osteoarthritis (OA) is a prevalent degenerative joint condition characterized by cartilage deterioration, joint inflammation, and functional limitations, particularly impacting the elderly population. Rehabilitation and hyaluronic acid (HA) injections are common therapeutic approaches routinely used in clinical practice, but their synergistic potential is far from being fully characterized. Thus, the aim of this narrative review was to elucidate the multilevel benefits and synergies of integrating these two approaches in multidisciplinary OA rehabilitation. This narrative review follows the scale for the assessment of narrative review articles (SANRA) criteria and involves a comprehensive literature search from July to August 2023. Two independent reviewers screened studies, including those involving human subjects with OA, rehabilitation strategies, and outcomes following HA injection, published in English. Results: HA injections might improve joint biomechanics, reducing friction, absorbing shocks, and potentially regulating inflammation. Rehabilitation plays a pivotal role in strengthening muscles, increasing the range of motion, and enhancing overall function. Optimizing rehabilitation following HA injection might provide additional benefits in joint health. OA management requires a multidisciplinary approach integrating HA injections, rehabilitation, and personalized care. Challenges in patient adherence and healthcare resources currently exist, but emerging technologies offer opportunities to enhance patient engagement and monitoring optimizing sustainability and outcomes of patients with knee, hip, shoulder, and temporomandibular joint OA.

The development of a clinical nomogram to predict medication nonadherence in patients with knee osteoarthritis

Knee osteoarthritis (KOA) is a common bone disease in older patients. Medication adherence is of great significance in the prognosis of this disease. Therefore, this study analyzed the high-risk factors that lead to medication nonadherence in patients with KOA and constructed a nomogram risk prediction model. The basic information and clinical characteristics of inpatients diagnosed with KOA at the Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, were collected from January 2020 to January 2022. The Chinese version of the eight-item Morisky scale was used to evaluate medication adherence. The Kellgren-Lawrence (KL) classification was performed in combination with the imaging data of patients. Least absolute shrinkage and selection operator regression analysis and logistic multivariate regression analysis were used to analyze high-risk factors leading to medication nonadherence, and a prediction model of the nomogram was constructed. The model was internally verified using bootstrap self-sampling. The index of concordance (C-index), area under the operating characteristic curve (AUC), decision curve, correction curve, and clinical impact curve were used to evaluate the model. A total of 236 patients with KOA were included in this study, and the non-adherence rate to medication was 55.08%. Seven influencing factors were included in the nomogram prediction: age, underlying diseases, diabetes, age-adjusted Charlson comorbidity index (aCCI), payment method, painkillers, and use of traditional Chinese medicine. The C-index and AUC was 0.935. The threshold probability of the decision curve analysis was 0.02-0.98. The nomogram model can be effectively applied to predict the risk of medication adherence in patients with KOA, which is helpful for medical workers to identify and predict the risk of individualized medication adherence in patients with KOA at an early stage of treatment, and then carry out early intervention.

Association between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with knee osteoarthritis

Objective

To analyze the association between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with knee osteoarthritis (KOA).

Methods

A cross-sectional study was conducted involving 57 individuals with KOA. Evaluations were performed using the Exercise Adherence Rating Scale (EARS), the numerical rating scale (NRPS), the International Knee Documentation Committee (IKDC), The Central Sensitization Inventory (CSI), and the 30 sec sit and stand test (30SSST). Histograms were created to determine the normality of the data. The Kolmogorov-Smirnov test was used to determine the normality of the data. Thus, Pearson’s (r) and determination (R2) correlation coefficients were calculated to determine the strength of associations between variables.

Results

No significant association was found between adherence behavior or reasons for adherence and central sensitization symptoms, the intensity of pain on rest and movement, knee disability symptoms, and functionality.

Conclusion

No significant association was identified between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with KOA.

A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review

BACKGROUND

Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical.

PURPOSE

Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting.

MATERIALS AND METHODS

We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar.

RESULTS

The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence.

CONCLUSION

This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.

Physical activity and health-related quality of life in men and women with hip and/or knee osteoarthritis before and after a supported self-management programme - a prospective observational study

PURPOSE

To study differences between men and women in physical activity (PA) and health-related quality of life (HRQoL) before and after participating in a supported osteoarthritis (OA) self-management programme.

MATERIALS AND METHODS

A prospective observational study using data from a Swedish National Quality Register. Patients recorded between 2008 and 2013 with hip and/or knee OA with data at baseline, at 3 and 12 months follow-up (n = 7628) were included. Outcome measures were patient-reported PA and HRQoL (EQ-5D-3L).

RESULTS

A greater proportion of men (p = 0.002) changed to being physically active ≥150 min/week at 3 months follow-up. The proportion of women being physically active ≥150 min/week was larger than for men at baseline (p = 0.003) and at follow-up at 12 months (p = 0.035). Women reported lower HRQoL than men at baseline (p < 0.001), at follow-up at 3 (p < 0.001) and 12 months (p = 0.010). There were no differences between men and women in change in HRQoL at 3 (p = 0.629) and 12 months (p = 0.577) follow-up.

CONCLUSIONS

This study showed differences between men and women in PA and HRQoL before and after participating in a supported OA self-management programme. These differences should be considered when supporting PA and HRQoL.Implications for rehabilitationMen with hip and/or knee osteoarthritis (OA) might need more support during rehabilitation in order to maintain or even increase physical activity (PA) in the long run.Women with hip and/or knee OA might need more support during rehabilitation in order to maintain or even increase health-related quality of life (HRQoL) in the long run.Booster sessions might be suggested in order to enable both men and women with hip and/or knee OA to sustain improvements in PA and HRQoL after participating in a supported OA self-management programme.

Association of health-related private transfers with treatment compliance of musculoskeletal disorders in the rural elderly: evidence from an underdeveloped region of China

BACKGROUND

The prevalence and economic burdens of musculoskeletal disorders (MSD) are serious in rural China. In addition to formal support, health-related private transfers (HRPTs), including adult children transfers (ACTs), as well as relatives and friends transfers (RFTs), are very common in rural China. We explored the relationship between HRPTs and MSD treatment compliance and the heterogeneity of this relationship in terms of family socioeconomic status.

METHODS

A questionnaire survey was carried out in Enshi, Hubei, China by stratified random sampling in July 15-25,2018. A total of 2679 questionnaires on the economic burden of chronic diseases were collected. We deleted two questionnaires with missing data. The data was described using the mean and proportion. The Chi-square test and one-way ANOVA was used to compare each independent variable in the three groups, and ordered probit regression was used to analyse the relationship between each factor and treatment compliance. The heterogeneity of the effect was examined by group regression analysis of the samples with or without poverty.

RESULTS

In total, 853 samples with MSD were included in the analysis. The age was 70.27 ± 6.97 (mean +/- sd) years old, and the ADL was 11.64 ± 0.12, with more respondents being female (56.15%), partnered (73.51%), primary school educated (45.96%), working (57.91%), feeling poor in health (55.69%), lived alone or with a spouse (54.75%). Respondents with both ACTs and RFTs had better treatment compliance, and this was significant only in poor populations (p < 0.05). Under the same HRPTs' condition, respondents who more compliant with MSD treatment were female (p < 0.01), had primary school education (p < 0.05), has self-reported poor (p < 0.01) and very poor (p < 0.05) health, had a high level of physical disability (p < 0.01), and were living with their children and grandchildren (p < 0.05). Respondents with more chronic diseases had poorer treatment compliance (p < 0.05).

CONCLUSIONS

Only those in poverty who both have ACTs and RFTs are likely to have better treatment compliance for MSD. Promoting a culture of filial piety and fostering harmonious interpersonal relationships, policies that focus on groups that lack social support, and general formal support are essential for sustained access to treatment for MSD.

Factors Influencing Walking and Exercise Adherence in Healthy Older Adults Using Monitoring and Interfacing Technology: Preliminary Evidence

BACKGROUND

Monitoring and interfacing technologies may increase physical activity (PA) program adherence in older adults, but they should account for aspects influencing older adults' PA behavior. This study aimed at gathering preliminary wrist-based PA adherence data in free-living and relate these to the influencing factors.

METHODS

Ten healthy older adults (4 females, aged 70-78 years) provided health, fatigue, activity levels, attitude towards pacing, and self-efficacy information and performed a 6 min-walk test to assess their fitness. After a baseline week they followed a two-week walking and exercise intervention. Participants saw their progress via a purposely designed mobile application.

RESULTS

Walking and exercise adherence did not increase during the intervention (p = 0.38, p = 0.65). Self-efficacy decreased (p = 0.024). The baseline physical component of the Short Form Health Survey was the most predictive variable of walking adherence. Baseline perceived risk of over-activity and resting heart rate (HRrest) were the most predictive variables of exercise adherence. When the latter two were used to cluster participants according to their exercise adherence, the fitness gap between exercise-adherent and non-adherent increased after the intervention (p = 0.004).

CONCLUSIONS

Risk of over-activity and HRrest profiled short-term exercise adherence in older adults. If confirmed in a larger and longer study, these could personalize interventions aimed at increasing adherence.

Older Adults' Perceptions of the Usefulness of Technologies for Engaging in Physical Activity: Using Focus Groups to Explore Physical Literacy

Insufficient physical activity (PA) levels observed among older adults remain extremely high and pose a danger to developing and maintaining their physical literacy (PL). Each person’s level of PL partly depends on their physical and cognitive skills, confidence level, and degree of motivation to practice PA daily. New technologies, such as exergames and wearable fitness trackers, may enable older adults to increase their PL, stimulating uptake and ongoing PA participation. Objective: This focus group study aims to describe older adults’ perceptions of the use of technologies to engage in physical exercise programs. Methods: Fifteen participants were randomly selected from a sample of 40 older adults who completed a randomized controlled trial that investigated the benefits of using technology in the context of group-based exercise programs. Separate post-intervention focus groups were performed with an exergaming group, a conventional physical training group, and a no training group (control). Data were mapped onto constructs from the four domains of PL: affective, physical, cognitive, and behavioral. Results: Generally, participants expressed positive perceptions about the benefits of using technology to engage in PA. These positive feelings outweighed the costs and the lack of familiarization with technology. Common themes for the three groups emerged from the discussions and included familiarization with technology, using fitness tracker to monitor PA, previous exposure to technology, and interaction with peers, staff members, and relatives. In particular, participants from the exergaming group explored the ideas of training their cognitive skills while using the exergame accessories, exercising in an alternative way, competitive versus cooperative play, changes in sense of humor, skill transferability from game to real environment, progressions of the exercise intensities, and the potential use of exergames for rehabilitation. Conclusions: Participants in this study reported positive perceptions about implementing technology into exercise. Emphasizing the benefits of using technology in group-based exercise programs may increase older adults’ PL levels and their future technology adoption. The potential implementation of technology into conventional exercise programs should focus on older adults’ lifelong values, biopsychosocial conditions, and the possibility of reducing age-related risk of injuries and chronic diseases.

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis

OBJECTIVE:

To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis.

METHODS:

A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P < 0.05).

RESULTS:

Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength.

CONCLUSION:

Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.

Randomized Controlled Trial Investigating the Role of Exercise in the Workplace to Improve Work Ability, Performance, and Patient-Reported Symptoms Among Older Workers With Osteoarthritis

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a 12-week workplace exercise program on work ability, performance, and patient-reported symptoms in older university employees with knee and/or hip osteoarthritis.

METHODS

Twenty-four participants with clinical hip and/or knee osteoarthritis were randomized to exercise or no exercise. At baseline and follow-up, several work (work ability, resilience), patient-reported (pain, physical function, depressive symptoms, self-efficacy), and performance outcomes (hip and knee strength, mobility performance) were measured.

RESULTS

Significant improvements in work ability (P < 0.049) and patient-reported outcomes (pain, function, depressive symptoms) existed in the exercise group. No improvements were demonstrated in the no exercise group.

CONCLUSIONS

Exercise in the workplace improved work ability and patient-reported symptoms in older workers with osteoarthritis. The benefits of workplace exercise programs should be studied in a larger sample in which attention is given to improving exercise adherence.

A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases

Medication adherence is a crucial part in the management of rheumatic diseases, especially with many such patients requiring long-term medications. In this paper, we aim to systematically review the literature for the factors associated with medication adherence in the rheumatic patient population. We carried out a systematic literature search using PubMed^®, PsychInfo^® and Embase ^® with relevant keywords and employed the PRISMA^® criteria. We included English peer-reviewed articles that studied the factors affecting medication adherence in patients with rheumatic diseases, which were assessed by two independent reviewers. Hand searches were conducted and relevant factors were extracted and classified using the World Health Organization (WHO)'s five dimensions of medication adherence. A simple diagram was drawn to summarise the factors extracted. 1977 articles were identified and reviewed and 90 articles were found to be relevant. A total of 17 factors and 38 sub-factors were identified and categorized based on the WHO's five dimensions of medication adherence. A hand model for medication adherence was developed to succinctly summarise these dimension to remind clinicians the importance of medication adherence in daily practice. We conducted a systematic review on the various factors including patient, therapy, condition, health system and socioeconomic-related factors that affected medication adherence in rheumatic patients. We found 17 factors and 38 sub-factors that affected medication adherence in this population. This systematic review can facilitate future focused research in unexplored dimensions.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs

OBJECTIVE

To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis.

METHODS

A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement).

RESULTS

The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+).

CONCLUSION

There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.