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Stevenson RDM, Chowdhury EA, Inza VB, Western MJ, Walsh NE, Jones SL, Bilzon JLJ. Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach. BMC Musculoskelet Disord 2024; 25:189. [PMID: 38431553 PMCID: PMC10908108 DOI: 10.1186/s12891-024-07313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support. METHODS The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention. RESULTS Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application. CONCLUSIONS Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.
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Affiliation(s)
- Richard D M Stevenson
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Enhad A Chowdhury
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Victor B Inza
- Visual Computing Centre, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Max J Western
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
| | - Nicola E Walsh
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Simon L Jones
- Department of Computer Science, The University of Bath, Bath, BA2 7AY, UK
| | - James L J Bilzon
- Department for Health, The University of Bath, Bath, BA2 7AY, UK.
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK.
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Vina ER, Patel P, Grest CV, Kwoh CK, Jakiela JT, Bye T, White DK. Does Physical Activity Confound Race Differences in Osteoarthritis-Related Functional Limitation? Arthritis Care Res (Hoboken) 2024; 76:200-207. [PMID: 37518677 DOI: 10.1002/acr.25209] [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: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)-related functional limitation. METHODS OA Initiative study participants with or at increased risk of knee OA who wore an accelerometer were included. Race was self-reported. Average time spent in moderate to vigorous physical activity (minutes per day) based on ActiGraph uniaxial accelerometer data was assessed. Functional limitation was based on the following: (1) inability to achieve a community walking speed (1.2 m/s) standard, (2) slow walking speed (<1.0 m/s), and (3) low physical functioning based on a Western Ontario and McMaster Universities OA Index (WOMAC) physical function score greater than 28 of 68. RESULTS African American (AA) participants (n = 226), compared with White participants (n = 1348), had a higher likelihood of developing functional limitation based on various measures. When adjusted for time in moderate to vigorous physical activity, the association between AA race and inability to walk a community walking speed slightly decreased (from relative risk [RR] 2.15, 95% confidence interval [95% CI] 1.64-2.81, to RR 1.99, 95% CI 1.51-2.61). Association between AA race and other measures of functional limitation mildly decreased (slow walking speed: from RR 2.06, 95% CI 1.40-3.01, to RR 1.82, 95% CI 1.25-2.63; low physical functioning: from RR 3.44, 95% CI 1.96-6.03, to RR 3.10, 95% CI 1.79-5.39). When further adjusted for demographic and other clinical variables, only the association between race and low physical functioning (WOMAC) significantly decreased and no longer met statistical significance. CONCLUSION Greater physical activity is unlikely to completely make up for race differences in OA-related functional limitation, and other barriers to health equity need to be addressed.
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Affiliation(s)
- Ernest R Vina
- Temple University, Philadelphia, Pennsylvania, and University of Arizona, Tucson
| | - Puja Patel
- Temple University, Philadelphia, Pennsylvania
| | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
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Ceballos-Laita L, Lahuerta-Martín S, Carrasco-Uribarren A, Cabanillas-Barea S, Hernández-Lázaro H, Pérez-Guillén S, Jiménez-del-Barrio S. Strength Training vs. Aerobic Training for Managing Pain and Physical Function in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 12:33. [PMID: 38200939 PMCID: PMC10778769 DOI: 10.3390/healthcare12010033] [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: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Strength training (ST) and aerobic training (AT) are the most recommended interventions in patients with knee OA. These recommendations are supported by high-quality evidence, but it is still unknow whether one type of exercise is superior to the other. Thus, the aim was to investigate whether one type of exercise (ST or AT) is superior to the other for improving pain and physical function in patients with knee osteoarthritis. (2) Methods: A systematic review and meta-analysis was carried out following the PRISMA statement. The search strategy was conducted in PubMed, PEDro, Scopus, Web of Science and Cochrane Library databases. Randomized controlled trials comparing ST and AT on pain intensity and physical function in patients with knee osteoarthritis were included. Methodological quality and risk of bias were assessed with a PEDro scale and risk-of-bias tool, respectively. The certainty of evidence was evaluated using GRADE guidelines. (3) Results: Four studies (6 publications) were included. The qualitative and quantitative synthesis showed that ST produces no more improvement in pain intensity (SMD after intervention: 0.02; 95%CI: -0.15, 0.19; I2: 0%; three studies; 426 patients) and physical function (SMD after intervention: 0.07; 95%CI: -0.10, 0.24; I2: 0%; three studies; 426 patients) compared to AT in patients with knee osteoarthritis. The certainty of evidence was rated as very low. (4) Conclusions: Both type of exercises showed clinical benefits in people with knee osteoarthritis, but no differences between ST and AT were found.
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Affiliation(s)
- Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Silvia Lahuerta-Martín
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Andoni Carrasco-Uribarren
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Sara Cabanillas-Barea
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Héctor Hernández-Lázaro
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Silvia Pérez-Guillén
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
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Akinpelu AO, Omosanya OJ, Odole AC, Adegoke BOA, Oyewole OO. Cross-cultural adaptation and psychometric testing of the Yoruba lequesne algofunctional index of knee osteoarthritis among patients with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:897. [PMID: 37980475 PMCID: PMC10657015 DOI: 10.1186/s12891-023-07032-2] [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: 02/01/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND The Lequesne Algofunctional Index of Knee Osteoarthritis (LAIKOA) is a widely used knee osteoarthritis (KOA) outcome measure and is recommended by many international authorities. It has been cross-culturally adapted to many languages, excluding indigenous Nigerian languages. The aim of this study was to cross-culturally adapt and validate the LAIKOA into Yoruba language. METHODS This was a validation study. Yoruba LAIKOA was translated and culturally adapted from English version following Beaton's guidelines (including cognitive debriefing). The Yoruba LAIKOA was psychometrically tested for test-retest reliability, standard error of measurements (SEM), smallest detectable change (SDC), internal consistency, and construct validity among 108 Yoruba-speaking patients with KOA recruited from selected hospitals in Ibadan, Nigeria. Participants completed the Yoruba and English versions of LAIKOA, and the Yoruba version of Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM). RESULTS The mean age of participants was 63.60 ± 11.77 years. Acceptable internal consistency was observed for the global index and function domain (α = 0.63-0.82) and good test-retest for items and domains (ICC = 0.81-0.995). Item-to-scale correlation was significant (r = 0.28-0.69). Its three domains demonstrated structural validity when subjected to confirmatory factor analysis (CFI = 0.99, TLI = 0.99, RMSEA = 0.02). Construct validity was supported by the correlation between Yoruba LAIKOA and IKHOAM (r = -0.39, p = 0.011). The overall scores and domain scores of the Yoruba and English versions of LAIKOA did not differ significantly. The Yoruba LAIKOA has no floor or ceiling effects. CONCLUSION The Yoruba LAIKOA is reliable and valid, and it is recommended for use in clinical settings in southwestern Nigeria and other Yoruba-speaking populations.
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Affiliation(s)
| | | | - Adesola C Odole
- Physiotherapy Department, University of Ibadan, Ibadan, Nigeria
| | | | - Olufemi O Oyewole
- Physiotherapy Department, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
- College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, South Africa.
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Lee SY, Kim SC, Gim JA, Park SJ, Seo SH, Kim SJ, Kim HS, Yoo JI. Accelerometer-derived physical activity analysis of elderly osteoarthritis patients. Musculoskelet Sci Pract 2023; 66:102808. [PMID: 37352763 DOI: 10.1016/j.msksp.2023.102808] [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: 03/14/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Because disability in Osteoarthritis (OA) may change physical activity (PA), which might affect the disease progression, it is important to measure a patient's daily PA to study the relationship between a patient's PA and disease progression. OBJECTIVE The objective of the present study was to investigate the relationship between PA and patients with OA and people without OA using data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS Demographic study was conducted to obtain data of comorbidities of participants. PA was compared between the group with OA (OA group) and the group without OA (non-OA group). In addition, PAs of OA patients with comorbidities and those without comorbidities were compared. The cut-off of moderate to vigorous physical activity (MVPA) was obtained through a receiver operating characteristic (ROC) curve. RESULTS In the demographic study, there were significantly more educated participants in the OA group (p < .001). Actigraph data showed a significant decrease in MVPA (p < .001) but a significant increase in light activity (p = .002) in the OA group. In addition, the OA group showed significantly lower light PA but significantly higher MVPA in ≥10 min bout length. OA patients with comorbidities showed higher MVPA than OA patients without comorbidities (p = .044). The cut-off point of MVPA was 7.071 min/day when ROC curve was conducted. CONCLUSIONS The present study suggests that patients with OA and low activity need a certain level of physical activity and a cut-off point for MVPA is presented which accounts for comorbidities in OA patients.
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Affiliation(s)
- Sang-Yeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, South Korea
| | - Seung Chan Kim
- Department of Biostatistics Cooperation Center, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jeong-An Gim
- Department of Medical Science Research Center, College of Medicine, Korea University, Seoul, South Korea
| | - Seong Jin Park
- Department of Hospital-based Business Innovation Center, Gyeongsang National University Hospital, Jinju, South Korea
| | - Sung Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, South Korea
| | - Shin June Kim
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, South Korea
| | - Hyeon Su Kim
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, South Korea.
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White DK, Jakiela J, Bye T, Aily J, Voinier D. Stepping Forward: A Scoping Review of Physical Activity in Osteoarthritis. J Rheumatol 2023; 50:611-616. [PMID: 36455947 PMCID: PMC10159874 DOI: 10.3899/jrheum.220728] [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] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 05/03/2023]
Abstract
Physical activity (PA) is recommended to mitigate the symptoms of osteoarthritis (OA); however, this modality remains an unfamiliar construct for many patients and clinicians. Moreover, there can be confusion over the nuanced differences in terminology, such as exercise, sedentary behavior, and moderate intensity. The purpose of this scoping review is to provide a basic overview of PA including terminology, summarize the importance of PA for adults with OA, and discuss current gaps in the literature. Broadly, PA is defined as any energy expenditure from skeletal muscle above a resting level, and exercise is considered a type of PA that is planned, structured, and repetitive. Robust literature shows that PA has a modest protective effect on pain, functional limitation, and disability for OA, in addition to positive effects on a broad range of outcomes from mood and affect to mortality and morbidity in the general population. We provide recommendations for which measurement instruments can be used to record PA, both from a clinical and research perspective, as well as which metrics to employ for summarizing daily activity.
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Affiliation(s)
- Daniel K White
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
| | - Jason Jakiela
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Tom Bye
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Jessica Aily
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Dana Voinier
- D.K. White, PT, ScD, MSc, J. Jakiela, MSc, T. Bye, PT, J. Aily, PT, D. Voinier, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Lozinski J, Heidary SH, Brandon SCE, Komeili A. An Adaptive Pedaling Assistive Device for Asymmetric Torque Assistant in Cycling. SENSORS (BASEL, SWITZERLAND) 2023; 23:2846. [PMID: 36905050 PMCID: PMC10007182 DOI: 10.3390/s23052846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Dynamic loads have short and long-term effects in the rehabilitation of lower limb joints. However, an effective exercise program for lower limb rehabilitation has been debated for a long time. Cycling ergometers were instrumented and used as a tool to mechanically load the lower limbs and track the joint mechano-physiological response in rehabilitation programs. Current cycling ergometers apply symmetrical loading to the limbs, which may not reflect the actual load-bearing capacity of each limb, as in Parkinson's and Multiple Sclerosis diseases. Therefore, the present study aimed to develop a new cycling ergometer capable of applying asymmetric loads to the limbs and validate its function using human tests. The instrumented force sensor and crank position sensing system recorded the kinetics and kinematics of pedaling. This information was used to apply an asymmetric assistive torque only to the target leg using an electric motor. The performance of the proposed cycling ergometer was studied during a cycling task at three different intensities. It was shown that the proposed device reduced the pedaling force of the target leg by 19% to 40%, depending on the exercise intensity. This reduction in pedal force caused a significant reduction in the muscle activity of the target leg (p < 0.001), without affecting the muscle activity of the non-target leg. These results demonstrated that the proposed cycling ergometer device is capable of applying asymmetric loading to lower limbs, and thus has the potential to improve the outcome of exercise interventions in patients with asymmetric function in lower limbs.
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Affiliation(s)
- Jesse Lozinski
- School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | | | - Amin Komeili
- Department of Biomedical Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
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Altuwairqi AA, Qronfla HM, Aljehani LS, Khashoggi KG. The Association Between Gonarthrosis Pain Severity and Radiographic Findings on X-Ray: A Cross-Sectional Study. Cureus 2023; 15:e35258. [PMID: 36968852 PMCID: PMC10036238 DOI: 10.7759/cureus.35258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a degenerative joint disease that progresses over time due to articular cartilage loss. Orthopedic surgeons use plain radiography (X-ray) with an anteroposterior (AP) standing (weight-bearing) view, which is currently considered the gold standard modality, to diagnose KOA. They base this diagnosis on the clinical history and physical examination of the knee joint. However, many previous studies have reported a weak correlation between knee-joint structural abnormalities on X-rays and described pain. Therefore, our study aimed to assess the incompatibility between patients' pain-severity complaints and radiographic findings on standing AP view. No similar study has been recently published in the Middle East. METHODS 158 participants were selected for the study from King Abdulaziz University Hospital, Jeddah, between March 2022 and August 2022. We graded the patients' AP knee radiographs using the Kellgren-Lawrence (KL) grading scale and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, by which we made phone calls to assess pain severity on a 0-10 pain subscale. RESULTS We found a significant association between the 0-10 pain subscale and WOMAC questions describing difficulty in sitting (p < 0.05). Comparing KL scores on X-ray on a 0-10 pain subscale, we found a significant association between mild pain and severe radiological findings on X-ray and vice versa. In addition, the comparison between KL scores on X-ray and WOMAC questions describing difficulty in sitting showed a significant association between moderate difficulty in sitting and severe radiological findings and vice versa. CONCLUSION Our results indicated that there was a significant relationship between mild pain and severe radiological findings on X-rays and vice versa. Additionally, there was a significant relationship, based on the KL score and the WOMAC item that assessed sitting difficulty, between moderate sitting difficulty and severe radiological findings and vice versa. This may suggest that central and peripheral sensitization could be one factor in the causes of pain.
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Association between knee osteoarthritis and the risk of cardiovascular disease and the synergistic adverse effects of lack of exercise. Sci Rep 2023; 13:2777. [PMID: 36797339 PMCID: PMC9935498 DOI: 10.1038/s41598-023-29581-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
We aimed to determine whether knee OA is associated with CVD risk and all-cause death and to evaluate whether the association differs by exercise behavior. We used Korea National Health Insurance Service (KNHIS) database and included 201,466 participants (7572 subjects diagnosed with knee OA) who underwent health screening between 2009 and 2015. Those who had been diagnosed with knee OA or CVD before the index year were excluded. Cox proportional hazard models were used after adjusting for sociodemographic and CVD risk factors to evaluate the association between knee OA and CVD risk and all-cause death. Stratification analysis was further performed to determine the effect of exercise behavior on this relationship. During a median follow-up of 7.06 ± 2.24 years, 8743 CVD (2510 MI and 6553 stroke) cases developed. Individuals with knee OA had increased risks of CVD [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.15-1.38], myocardial infarction (MI) (HR 1.20, 95% CI 1.00-1.44), and stroke (HR 1.29, 95% CI 1.16-1.43) compared with those without knee OA. Those with knee OA who did not exercise had an increased risk of CVD (HR 1.25, 95% CI 1.11-1.40), whereas no significant increased CVD risk was observed in those with knee OA who exercised at least once a week (HR 1.11, 95% CI 0.96-1.28). There was no association between knee osteoarthritis and all-cause death. Knee OA was independently associated with an increased risk of CVD. Lack of exercise might have a synergistic adverse effect on the association between knee OA and CVD.
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Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis. Vet Sci 2022; 10:vetsci10010002. [PMID: 36669003 PMCID: PMC9863568 DOI: 10.3390/vetsci10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient's overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the "Physiotherapy Pyramid") aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.
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Kushioka J, Sun R, Zhang W, Muaremi A, Leutheuser H, Odonkor CA, Smuck M. Gait Variability to Phenotype Common Orthopedic Gait Impairments Using Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2022; 22:9301. [PMID: 36502003 PMCID: PMC9739785 DOI: 10.3390/s22239301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Mobility impairments are a common symptom of age-related degenerative diseases. Gait features can discriminate those with mobility disorders from healthy individuals, yet phenotyping specific pathologies remains challenging. This study aims to identify if gait parameters derived from two foot-mounted inertial measurement units (IMU) during the 6 min walk test (6MWT) can phenotype mobility impairment from different pathologies (Lumbar spinal stenosis (LSS)-neurogenic diseases, and knee osteoarthritis (KOA)-structural joint disease). Bilateral foot-mounted IMU data during the 6MWT were collected from patients with LSS and KOA and matched healthy controls (N = 30, 10 for each group). Eleven gait parameters representing four domains (pace, rhythm, asymmetry, variability) were derived for each minute of the 6MWT. In the entire 6MWT, gait parameters in all four domains distinguished between controls and both disease groups; however, the disease groups demonstrated no statistical differences, with a trend toward higher stride length variability in the LSS group (p = 0.057). Additional minute-by-minute comparisons identified stride length variability as a statistically significant marker between disease groups during the middle portion of 6WMT (3rd min: p ≤ 0.05; 4th min: p = 0.06). These findings demonstrate that gait variability measures are a potential biomarker to phenotype mobility impairment from different pathologies. Increased gait variability indicates loss of gait rhythmicity, a common feature in neurologic impairment of locomotor control, thus reflecting the underlying mechanism for the gait impairment in LSS. Findings from this work also identify the middle portion of the 6MWT as a potential window to detect subtle gait differences between individuals with different origins of gait impairment.
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Affiliation(s)
- Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
| | - Wei Zhang
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, 4056 Basel, Switzerland
| | - Heike Leutheuser
- Machine Learning and Data Analytics Lab (MaD Lab), Department Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91052 Erlangen, Germany
| | - Charles A. Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
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12
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Nonpharmacologic and Rehabilitative Strategies to Address Chronic Pain. Prim Care 2022; 49:403-413. [DOI: 10.1016/j.pop.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Aldosari AA, Majadah S, Amer KA, Alamri HH, Althomali RN, Alqahtani RF, Alamer RA, Alshehri SZ, Alhayyani RM, Aleman SY, Somaily M. The Association Between Physical Activity Level and Severity of Knee Osteoarthritis: A Single Centre Study in Saudi Arabia. Cureus 2022; 14:e24377. [PMID: 35611031 PMCID: PMC9124548 DOI: 10.7759/cureus.24377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
Background and aim Knee osteoarthritis (OA) is a disabling joint disease that results in degeneration of the joint cartilage. Many studies demonstrate the risk factors and complications of knee osteoarthritis, but how physical activity impacts the osteoarthritis severity needs to be studied. The study aimed to assess the impact and association of physical activity level with the severity of knee osteoarthritis among patients attending a single center in the Aseer region, southwest Saudi Arabia. Methods An analytical cross-sectional study was conducted targeting all patients clinically diagnosed with knee osteoarthritis in the Aseer region from June 2021 to September 2021. Data was collected using a pre-structured online questionnaire. The questionnaire included patients' socio-demographic data and clinical data on knee osteoarthritis. The level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). The severity of knee osteoarthritis was assessed using the index of severity for osteoarthritis of the knee. Results Out of 473 patients clinically diagnosed with knee OA, only 145 patients met our inclusion criteria. Patients' ages ranged from 35 years to 71 years, with a mean age of 44.3 (±12.9) years. A total of 122 (84.1%) patients were females. Sixty-five (44.8%) patients complained of knee OA for less than two years, 46 (31.7%) for two to five years, and 34 (23.4%) were diagnosed for more than five years. A total of 96 (66.2%) had a low level of physical activity, 32 (22.1%) had a moderate level of physical activity, while 17 (11.7%) had a high level of physical activity. Thirty-eight (26.2%) cases complained of extremely severe knee OA, 37 (25.5%) had very severe knee OA, 28 (19.3%) complained of severe knee OA, 36 (24.9%) had mild to moderate knee OA, while six (4.1%) had minimal knee OA. There was a significant beneficial effect of physical activity on the severity of knee OA. Conclusion The study revealed that physical activity, especially at high levels, was associated with lower knee OA severity which means a beneficial effect. Most of the patients included in the study had severe to extremely severe knee OA with low physical activity levels.
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Affiliation(s)
| | - Saeed Majadah
- Department of Medicine, Rheumatology Division, Khamis Mushayt General Hospital, Abha, SAU
| | - Khaled A Amer
- College of Medicine, King Khalid University, Abha, SAU
| | - Hend H Alamri
- College of Medicine, King Khalid University, Abha, SAU
| | | | | | | | | | | | - Shahenda Y Aleman
- Department of Medicine, Rheumatology Division, Khamis Mushayt General Hospital, Abha, SAU
| | - Mansour Somaily
- Department of Medicine, Rheumatology Division, King Khalid University, Abha, SAU
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14
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Osteoarthritis complications and the recent therapeutic approaches. Inflammopharmacology 2021; 29:1653-1667. [PMID: 34755232 DOI: 10.1007/s10787-021-00888-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
The accelerated prevalence of osteoarthritis (OA) disease worldwide and the lack of convenient management led to the frequent search for unprecedented and specific treatment approaches. OA patients usually suffer from many annoying complications that negatively influence their quality of life, especially in the elderly. Articular erosions may lead eventually to the loss of joint function as a whole which occurs over time according to the risk factors presented in each case and the grade of the disease. Conventional therapies are advancing, showing most appropriate results but still greatly associated with many adverse effects and have restricted curative actions as well. Hence, novel management tools are usually required. In this review, we summarized the recent approaches in OA treatment and the role of natural products, dietary supplements and nanogold application in OA treatment to provide new research tracks for more therapeutic opportunities to those who are in care in this field.
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15
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Intra-articular Hymovis injection for managing hip OA in active sportsmen. A 24-month observational retrospective clinical investigation. J Clin Orthop Trauma 2021; 22:101594. [PMID: 34603955 PMCID: PMC8463867 DOI: 10.1016/j.jcot.2021.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hip Osteoarthitis (OA) risk is sport-specific and depends on frequency, intensity, and type of mechanic stress the hip is subjected to. This retrospective observational study aims to investigate the safety and performance of Hymovis (HYADD-4) injection, a hexadecyl (C-16) HA-derivative, when used to manage symptomatic hip OA in active middle-aged sportsmen over a 24-month observation period. METHODS The retrospective analysis included clinical records of active sportsmen, aged between 40 and 65 years, and suffering from symptomatic Kellgren-Lawrence grade II to III hip OA, treated with two (24 mg/3 ml) Hymovis injections, two weeks apart, every 3-4 months, for two years. When available, data on MRI examination were included in the analysis as well as Heidelberg Sports Activity Score (HAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaires. RESULTS Thirty patients (56.4 ± 7.3 years) were included in the study, sixteen cyclists and 14 tennis players. For all patients, HAS and most HAGOS scores improved significantly (p < 0.05) at the first control visit (4 months) and further improved over time. For all other scores an important clinical benefit was experienced by more than 50% of participants. No adverse events were recorded. CONCLUSION Treatment of hip OA in active sportsmen with Hymovis seems a safe and effective approach for the management of OA symptoms, by potentially protecting cartilage and subchondral bone from further damage.
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16
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Davis-Wilson HC, Thoma LM, Longobardi L, Franz JR, Blackburn JT, Hackney AC, Pietrosimone B. Quality of Life Associates With Moderate to Vigorous Physical Activity Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 57:532-539. [PMID: 34329413 DOI: 10.4085/1062-6050-0670.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Higher knee function is linked to psychological readiness to return to sport following anterior cruciate ligament reconstruction (ACLR). Individuals with ACLR participate in less physical activity compared to matched uninjured controls, yet the association between knee function and physical activity following ACLR remains unclear. OBJECTIVE To determine the association between patient-reported knee function measured with the Knee Injury and Osteoarthritis Outcomes Score Quality of Life (KOOS-QOL), daily steps, and minutes spent in moderate to vigorous physical activity (MVPA) in individuals with ACLR. Secondarily, we determined associations between KOOS-QOL, daily steps, and MVPA in individuals with ACLR who presented with (symptomatic) and without (asymptomatic) clinically meaningful knee related symptoms. DESIGN Cross-sectional study. SETTING Laboratory, Free-living conditions. PATIENTS OR OTHER PARTICIPANTS Sixty-six individuals with primary unilateral ACLR (55% female, 22±4 years, 28±33 months post-ACLR, BMI: 24.2±2.9 kg/m2). OUTCOME MEASURE(S) We collected KOOS and retrospectively stratified participants into those with (symptomatic [n=30]) or without (asymptomatic [n=36]) clinically meaningful knee related symptoms based on previously defined KOOS cutoffs. We assessed daily steps and MVPA from ActiGraph GT9X Link accelerometers which each participant wore on the right hip for 7 days. We conducted linear regressions to determine associations between KOOS-QOL, daily steps, and MVPA. RESULTS No significant associations existed in the entire sample between KOOS-QOL and daily steps (ΔR2=0.01, P=0.50) or MVPA (ΔR2=0.01, P=0.36). In symptomatic individuals, greater KOOS-QOL associated with greater MVPA (ΔR2=0.12, P=0.05,). No significant associations existed between KOOS-QOL, daily steps, and MVPA in the asymptomatic group. CONCLUSIONS Symptomatic individuals with ACLR who spent more time in MVPA reported higher quality of life.
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Affiliation(s)
- Hope C Davis-Wilson
- 1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Louise M Thoma
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,3Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lara Longobardi
- 4Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- 5Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - J Troy Blackburn
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A C Hackney
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,8Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Tucker JD, Goetz LL, Duncan MB, Gilman JB, Elmore LW, Sell SA, McClure MJ, Quagliano PV, Martin CC. Randomized, Placebo-Controlled Analysis of the Knee Synovial Environment Following Platelet-Rich Plasma Treatment for Knee Osteoarthritis. PM R 2021; 13:707-719. [PMID: 33492733 DOI: 10.1002/pmrj.12561] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Platelet-rich-plasma (PRP) is used to treat knee osteoarthritis; however, mechanistic evidence of PRP effectiveness for pain relief is limited. OBJECTIVE To assess molecular biomarkers and mesenchymal stem cells (MSCs) in synovial fluid during PRP treatment of the osteoarthritic knee joint. DESIGN Single blinded, randomized, placebo controlled pilot study. SETTING Veterans Affairs Medical Center. PARTICIPANTS Seventeen participants with mild to moderate knee osteoarthritis were randomized in a 2:1 placebo-controlled ratio, receiving PRP or saline (placebo) intra-articular injection into the knee joint. METHODS Knee synovial fluid was analyzed before the respective injections and again 10 days following injection. Participants were followed up to 12 months completing visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires at intervals over that period. MAIN OUTCOME MEASURES The effects of PRP on synovial protein and MSC gene expression levels were measured by multiplex enzyme-linked immunosorbent assay and quantitative polymerase chain reaction. RESULTS Novel biomarkers including levels of interleukin (IL)-5, IL-6, IL-10, and tumor necrosis factor-α were measured in synovial fluid 10 days after PRP treatment. Altered gene expression profiles in MSCs from patients treated with PRP were observed for matrix metalloproteinases and inflammatory markers (IL-6, IL-8, CCL2, TNF-α). A2M protease was significantly increased following PRP treatment (P = .005). WOMAC scores declined for up to 3 months from baseline levels and remained low at 6 and 12 months in the PRP group. In contrast, WOMAC scores for patients receiving the saline injection were relatively unchanged for up to 12 months. CONCLUSIONS We report significant changes for the biomarker A2M (P = .005) as well as differences in expression of cellular markers and postulate that PRP modulates the local knee synovial environment by altering the inflammatory milieu, matrix degradation, and angiogenic growth factors. The PRP treatment group had less pain and stiffness and improved function scores.
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Affiliation(s)
- Jason D Tucker
- iOrthoBiologix, Charlotte, NC.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, Richmond, VA
| | - Lance L Goetz
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | | | - Jared B Gilman
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, Richmond, VA
| | | | - Scott A Sell
- Department of Biomedical Engineering, Parks College of Engineering, Aviation, and Technology, Saint Louis University, St. Louis, MO
| | - Michael J McClure
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - Peter V Quagliano
- Department of Radiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Caroline C Martin
- Department or Pathology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
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18
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Lakshmanan DK, Ravichandran G, Elangovan A, Jeyapaul P, Murugesan S, Thilagar S. Cissus quadrangularis (veldt grape) attenuates disease progression and anatomical changes in mono sodium iodoacetate (MIA)-induced knee osteoarthritis in the rat model. Food Funct 2021; 11:7842-7855. [PMID: 32812575 DOI: 10.1039/d0fo00992j] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Cissus quadrangularis (CQ) stem has interesting nutritional and pharmacological properties to promote the health of the skeletal system. It is a well-recognized plant in the conventional system of medicine in India for treating bone and joint-associated complications. This study focuses on identifying the active constituents from the stem and root extracts of CQ and validating its anti-osteoarthritic activity by the in vivo model. Notable levels of phenolics and flavonoids were found in the ethanol extracts of both CQ stem (CQSE) and root (CQRE), among other solvent fractions. UPLC-MS/MS analysis of these selective extracts resulted in different classes of active compounds from both positive and negative ionization modes. By analyzing their mass spectra and fragmentation pattern, 25 active compounds were identified. The CQSE and CQRE extracts, along with the standard drug (naproxen), were further tested in mono-sodium iodoacetate-induced experimental OA animals. The modulatory effects of the test extracts were assessed by haematology, synovial and cartilage marker profiling, radiology and histopathological analysis. The in vivo findings from the biochemical and physiological studies have led to the conclusion that the CQSE extract is a good choice for the management of OA. The results were substantially better than CQ root extract and naproxen drug-treated groups. Thus, CQS has bioactive constituents, which could facilitate recovery from joint tissue damage, cellular metabolism and associated risk factors attributable to dysfunctions in OA incidence and progression.
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Affiliation(s)
- Dinesh Kumar Lakshmanan
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu 620024, India.
| | - Guna Ravichandran
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu 620024, India.
| | - Abbirami Elangovan
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu 620024, India.
| | - Preethi Jeyapaul
- Department of Biochemistry, Bharathidasan University, Tiruchirappalli, Tamil Nadu 620024, India
| | - Selvakumar Murugesan
- Department of Biotechnology, Anna University, BIT-Campus, Tiruchirappalli, Tamil Nadu 620024, India
| | - Sivasudha Thilagar
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu 620024, India.
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19
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de Hoop AMS, Kloek CJJ, Pisters MF, Veenhof C. Movement behaviour patterns in patients with hip and/or knee osteoarthritis in the physical therapy setting: a cross-sectional study. BMC Musculoskelet Disord 2020; 21:651. [PMID: 33023578 PMCID: PMC7539450 DOI: 10.1186/s12891-020-03644-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Osteoarthritis is one of the most common chronic joint diseases, mostly affecting the knee or hip through pain, joint stiffness and decreased physical functioning in daily life. Regular physical activity (PA) can help preserve and improve physical functioning and reduce pain in patients with osteoarthritis. Interventions aiming to improve movement behaviour can be optimized by tailoring them to a patients’ starting point; their current movement behaviour. Movement behaviour needs to be assessed in its full complexity, and therefore a multidimensional description is needed. Objectives The aim of this study was to identify subgroups based on movement behaviour patterns in patients with hip and/or knee osteoarthritis who are eligible for a PA intervention. Second, differences between subgroups regarding Body Mass Index, sex, age, physical functioning, comorbidities, fatigue and pain were determined between subgroups. Methods Baseline data of the clinical trial ‘e-Exercise Osteoarthritis’, collected in Dutch primary care physical therapy practices were analysed. Movement behaviour was assessed with ActiGraph GT3X and GT3X+ accelerometers. Groups with similar patterns were identified using a hierarchical cluster analysis, including six clustering variables indicating total time in and distribution of PA and sedentary behaviours. Differences in clinical characteristics between groups were assessed via Kruskall Wallis and Chi2 tests. Results Accelerometer data, including all daily activities during 3 to 5 subsequent days, of 182 patients (average age 63 years) with hip and/or knee osteoarthritis were analysed. Four patterns were identified: inactive & sedentary, prolonged sedentary, light active and active. Physical functioning was less impaired in the group with the active pattern compared to the inactive & sedentary pattern. The group with the prolonged sedentary pattern experienced lower levels of pain and fatigue and higher levels of physical functioning compared to the light active and compared to the inactive & sedentary. Conclusions Four subgroups with substantially different movement behaviour patterns and clinical characteristics can be identified in patients with osteoarthritis of the hip and/or knee. Knowledge about these subgroups can be used to personalize future movement behaviour interventions for this population. Trial registration Dutch clinical trial registration number of e-Exercise Osteoarthritis: NTR4224.
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Affiliation(s)
- Anne Maria Sjoerdtje de Hoop
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Research Centre for Healthy and Sustainable Living, Research group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | - Corelien Jacoba Johanna Kloek
- Research Centre for Healthy and Sustainable Living, Research group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Martijn Frits Pisters
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Research Centre for Healthy and Sustainable Living, Research group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
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20
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Mancipe Castro LM, García AJ, Guldberg RE. Biomaterial strategies for improved intra-articular drug delivery. J Biomed Mater Res A 2020; 109:426-436. [PMID: 32780515 DOI: 10.1002/jbm.a.37074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022]
Abstract
Osteoarthritis (OA) is a joint degenerative disease that has become one of the leading causes of disability in the world. It is estimated that OA affects 50 million adults in the United States. Currently, there are no FDA-approved treatments that slow OA progression and its treatment is limited to pain management strategies and life style changes. Despite the discovery of several disease-modifying OA drugs (DMOADs) and promising results in preclinical studies, their clinical translation has been significantly limited because of poor intra-articular (IA) bioavailability and challenges in delivering these compounds to tissues of interest within the joint. Here, we review current OA treatments and their effectiveness at reducing joint pain, as well as novel targets for OA treatment and the challenges related to their clinical translation. Moreover, we discuss intra-articular (IA) drug delivery as a promising route of administration, describe its inherent challenges, and review recent advances in biomaterial-based IA drug delivery for OA treatment. Finally, we highlight the potential of tissue targeting in the development of effective IA drug delivery systems.
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Affiliation(s)
- Lina M Mancipe Castro
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Andrés J García
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Robert E Guldberg
- Phil and Penny Knight Campus for Accelerating Scientific Impact, 6231 University of Oregon, Eugene, Oregon, USA
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21
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Odonkor C, Kuwabara A, Tomkins-Lane C, Zhang W, Muaremi A, Leutheuser H, Sun R, Smuck M. Gait features for discriminating between mobility-limiting musculoskeletal disorders: Lumbar spinal stenosis and knee osteoarthritis. Gait Posture 2020; 80:96-100. [PMID: 32497982 DOI: 10.1016/j.gaitpost.2020.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional ambulation limitations are features of lumbar spinal stenosis (LSS) and knee osteoarthritis (OA). With numerous validated walking assessment protocols and a vast number of spatiotemporal gait parameters available from sensor-based assessment, there is a critical need for selection of appropriate test protocols and variables for research and clinical applications. RESEARCH QUESTION In patients with knee OA and LSS, what are the best sensor-derived gait parameters and the most suitable clinical walking test to discriminate between these patient populations and controls? METHODS We collected foot-mounted inertial measurement unit (IMU) data during three walking tests (fast-paced walk test-FPWT, 6-min walk test- 6MWT, self-paced walk test - SPWT) for subjects with LSS, knee OA and matched controls (N = 10 for each group). Spatiotemporal gait characteristics were extracted and pairwise compared (Omega partial squared - ωp2) between patients and controls. RESULTS We found that normal paced walking tests (6MWT, SPWT) are better suited for distinguishing gait characteristics between patients and controls. Among the sensor-based gait parameters, stance and double support phase timing were identified as the best gait characteristics for the OA population discrimination, whereas foot flat ratio, gait speed, stride length and cadence were identified as the best gait characteristics for the LSS population discrimination. SIGNIFICANCE These findings provide guidance on the selection of sensor-derived gait parameters and clinical walking tests to detect alterations in mobility for people with LSS and knee OA.
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Affiliation(s)
- Charles Odonkor
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, CT, United States
| | - Anne Kuwabara
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, United States.
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Wei Zhang
- Laboratory of Movement Analysis and Measurements, École Polytechnique Fédérale De Lausanne, Lausanne, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Heike Leutheuser
- Central Institute for Medical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ruopeng Sun
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, United States
| | - Matthew Smuck
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, United States
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22
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Frimpong E, van der Jagt DR, Mokete L, Pietrzak J, Kaoje YS, Smith A, McVeigh JA, Meiring RM. Improvements in Objectively Measured Activity Behaviors Do Not Correlate With Improvements in Patient-Reported Outcome Measures Following Total Knee Arthroplasty. J Arthroplasty 2020; 35:712-719.e4. [PMID: 31722854 DOI: 10.1016/j.arth.2019.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/29/2019] [Accepted: 10/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Activity monitors have added a new dimension to our ability to objectively measure physical activity in patients undergoing total knee arthroplasty (TKA). The aim of the study is to assess whether changes in the time spent sitting, standing, and stepping were associated with changes in patient-reported outcome measures (PROMs) before and after TKA. METHODS Valid activPAL data (>3 days) and PROMs were obtained from 49 men and women (mean [SD] age, 62.8 [8.6] years; body mass index, 33.8 [7.1] kg/m2) who underwent primary TKA, before and at 6 weeks or 6 months after surgery. Patient-reported symptoms of pain, stiffness, and knee function were obtained using the Knee injury and Osteoarthritis Outcome Score and Oxford Knee Score questionnaires. RESULTS Mean (SD) Knee injury and Osteoarthritis Outcome Score (80.1 [16.3] to 41.6 [6.5], P < .001) and Oxford Knee Score (12.0 [9.8] to 17.7 [22.8], P < .001) scores improved 6 months after TKA. Walking time (mean [95% confidence interval]; min/d) increased from before (79 [67-91]) to 6 months after TKA (101 [88-114], P = .006). Standing time (318 [276-360] to 321 [291-352], P = .782) and sitting time (545 [491-599] to 509.0 [459.7-558.3], P = .285) did not change from before to 6 months after TKA. Participants took more steps (2559 [2128-2991] to 3515 [2983-4048] steps/day, P = .001) and accumulated more steps (31 [30-34] to 34 [33-35] steps/min, P < .001) after TKA compared to before. There were no associations between changes in activity behaviors and changes in PROMs (P > .05). CONCLUSION Despite improvements in self-reported knee pain and functional ability, these changes do not correlate with improvements in objectively measured light-intensity and sedentary activity behaviors.
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Affiliation(s)
- Emmanuel Frimpong
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Dick R van der Jagt
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Lipalo Mokete
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Jurek Pietrzak
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Yusuf S Kaoje
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley Campus, Perth, Australia
| | - Joanne A McVeigh
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; Occupational Therapy, Speech Therapy and Social Work, Curtin University, Bentley Campus, Perth, Australia
| | - Rebecca M Meiring
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; Department of Exercise Sciences, Faculty of Science, University of Auckland, Newmarket, Auckland, New Zealand
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Molyneux J, Herrrington L, Riley B, Jones R. A single‐arm, non‐randomized investigation into the short‐term effects and follow‐up of a 4‐week lower limb exercise programme on kinesiophobia in individuals with knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1831. [DOI: 10.1002/pri.1831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/07/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Jimmy Molyneux
- Physiotherapy DepartmentBridgewater Community Healthcare Foundation Trust, Leigh Health Centre Leigh, England UK
- School of Health SciencesUniversity of Salford Greater Manchester, England UK
| | - Lee Herrrington
- School of Health SciencesUniversity of Salford Greater Manchester, England UK
| | - Ben Riley
- Physiotherapy DepartmentBridgewater Community Healthcare Foundation Trust, Leigh Health Centre Leigh, England UK
| | - Richard Jones
- School of Health SciencesUniversity of Salford Greater Manchester, England UK
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Gohir SA, Greenhaff P, Abhishek A, Valdes AM. Evaluating the efficacy of Internet-Based Exercise programme Aimed at Treating knee Osteoarthritis (iBEAT-OA) in the community: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e030564. [PMID: 31662373 PMCID: PMC6830654 DOI: 10.1136/bmjopen-2019-030564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/22/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is the most common joint disease worldwide. As of today, there are no disease-modifying drugs, but there is evidence that muscle strengthening exercises can substantially reduce pain and improve function in this disorder, and one very well tested physiotherapy protocol is the 'Better Management of Patients with Osteoarthritis' developed in Sweden. Given the high prevalence of knee OA, a potentially cost-effective, digitally delivered approach to treat knee OA should be trialled. This study aims to explore the benefits of iBEAT-OA (Internet-Based Exercise programme Aimed at Treating knee Osteoarthritis) in modulating pain, function and other health-related outcomes in individuals with knee OA. METHODS AND ANALYSIS A randomised controlled trial was designed to evaluate the efficacy of a web-based exercise programme in a population with knee OA compared with standard community care provided by general practitioners (GPs) in the UK. We anticipate recruiting participants into equal groups. The intervention group (n=67) will exercise for 20-30 min daily for six consecutive weeks, whereas the control group (n=67) will follow GP-recommended routine care. The participants will be assessed using a Numerical Rating Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the Arthritis Research UK Musculoskeletal Health Questionnaire, the Pittsburgh Sleep Quality Index, 30 s sit to stand test, timed up and go test, quantitative sensory testing, musculoskeletal ultrasound scan, muscle thickness assessment of the vastus lateralis, and quadriceps muscles force generation during an isokinetic maximum voluntary contraction (MVC). Samples of urine, blood, faeces and synovial fluid will be collected to establish biomarkers associated with changes in pain and sleep patterns in individuals affected with knee OA. Standard parametric regression methods will be used for statistical analysis. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Committee (ref: 18/EM/0154) and the Health Research Authority (protocol no: 18021). The study was registered in June 2018. The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03545048.
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Affiliation(s)
- Sameer Akram Gohir
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
| | - Paul Greenhaff
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
- Division of Physiology, Pharmacology and Neuroscience, University of Nottingham School of Medical and Surgical Sciences, Nottingham, Nottingham, UK
- MRC Arthritis Research UK Centre, MSK Ageing Research, Nottingham, United Kingdom
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Ana M Valdes
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
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Importance of Rehabilitation in Primary Knee Osteoarthritis. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:148-155. [PMID: 31624641 PMCID: PMC6778300 DOI: 10.12865/chsj.45.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/21/2019] [Indexed: 11/29/2022]
Abstract
In our observational study, we aim to highlight the role of rehabilitation program in the control and maintaining of the clinical and functional status of people with primary knee osteoarthritis and co-morbidities. We established that the complete rehabilitation program (diet, symptomatic medication and herbal products, electrotherapy measures and kinetic exercises) will give the optimal healthcare for this type of patients.
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Does face-to-face pre-operative joint replacement education reduce hospital costs in a regional Australian hospital? A descriptive retrospective clinical audit. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:257-265. [PMID: 31612317 DOI: 10.1007/s00590-019-02548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether attending a face-to-face pre-operative joint replacement education in a regional setting reduces overall hospital costs and length of stay (LOS) following total knee replacement (TKR) or total hip replacement (THR). METHODS A retrospective clinical audit reviewed the medical records of all patients who underwent an elective THR or TKR at Rockhampton Hospital in regional Queensland, Australia, between 03/2015 and 12/2016 (22 months). The pre-operative joint replacement education class was provided by a multidisciplinary team that included a physiotherapist, an occupational therapist, a dietician, a pharmacist and a social worker. In addition to demographic data, we extracted and analysed data related to total acute care and total healthcare cost, prevalence of post-operative complications, discharge destination and comorbidities (using the Functional Comorbidity Index). RESULTS Out of 326 cases that were included in the analysis, 115 cases with TKR and 51 cases with THR attended a pre-operative education class. Demographic characteristics between those attending and not attending the class were largely similar, except from more females attending in the THR group. There was no difference in hospital costs or LOS between those who attended the class compared to those who did not for both the TKR and THR groups. Outcomes related to total acute stay costs, total cost including travel and education and score for Functional Comorbidities Index were similar between those who attended the class and those who did not. CONCLUSION Pre-operative education does not reduce hospital costs (surgery and hospital stay) in Central Queensland.
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Davies MAM, Kerr ZY, DeFreese JD, Arden NK, Marshall SW, Guskiewicz KM, Padua DA, Pietrosimone B. Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes. Am J Sports Med 2019; 47:2863-2870. [PMID: 31498654 DOI: 10.1177/0363546519870804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention. PURPOSE To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight. RESULTS Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05). CONCLUSION Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.
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Affiliation(s)
- Madeleine A M Davies
- Department of Health, University of Bath, Bath, UK.,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nigel K Arden
- The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Stephen W Marshall
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Darin A Padua
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
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Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice for Hip and/or Knee Osteoarthritis. J Orthop Sports Phys Ther 2019; 49:501-512. [PMID: 31258044 DOI: 10.2519/jospt.2019.8676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical therapists are key providers of conservative management for hip and/or knee osteoarthritis (OA), yet not all guideline recommendations are tailored to their scope of practice. OBJECTIVE To identify and prioritize the most important recommendations relevant to physical therapy practice for hip and/or knee OA. METHODS International physical therapists (n = 132) were invited to participate in an online modified Delphi survey, followed by a priority-ranking exercise. A total of 63 recommendations were extracted from 2 recent high-quality clinical guidelines. In 3 Delphi rounds, the panel identified those recommendations they considered to be most relevant to physical therapy practice for hip and knee OA. Any new recommendations were ascertained. For a recommendation to be included, at least 70% of respondents had to rate the recommendation as 7 or above on a numeric rating scale (0 is not important and 10 is extremely important). The panel prioritized recommendations that remained after the final round using decision-making software. RESULTS Of 132 therapists from 14 countries, 62 completed round 1, 52 completed round 2, 45 completed round 3, and 35 completed the priority-ranking exercise. From an initial list of 70 potential recommendations (including 7 new recommendations), 30 were included in the priority-ranking exercise. The top recommendations were related to providing education and prescribing exercise and weight loss as core treatments, followed by individualized OA assessment and treatment and communication strategies. CONCLUSION This study identified and ranked the most important recommendations relevant to physical therapy practice for hip and/or knee OA. J Orthop Sports Phys Ther 2019;49(7):501-512. doi:10.2519/jospt.2019.8676.
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van der Zee-Neuen A, Wirth W, Hösl K, Osterbrink J, Eckstein F. The association of physical activity and depression in patients with, or at risk of, osteoarthritis is captured equally well by patient reported outcomes (PROs) and accelerometer measurements - Analyses of data from the Osteoarthritis Initiative. Semin Arthritis Rheum 2019; 49:325-330. [PMID: 31248586 DOI: 10.1016/j.semarthrit.2019.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) patients are at increased risk of depression, and low levels of physical activity (PA) are a potential warning sign of depression. PA can be estimated by patient reported outcomes (PROs) or measured with accelerometers (ACCs). We explored which of these two best captures depression in patients with, or at risk of, OA. METHODS 48-months data from the Osteoarthritis Initiative were cross-sectionally analysed. The dichotomized Centre for Epidemiological Studies Depression Scale score was used as outcome (depression y/n). The Physical Activity Scale for the Elderly (PASE) was selected as PRO. ACC-data comprised average minutes of daily moderate to vigorous activity. Two multivariable models (PRO-model/ACC-model) were compared directly and indirectly using areas under the curve (AUC) for the predicted probability of depression, penalized model selection criteria (PMSC) and log-likelihood ratio tests. RESULTS AUCs from the ACC (0.71 [95% CI 0.67; 0.75]) and PRO model (0.72 [95% CI 0.68; 0.76]) were not significantly different (p = 0.28). Differences in PMSC were small (<10). The log-likelihood ratio test for the comparison of the ACC (ll -505.22) with the base model (ll -505.98) was not significant (LR chi2 = 1.52; p = 0.22), but the PRO model (ll -501.55) had a better fit than the base model (LR chi2 = 8.87; p < 0.01). CONCLUSIONS PRO and ACC data perform similarly in capturing depression. Indirect comparison even pleads for PROs. Costs of accelerometers and the additional burden for patients are in support of the PASE as an appropriate alternative to screen for depression in OA patients.
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Affiliation(s)
- Antje van der Zee-Neuen
- Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria.
| | - Wolfgang Wirth
- Paracelsus Medical University, Institute of Anatomy, Salzburg, Austria
| | - Katharina Hösl
- Paracelsus Medical University, Department of Psychiatry and Psychotherapy, Nuremberg, Germany
| | - Jürgen Osterbrink
- Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Felix Eckstein
- Paracelsus Medical University, Institute of Anatomy, Salzburg, Austria
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Apurba G. Evaluation of a Cost-Effective Novel Diagnostic Method for Lumbar Herniated Disc with Knee-Osteoarthritis: A Randomized Sample Study. Med Sci (Basel) 2019; 7:E69. [PMID: 31212862 PMCID: PMC6630886 DOI: 10.3390/medsci7060069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to determine a cost-effective diagnostic method for lumbar herniated disc with knee osteoarthritis (LHD-KOA) based on aberrant outcome measures, levels of biomarkers, and examination of the lower-extremity. Data were separately analyzed for each cohort suffering with LHD-KOA (n=108; 59.82±7.15years) and without LHD-KOA (n=108; 58.81±7.61years), and findings were confirmed with radiological images. The aberrant-leg-features (bilateral: knee gaps between the short head of biceps femoris and the surface of the bed, diameters of calves and thighs, angles of straight leg raising, knee-flexion and -extension in a supine position) and biochemical parameters (Interleukin-10, Tumor necrosis factor-alpha, C-reactive protein, creatine kinase-muscle, and Aldolase-A), and outcome measures, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), knee-injury osteoarthritis outcomes scale (KOOS), Oswestry disability index (ODI), and body mass index (BMI)for participants with and without LHD-KOA were evaluated with appropriate techniques. All the subjects underwent standardized physical examination and completed a questionnaire. The risk ratios and mean± standard deviations of biomarkers, anatomical features, and outcome measures of the experimental subjects were highly significant compared to controls (p<0.0001). Results suggest that monitoring the studied aberrant outcome measures, biomarkers, and lower-anatomical features may be a cost-effective diagnostic tool for LHD-KOA. Further research is recommended for an alternative treatment protocol for LHD-KOA.
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Affiliation(s)
- Ganguly Apurba
- Department of Research and Development, OPTM Research Institute, 145 Rashbehari Avenue, Kolkata-700029, India.
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31
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Georgiev T, Angelov AK. Modifiable risk factors in knee osteoarthritis: treatment implications. Rheumatol Int 2019; 39:1145-1157. [DOI: 10.1007/s00296-019-04290-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 12/23/2022]
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Tomkins-Lane C, Norden J, Sinha A, Hu R, Smuck M. Digital biomarkers of spine and musculoskeletal disease from accelerometers: Defining phenotypes of free-living physical activity in knee osteoarthritis and lumbar spinal stenosis. Spine J 2019; 19:15-23. [PMID: 30025995 DOI: 10.1016/j.spinee.2018.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) and knee osteoarthritis (OA) are 2 of the leading causes of disability worldwide. In order to provide disease-specific prescriptions for physical activity, there is a clear need to better understand physical activity in daily life (performance) in these populations. PURPOSE To discover performance phenotypes for LSS and OA by applying novel analytical methods to accelerometry data. Specific objectives include the following: (1) to identify characteristic features (phenotypes) of free-living physical activity unique to individuals with LSS and OA, and (2) to determine which features can best differentiate between these conditions. STUDY DESIGN AND SETTING Leveraging data from 3 existing cross-sectional cohorts, accelerometry signal feature characterization and selection were performed in a computational laboratory. PATIENT SAMPLE Data from a total of 4,028 individuals were analyzed from the following 3 datasets: LSS Accelerometry Database (n=75); OA Initiative (n=1950); and the 2003 to 2004 National Health and Nutrition Examination Survey (pain-free controls, n=2003). METHODS In order to characterize the accelerometry signals, data were examined using (1) standard intervals for counts/minute from Freedson et al. and (2) the physical performance intervals for mobility-limited pain populations. From this, 42 novel accelerometry features were defined and evaluated for significance in discriminating between the groups (LSS, OA, and controls) in order to then determine which sparse set of features best differentiates between the groups. These sparse sets of features defined the performance phenotypes. OUTCOME MEASURES Accelerometry features and their ability to differentiate between individuals with LSS, OA, and controls. RESULTS Given age and gender, classification rates were at least 80% accurate (pairwise) between diseased and pain-free populations (LSS vs. controls and OA vs. controls). The most important features to distinguish between disease groups corresponded to measures in the light and sedentary activity intervals. The more subtle classification between diseased populations (LSS vs. OA) was 72% accurate, with light and moderate activity providing the prominent distinguishing features. CONCLUSIONS We describe the discovery of performance phenotypes of LSS and OA from accelerometry data, revealed through a novel set of features that characterize daily patterns of movement in people with LSS and OA. These performance phenotypes provide a new method for analyzing free-living physical activity (performance) in LSS and OA, and provide the groundwork for more personalized approaches to measuring and improving function.
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Affiliation(s)
- Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
| | - Justin Norden
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA
| | - Aman Sinha
- Department of Electrical Engineering, Stanford University, 350 Serra Mall, Stanford, CA 94305, USA
| | - Richard Hu
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
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Farris SG, Abrantes AM, Uebelacker LA, Weinstock LM, Battle CL. Exercise as a Nonpharmacological Treatment for Depression. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181204-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Badr MEM, Hafez EAR, El-Ghaweet AI, El-Sayed HM. Intra-articular injection of platelet - rich plasma and therapeutic exercise in knee osteoarthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_22_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res 2018; 11:2189-2196. [PMID: 30323653 PMCID: PMC6179584 DOI: 10.2147/jpr.s154002] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
For decades, multiple attempts to fully understand knee osteoarthritis pathophysiology and natural history have been attempted. Despite the extensive amount of research regarding this topic, there are still marked controversies. This multifactorial condition gets influenced by local, systemic, and external factors and its progression and/or response to treatments widely varies from patient to patient. Multiple therapies have been studied in the past, low impact physical activity seems to be supported by all the current medical societies while other interventions have shown conflicting findings. Newer therapies and routes of administration are under investigation and some of them have shown promising preliminary reports. This review intends to give an overview of the current knowledge of pathophysiology and non-surgical therapies available for knee osteoarthritis.
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Affiliation(s)
- Juan C Mora
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, Gainesville, FL, USA,
| | - Rene Przkora
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, Gainesville, FL, USA,
| | - Yenisel Cruz-Almeida
- Department of Aging and Geriatric Research, Institute on Aging, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Harms A, Heredia-Rizo AM, Moseley GL, Hau R, Stanton TR. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care. Physiother Theory Pract 2018; 36:142-156. [PMID: 29889597 DOI: 10.1080/09593985.2018.1482391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
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Affiliation(s)
- Anton Harms
- Department of Physiotherapy, Northern Hospital, Epping, Victoria, Australia
| | - Alberto M Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Sevilla, Spain.,School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Raphael Hau
- Northern Clinical School of Melbourne Medical School, Northern Hospital, Epping, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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Akin-Akinyosoye K, Frowd N, Marshall L, Stocks J, Fernandes GS, Valdes A, McWilliams DF, Zhang W, Doherty M, Ferguson E, Walsh DA. Traits associated with central pain augmentation in the Knee Pain In the Community (KPIC) cohort. Pain 2018; 159:1035-1044. [PMID: 29438225 PMCID: PMC5959005 DOI: 10.1097/j.pain.0000000000001183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/22/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
This study aimed to identify self-report correlates of central pain augmentation in individuals with knee pain. A subset of participants (n = 420) in the Knee Pain and related health In the Community (KPIC) baseline survey undertook pressure pain detection threshold (PPT) assessments. Items measuring specific traits related to central pain mechanisms were selected from the survey based on expert consensus, face validity, item association with underlying constructs measured by originating host questionnaires, adequate targeting, and PPT correlations. Pain distribution was reported on a body manikin. A "central pain mechanisms" factor was sought by factor analysis. Associations of items, the derived factor, and originating questionnaires with PPTs were compared. Eight self-report items measuring traits of anxiety, depression, catastrophizing, neuropathic-like pain, fatigue, sleep disturbance, pain distribution, and cognitive impact were identified as likely indices of central pain mechanisms. Pressure pain detection thresholds were associated with items representing each trait and with their originating scales. Pain distribution classified as "pain below the waist additional to knee pain" was more strongly associated with low PPT than were alternative classifications of pain distribution. A single factor, interpreted as "central pain mechanisms," was identified across the 8 selected items and explained variation in PPT (R = 0.17) better than did any originating scale (R = 0.10-0.13). In conclusion, including representative items within a composite self-report tool might help identify people with centrally augmented knee pain.
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Affiliation(s)
- Kehinde Akin-Akinyosoye
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nadia Frowd
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Laura Marshall
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Joanne Stocks
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Gwen S. Fernandes
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Centre for Sports, Exercise, and Osteoarthritis, Nottingham, United Kingdom
| | - Ana Valdes
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom
| | - Daniel F. McWilliams
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Weiya Zhang
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom
| | - Michael Doherty
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom
| | - Eamonn Ferguson
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - David A. Walsh
- Arthritis Research UK Pain Centre, Nottingham, United Kingdom
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom
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Stewart C, Fraiser R, Zheng P. The Potential of Digital Technology to Improve Self-Care for Musculoskeletal Conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Changes in Weight and Body Composition Among Women With Breast Cancer During and After Adjuvant Treatment. Cancer Nurs 2017; 40:369-376. [DOI: 10.1097/ncc.0000000000000426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ojoawo AO, Olaogun MOB, Hassan MA. Comparative effects of proprioceptive and isometric exercises on pain intensity and difficulty in patients with knee osteoarthritis: A randomised control study. Technol Health Care 2017; 24:853-863. [PMID: 27434280 DOI: 10.3233/thc-161234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The study compared the effects of isometric quadriceps exercise and proprioceptive exercise on pain, joint stiffness and physical difficulties of patients with knee osteoarthritis. SUBJECTS Forty-five patients with history of knee osteoarthritis were randomly allocated into two groups; A with 23 subjects and B with 22 subjects. METHODS All subjects received infrared radiation for 20 minutes and kneading massage with methyl salicylate ointment. Group A underwent proprioceptive exercises while Group B had isometric quadriceps exercise. Each exercise session lasted for 10 minutes according to standard protocol, twice in a week for six weeks. Pre-treatment, 3rd week and 6th week pain intensity, joint stiffness and physical difficulties were assessed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical package for social sciences (SPSS) version 17 was used to analyse the data while descriptive and inferential statistics were used to summarise the result. RESULTS Proprioceptive exercises reduced pain intensity significantly (F = 4.76; p = 0.00) at 6th week with effect size of 2.79, and physical difficulty (F = 3.69; p < 0.04) with effect size of 7.53 better than isometric exercises. There was a significant reduction in the pain intensity (F = 12.08; p < 0.001), and physical difficulties (F = 3.69, p = 0.04) in pre-treatment, 3rd week and 6th week in both Group A and B. CONCLUSION Both exercises are effective but proprioceptive exercises may be more effective in the management of patients with knee osteoarthritis (KOA) than isometric exercises.
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Ernstgård A, PirouziFard M, Thorstensson CA. Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study. BMC Musculoskelet Disord 2017; 18:42. [PMID: 28122519 PMCID: PMC5267429 DOI: 10.1186/s12891-017-1394-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/11/2017] [Indexed: 01/04/2023] Open
Abstract
Background Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity. Methods An observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran’s Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model. Results The proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability. Conclusions Following the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.
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Affiliation(s)
- Anna Ernstgård
- Linneaus University, Kalmar, Sweden. .,Capio Artro Clinic AB, Box 5606, Stockholm, SE-114 86, Sweden.
| | | | - Carina A Thorstensson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BOA-registry, Centre of Registers Västra Götaland, Gothenburg, Sweden
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Srivastava S, Saksena AK, Khattri S, Kumar S, Dagur RS. Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: a four-month, double-blind, randomized, placebo-controlled trial. Inflammopharmacology 2016; 24:377-388. [DOI: 10.1007/s10787-016-0289-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022]
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Goh SL, Persson MSM, Bhattacharya A, Hall M, Doherty M, Zhang W. Relative efficacy of different types of exercise for treatment of knee and hip osteoarthritis: protocol for network meta-analysis of randomised controlled trials. Syst Rev 2016; 5:147. [PMID: 27590834 PMCID: PMC5010721 DOI: 10.1186/s13643-016-0321-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/18/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND 'Exercise' is universally recommended as a core treatment for knee and hip osteoarthritis (OA). However, there are very few head-to-head comparative trials to determine the relative efficacy between different types of exercise. The aim of this study is to benchmark different types of exercises against each other through the use of a common comparator in a network meta-analysis of randomised controlled trials (RCTs). METHODS This study will include only RCTs published in peer-reviewed journals. A systematic search will be conducted in several electronic databases and other relevant online resources. No limitations are imposed on language or publication date. Participants must be explicitly identified by authors as having OA. Interventions that involved exercise or comparators in any form will be included. Pain is the primary outcome of interest; secondary outcomes will include function and quality of life measures. Quality assessment of studies will be based on the modified Cochrane's risk of bias assessment tool. At least two investigators will be involved throughout all stages of screening and data acquisition. Conflicts will be resolved through discussion. Conventional meta-analysis will be performed based on random effects model and network meta-analysis on a Bayesian model. Subgroup analysis will also be conducted based on study, patient and disease characteristics. DISCUSSION This study will provide for the first time comprehensive research evidence for the relative efficacy of different exercise regimens for treatment of OA. We will use network meta-analysis of existing RCT data to answer this question. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033865.
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Affiliation(s)
- Siew-Li Goh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | - Monica S. M. Persson
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Archan Bhattacharya
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | - Michelle Hall
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
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Chen S, Zhang L, Xu R, Ti Y, Zhao Y, Zhou L, Zhao J. BDKRB2 +9/-9 bp polymorphisms influence BDKRB2 expression levels and NO production in knee osteoarthritis. Exp Biol Med (Maywood) 2016; 242:422-428. [PMID: 26764266 DOI: 10.1177/1535370215625471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The bradykinin B2 receptor (BDKRB2) plays a key role in the inflammation process of osteoarthritis. Nitric oxide has also long been considered to be a catabolic factor that contributes to inflammatory response and the osteoarthritis disease pathology. Several studies have reported that the BDKRB2 +9/-9 bp polymorphisms are associated with transcription of the receptor. However, the roles of BDKRB2 polymorphisms in inflammation in osteoarthritis remain unclear. This study enrolled 156 subjects with primary knee osteoarthritis and 58 healthy volunteers. BDKRB2 polymorphisms were genotyped, and the mRNA and protein levels of BDKRB2 in synovial tissues from osteoarthritis patients were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. Nitric oxide production in serum from patients with osteoarthritis was measured using a nitric oxide assay kit. We found that the mean BDKRB2 mRNA levels were significantly higher in Kallgren-Lawrence grade-4 osteoarthritis patients than patients with lower grade osteoarthritis. The +9/-9 bp polymorphisms significantly affected the BDKRB2 mRNA and protein expression levels in synovial tissues from osteoarthritis subjects. Osteoarthritis patients with +9/-9 and -9/-9 genotypes had higher BDKRB2 expression levels in synovial tissue and nitric oxide production in serum. Moreover, positive correlation was found between the BDKRB2 levels in synovial tissue and nitric oxide production. Compared with health controls, significant increases of nitric oxide production in osteoarthritis were detected which were associated with increasing severity of osteoarthritis. Multiple linear regression analysis (adjusted for gender and age) showed serum nitric oxide level was positively associated with BDKRB2 polymorphism and Kallgren-Lawrence grade and was inversely associated with obesity. Our findings showed that the BDKRB2 +9/-9 bp polymorphisms affected the gene expression and nitric oxide production, which were associated with radiographic severity of osteoarthritis, suggesting that the BDKRB2 +9/ -9 bp polymorphisms may act as a genetic modulator of osteoarthritis, and play an essential role in inflammatory process in osteoarthritis.
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Affiliation(s)
- Shuo Chen
- 1 Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Lei Zhang
- 1 Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ruonan Xu
- 2 Offices of Health Care, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yunfan Ti
- 1 Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yunlong Zhao
- 3 Department of Orthopedics, School of Clinical Medicine, Nanjing University, Nanjing 210000, China The first two authors contributed equally to this work
| | - Liwu Zhou
- 1 Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jianning Zhao
- 1 Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Jayabalan P, Ihm J. Rehabilitation Strategies for the Athletic Individual with Early Knee Osteoarthritis. Curr Sports Med Rep 2016; 15:177-83. [PMID: 27172082 DOI: 10.1249/jsr.0000000000000260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Knee osteoarthritis (OA) is a major cause of disability in the United States. The condition has most commonly been associated with elderly sedentary individuals; however, it also can affect those who participate in regular athletic activities. The diagnosis and management of these individuals can be challenging because of both their higher level of physical activity and their overall athletic goals. Treatment requires an appropriate exercise regimen, rehabilitation program, and education of both the athlete and the coach. The focus of our article is to provide an up-to-date overview of the evaluation and management of the athletic individual who presents with symptomatic early knee OA, in particular, the nonsurgical rehabilitation treatment options available to the practitioner and the evidence to support these recommendations.
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Mata-Miranda MM, Martinez-Martinez CM, Noriega-Gonzalez JE, Paredes-Gonzalez LE, Vázquez-Zapién GJ. Morphological, genetic and phenotypic comparison between human articular chondrocytes and cultured chondrocytes. Histochem Cell Biol 2016; 146:183-9. [PMID: 27094849 DOI: 10.1007/s00418-016-1437-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/20/2022]
Abstract
Articular cartilage is an avascular and aneural tissue with limited capacity for regeneration. On large articular lesions, it is recommended to use regenerative medicine strategies, like autologous chondrocyte implantation. There is a concern about morphological changes that chondrocytes suffer once they have been isolated and cultured. Due to the fact that there is little evidence that compares articular cartilage chondrocytes with cultured chondrocytes, in this research we proposed to obtain chondrocytes from human articular cartilage, compare them with themselves once they have been cultured and characterize them through genetic, phenotypic and morphological analysis. Knee articular cartilage samples of 10 mm were obtained, and each sample was divided into two fragments; a portion was used to determine gene expression, and from the other portion, chondrocytes were obtained by enzymatic disaggregation, in order to be cultured and expanded in vitro. Subsequently, morphological, genetic and phenotypic characteristics were compared between in situ (articular cartilage) and cultured chondrocytes. Obtained cultured chondrocytes were rounded in shape, possessing a large nucleus with condensed chromatin and a clear cytoplasm; histological appearance was quite similar to typical chondrocyte. The expression levels of COL2A1 and COL10A1 genes were higher in cultured chondrocytes than in situ chondrocytes; moreover, the expression of COL1A1 was almost undetectable on cultured chondrocytes; likewise, COL2 and SOX9 proteins were detected by immunofluorescence. We concluded that chondrocytes derived from adult human cartilage cultured for 21 days do not tend to dedifferentiate, maintaining their capacity to produce matrix and also retaining their synthesis capacity and morphology.
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Affiliation(s)
- Mónica Maribel Mata-Miranda
- Laboratorio de Biología Celular y Tisular, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico.,CIBA-Tlaxcala, Instituto Politécnico Nacional, 90700, Tepetitla, Tlaxcala, Mexico
| | - Claudia María Martinez-Martinez
- Laboratorio de Biología Celular y Tisular, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico
| | - Jesús Emmanuel Noriega-Gonzalez
- Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Cerrada de Palomas S/N, Lomas de Sotelo, Miguel Hidalgo, 11200, Ciudad de México, Mexico
| | - Luis Enrique Paredes-Gonzalez
- Laboratorio Multidisciplinario de Investigación, Escuela Militar de Graduados de Sanidad, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico
| | - Gustavo Jesús Vázquez-Zapién
- CIBA-Tlaxcala, Instituto Politécnico Nacional, 90700, Tepetitla, Tlaxcala, Mexico. .,Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Cerrada de Palomas S/N, Lomas de Sotelo, Miguel Hidalgo, 11200, Ciudad de México, Mexico.
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Herbolsheimer F, Schaap LA, Edwards MH, Maggi S, Otero Á, Timmermans EJ, Denkinger MD, van der Pas S, Dekker J, Cooper C, Dennison EM, van Schoor NM, Peter R. Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries. Arthritis Care Res (Hoboken) 2016; 68:228-36. [PMID: 26212673 DOI: 10.1002/acr.22669] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/10/2015] [Accepted: 07/14/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle. METHODS Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included. RESULTS Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07-1.62). CONCLUSION This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account.
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Affiliation(s)
| | - Laura A Schaap
- VU University Medical Center, Amsterdam, The Netherlands
| | - Mark H Edwards
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Stefania Maggi
- University of Padua and National Research Council, Padua, Italy
| | - Ángel Otero
- Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | | | - Joost Dekker
- VU University Medical Center, Amsterdam, The Netherlands
| | - Cyrus Cooper
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- University of Southampton and Southampton General Hospital, Southampton, UK
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Alkatan M, Baker JR, Machin DR, Park W, Akkari AS, Pasha EP, Tanaka H. Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis. J Rheumatol 2016; 43:666-72. [DOI: 10.3899/jrheum.151110] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/22/2022]
Abstract
Objective.Arthritis and its associated joint pain act as significant barriers for adults attempting to perform land-based physical activity. Swimming can be an ideal form of exercise for patients with arthritis. Yet there is no information on the efficacy of regular swimming exercise involving patients with arthritis. The effect of a swimming exercise intervention on joint pain, stiffness, and physical function was evaluated in patients with osteoarthritis (OA).Methods.Using a randomized study design, 48 sedentary middle-aged and older adults with OA underwent 3 months of either swimming or cycling exercise training. Supervised exercise training was performed for 45 min/day, 3 days/week at 60–70% heart rate reserve for 12 weeks. The Western Ontario and McMaster Universities Arthritis Index was used to measure joint pain, stiffness, and physical limitation.Results.After the exercise interventions, there were significant reductions in joint pain, stiffness, and physical limitation accompanied by increases in quality of life in both groups (all p < 0.05). Functional capacity as assessed by maximal handgrip strength, isokinetic knee extension and flexion power (15–30% increases), and the distance covered in the 6-min walk test increased (all p < 0.05) in both exercise groups. No differences were observed in the magnitude of improvements between swimming and cycling training.Conclusion.Regular swimming exercise reduced joint pain and stiffness associated with OA and improved muscle strength and functional capacity in middle-aged and older adults with OA. Additionally, the benefits of swimming exercise were similar to the more frequently prescribed land-based cycling training. Trial registration: clinicaltrials.govNCT01836380.
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Abstract
Osteoarthritis (OA) is a common problem in society and can lead to significant disability and impairment of a patient's capacity to perform activities of daily living. The focus of this article is various treatment options for the management of OA, with emphasis on conservative management. The emphasis is on the role of exercise, pharmacology, intra-articular joint injections, and bracing options in the management of OA.
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Affiliation(s)
- Andrew Dubin
- Department of Physical Medicine and Rehabilitation, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, USA.
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50
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Smith T. The challenges of heterogeneity across physiotherapy trials when considering meta-analysis. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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