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Fu K, Makovey J, Metcalf B, Bennell KL, Zhang Y, Asher R, Robbins SR, Deveza LA, Cistulli PA, Hunter DJ. Sleep Quality and Fatigue Are Associated with Pain Exacerbations of Hip Osteoarthritis: An Internet-based Case-crossover Study. J Rheumatol 2019; 46:1524-1530. [PMID: 30936279 DOI: 10.3899/jrheum.181406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the association of sleep quality, sleep duration, and fatigue with hip pain exacerbations in persons with symptomatic hip osteoarthritis (OA). METHODS Participants (n = 252) were followed for 90 days and asked to complete online questionnaires at 10-day intervals (control periods). A hip pain exacerbation (case periods) was defined as an increase of 2 points in pain intensity compared with baseline on a numeric rating scale (0-10). Subjective sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index, and fatigue was measured by Multidimensional Assessment of Fatigue in both periods. Univariable and multivariable conditional logistic regressions were used to assess the association. RESULTS Of the 252 participants, 130 (52%) were included in the final analysis. Univariate association analysis showed that both poor sleep quality and greater fatigue were associated with increased odds of pain exacerbations (OR 1.72, 95% CI 1.04-2.86; OR 1.92, 95% CI 1.21-3.05, respectively). Short sleep duration was not associated with pain exacerbations. Poor sleep quality and greater fatigue remained associated with pain exacerbations after adjustment for physical activity and night pain levels in multivariable analysis. There was no significant interaction between sleep quality and fatigue (p = 0.21). CONCLUSION Poor sleep quality and greater fatigue were related to pain exacerbation in persons with symptomatic hip OA. Sleep disorders and fatigue should be considered when dealing with pain exacerbations.
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Affiliation(s)
- Kai Fu
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. .,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney.
| | - Joanna Makovey
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Ben Metcalf
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Kim L Bennell
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Yuqing Zhang
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Rebecca Asher
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Sarah R Robbins
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Leticia A Deveza
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - Peter A Cistulli
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
| | - David J Hunter
- From the Kolling Institute of Medical Research, Institute of Bone and Joint Research; Department of Rheumatology, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney; Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,K. Fu, MBBS, Mch, PhD Candidate, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; J. Makovey, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; B. Metcalf, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne; Y. Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard School of Medicine; R. Asher, PhD, NHMRC Clinical Trials Centre, University of Sydney; S.R. Robbins, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; L.A. Deveza, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney; P.A. Cistulli, PhD, Charles Perkins Centre, Sydney Medical School, University of Sydney, and Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Northern Clinical School, University of Sydney; D.J. Hunter, PhD, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, and Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney
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