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Beales D, Boyle E, Fary R, Mikhailov A, Saunders B, Coates S, Evans K, Simic M, Sterling M, Bennell K, Rebbeck T. Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study. Musculoskelet Sci Pract 2024; 74:103178. [PMID: 39270531 DOI: 10.1016/j.msksp.2024.103178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/11/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis). DESIGN Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction). RESULTS Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of 'ethicality', 'intervention coherence', 'self-efficacy' and 'affective attitude'. Divergence was identified in 'perceived effectiveness'. DISCUSSION In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists' care was perceived as a positive addition to usual care.
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Affiliation(s)
- Darren Beales
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845. https://twitter.com/DBealesPhysio
| | - Eileen Boyle
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Robyn Fary
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Anton Mikhailov
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Benjamin Saunders
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; School of Allied Health, Australian Catholic University, 33 Berry Street, North Sydney, New South Wales, 2060, Australia.
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; Healthia Limited, Brisbane, Queensland, 4006, Australia.
| | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR CRE: Better Health Outcomes for Compensable Injuries University of Queensland, Level 7 STARS Building, Herston Road, Herston, 4006, Australia.
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria, 3053, Australia.
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
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Goree JH, Grant SA, Dickerson DM, Ilfeld BM, Eshraghi Y, Vaid S, Valimahomed AK, Shah JR, Smith GL, Finneran JJ, Shah NN, Guirguis MN, Eckmann MS, Antony AB, Ohlendorf BJ, Gupta M, Gilbert JE, Wongsarnpigoon A, Boggs JW. Randomized Placebo-Controlled Trial of 60-Day Percutaneous Peripheral Nerve Stimulation Treatment Indicates Relief of Persistent Postoperative Pain, and Improved Function After Knee Replacement. Neuromodulation 2024; 27:847-861. [PMID: 38739062 DOI: 10.1016/j.neurom.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) is an effective surgery for end-stage knee osteoarthritis, but chronic postoperative pain and reduced function affect up to 20% of patients who undergo such surgery. There are limited treatment options, but percutaneous peripheral nerve stimulation (PNS) is a promising nonopioid treatment option for chronic, persistent postoperative pain. The objective of the present study was to evaluate the effect of a 60-day percutaneous PNS treatment in a multicenter, randomized, double-blind, placebo-controlled trial for treating persistent postoperative pain after TKA. MATERIALS AND METHODS Patients with postoperative pain after knee replacement were screened for this postmarket, institutional review board-approved, prospectively registered (NCT04341948) trial. Subjects were randomized to receive either active PNS or placebo (sham) stimulation. Subjects and a designated evaluator were blinded to group assignments. Subjects in both groups underwent ultrasound-guided placement of percutaneous fine-wire coiled leads targeting the femoral and sciatic nerves on the leg with postoperative pain. Leads were indwelling for eight weeks, and the primary efficacy outcome compared the proportion of subjects in each group reporting ≥50% reduction in average pain relative to baseline during weeks five to eight. Functional outcomes (6-minute walk test; 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index) and quality of life (Patient Global Impression of Change) also were evaluated at end of treatment (EOT). RESULTS A greater proportion of subjects in the PNS groups (60%; 12/20) than in the placebo (sham) group (24%; 5/21) responded with ≥50% pain relief relative to baseline (p = 0.028) during the primary endpoint (weeks 5-8). Subjects in the PNS group also walked a significantly greater distance at EOT than did those in the placebo (sham) group (6MWT; +47% vs -9% change from baseline; p = 0.048, n = 18 vs n = 20 completed the test, respectively). Prospective follow-up to 12 months is ongoing. CONCLUSIONS This study provides evidence that percutaneous PNS decreases persistent pain, which leads to improved functional outcomes after TKA at EOT.
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Affiliation(s)
- Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Stuart A Grant
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Yashar Eshraghi
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Sandeep Vaid
- Better Health Clinical Research, Newnan, GA, USA
| | | | - Jarna R Shah
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Lawson Smith
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Nirav N Shah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Maged N Guirguis
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Maxim S Eckmann
- Department of Anesthesiology, University of Texas San Antonio, San Antonio, TX, USA
| | | | - Brian J Ohlendorf
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Mayank Gupta
- Neuroscience Research Center, Overland Park, KS, USA
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Jönsson T, Eek F, Hansson EE, Dahlberg LE, Dell’Isola A. Factors associated with clinically relevant pain reduction after a self-management program including education and exercise for people with knee and/or hip osteoarthritis: Data from the BOA register. PLoS One 2023; 18:e0282169. [PMID: 36827245 PMCID: PMC9955666 DOI: 10.1371/journal.pone.0282169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
AIM To examine the associations between individual- and disease-related factors and the odds of reaching a clinically relevant pain reduction in people with knee and/or hip osteoarthritis (OA) who underwent a first-line self-management program. MATERIALS AND METHODS An observational registry-based study including people with knee (n = 18,871) and hip (n = 7,767) OA who participated in a self-management program including education and exercise and had data recorded in the Better Management of patients with Osteoarthritis (BOA) register. We used multivariable logistic regression models to study the association between sex, age, body mass index (BMI), education, comorbidity, pain frequency, walking difficulties, willingness to undergo surgery and the odds of reaching a clinically relevant pain reduction (decrease of >33% on a 0-10 NRS scale) 3 and 12 months after the intervention. All analyses were stratified by joint (knee/hip). RESULTS Both in the short- and long-term follow-up, a younger age (18-65 years), a lower BMI (< 25), a higher level of education (university), the absence of comorbidities impacting the ability to walk, less frequent pain and not being willing to undergo surgery were associated with higher odds of reaching a clinically relevant pain reduction in people with knee OA. We found similar results for people with hip OA, but with larger uncertainty in the estimates (wider 95% CI). CONCLUSION Our study suggests that early fist line self-management interventions delivered when people have unilateral hip or knee OA with less frequent pain and are unwilling to undergo surgery, may be important for reaching a clinically relevant pain reduction after participation. Providing the most appropriate treatment to the right patient at the right time is a step in reducing the burden of OA for society and the patient.
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Affiliation(s)
- Thérése Jönsson
- Department of Health Sciences, Sport Sciences, Lund University, Lund, Sweden,* E-mail:
| | - Frida Eek
- Department of Health Sciences, Human Movement: Health and Rehabilitation, Lund University, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Human Movement: Health and Rehabilitation, Lund University, Lund, Sweden
| | - Leif E. Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
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Eyles JP, Mills K, Lucas BR, Robbins SR, O'Connell RL, Williams M, Lee H, Appleton S, Hunter DJ. Examining patient activation and other factors associated with changes in pain and function following best evidence osteoarthritis care. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100197. [DOI: 10.1016/j.ocarto.2021.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
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Pihl K, Roos EM, Taylor RS, Grønne DT, Skou ST. Prognostic Factors for Health Outcomes After Exercise Therapy and Education in Individuals With Knee and Hip Osteoarthritis With or Without Comorbidities: A Study of 37,576 Patients Treated in Primary Care. Arthritis Care Res (Hoboken) 2021; 74:1866-1878. [PMID: 34085408 PMCID: PMC7613737 DOI: 10.1002/acr.24722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify prognostic factors for health outcomes following an 8-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis (OA) alone or with concomitant hypertension, heart or respiratory disease, diabetes mellitus, or depression. METHODS We included individuals with knee and/or hip OA from the Good Life With OsteoArthritis in Denmark (GLA:D) program. GLA:D consists of 2 patient education sessions and 12 supervised exercise therapy sessions. Before GLA:D, participants self-reported any comorbidities and were categorized into 8 comorbidity groups. Twenty-one potential prognostic factors (demographic information, clinical data, and performance-based physical function) gathered from participants and clinicians before the program were included. Outcomes were physical function using the 40-meter Fast-Paced Walk Test (FPWT), health-related quality of life using the 5-level EuroQol 5-domain (EQ-5D-5L) index score, and pain intensity using a visual analog scale (VAS; range 0-100) assessed before and immediately after the GLA:D program. Within each comorbidity group, associations of prognostic factors with outcomes were estimated using multivariable linear regression. RESULTS Data from 35,496 (40-meter FPWT) and 37,576 (EQ-5D-5L and VAS) participants were included in the analyses. Clinically relevant associations were demonstrated between age, self-efficacy, self-rated health, and pain intensity and change in 40-meter FPWT, EQ-5D-5L, or VAS scores across comorbidity groups. Furthermore, anxiety, education, physical function, and smoking were associated with outcomes among subgroups having depression or diabetes mellitus in addition to OA. CONCLUSION Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an 8-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities.
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Affiliation(s)
- Kenneth Pihl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, UK,Institute of Health Services Research, University of Exeter Medical School, UK
| | - Dorte T Grønne
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
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Weigl M, Letzel J, Angst F. Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain. BMC Musculoskelet Disord 2021; 22:330. [PMID: 33812386 PMCID: PMC8019506 DOI: 10.1186/s12891-021-04194-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme. Methods In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period. Results The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172). Conclusions Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04194-9.
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Affiliation(s)
- Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Josefine Letzel
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Internal Medicine, Klinikum Dritter Orden, Munich, Germany
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
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Kocic M, Milenkovic M, Nikolic D, Lazovic M, Grbic R, Colovic H, Stojanovic Z. Factors associated with poor self-reported function and quality of life in patients with end-stage knee or hip osteoarthritis immediately prior to total joint arthroplasty. Arch Med Sci 2021; 17:1340-1350. [PMID: 34522264 PMCID: PMC8425251 DOI: 10.5114/aoms.2019.90143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/30/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The aim was to evaluate patients' perception of function and physical and mental dimensions of health-related quality of life (HRQoL) in patients with end-stage knee or hip osteoarthritis (OA) immediately prior to surgery and to identify the factors associated with the outcomes. MATERIAL AND METHODS The study included 200 patients with end-stage OA (100 knee OA and 100 hip OA patients). Self-reported physical function was assessed using the Oxford Knee Score or Oxford Hip Score. Physical and mental dimensions of HRQoL were assessed using the physical and mental component summary scores of the 36-Item Short-Form Health Survey. Multivariate linear regression analysis was used to identify the sociodemographic, clinical and psychological factors associated with self-reported function and physical and mental dimensions of HRQoL. RESULTS End-stage knee or hip OA patients had poor function and physical dimension of HRQoL, while the mental dimension of HRQoL was not impaired. In knee OA, pain, flexion range of motion (ROM), catastrophizing, and anxiety were significantly associated with self-reported function (explained 56% of the variance), whereas catastrophizing explained 10% of the variance of the physical dimension of HRQoL. In hip OA, flexion ROM, catastrophizing and being employed were significantly associated with self-reported function (explained 44% of the variance), whereas catastrophizing and flexion ROM explained 34% of the variance of the physical dimension of HRQoL. CONCLUSIONS Many investigated factors were associated with poor self-reported function and HRQoL in knee and hip OA. However, the most important factors for both knee and hip OA were catastrophizing and flexion ROM.
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Affiliation(s)
- Mirjana Kocic
- Physical Medicine and Rehabilitation Clinic, Clinical Center Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | | | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Physical Medicine and Rehabilitation Department, University Children’s Hospital, Belgrade, Serbia
| | - Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Rehabilitation, Belgrade, Serbia
| | - Rade Grbic
- Faculty of Medicine Kosovska Mitrovica, University of Pristina, Pristina, Serbia
| | - Hristina Colovic
- Physical Medicine and Rehabilitation Clinic, Clinical Center Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
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Tanaka S, Robbins SM, Inoue Y, Tanaka R. Factors associated with health-related quality of life in Japanese patients with hip osteoarthritis: A cross-sectional study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720921183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Purpose: Chronic symptoms related with hip osteoarthritis (OA) can negatively affect health-related quality of life (HRQoL). The purpose of this study was to examine factors related to a HRQoL measure that considers an Asian lifestyle in Japanese patients with hip OA. Methods: Forty-seven female subjects participated. The dependent variable was the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), which assessed HRQoL. Potential factors were measured as independent variables. After screening, potential variables were entered into a multiple regression analysis to determine which variables were related to HRQoL. Results: In the regression model, knee extension muscle strength on the unaffected side and hip flexion range of motion (ROM) on the affected side were associated with HRQoL. Higher strength and higher ROM were related to greater HRQoL. Conclusion: Results can help health-care providers develop appropriate rehabilitation programs for improving HRQoL in patients with hip OA.
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Affiliation(s)
- Shigeharu Tanaka
- Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Davis House, Promenade Sir-William-Osler, Montreal, QC, Canada
| | - Yu Inoue
- Research Institute of Health and Welfare, KIBI International University, Takahashi, Okayama, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan
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Responder Profile to Pharmaceutical-Grade Chondroitin Sulfate: An Analysis of the CONCEPT Trial. Adv Ther 2020; 37:4641-4648. [PMID: 32954487 PMCID: PMC7547984 DOI: 10.1007/s12325-020-01484-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 12/25/2022]
Abstract
Introduction The recent CONCEPT study showed that 800 mg/day of pharmaceutical-grade chondroitin sulfate (CS) was superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in patients with symptomatic knee osteoarthritis (OA). We investigate, in the present study, whether a responder profile to CS could be defined (i.e., to determine a patient’s profile with the best response to treatment). Methods Subjects from the CS group of the CONCEPT study were included in the present analysis. Within the CS group, various subgroups were created on the basis of different categories of age, sex, body mass index, Kellgren and Lawrence grade, age since the beginning of OA, and baseline level of pain (i.e., VAS) or function (i.e., Lequesne index). The nonparametric Kruskal–Wallis (KW) test was applied to compare the VAS pain/Lequesne index evolutions between the subgroups, and the Dwass, Steel, Critchlow, Fligner (DSCF) procedure was used to compute multiple comparisons. The impact of various covariates on the VAS pain/Lequesne index evolution was assessed by means of multiple regression. Results Across all analyses, the probability of response to CS treatment was significantly associated with the duration between the date of diagnosis and the initiation of treatment. In other words, the shorter the interval between the diagnosis and the beginning of the treatment, the higher the response for both pain and function, particularly for patients with a duration of less than 5 years compared to patients with a duration of 10 years or more. No other criteria were found to be consistently associated with the response to CS treatment. Conclusion The treatment of OA with CS has the highest chance of success if administered in the early stage of the disease. Further research with other clinical outcomes should be carried out prior to widespread application of these findings. Trial Registration ClinicalTrials.gov identifier, NCT03200288.
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Sociodemographic Inequalities in Outcomes of a Swedish Nationwide Self-Management Program for Osteoarthritis: Results from 22,741 Patients between Years 2008-2017. J Clin Med 2020; 9:jcm9072294. [PMID: 32707725 PMCID: PMC7408785 DOI: 10.3390/jcm9072294] [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: 06/17/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to investigate if there are educational level and birthplace related differences in joint-related pain, health-related quality of life (HRQoL), willingness to undergo joint surgery, walking difficulties, physical activity level, fear-avoidance behavior before, as well as three and 12 months after participation in a structured self-management program for hip and knee osteoarthritis. Differences in adherence to and use of knowledge from the program were also investigated. An observational national register-based study was performed with a prospective longitudinal design using patient and physiotherapist-reported data on 22,741 complete cases from the National Quality Register for better management of patients with osteoarthritis (BOA) during years 2008–2017. At baseline and after three and 12 months follow-up, higher educational level and being domestic-born was associated with less joint-related pain, better HRQoL, lower willingness to undergo joint surgery, fewer walking difficulties, higher physical activity level, and less fear-avoidance behavior. Foreign born individuals demonstrated higher adherence to exercise and reported better use of the self-management program. The BOA self-management program may require further pedagogical refinement to suit participants of different sociodemographic backgrounds and health literacy. A more patient-centered delivery, sensitive to educational, ethnic, and cultural differences may potentially reduce inequalities in future outcomes.
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Ditton E, Johnson S, Hodyl N, Flynn T, Pollack M, Ribbons K, Walker FR, Nilsson M. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol 2020; 11:1061. [PMID: 32670136 PMCID: PMC7326061 DOI: 10.3389/fpsyg.2020.01061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients' real-world "quality of life" experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model's predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Johnson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computing, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicolette Hodyl
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Traci Flynn
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Humanities and Social Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Pollack
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Karen Ribbons
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Gwynne-Jones DP, Gray AR, Hutton LR, Stout KM, Abbott JH. Outcomes and Factors Influencing Response to an Individualized Multidisciplinary Chronic Disease Management Program for Hip and Knee Osteoarthritis. J Arthroplasty 2018; 33:2780-2786. [PMID: 29739632 DOI: 10.1016/j.arth.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective of the study was to investigate the effectiveness of, and factors associated with, response to a chronic disease management program for patients with hip and knee osteoarthritis (OA). METHODS Over a 2-year period (2012-2014), 218 patients (97 hip OA; 121 knee OA) were managed with an individualized program of interventions that could include education, physiotherapy, orthotics, occupational therapy, or dietitian referral. Changes in Oxford Hip Score or Oxford Knee Score and Short Form-12 (SF-12) Physical and Mental Component Summary Score (PCS, MCS) were analyzed by joint affected, both unadjusted, and gender and age adjusted. A further analysis also adjusted for body mass index. RESULTS At mean 12-month follow-up, patients with knee OA had a statistically significant improvement in Oxford Knee Score and PCS, while patients with hip OA had a statistically significant deterioration in all 3 scores. There was evidence that these changes differed between joints for Oxford and PCS scores. Older age was associated with worse outcomes for Oxford scores. Higher body mass index was associated with worse outcomes for Oxford and PCS scores. Patients with hip OA (35%) were more likely to deteriorate to a clinically significant extent (5 points) for Oxford scores than those with knee OA. Gender was not associated with outcomes. Patients with hip OA (54%) were more likely than those with knee OA (24%) to have subsequently had surgery (P < .001). CONCLUSIONS Patients with knee OA were more likely to improve with a chronic disease management plan than patients with hip OA and efforts should be directed to them.
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Affiliation(s)
- David P Gwynne-Jones
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Section of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Andrew R Gray
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Liam R Hutton
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Kirsten M Stout
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Section of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Ilfeld BM, Ball ST, Gabriel RA, Sztain JF, Monahan AM, Abramson WB, Khatibi B, Said ET, Parekh J, Grant SA, Wongsarnpigoon A, Boggs JW. A Feasibility Study of Percutaneous Peripheral Nerve Stimulation for the Treatment of Postoperative Pain Following Total Knee Arthroplasty. Neuromodulation 2018; 22:653-660. [PMID: 30024078 PMCID: PMC6339601 DOI: 10.1111/ner.12790] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/19/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The objective of the present feasibility study was to investigate the use of a new treatment modality-percutaneous peripheral nerve stimulation (PNS)-in controlling the often severe and long-lasting pain following total knee arthroplasty (TKA). METHODS For patients undergoing a primary, unilateral TKA, both femoral and sciatic open-coil percutaneous leads (SPR Therapeutics, Cleveland, OH) were placed up to seven days prior to surgery using ultrasound guidance. The leads were connected to external stimulators and used both at home and in the hospital for up to six weeks total. RESULTS In six of seven subjects (86%), the average of daily pain scores across the first two weeks was <4 on the 0-10 Numeric Rating Scale for pain. A majority of subjects (four out of seven; 57%) had ceased opioid use within the first week (median time to opioid cessation for all subjects was six days). Gross sensory/motor function was maintained during stimulation, enabling stimulation during physical therapy and activities of daily living. At 12 weeks following surgery, six of seven subjects had improved by >10% on the Six-Minute Walk Test compared to preoperative levels, and WOMAC scores improved by an average of 85% compared to before surgery. No falls, motor block, or lead infections were reported. CONCLUSIONS This feasibility study suggests that for TKA, ultrasound-guided percutaneous PNS is feasible in the immediate perioperative period and may provide analgesia without the undesirable systemic effects of opioids or quadriceps weakness induced by local anesthetics-based peripheral nerve blocks.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.,The Outcomes Research Consortium, Cleveland, OH, USA
| | - Scott T Ball
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.,The Outcomes Research Consortium, Cleveland, OH, USA
| | - Jacklynn F Sztain
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Amanda M Monahan
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Wendy B Abramson
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Bahareh Khatibi
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Jesal Parekh
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Stuart A Grant
- Duke University Medical Center, Duke University, Durham, NC, USA
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis. Pain 2018; 159:1877-1886. [DOI: 10.1097/j.pain.0000000000001288] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lee AC, Harvey WF, Han X, Price LL, Driban JB, Bannuru RR, Wang C. Pain and functional trajectories in symptomatic knee osteoarthritis over up to 12 weeks of exercise exposure. Osteoarthritis Cartilage 2018; 26:501-512. [PMID: 29391277 PMCID: PMC5871586 DOI: 10.1016/j.joca.2018.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/28/2017] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is the recommended treatment for knee osteoarthritis (OA). However, heterogeneous patterns in treatment response are poorly understood. Our purpose was to identify pain and functional trajectories from exercise interventions in knee OA, and to determine their association with baseline factors. METHODS Prospective cohort of 171 participants (mean age 61 years; BMI 32 kg/m2, 71% female; 57% white) with symptomatic knee OA from a randomized trial comparing 12-week Tai Chi and Physical Therapy. We analyzed weekly Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores using group-based trajectory models. Associations between baseline factors and trajectories were examined using multinomial logistic regression. RESULTS We identified four pain trajectories: Lower-Early Improvement (43%), Moderate-Early Improvement (32%), Higher-Delayed Improvement (15%), and Higher-No Improvement (10%). We found similar trajectories for function, except that the lower function trajectories diverged into gradual (12%) or delayed-improvement (15%). Compared with the Lower-Early Improvement pain trajectory, moderate and higher trajectories were associated with poorer physical and psychosocial health. A similar pattern of associations were found among the function trajectories. CONCLUSIONS We found four distinct trajectories for pain and function over up to 12-weeks of exercise interventions. While most participants experienced improvements over a short-term exposure, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care in knee OA.
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Affiliation(s)
- Augustine C. Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - William F. Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Xingyi Han
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Jeffrey B. Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Raveendhara R. Bannuru
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA,Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
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Kobsar D, Osis ST, Boyd JE, Hettinga BA, Ferber R. Wearable sensors to predict improvement following an exercise intervention in patients with knee osteoarthritis. J Neuroeng Rehabil 2017; 14:94. [PMID: 28899433 PMCID: PMC5596963 DOI: 10.1186/s12984-017-0309-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/07/2017] [Indexed: 01/09/2023] Open
Abstract
Background Muscle strengthening exercises consistently demonstrate improvements in the pain and function of adults with knee osteoarthritis, but individual response rates can vary greatly. Identifying individuals who are more likely to respond is important in developing more efficient rehabilitation programs for knee osteoarthritis. Therefore, the purpose of this study was to determine if pre-intervention multi-sensor accelerometer data (e.g., back, thigh, shank, foot accelerometers) and patient reported outcome measures (e.g., pain, symptoms, function, quality of life) can retrospectively predict post-intervention response to a 6-week hip strengthening exercise intervention in a knee OA cohort. Methods Thirty-nine adults with knee osteoarthritis completed a 6-week hip strengthening exercise intervention and were sub-grouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in patient reported outcome measures. Pre-intervention multi-sensor accelerometer data recorded at the back, thigh, shank, and foot and Knee Injury and Osteoarthritis Outcome Score subscale data were used as potential predictors of response in a discriminant analysis of principal components. Results The thigh was the single best placement for classifying responder sub-groups (74.4%). Overall, the best combination of sensors was the back, thigh, and shank (81.7%), but a simplified two sensor solution using the back and thigh was not significantly different (80.0%; p = 0.27). Conclusions While three sensors were best able to identify responders, a simplified two sensor array at the back and thigh may be the most ideal configuration to provide clinicians with an efficient and relatively unobtrusive way to use to optimize treatment. Electronic supplementary material The online version of this article (10.1186/s12984-017-0309-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dylan Kobsar
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
| | - Sean T Osis
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Running Injury Clinic, Calgary, AB, Canada
| | - Jeffrey E Boyd
- Department of Computer Science, University of Calgary, Calgary, AB, Canada
| | - Blayne A Hettinga
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Running Injury Clinic, Calgary, AB, Canada
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Lee AC, Harvey WF, Price LL, Han X, Driban JB, Wong JB, Chung M, McAlindon TE, Wang C. Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis. Arch Phys Med Rehabil 2017; 98:2265-2273.e1. [PMID: 28506776 DOI: 10.1016/j.apmr.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association between baseline mindfulness and response from exercise interventions in knee osteoarthritis (OA). DESIGN Cohort study; responder analysis of a clinical trial subset. SETTING Urban tertiary care academic hospital. PARTICIPANTS Participants with symptomatic, radiographic knee OA (N=86; mean age, 60y; 74% female; 48% white). INTERVENTIONS Twelve weeks (twice per week) of Tai Chi or physical therapy exercise. MAIN OUTCOME MEASURES Treatment response was defined using Osteoarthritis Research Society International criteria indicating meaningful improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC function, or Patient Global Assessment scores. At baseline, participants completed the Five Facet Mindfulness Questionnaire (mean total score, 142±17) and were grouped into 3 categories of total mindfulness: higher, medium, or lower. Relative risk (RR) ratios were used to compare treatment response across groups. RESULTS Participants with higher total mindfulness were 38% (95% confidence interval [CI], 1.05-1.83) more likely to meet responder criteria than those with lower mindfulness. We found no significant difference between medium and lower mindfulness groups (RR=1.0; 95% CI, 0.69-1.44). Among the 5 mindfulness facets, medium acting-with-awareness was 46% (95% CI, 1.09-1.96) more likely to respond than lower acting-with-awareness, and higher acting-with-awareness was 34% more likely to respond, but this did not reach significance (95% CI, 0.97-1.86). CONCLUSIONS In this study, higher mindfulness, primarily driven by its acting-with-awareness facet, was significantly associated with a greater likelihood of response to nonpharmacologic exercise interventions in knee OA. This suggests that mindfulness-cultivating interventions may increase the likelihood of response from exercise.
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Affiliation(s)
- Augustine C Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Xingyi Han
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Jeffrey B Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - John B Wong
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Mei Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Timothy E McAlindon
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.
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Allen KD, Oddone EZ, Coffman CJ, Jeffreys AS, Bosworth HB, Chatterjee R, McDuffie J, Strauss JL, Yancy WS, Datta SK, Corsino L, Dolor RJ. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial. Ann Intern Med 2017; 166:401-411. [PMID: 28114648 PMCID: PMC6862719 DOI: 10.7326/m16-1245] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. OBJECTIVE To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. DESIGN Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). SETTING 10 Duke University Health System community-based primary care clinics. PARTICIPANTS 537 outpatients with symptomatic hip or knee osteoarthritis. INTERVENTION The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. MEASUREMENTS The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. RESULTS No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. LIMITATIONS The study involved 1 health care network. Data on provider referrals were not collected. CONCLUSION Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. PRIMARY FUNDING SOURCE National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Kelli D Allen
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Eugene Z Oddone
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Cynthia J Coffman
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Amy S Jeffreys
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Hayden B Bosworth
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Ranee Chatterjee
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer McDuffie
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Strauss
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - William S Yancy
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Santanu K Datta
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Leonor Corsino
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Rowena J Dolor
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
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Teoh LSG, Eyles JP, Makovey J, Williams M, Kwoh CK, Hunter DJ. Observational study of the impact of an individualized multidisciplinary chronic care program for hip and knee osteoarthritis treatment on willingness for surgery. Int J Rheum Dis 2016; 20:1383-1392. [DOI: 10.1111/1756-185x.12950] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laurence S. G. Teoh
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Jillian P. Eyles
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Joanna Makovey
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - Matthew Williams
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
| | - C. Kent. Kwoh
- Department of Medicine; University of Arizona Arthritis Center and Division of Rheumatology; University of Arizona College of Medicine; Tucson Arizona USA
| | - David J. Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research; Kolling Institute; University of Sydney; Sydney New South Wales Australia
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Eyles JP, Mills K, Lucas BR, Williams MJ, Makovey J, Teoh L, Hunter DJ. Can We Predict Those With Osteoarthritis Who Will Worsen Following a Chronic Disease Management Program? Arthritis Care Res (Hoboken) 2016; 68:1268-77. [PMID: 26749177 DOI: 10.1002/acr.22836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify predictors of worsening symptoms and overall health of the treated hip or knee joint following 26 weeks of a nonsurgical chronic disease management program for hip and knee osteoarthritis (OA) and to examine the consistency of these predictors across 3 definitions of worsening. METHODS This prospective cohort study followed 539 participants of the program for 26 weeks. The 3 definitions of worsening included symptomatic worsening based on change in the Western Ontario and McMaster Universities Osteoarthritis Index Global score (WOMAC-G) measuring pain, stiffness, and function; a transition scale that asked about overall health of the treated hip or knee joint; and a composite outcome including both. Multivariate logistic regression models were constructed for the 3 definitions of worsening. RESULTS Complete data were available for 386 participants: mean age was 66.3 years, 69% were female, 85% reported knee joint pain as primary symptom (signal joint), 46% were waitlisted for total joint arthroplasty (TJA). TJA waitlist status, signal joint, 6-Minute Walk Test (6MWT), depressive symptoms, pain, and age were independently associated with at least 1 definition of worsening. TJA waitlist status and 6MWT remained in the multivariate models for the transition and composite definitions of worsening. CONCLUSION Participants reporting worsening on the transition scale did not consistently meet the WOMAC-G definition of worsening symptoms. TJA waitlist status was predictive of the composite definition of worsening, a trend apparent for the transition definition. However, variables that predict worsening remain largely unknown. Further research is required to direct comprehensive and targeted management of patients with hip and knee OA.
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Affiliation(s)
- Jillian P Eyles
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Mills
- Macquarie University, Sydney, New South Wales, Australia
| | - Barbara R Lucas
- Royal North Shore Hospital, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew J Williams
- Royal North Shore Hospital, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Joanna Makovey
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Laurence Teoh
- North Shore Hospital, Takapuna, Auckland, New Zealand
| | - David J Hunter
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
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Amano T, Tamari K, Tanaka S, Uchida S, Ito H, Morikawa S, Kawamura K. Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study. PLoS One 2016; 11:e0159172. [PMID: 27410385 PMCID: PMC4943652 DOI: 10.1371/journal.pone.0159172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/28/2016] [Indexed: 11/18/2022] Open
Abstract
The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of early rehabilitation.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan
- Graduate School of Health Science, KIBI International University, Takahashi, Okayama, Japan
- * E-mail:
| | | | - Shigeharu Tanaka
- Department of Physical Therapy, Kawasaki Junior College of Rehabilitation, Kurashiki, Okayama, Japan
| | - Shigehiro Uchida
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Hiroshima, Japan
| | - Hideyuki Ito
- Department of Physical Therapy, Yamaguchi Allied Health College, Yamaguchi, Yamaguchi, Japan
| | - Shinya Morikawa
- Department of Rehabilitation, Hohsyasen Daiichi Hospital, Imabari, Ehime, Japan
| | - Kenji Kawamura
- Graduate School of Health Science, KIBI International University, Takahashi, Okayama, Japan
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Allen KD, Yancy WS, Bosworth HB, Coffman CJ, Jeffreys AS, Datta SK, McDuffie J, Strauss JL, Oddone EZ. A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial. Ann Intern Med 2016; 164:73-83. [PMID: 26720751 PMCID: PMC4732728 DOI: 10.7326/m15-0378] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused. OBJECTIVE To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes. DESIGN Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740). SETTING Department of Veterans Affairs Medical Center in Durham, North Carolina. PARTICIPANTS 30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis. INTERVENTION The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record. MEASUREMENTS The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes. RESULTS At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ. LIMITATION The study was conducted in a single Veterans Affairs medical center. CONCLUSION The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Health Services Research and Development Service.
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Kobsar D, Osis ST, Hettinga BA, Ferber R. Gait Biomechanics and Patient-Reported Function as Predictors of Response to a Hip Strengthening Exercise Intervention in Patients with Knee Osteoarthritis. PLoS One 2015; 10:e0139923. [PMID: 26444426 PMCID: PMC4596804 DOI: 10.1371/journal.pone.0139923] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/19/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Muscle strengthening exercises have been shown to improve pain and function in adults with mild-to-moderate knee osteoarthritis, but individual response rates can vary greatly. Predicting individuals who respond and those who do not is important in developing a more efficient and effective model of care for knee osteoarthritis (OA). Therefore, the purpose of this study was to use pre-intervention gait kinematics and patient-reported outcome measures to predict post-intervention response to a 6-week hip strengthening exercise intervention in patients with mild-to-moderate knee OA. Methods Thirty-nine patients with mild-to-moderate knee osteoarthritis completed a 6-week hip-strengthening program and were subgrouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in Knee injury Osteoarthritis Outcome Score (KOOS). Predictors of responder subgroups were retrospectively determined from baseline patient-reported outcome measures and kinematic gait parameters in a discriminant analysis of principal components. A 3–4 year follow-up on 16 of the patients with knee OA was also done to examine long-term changes in these parameters. Results A unique combination of patient-reported outcome measures and kinematic factors was able to successfully subgroup patients with knee osteoarthritis with a cross-validated classification accuracy of 85.4%. Lower patient-reported function in daily living (ADL) scores and hip frontal plane kinematics during the loading response were most important in classifying High-Responders from other sub-groups, while a combination of hip, knee, ankle kinematics were used to classify Non-Responders from Low-Responders. Conclusion Patient-reported outcome measures and objective biomechanical gait data can be an effective method of predicting individual treatment success to an exercise intervention. Measuring gait kinematics, along with patient-reported outcome measures in a clinical setting can be useful in helping make evidence-based decisions regarding optimal treatment for patients with knee OA.
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Affiliation(s)
- Dylan Kobsar
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Sean T. Osis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Blayne A. Hettinga
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study. BMJ Open 2015; 5:e007430. [PMID: 26059523 PMCID: PMC4466621 DOI: 10.1136/bmjopen-2014-007430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. METHODS AND ANALYSIS This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. ETHICS AND DISSEMINATION This study has been approved by St James' Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. TRIAL REGISTRATION NUMBER NCT02310945.
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Affiliation(s)
- Helen O'Leary
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Keith M Smart
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh A Moloney
- Discipline of Physiotherapy, Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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Eyles JP, Lucas BR, Patterson JA, Williams MJ, Weeks K, Fransen M, Hunter DJ. Does clinical presentation predict response to a nonsurgical chronic disease management program for endstage hip and knee osteoarthritis? J Rheumatol 2014; 41:2223-31. [PMID: 25225284 DOI: 10.3899/jrheum.131475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify baseline characteristics of participants who will respond favorably following 6 months of participation in a chronic disease management program for hip and knee osteoarthritis (OA). METHODS This prospective cohort study assessed 559 participants at baseline and following 6 months of participation in the Osteoarthritis Chronic Care Program. Response was defined as the minimal clinically important difference of an 18% and 9-point absolute improvement in the Western Ontario and McMaster Universities Arthritis Index global score. Multivariate logistic regression modeling was used to identify predictors of response. RESULTS Complete data were available for 308 participants. Those who withdrew within the study period were imputed as nonresponders. Three variables were independently associated with response: signal joint (knee vs hip), sex, and high level of comorbidity. Index joint and sex were significant in the multivariate model, but the model was not a sensitive predictor of response. CONCLUSION Strong predictors of response to a chronic disease management program for hip and knee OA were not identified. The significant predictors that were found should be considered in future studies.
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Affiliation(s)
- Jillian P Eyles
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Barbara R Lucas
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Jillian A Patterson
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Matthew J Williams
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Kate Weeks
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Marlene Fransen
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - David J Hunter
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney.
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Abstract
BACKGROUND Physical therapy for hip osteoarthritis (OA) has shown short-term effects but limited long-term benefit. There has been limited research, with inconsistent results, in identifying prognostic factors associated with a positive response to physical therapy. OBJECTIVES The purpose of this study was to identify potential predictors of response to physical therapy (exercise therapy [ET] with or without adjunctive manual therapy [MT]) for hip OA based on baseline patient-specific and clinical characteristics. DESIGN A prognostic study was conducted. METHODS Secondary analysis of data from a multicenter randomized controlled trial (RCT) (N=131) that evaluated the effectiveness of ET and ET+MT for hip OA was undertaken. Treatment response was defined using OMERACT/OARSI responder criteria. Ten baseline measures were used as predictor variables. Regression analyses were undertaken to identify predictors of outcome. Discriminative ability (sensitivity, specificity, and likelihood ratios) of significant variables was calculated. RESULTS The RCT results showed no significant difference in most outcomes between ET and ET+MT at 9 and 18 weeks posttreatment. Forty-six patients were classified as responders at 9 weeks, and 36 patients were classified as responders at 18 weeks. Four baseline variables were predictive of a positive outcome at 9 weeks: male sex, pain with activity (<6/10), Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale score (<34/68), and psychological health (Hospital Anxiety and Depression Scale score <9/42). No predictor variables were identified at the 18-week follow-up. Prognostic accuracy was fair for all 4 variables (sensitivity=0.5-0.58, specificity=0.57-0.72, likelihood ratios=1.25-1.77), indicating fair discriminative ability at predicting treatment response. LIMITATIONS The short-term follow-up limits the interpretation of results, and the low number of identified responders may have resulted in possible overfitting of the predictor model. CONCLUSIONS The authors were unable to identify baseline variables in patients with hip OA that indicate those most likely to respond to treatment due to low discriminative ability. Further validation studies are needed to definitively define the best predictors of response to physical therapy in people with hip OA.
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Cooper C, Adachi JD, Bardin T, Berenbaum F, Flamion B, Jonsson H, Kanis JA, Pelousse F, Lems WF, Pelletier JP, Martel-Pelletier J, Reiter S, Reginster JY, Rizzoli R, Bruyère O. How to define responders in osteoarthritis. Curr Med Res Opin 2013; 29:719-29. [PMID: 23557069 PMCID: PMC3690437 DOI: 10.1185/03007995.2013.792793] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Osteoarthritis is a clinical syndrome of failure of the joint accompanied by varying degrees of joint pain, functional limitation, and reduced quality of life due to deterioration of articular cartilage and involvement of other joint structures. SCOPE Regulatory agencies require relevant clinical benefit on symptoms and structure modification for registration of a new therapy as a disease-modifying osteoarthritis drug (DMOAD). An international Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and International Osteoporosis Foundation was convened to explore the current burden of osteoarthritis, review current regulatory guidelines for the conduct of clinical trials, and examine the concept of responder analyses for improving drug evaluation in osteoarthritis. FINDINGS The ESCEO considers that the major challenges in DMOAD development are the absence of a precise definition of the disease, particularly in the early stages, and the lack of consensus on how to detect structural changes and link them to clinically meaningful endpoints. Responder criteria should help identify progression of disease and be clinically meaningful. The ideal criterion should be sensitive to change over time and should predict disease progression and outcomes such as joint replacement. CONCLUSION The ESCEO considers that, for knee osteoarthritis, clinical trial data indicate that radiographic joint space narrowing >0.5 mm over 2 or 3 years might be a reliable surrogate measure for total joint replacement. On-going research using techniques such as magnetic resonance imaging and biochemical markers may allow the identification of these patients earlier in the disease process.
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Affiliation(s)
- Cyrus Cooper
- MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK
| | - Jonathan D. Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Bardin
- Department of Rheumatology, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris and University Paris VII, Paris, France
| | - Francis Berenbaum
- Department of Rheumatology, AP-HP, Saint-Antoine Hospital, Pierre and Marie Curie University, Paris, France
| | - Bruno Flamion
- Laboratory of Physiology and Pharmacology, URPhyM, NARILIS, University of Namur, Belgium
| | - Helgi Jonsson
- Landspitalinn University Hospital, University of Iceland, Reykjavik, Iceland
| | - John A. Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Franz Pelousse
- Department of Radiodiagnostics, CHR de la Citadelle, Liège, Belgium
| | - Willem F. Lems
- Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Susanne Reiter
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Jean-Yves Reginster
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium
| | - René Rizzoli
- Division of Bone Diseases, Department of Rehabilitation and Geriatrics, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Olivier Bruyère
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium
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Benz T, Angst F, Lehmann S, Aeschlimann A. Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study. BMC Musculoskelet Disord 2013; 14:159. [PMID: 23641831 PMCID: PMC3646687 DOI: 10.1186/1471-2474-14-159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background According to Antonovsky’s salutogenic concept, a strong sense of coherence is associated with physical and psychological health. The goal of this study was to analyze the association of Antonovsky’s sense of coherence with physical and psychosocial health components in patients with hip and knee osteoarthritis before and after in- and outpatient rehabilitation. Methods Prospective cohort study with 335 patients, 136 (41%) with hip and 199 (59%) with knee osteoarthritis. The outcome was measured by Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Sense of Coherence (SOC-13). Baseline scores of the SF-36 and WOMAC scales and the observed effect sizes after rehabilitation were correlated with the baseline SOC-13. These correlations of the SF-36 scales were compared to the Factor Score Coefficients for the Mental Component Summary of SF-36, which quantify the factor load on the psychosocial dimension. Predictive impact of the baseline SOC-13 for the SF-36 and WOMAC scales (baseline scores and effect sizes) was then determined by multivariate linear regression controlled for possible confounders. Results At baseline, the SOC-13 correlated with the WOMAC scores between r = 0.18 (stiffness) and r = 0.25 (pain) and with the SF-36 scores between r = 0.10 (physical functioning) and r = 0.53 (mental health). The correlation of these SF-36 correlation coefficients to the Factor Score Coefficient of the SF-36 Mental Component Summary was r = 0.95. The correlations for the effect sizes (baseline → discharge) with the baseline SOC-13 global score were all negative and varied between r = 0.00 (physical functioning) and r = −0.19 (social functioning). In the multivariate linear regression model, the explained variance of the SF-36 scores by the baseline SOC-13 increased continuously from physical to psychosocial health dimensions (from 12.9% to 29.8%). This gradient was consistently observed for both the baseline scores and the effect sizes. The results of the WOMAC were consistent with the physical health scales of SF-36. Conclusions The sense of coherence was associated with psychosocial health dimensions but hardly with physical health. The higher the load of a scale on the psychosocial dimension the higher was its correlation to the sense of coherence. This is in contrast to the idea of Antonovsky who predicted high associations with both mental and physical health.
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Affiliation(s)
- Thomas Benz
- Research department, Rehabilitation clinic RehaClinic, Bad Zurzach, 5330, Switzerland.
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Which prognostic factors for low back pain are generic predictors of outcome across a range of recovery domains? Phys Ther 2013; 93:32-40. [PMID: 22879443 DOI: 10.2522/ptj.20120216] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered "universal" prognostic variables. OBJECTIVE The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP. DESIGN Predictive modeling was performed using data extracted from a randomized controlled trial. Four prognostic models were created using backward stepwise deletion logistic, Poisson, and linear regression. METHODS Data were collected from 16 outpatient physical therapy facilities in 10 states. All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge. Four different measures of response were used: Oswestry Disability Index and Numeric Pain Rating Scale change scores, total visits, and report of rate of recovery. RESULTS The set of statistically significant predictors was dependent on the definition of response. All regression models were significant. Within both forms of the 4 models, meeting the clinical prediction rule for manipulation at baseline was present in all 4 models, whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models. LIMITATIONS The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP. CONCLUSIONS Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor. Other predictive variables were dependent on the outcomes measure used in the predictive model.
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Targeting care: tailoring nonsurgical management according to clinical presentation. Rheum Dis Clin North Am 2012; 39:213-33. [PMID: 23312418 DOI: 10.1016/j.rdc.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
International evidence-based guidelines recommend a multitude of nonsurgical treatment options for the management of osteoarthritis. This article summarizes the evidence available for patient characteristics that have been analyzed as potential predictors of response to nonsurgical interventions for patients with hip and knee osteoarthritis. The specific variables targeted for this review include body mass index, psychological factors, muscle strength, tibiofemoral alignment, radiographic changes, and signs of inflammation. Several studies provide moderate to good evidence of potential predictors of response to nonsurgical treatments, and areas for future research are illuminated.
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Hmamouchi I, Allali F, Tahiri L, Khazzani H, Mansouri LE, Ali Ou Alla S, Abouqal R, Hajjaj-Hassouni N. Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study. BMC Res Notes 2012; 5:58. [PMID: 22269793 PMCID: PMC3283484 DOI: 10.1186/1756-0500-5-58] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/23/2012] [Indexed: 01/22/2023] Open
Abstract
Background The aims of the present study were first to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, non-steroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion. Methods The study involved 173 patients with osteoarthritis in whom primary care physicians decided to start treatment with non-selective NSAIDs. Assessments at admission and after 6 weeks were conducted. In order to determine the threshold levels associated with a definition of clinically important improvement, the receiver operating characteristic method was used. Three different measures of response to a 6-week NSAIDs treatment were used: one indirect measure (MCID in the total WOMAC score), one direct measure (transition question) and a combination of both criteria. Results Eighty patients (46.3%) reported "a slightly better" general health status compared to that of 6 weeks before NSAIDs treatment. The MCID proportion is a 16.0% reduction in WOMAC. The most stable pre-treatment predictors on the improvement of health after treatment by NSAIDs were the absence of previous knee injury and a high level of education. Conclusions In our data, a 16.0% reduction of the total WOMAC score from baseline was associated with the highest degree of improvement on the transition scale category. This cut-off point had good accuracy, and should be appropriate for use in the interpretation of clinical studies results, as well as in clinical care.
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Affiliation(s)
- Ihsane Hmamouchi
- Laboratory of Information and Research on Bone Diseases (LIRPOS), Faculty of Medicine and Pharmacy, Rabat, Morocco.
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Denegar CR, Schimizzi ME, Dougherty DR, Friedman JE, Clark JE, Comstock, BA, Kraemer WJ. Responses to superficial heating and cooling differ in men and women with knee osteoarthritis. Physiother Theory Pract 2011; 28:198-205. [DOI: 10.3109/09593985.2011.586097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tamari K. Self-reported Home Exercise and Younger Age Predict Improved Health-related Quality of Life among Community-Dwelling Elderly Participants in a Three-month Group Exercise Class. J Physiol Anthropol 2011; 30:77-85. [DOI: 10.2114/jpa2.30.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Vasilceac FA, Renner AF, Teodoro WR, Mattiello-Rosa SM. The remodeling of collagen fibers in rats ankles submitted to immobilization and muscle stretch protocol. Rheumatol Int 2010; 31:737-42. [PMID: 20155269 DOI: 10.1007/s00296-010-1371-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 01/27/2010] [Indexed: 11/28/2022]
Abstract
To evaluate the remodeling of collagen fibers in the articular cartilage of rat ankles, with and without immobilization, after application of muscle stretching protocol. Twenty three Wistar rats were divided into four groups: immobilized (I), n=6; immobilized and stretched (IS), n=6; stretched (S), n=6 and control (C), n=5. The animals in groups I and IS were submitted to immobilization. After the period of immobilization, the animals in groups IS and S were submitted to a muscle stretching protocol. At the end of the experiment, the animals were euthanized and the joints removed, processed and stained with Picrosirius red. The analysis was carried out using a polarized light microscope. The density of collagen fibers were quantified according to the intensity of birefringence displayed. By way of statistical analyses, the right and left hind limbs of the different groups were compared based on the total density of collagen fibers, the density of thick collagen fibers and the density of thin collagen fibers. Immobilization promoted a reduction in density of the thin fibers and of total collagen. The muscle stretching protocol after immobilization promoted a reduction in density of the total collagen and of the thick fibers, but the density of the thin fibers showed the same values as control. The collagen fibers were remodeled by the different stimuli. Immobilization was harmful to the collagen fibers and the muscle stretching protocol only recovered the thin collagen fibers.
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van Dijk GM, Veenhof C, Spreeuwenberg P, Coene N, Burger BJ, van Schaardenburg D, van den Ende CH, Lankhorst GJ, Dekker J. Prognosis of Limitations in Activities in Osteoarthritis of the Hip or Knee: A 3-Year Cohort Study. Arch Phys Med Rehabil 2010; 91:58-66. [DOI: 10.1016/j.apmr.2009.08.147] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/21/2009] [Accepted: 08/28/2009] [Indexed: 01/22/2023]
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Wright AA, Cook C, Abbott JH. Variables associated with the progression of hip osteoarthritis: A systematic review. ACTA ACUST UNITED AC 2009; 61:925-36. [DOI: 10.1002/art.24641] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kirkness CS, Yu J, Asche CV. The Effect on Comorbidity and Pain in Patients with Osteoarthritis. J Pain Palliat Care Pharmacother 2009; 22:336-48. [DOI: 10.1080/15360280802536649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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French HP, Cusack T, Brennan A, White B, Gilsenan C, Fitzpatrick M, O'Connell P, Kane D, Fitzgerald O, McCarthy GM. Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial. BMC Musculoskelet Disord 2009; 10:9. [PMID: 19152689 PMCID: PMC2653461 DOI: 10.1186/1471-2474-10-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 01/19/2009] [Indexed: 01/22/2023] Open
Abstract
Background Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy. Methods and design An assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6–8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests. Discussion This RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA. Trial Registration Number: NCT00709566
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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van Dijk GM, Veenhof C, Schellevis F, Hulsmans H, Bakker JP, Arwert H, Dekker JH, Lankhorst GJ, Dekker J. Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee. BMC Musculoskelet Disord 2008; 9:95. [PMID: 18582362 PMCID: PMC2453124 DOI: 10.1186/1471-2474-9-95] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 06/26/2008] [Indexed: 12/02/2022] Open
Abstract
Background This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity. Methods A cross-sectional cohort study was conducted, in which 288 elderly patients with hip or knee osteoarthritis were included. Apart from demographic and clinical data, information about comorbidity, limitations in activities (WOMAC, SF-36 and timed walking test) and pain (VAS) was collected by questionnaires and tests. Statistical analyses included descriptive statistics, multivariate regression techniques, t-tests and one-way ANOVA. Results Almost all patients suffered from at least one comorbid disease, with cardiac diseases, diseases of eye, ear, nose, throat and larynx, other urogenital diseases and endocrine/metabolic diseases being most prevalent. Morbidity count and severity index were associated with more limitations in activities and with more pain. The presence of most of the moderate or severe diseases and obesity was associated with limitations in activities or with pain. Conclusion The results of this study emphasize the importance of comorbidity in the rehabilitation of elderly patients with osteoarthritis of the hip or knee. Clinical practitioners should be aware of the relationship of comorbidity with functional problems in OA patients.
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Affiliation(s)
- Gabriella M van Dijk
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Transdermal fentanyl improves pain control and functionality in patients with osteoarthritis: an open-label Canadian trial. Clin Rheumatol 2007; 27:587-95. [DOI: 10.1007/s10067-007-0751-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 09/13/2007] [Accepted: 09/17/2007] [Indexed: 01/22/2023]
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Weigl M, Cieza A, Cantista P, Stucki G. Physical disability due to musculoskeletal conditions. Best Pract Res Clin Rheumatol 2007; 21:167-90. [PMID: 17350551 DOI: 10.1016/j.berh.2006.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Musculoskeletal conditions (MSC) are common throughout the world and their impact on individuals is diverse and manifold. Knowledge of the determinants for disability and of strategies for prevention and rehabilitation management according to the scientific evidence is critical for reducing the burden of MSC. The first section of this chapter reviews the evidence for common determinants of functioning and disability in patients with MSC. We have focussed on environmental factors (EF) and personal factors (PF) and have structured them according to the International Classification of Functioning, Disability and Health (ICF) framework. The second section discusses prevention strategies. Generally, prevention needs to address those EF and PF that were presented in the first section. The final section describes modern principles of rehabilitation and reviews the evidence for specific rehabilitation interventions.
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Affiliation(s)
- Martin Weigl
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian-University, Munich, Germany, and Hospital Geral de Santo António, Porto, Portugal
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