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Murakami Y, Ota S, Fujita R, Ohko H, Kawasaki S. Effects of gait intervention using the draw-in maneuver on knee joint function and the thoracic kyphosis angle in knee osteoarthritis. Gait Posture 2024; 112:53-58. [PMID: 38744021 DOI: 10.1016/j.gaitpost.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/08/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND To evaluate whether the knee adduction moment (KAM) could be reduced by a short instruction in the Draw-in (DI) maneuver in healthy adults, and whether knee joint function would improve with a longer DI gait intervention in patients with knee osteoarthritis (OA). METHOD In Study 1, healthy adults received 10 minutes supervised instruction in DI gait in and then practiced the gait independently for 10 minutes. Three-dimensional motion analysis measurement was performed in each phase. In Study 2, patients with OA performed a 20-minute DI gait intervention daily for 6 weeks. At baseline and after 6 weeks, knee pain, the Knee injury and Osteoarthritis Outcome Score, the MOS 8 item Short-Form Health Survey, thoracic kyphosis angle, knee joint range of motion, knee extension muscle strength, hip abduction muscle strength, and activity level were evaluated. RESULTS In Study 1, the DI gait to decrease KAM could be learning following only 10 minutes of instruction and 10 minutes of self-practice in healthy adults. In Study 2, knee pain was reduced by 19 % and the thoracic kyphosis angle was reduced by 2.6° after 6 weeks. No significant changes in other parameters were detected, and the implementation rate was 86 ± 14 %. SIGNIFICANCE In healthy adults, DI gait instruction for 10 minutes of instruction and 10 minutes of self-practice reduced the KAM. In patients with knee OA, 20 minutes of DI gait per day for 6 weeks may reduce knee pain and thoracic kyphosis.
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Affiliation(s)
- Y Murakami
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, Nagoya, Aichi, Japan.
| | - S Ota
- Department of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan; Graduate School of Health Care Studies, Seijoh University, Tokai, Aichi, Japan.
| | - R Fujita
- Department of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan.
| | - H Ohko
- Department of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan.
| | - S Kawasaki
- Fukinodai Orthopaedics Clinic, Tokai, Aichi, Japan.
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Matile F, Nast I, Niedermann K. Facilitators, barriers and support needs to GLA:D exercise adherence - a mixed method study. BMC Sports Sci Med Rehabil 2024; 16:130. [PMID: 38872226 PMCID: PMC11170889 DOI: 10.1186/s13102-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Knee and hip osteoarthritis (OA) are among the most common musculoskeletal joint diseases worldwide. International guidelines recommend exercise and education as first-line interventions for their management. The Good Life with osteoArthritis Denmark (GLA:D) programme aims to achieve self-management using group exercise and education sessions. It also encourages participants to stay physically active and perform GLA:D exercises (GE) twice weekly after programme end. This study investigated the participants' self-reported level of physical activity (PA) and self-reported adherence to the GE between five and 17 months after completion of the GLA:D programme and also explored the barriers, facilitators and support needs to achieve long-term adherence to GE. METHODS A mixed method study using an exploratory sequential design was performed. A qualitative phase, involving semi-structured interviews and a focus group, led to the development of a questionnaire on participants' level of PA, as well as ratings of the barriers, facilitators and support needs for the achievement of long-term adherence to GE. In a second quantitative phase, the survey was conducted online with former GLA:D participants from Switzerland. Descriptive statistical analysis and a group comparison between adherent and non-adherent participants to the GE were performed using Fisher's exact test, odds ratio, and confidence interval. RESULTS Eleven former GLA:D participants attended the interviews and focus group, and former GLA:D participants (30% response rate) participated in the survey. Of these, 84% (n = 285) reported to reach the recommended level of PA and 53% (n = 178) GE adherence. The top barrier to GE adherence was no/little self-discipline to perform GE (40%, n = 112) and the top facilitator was GE are easy to perform (93%, n = 300). The top 3 items regarding support needs to enhance GE adherence were a shortened version (max. 30 min) of the GE home programme (75%, n = 255), monthly continuation of small GE groups under GLA:D physiotherapists' supervision (65%, n = 221), and monitoring with regular testing of individual progress (65%, n = 221). CONCLUSIONS The top barriers and facilitators should be considered by those responsible for the GLA:D programme and may need to be specifically addressed during and after the programme. The development of a shortened version of the GLA:D programme, a post-GLA:D group, and monitoring with regular testing seem crucial for enhancing GE adherence. CLINICAL TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Franziska Matile
- ZHAW School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - Irina Nast
- ZHAW School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - Karin Niedermann
- ZHAW School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland.
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Bendrik R, Kallings LV, Bröms K, Emtner M. Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis: A randomised controlled trial. Clin Rehabil 2024; 38:770-782. [PMID: 38409798 PMCID: PMC11059830 DOI: 10.1177/02692155241234666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. DESIGN Randomised, assessor-blinded, controlled trial. SETTING Primary care. SUBJECTS Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40-74. INTERVENTION The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. MAIN MEASURES Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. RESULTS There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups). CONCLUSIONS There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.
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Affiliation(s)
- Regina Bendrik
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University/ Region Gävleborg, Gävle, Sweden
| | - Lena V Kallings
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Department of Physical Activity and Health, the Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Ahler JR, Busk H, Holm PM, Bricca A, Poulsen DV, Skou ST, Tang LH. Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis. Prev Med 2024; 183:107966. [PMID: 38641081 DOI: 10.1016/j.ypmed.2024.107966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases. METHODS We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE. RESULTS From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low. CONCLUSION Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.
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Affiliation(s)
- Jonas R Ahler
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Henriette Busk
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands
| | - Alessio Bricca
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Dorthe V Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Spitzer AI, Rodbard HW, Iqbal SU, Nakazawa M, DiGiorgi M, Winston R. Extended-Release Versus Immediate-Release Triamcinolone Acetonide in Patients Who Have Knee Osteoarthritis and Type 2 Diabetes Mellitus. J Arthroplasty 2024:S0883-5403(24)00527-8. [PMID: 38815874 DOI: 10.1016/j.arth.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injections may cause hyperglycemia (glucose level > 180 mg/dL). In a phase 2 study of 33 patients who had osteoarthritis of the knee (OAK) and type 2 diabetes mellitus (T2D), triamcinolone acetonide extended-release (TA-ER) was associated with minimal glycemic control disruption compared with triamcinolone acetonide immediate-release (TA-IR). This post hoc analysis characterizes the clinical relevance of these results. METHODS Patients who had symptomatic OAK for ≥ 6 months, T2D for ≥ 1 year, and hemoglobin A1c ≥ 6.5 and ≤ 9.0% were randomized to receive an IA injection of either TA-ER or TA-IR. Changes in continuous glucose monitor daily glucose level, percentage of time in or above the target glucose range (> 70 to 180 mg/dL), time to glucose level 250 mg/dL and maximum glucose level > 250 mg/dL, and glycemic variability were evaluated. RESULTS Across postinjection days 1 to 3, the TA-ER group (n = 18) had a lower median change from baseline in maximum glucose level (92.3 versus 169.1 mg/dL), a reduced percentage of time with a glucose level > 250 mg/dL (12 versus 26%), a smaller proportion of patients who had a maximum glucose level > 250 mg/dL (50 versus 93%), and a greater percentage of time in the target glucose range (62 versus 48%) versus the TA-IR group (n = 15). There was less glycemic variability and lower glucose spikes in the TA-ER versus TA-IR group. Median times to glucose level 250 mg/dL (44 versus 6 hours) and maximum glucose level (34 versus 13 hours) were significantly longer in the TA-ER versus TA-IR group. CONCLUSIONS Use of TA-ER was associated with a clinically meaningful reduction in hyperglycemia versus TA-IR.
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MacIntyre E, Braithwaite FA, Stanton TR. Painful distortions: people with painful knee osteoarthritis have biased visuospatial perception of the environment. Pain 2024:00006396-990000000-00577. [PMID: 38635468 DOI: 10.1097/j.pain.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Visuospatial perception is thought to be adaptive-ie, hills are perceived as steeper when capacity is low, or threat is high-guiding appropriate interaction with the environment. Pain (bodily threat) may similarly modulate visuospatial perception, with the extent of modulation influenced by threat magnitude (pain intensity, fear) and associated with behaviour (physical activity). We compared visuospatial perception of the environment between 50 people with painful knee osteoarthritis and 50 age-/sex-matched pain-free control participants using 3 virtual reality tasks (uphill steepness estimation, downhill steepness estimation, and a distance-on-hill measure), exploring associations between visuospatial perception, clinical characteristics (pain intensity, state and trait fear), and behaviour (wrist-worn accelerometry) within a larger knee osteoarthritis group (n = 85). People with knee osteoarthritis overestimated uphill (F1,485 = 19.4, P < 0.001) and downhill (F1,480 = 32.3, P < 0.001) steepness more so than pain-free controls, but the groups did not differ for distance-on-hill measures (U = 1273, P = 0.61). There was also a significant group x steepness interaction for the downhill steepness task (F4,480 = 3.11, P = 0.02). Heightened overestimation in people with knee osteoarthritis relative to pain-free controls increased as downhill slopes became steeper. Results were unchanged in a replication analysis using all knee osteoarthritis participants (n = 85), except the downhill steepness interaction was no longer significant. In people with knee osteoarthritis, higher state fear was associated with greater over-estimation of downhill slope steepness (rho = 0.69, P < 0.001), and greater visuospatial overestimation (distance-on-hill) was associated with lower physical activity levels (rho = -0.22, P = 0.045). These findings suggest that chronic pain may shift perception of the environment in line with protection, with overestimation heightened when threat is greater (steeper hills, more fearful), although impact on real-world behaviour is uncertain.
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Affiliation(s)
- Erin MacIntyre
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Ng N, Parkinson L, Brown WJ, Moorin R, Peeters GMEEG. Lifestyle behaviour changes associated with osteoarthritis: a prospective cohort study. Sci Rep 2024; 14:6242. [PMID: 38485979 PMCID: PMC10940587 DOI: 10.1038/s41598-024-54810-6] [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: 03/03/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
The aim of this prospective cohort study was to compare changes in lifestyle behaviours over nine years in women who were and were not diagnosed with osteoarthritis (OA). Data were from the 1945-51 cohort of the Australian Longitudinal Study on Women's Health (aged 50-55 in 2001) who completed written surveys in 2001, 2004, 2007 and 2010. The sample included 610 women who were, and 3810 women who were not diagnosed with OA between 2004 and 2007. Descriptive statistics were used to assess changes in lifestyle behaviours (weight, sitting time, physical activity, alcohol and smoking) in the two groups, over three survey intervals: from 2001-2004 (prior to diagnosis); from 2004-2007 (around diagnosis); and from 2007-2010 (following diagnosis). Compared with women without OA (28%), a greater proportion of women with OA (38%) made at least one positive lifestyle change (p < 0.001). These included losing > 5 kg (9.8% vs. 14.4%, p < 0.001), and reducing sitting time by an hour (29.5% vs. 39.1%, p < 0.001) following diagnosis. However, women with OA also made negative lifestyle changes (35% vs. 29%, p < 0.001), for example, gaining > 5 kg around the time of diagnosis (21.4% vs. 14.5%, p < 0.001) and increasing sitting time by an hour following diagnosis (38.4% vs. 32.3%, p = 0.003). More women with OA also started smoking following diagnosis (8.9% vs. 0.8%, p < 0.001). While some women made positive changes in lifestyle behaviours during and following OA diagnosis, others made negative changes. Consistent support from clinicians for managing OA symptoms may enable patients to make more positive changes in lifestyle behaviours.
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Affiliation(s)
- Norman Ng
- School of Human Movement and Nutrition Science (#26B), The University of Queensland, Blair Drive, St Lucia Campus, Brisbane, QLD, 4072, Australia.
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Science (#26B), The University of Queensland, Blair Drive, St Lucia Campus, Brisbane, QLD, 4072, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Australia
| | - G M E E Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
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Rickenbach A, Acheampong MK, Bogar A, Booth G. Perspectives of the World Health Organization's physical activity guidelines among patients with musculoskeletal conditions: A mixed-methods survey. Musculoskeletal Care 2024; 22:e1868. [PMID: 38353327 DOI: 10.1002/msc.1868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Physical activity (PA) promotion is a core element of musculoskeletal rehabilitation. Many people with musculoskeletal conditions do not meet PA guidelines, such as those provided by the World Health Organization (WHO). This study aimed to explore the level of awareness and perspectives on the WHO PA guidelines among people with musculoskeletal conditions and identify how patients can be supported with PA in clinical practice. METHODS A mixed-method cross-sectional survey was conducted using a uniquely developed questionnaire, which was disseminated to patients attending outpatient physiotherapy or occupational therapy appointments. The questionnaire collected data on participant characteristics, awareness and perspectives on the WHO guidelines and suggestions for supporting patients with PA in clinical practice. Descriptive statistics and content analysis were used to analyse the quantitative and qualitative data respectively. RESULTS One-hundred and two responses were included in the analysis. Forty-two percent of respondents were aware of the guidelines, 50% knew why they existed and 53% felt they were achievable. Perspectives varied, ranging from the guidelines being positive and aiding motivation to being unachievable. Some respondents felt an individualised approach is required. Suggestions for supporting patients with PA included facilitating social support, providing education, exercise groups and personalised advice, and signposting to community services. CONCLUSION There is limited awareness of the WHO PA guidelines and a variety of perspectives on the guidelines among patients with musculoskeletal conditions. There is a need to enhance the promotion of the guidelines in clinical practice, whilst considering local context and individual patient's circumstances.
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Affiliation(s)
- Amelia Rickenbach
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | | | | | - Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
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Lebleu J, Daniels K, Pauwels A, Dekimpe L, Mapinduzi J, Poilvache H, Bonnechère B. Incorporating Wearable Technology for Enhanced Rehabilitation Monitoring after Hip and Knee Replacement. SENSORS (BASEL, SWITZERLAND) 2024; 24:1163. [PMID: 38400321 PMCID: PMC10892564 DOI: 10.3390/s24041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Osteoarthritis (OA) poses a growing challenge for the aging population, especially in the hip and knee joints, contributing significantly to disability and societal costs. Exploring the integration of wearable technology, this study addresses the limitations of traditional rehabilitation assessments in capturing real-world experiences and dynamic variations. Specifically, it focuses on continuously monitoring physical activity in hip and knee OA patients using automated unsupervised evaluations within the rehabilitation process. We analyzed data from 1144 patients who used a mobile health application after surgery; the activity data were collected using the Garmin Vivofit 4. Several parameters, such as the total number of steps per day, the peak 6-minute consecutive cadence (P6MC) and peak 1-minute cadence (P1M), were computed and analyzed on a daily basis. The results indicated that cadence-based measurements can effectively, and earlier, differ among patients with hip and knee conditions, as well as in the recovery process. Comparisons based on recovery status and type of surgery reveal distinctive trajectories, emphasizing the effectiveness of P6MC and P1M in detecting variations earlier than total steps per day. Furthermore, cadence-based measurements showed a lower inter-day variability (40%) compared to the total number of steps per day (80%). Automated assessments, including P1M and P6MC, offer nuanced insights into the patients' dynamic activity profiles.
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Affiliation(s)
- Julien Lebleu
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Kim Daniels
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
| | | | - Lucie Dekimpe
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Jean Mapinduzi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Filière de Kinésithérapie et Réadaptation, Département des Sciences Clinique, Institut National de la Santé Publique, 6807 Bujumbura, Burundi
| | - Hervé Poilvache
- Orthopedic Surgery Department, CHIREC, 1420 Braine-l’Alleud, Belgium
| | - Bruno Bonnechère
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, 3590 Diepenbeek, Belgium
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Manojlovic M, Roklicer R, Trivic T, Carraro A, Gojkovic Z, Maksimovic N, Bianco A, Drid P. Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e001682. [PMID: 38347861 PMCID: PMC10860114 DOI: 10.1136/bmjsem-2023-001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 02/15/2024] Open
Abstract
Objective To compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR) and healthy control group. Design Systematic review and meta-analysis of observational studies. Data sources Web of Science, Scopus, and PubMed have been comprehensively searched to identify relevant investigations. Eligibility criteria for selecting studies An observational research that objectively evaluated physical activity among respondents with a history of ACLR. Results Of 302 records, a total of 12 studies fulfilled the eligibility criteria. Four hundred and forty-three participants underwent the ACLR, 153 men and 290 women. The mean time between anterior cruciate ligament (ACL) surgery and evaluation of analysed outcomes was 34.8 months. The main findings demonstrated that the ACLR group spent less time in weekly MVPA (standardised mean differences (SMD)=-0.43 (95% CI -0.66 to -0.20); mean = -55.86 min (95% CI -86.45 to -25.27); p=0.0003; τ2=0.00), in daily MVPA (SMD=-0.51 95% CI -0.76 to -0.26]; mean = -15.59 min (95% CI -22.93 to -8.25); p<0.0001; τ2=0.00), and they had fewer daily steps (SMD=-0.60 95% CI -0.90 to -0.30); mean = -1724.39 steps (95% CI -2552.27 to -896.50); p<0.0001; τ2=0.00) relative to their non-injured counterparts. Additionally, available investigations indicated that individuals with a history of ACLR participated in 316.8 min of MVPA per week, 67 min in MVPA per day, and 8337 steps per day. Conclusion Long-term after ACLR, participants undergoing ACL surgery were less physically active compared with their non-injured peers, and they did not satisfy recommendations regarding steps per day. PROSPERO registration number CRD42023431991.
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Affiliation(s)
- Marko Manojlovic
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Roberto Roklicer
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Tatjana Trivic
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Attilio Carraro
- Faculty of Education Free University of Bozen-Bolzano, Brixen-Bressanone, Italy
| | - Zoran Gojkovic
- University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
| | - Nemanja Maksimovic
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Patrik Drid
- University of Novi Sad Faculty of Sport and Physical Education, Novi Sad, Serbia
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Dawson ZE, Beaumont AJ, Carter SE. A Systematic Review of Physical Activity and Sedentary Behavior Patterns in an Osteoarthritic Population. J Phys Act Health 2024; 21:115-133. [PMID: 38086351 DOI: 10.1123/jpah.2023-0195] [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: 05/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To explore physical activity (PA) and sedentary behaviors (SB) in individuals with lower limb (LL) Osteoarthritis (OA) and the influence of age, sex, and body mass index (BMI) on these behaviors. DESIGN Systematic review search: PubMed, Cochrane Library, ScienceDirect, and CINAHL databases were searched from inception until July 2023. Study criteria: Studies that reported quantifiable device-based or self-reported data for PA and SB variables in adults clinically diagnosed with LL OA were included. DATA SYNTHESIS A synthesis of PA and SB levels for those diagnosed with LL OA and the influence age, sex, and BMI have on these behaviors. RESULTS From the 1930 studies identified through the electronic search process, 48 met the inclusion criteria. PA guidelines were met by 33% of the sample population that measured moderate and moderate to vigorous PA. No studies reported 75 minutes per week or more of vigorous PA. Additionally, 58% of the population reporting SB were sedentary for 8 hours per day or more. Also, increasing age, BMI, and the female sex were identified as negative influences on PA levels. There were numerous methodological inconsistencies in how data were collected and reported, such as various activity monitor cut points for PA and SB bout duration. CONCLUSION Adults with LL OA may be at an increased risk of noncommunicable diseases due to low PA and high SB levels. It is important to consider age, sex, and BMI when investigating behavior patterns in those with LL OA.
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Affiliation(s)
- Zoe E Dawson
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
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12
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Goff AJ, Jones LE, Lim CJ, Tan BY. A cross sectional study exploring the relationship of self-reported physical activity with function, kinesiophobia, self-efficacy and quality of life in an Asian population seeking care for knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:74. [PMID: 38238654 PMCID: PMC10795260 DOI: 10.1186/s12891-024-07181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Physical activity is a guideline-recommended first-line intervention for people with knee osteoarthritis. Physical activity levels, and its potential correlates, is underexplored in Asian populations with knee osteoarthritis. METHODS Participants enrolled in a longitudinal study in Singapore self-reported physical activity (UCLA activity score), function (Knee Osteoarthritis Outcome Score [KOOS-12]), kinesiophobia (Brief fear of movement [BFOM]), self-efficacy (ASES-8), and quality of life (EQ-5D-5 L). One-Way ANOVA was used to test the difference in outcomes between UCLA categories, while ordinal logistic regression was used to identify the associated factors to physical activity level. RESULTS Seventy-three percent of all enrolled participants (n = 311/425) reported either inactivity or low physical activity (median 4, IQR 3-5). Significant, weak, positive correlations were observed be-tween UCLA activity score and either KOOS-12 (Spearman's rho: 0.1961; p < 0.001), ASES-8 (0.1983; p = 0.004), or EQ-5D-5 L (0.2078; p < 0.001). A significant, weak, negative correlation was observed between physical activity and BFOM (-0.2183; p < 0.001). Significant differences in function between groups (moderate vs. inactive or low physical activity) were not clinically important. Participants with obesity, from the eldest age category (i.e. ≥75), or who identified as Malay or female, were less physically active than those with a healthy BMI, below the age of 54, or who identified as Chinese or male, respectively. CONCLUSION Healthcare professionals in Asia should be aware of the large proportion of people with knee osteoarthritis who are either inactive or have low physical activity levels. Screening for, and offering interventions to promote, physical activity and its correlates should be prioritised.
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Affiliation(s)
- Anthony J Goff
- Singapore Institute of Technology, Health and Social Sciences, 10 Dover Drive, Singapore, 138683, Singapore
| | - Lester E Jones
- Singapore Institute of Technology, Health and Social Sciences, 10 Dover Drive, Singapore, 138683, Singapore
- Judith Lumley Centre, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, Vic, 3086, Australia
| | - Chien Joo Lim
- Orthopaedic Surgery, Woodlands Health, Yishun Community Hospital, 2 Yishun Central 2 Tower E, Singapore, 768024, Singapore
| | - Bryan Yijia Tan
- Orthopaedic Surgery, Woodlands Health, Yishun Community Hospital, 2 Yishun Central 2 Tower E, Singapore, 768024, Singapore.
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13
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Bell EC, Pazzinatto MF, Wallis JA, Kemp JL, Skou ST, O'Halloran P, Crossley KM, De Oliveira Silva D, Semciw AI, Dundules K, Barton CJ. Association of baseline physical activity participation with participant characteristics and outcomes following education and exercise-therapy in people with knee osteoarthritis: A GLA:D ® Australia prospective cohort study. Musculoskeletal Care 2023; 21:1470-1481. [PMID: 37795974 DOI: 10.1002/msc.1828] [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: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To investigate whether participants with knee osteoarthritis classified as 'more' or 'less' physically active at baseline differ in characteristics and/or outcomes at baseline and at 3 and 12 months following the commencement of an education and exercise-therapy program. METHODS Prospective cohort study using the GLA:D® Australia registry. The University of California, Los Angeles Physical Activity Scale (UCLA) participant data dichotomised as 'more' (≥7) or 'less' active (≤6). Groups were compared using chi-square (obesity [baseline only], comorbidity prevalence, medication consumption, fear of damage from physical activity); and linear mixed model regression (12-item Injury Osteoarthritis Outcome Score [KOOS-12], pain [visual analogue scale], health-related quality of life [QoL] [EQ-5D-5L]) statistics, adjusted for age, sex and baseline physical activity at 3 and 12 months. RESULTS We included 1059 participants (70% female). At baseline, 267 (25%) were classified as 'more' active, increasing to 29% and 30% at 3 and 12 months, respectively. At baseline, compared to the 'less' active group, the 'more' active group had a lower proportion of participants who were obese ('more' = 21% vs. 'less' = 44%), had comorbidities (58% vs. 74%) and consumed medications (71% vs. 85%); lower pain intensity (37 vs. 47); and higher KOOS-12 (59 vs. 50), and health-related QoL (0.738 vs. 0.665) scores. When accounting for age, sex and baseline physical activity, improvements seen in knee-related burden and health-related QoL were not different between groups at 3 or 12 months. Compared to the 'less' active group, the proportion of participants not consuming medication remained higher in the 'more' active group at 3 ('more' 45% vs. 'less' 28%) and 12 months (43% vs. 32%). CONCLUSION 'More' active people with knee osteoarthritis were less likely to be obese, had fewer comorbidities, lower medication consumption, knee-related burden and pain intensity, and higher health-related QoL than 'less' active participants at all timepoints.
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Affiliation(s)
- Emily C Bell
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Marcella F Pazzinatto
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Jason A Wallis
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Paul O'Halloran
- La Trobe University School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Danilo De Oliveira Silva
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
- Department of Allied Health, Northern Health, Epping, Victoria, Australia
| | - Karen Dundules
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Bell EC, O'Halloran P, Wallis JA, Crossley KM, Gibbs AJ, Lee A, Jennings S, Barton CJ. Using SUpported Motivational InTerviewing (SUMIT) to increase physical activity for people with knee osteoarthritis: a pilot, feasibility randomised controlled trial. BMJ Open 2023; 13:e075014. [PMID: 37989380 PMCID: PMC10668304 DOI: 10.1136/bmjopen-2023-075014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the feasibility and effectiveness of using SUpported Motivational InTerviewing (SUMIT) to increase physical activity in people with knee osteoarthritis (KOA). DESIGN Randomised controlled trial. SETTING We recruited people who had completed Good Life with osteoArthritis Denmark (GLA:D) from private, public and community settings in Victoria, Australia. INTERVENTIONS Participants were randomised participants to receive SUMIT or usual care. SUMIT comprised five motivational interviewing sessions targeting physical activity over 10 weeks, and access to a multimedia web-based platform. PARTICIPANTS Thirty-two participants were recruited (17 SUMIT, 15 control) including 22 females (69%). OUTCOME MEASURES Feasibility outcomes included recruitment rate, adherence to motivational interviewing, ActivPAL wear and drop-out rate. Effect sizes (ESs) were calculated for daily steps, stepping time, time with cadence >100 steps per minute, time in bouts >1 min; 6 min walk distance, Knee Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, function, sport and recreation, and quality of life (QoL)), Euroqual, systolic blood pressure, body mass index, waist circumference, 30 s chair stand test and walking speed during 40 m walk test. RESULTS All feasibility criteria were achieved, with 32/63 eligible participants recruited over seven months; with all participants adhering to all motivational interviewing calls and achieving sufficient ActivPAL wear time, and only two drop-outs (6%).12/15 outcome measures showed at least a small effect (ES>0.2) favouring the SUMIT group, including daily time with cadence >100 steps per minute (ES=0.43). Two outcomes, walking speed (ES= 0.97) and KOOS QoL (ES=0.81), showed a large effect (ES>0.8). CONCLUSION SUMIT is feasible in people with knee osteoarthritis. Potential benefits included more time spent walking at moderate intensity, faster walking speeds and better QoL. TRIAL REGISTRATION NUMBER ACTRN12621000267853.
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Affiliation(s)
- Emily Catherine Bell
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
| | - Paul O'Halloran
- La Trobe University School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Jason A Wallis
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Alison J Gibbs
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - A Lee
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Sophie Jennings
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Martin KR, Stelfox K, Macfarlane GJ, McNamee P, Morrison Z, Smith TO. Bringing the Walk with Ease Programme to the UK: a mixed-methods study to assess the relevance, acceptability, and feasibility of implementation for people with arthritis and musculoskeletal conditions. Transl Behav Med 2023; 13:851-866. [PMID: 37318354 PMCID: PMC10631876 DOI: 10.1093/tbm/ibad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Developed in the United States (US), Walk With Ease (WWE) is a popular evidence-based, 6-week community walking programme for adults with arthritis, delivered in either an instructor-led or self-directed format. While WWE has expanded into communities across the USA, it is relatively unknown in other countries across the globe. This study, in collaboration with community and patient partners, aimed to examine the relevance, acceptability and feasibility of introducing WWE into a UK context. After initial cultural adaptation, participants were recruited into the study. Eligible (≥18 years, doctor diagnosed arthritis (confirmed or self-report), self-reported joint symptoms in last 30 days, BMI ≥25 kg/m2, and <150 min/week of moderate/vigorous PA) and consented participants were randomized into two groups: WWE programme or usual care. A mixed-methods analysis approach integrated quantitative data (physical performance assessment; baseline and post-six week programme questionnaire) and qualitative data (narrative interviews exploring participants' pre- and post-WWE experiences and stakeholders' perceptions). Of 149 participants, the majority were women (70%) aged ≥60 years (76%). Among the 97 receiving the programme, 52 chose instructor-led; 45 chose self-directed. Participants found WWE relevant and acceptable-99% indicating they would recommend WWE to family/friends. Within both WWE formats, mixed differences representing improvement were observed at 6 weeks from baseline for physical performance and arthritis symptoms. Emergent themes included improved motivation, health, and social well-being. WWE is a relevant and acceptable walking programme with scope for wider implementation to support UK health and well-being policy strategies.
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Affiliation(s)
- Kathryn R Martin
- Academic Primary Care, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Kevin Stelfox
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, AB10 7QE, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
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16
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Qiu P, Wu J, Kui L, Chen M, Lv S, Zhang Z. Causal effects of walking pace on osteoarthritis: a two-sample mendelian randomization study. Front Genet 2023; 14:1266158. [PMID: 37886687 PMCID: PMC10598773 DOI: 10.3389/fgene.2023.1266158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Background: Osteoarthritis (OA) is one of the most common joint diseases worldwide, imposing a substantial burden on individuals and society. Numerous pieces of evidence suggest that walking pace (WP) can serve as a predictive indicator for the risk of various diseases, and observational studies have also found a potential link between WP and the risk of OA. However, the causal relationship between WP and the risk of OA remains unclear. Methods: We conducted a mendelian randomization (MR) study using data from the European Genome-wide Association Study, which included WP (including 459,915 participants), OA (including 10,083 cases and 40,425 controls), knee OA (including 24,955 cases and 378,169 controls), and hip OA (including 15,704 cases and 378,169 controls). Single nucleotide polymorphisms (SNPs) associated with WP were utilized to infer causal associations with OA and its subtypes. The Inverse Variance Weighted (IVW) technique served as the primary causal analysis method. Three auxiliary MR methods - MR-Egger, weighted median, and maximum likelihood - were used to substantiate the IVW results. Sensitivity analyses were performed to examine heterogeneity and pleiotropy. In addition, multivariate MR (MVMR) analysis was used to assess causality after adjustment for three potential confounders. Results: According to the results of the IVW method, every 1 standard deviation increased in genetic WP corresponds to an 89% reduction in the risk of OA (odds ratio (OR) = 0.11; 95% confidence interval (CI), 0. 06-0.19; p = 1.57 × 10-13), an 83% reduction in the risk of knee OA (OR = 0.17; 95% CI, 0.11-0.28; p = 2.78 × 10-13), and a 76% reduction in the risk of hip OA (OR = 0.24; 95% CI, 0.14-0.43; p = 1.51 × 10-6). These results were confirmed by the three additional MR methods and validated by the sensitivity analysis. Ultimately, the MVMR analysis confirmed that the role of WP in reducing the risk of OA and its subtypes remains consistent regardless of potential confounders. Conclusion: The results of our MR study highlight a significant causal association between WP and the susceptibility to OA, including its knee and hip subtypes. These findings propose that WP could be utilized as a potential prognostic factor for OA risk.
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Affiliation(s)
- Peng Qiu
- Department of Rehabilitation, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyu Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Lihong Kui
- Xiamen Rehabilitation Hospital, Xiamen, China
| | - Mingxian Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Shuaibing Lv
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Zhongkai Zhang
- Department of Rehabilitation, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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17
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Aily JB, de Noronha M, Approbato Selistre LF, Ferrari RJ, White DK, Mattiello SM. Face-to-face and telerehabilitation delivery of circuit training have similar benefits and acceptability in patients with knee osteoarthritis: a randomised trial. J Physiother 2023; 69:232-239. [PMID: 37684147 DOI: 10.1016/j.jphys.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
QUESTION Is periodised circuit training delivered via a telerehabilitation model of care as effective as the same training applied face-to-face for improving pain intensity, physical function, muscle strength, pain catastrophising, body composition, intermuscular adipose tissue and muscle architecture in people with knee osteoarthritis (OA)? DESIGN Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS One hundred adults aged ≥ 40 years with knee OA and pain for ≥ 3 months, with current pain ≥ 40 mm on a 100-mm visual analogue scale (VAS). INTERVENTION The experimental group received 14 weeks of circuit training delivered via telerehabilitation using video recordings, followed by periodic phone calls in order to motivate and instruct participants. The control group received the same circuit training program in a face-to-face format. OUTCOME MEASURES The primary outcomes were pain VAS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale, measured at 14 weeks. Secondary outcomes included objective physical function, strength, pain catastrophising and morphological measures (muscle architecture and thigh and body composition). Outcomes were measured at 14 and 26 weeks. RESULTS Periodised circuit training delivered via telerehabilitation had equivalent effects to face-to-face delivery for pain intensity, physical function, muscle strength, pain catastrophising, thigh composition, intermuscular adipose tissue and muscle architecture. Whole body composition did not change appreciably in either group. Adherence to the training was excellent and participants in each group reported good perceptions of their randomised intervention. CONCLUSION A periodised circuit training protocol can be delivered to people with knee OA in their own homes, using available technology while maintaining high levels of acceptability. More importantly, telerehabilitation appears to cause non-inferior physical and functional outcomes to face-to-face rehabilitation programs. TRIAL REGISTRATION RBR-662hn2.
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Affiliation(s)
- Jéssica Bianca Aily
- Physiotherapy Department, Universidade Federal de São Carlos, São Carlos, Brazil
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Zhu S, Wang Z, Liang Q, Zhang Y, Li S, Yang L, He C. Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence-based practice guideline. J Evid Based Med 2023; 16:376-393. [PMID: 37743650 DOI: 10.1111/jebm.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high-quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions. METHODS Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations. RESULTS The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations). CONCLUSION This is the first evidence-based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings.
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Affiliation(s)
- Siyi Zhu
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuo Wang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiu Liang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yuting Zhang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism and Department of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Yang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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19
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Goff AJ, Barton CJ, Merolli M, Zhang Quah AS, Ki-Cheong Hoe C, De Oliveira Silva D. Comprehensiveness, accuracy, quality, credibility and readability of online information about knee osteoarthritis. HEALTH INF MANAG J 2023; 52:185-193. [PMID: 35613496 DOI: 10.1177/18333583221090579] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality. OBJECTIVE To summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis. METHOD Systematic appraisal of website content. Searches for "knee osteoarthritis" and "knee arthritis" were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability. RESULTS Thirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0-14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16-56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21-74), and Flesch-Kincaid grade level was 8 (range = 5-11). CONCLUSION Few websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability. IMPLICATIONS Careful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs.
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Affiliation(s)
- Anthony J Goff
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic, Australia
| | - Mark Merolli
- Centre for Health Exercise, and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Vic, Australia
| | | | | | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
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20
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Pechstein AE, Jakiela JT, White DK. Exploring the relation of walking endurance with physical activity after total knee replacement. Musculoskeletal Care 2023; 21:939-942. [PMID: 36916139 DOI: 10.1002/msc.1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Andrew E Pechstein
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Jason T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Dantas GAF, Sacco ICN, Ferrari AV, Matias AB, Watari R, Oliveira LVM, Marcon TR, Fatore JA, Pott-Junior H, Salvini TF. Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther 2023; 27:100531. [PMID: 37603935 PMCID: PMC10457687 DOI: 10.1016/j.bjpt.2023.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Foot-ankle exercises could improve pain and function of individuals with KOA and need to be tested. OBJECTIVE To investigate whether an 8-week foot-ankle muscle strengthening program is effective for individuals with KOA to reduce pain and improve function. METHODS In this randomized controlled trial, individuals diagnosed with clinical and radiographic KOA were randomized into the intervention (supervised foot-ankle strengthening exercise program three times a week for 8 weeks) or control (usual care and recommendations of the healthcare team) group. Effectiveness was assessed by changes in clinical and functional outcomes between baseline and 8 weeks with pain as the primary outcome. ANCOVA tests using the intervention group as a reference and sex, body mass index, and baseline values as covariates assessed between-group differences. RESULTS The intervention group showed lower pain scores (-4.4 units; 95%CI = -7.5, -1.1), better function (-7.1 units; 95%CI = -12.7, -1.4), higher total functional score (-11.9 units; 95%CI = -20.7, -3.1), with confidence intervals indicating a potential for the differences to be clinically meaningful, and better scores for the 30-s chair stand test (2.7 repetitions; 95%CI = 1.1, 4.1), with a confidence interval indicating a moderate clinically meaningful difference, compared to the controls. CONCLUSION The 8-week foot-ankle exercise program showed positive, and potentially clinically meaningful, effects on knee pain and physical function among individuals with KOA, when compared to usual care. TRIAL REGISTRATION NCT04154059. https://clinicaltrials.gov/ct2/show/NCT04154059.
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Affiliation(s)
- Glauko A F Dantas
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Department of Physical Therapy, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil.
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Angélica V Ferrari
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Alessandra B Matias
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricky Watari
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Larissa V M Oliveira
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Thainá R Marcon
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - José A Fatore
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Tania F Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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22
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Truong AP, Wall CJ, Stoney JD, Graves SE, Lorimer MF, de Steiger RN. Obesity is associated with an increased risk of undergoing hip replacement in Australia. ANZ J Surg 2023; 93:1901-1906. [PMID: 37248204 DOI: 10.1111/ans.18543] [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: 12/15/2022] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Obesity is a known risk factor for the development of hip osteoarthritis. The aim of this study was to investigate whether obesity is associated with the risk of undergoing total hip replacement (THR) in Australia. METHODS A cohort study was conducted comparing data from the Australian Bureau of Statistics and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 2017 to 2018. Body mass index (BMI) data for patients undergoing primary total hip replacement and resurfacing for osteoarthritis were obtained from the AOANJRR. The distribution of THR patients by BMI category was compared to the general population, in age and sex sub-groups. RESULTS During the study period, 32 495 primary THR were performed for osteoarthritis in Australia. Compared to the general population, there was a higher prevalence of Class I, II and III obesity in patients undergoing THR in both sexes aged 35-74 years. Class III obese females and males aged 55-64 years were 2.9 and 1.7 times more likely to undergo THR, respectively (P < 0.001). Class III obese females and males underwent THR on average 5.7 and 7.0 years younger than their normal weight counterparts, respectively. CONCLUSION Obese Australians are at increased risk of undergoing THR, and at a younger age.
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Affiliation(s)
- Anthony P Truong
- Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
- School of Medicine, Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia
| | - James D Stoney
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Michelle F Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
- Department of Surgery, Epworth Healthcare, The University of Melbourne, Melbourne, Victoria, Australia
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23
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Fujita R, Ota S, Yamamoto Y, Kataoka A, Warashina H, Inoue T, Ozeki S, Sugiura H. Effect of diabetes mellitus on physical activity in patients with knee osteoarthritis: A cross-sectional study. J Orthop Surg (Hong Kong) 2023; 31:10225536231197726. [PMID: 37621081 DOI: 10.1177/10225536231197726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Knee osteoarthritis (OA) may be comorbid with diabetes mellitus (DM), and physical activity is a recommended lifestyle strategy for both diseases. The present study investigated the physical activity differences by intensity between knee OA patients with or without DM, and evaluated if physical activity was associated with the presence of DM in knee OA patients. METHODS A total of 183 patients (mean age 74.9 ± 6.4 years) with moderate-to-severe knee OA underwent evaluation of knee function (i.e., knee flexion/extension range-of-motion, knee-extension muscle strength, and knee pain), the timed up-and-go (TUG) test, and physical activity measurement using an accelerometer. Physical activity by intensity was compared between knee OA patients with and without DM. The association between physical activity, including knee function and the TUG test time, and DM was assessed. RESULTS The 2 groups (with or without DM) did not differ significantly in knee OA severity or age. Compared to knee OA patients without DM, knee OA patients with DM had a significantly lower average daily step count (p < 0.001), and significantly shorter times spent performing light-intensity physical activity (LPA; p < 0.001) and moderate-to-vigorous-intensity physical activity (MVPA; p = 0.006). After adjusting for age, sex, and body mass index, we found that a lower average daily step count and shorter LPA time significantly correlated with DM (β = -0.200, p = 0.006; β = -0.216, p = 0.004, respectively) and a longer TUG test time (β = -0.196, p = 0.014; β = -0.208, p = 0.011, respectively). A shorter MVPA time significantly correlated with lower contralateral knee-extension muscle strength (β = 0.187, p = 0.032). CONCLUSION Knee OA patients with DM had significantly lower physical activity levels than those without DM. Furthermore, the presence of DM correlated with a lower step count and a shorter LPA time in knee OA patients.
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Affiliation(s)
- Remi Fujita
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Yuri Yamamoto
- Department of Rehabilitation, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Akito Kataoka
- Department of Rehabilitation, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Hideki Warashina
- Department of Orthopedics, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Tomoe Inoue
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Ozeki
- Department of Rehabilitation, Mariana Home-Nursing Station, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Grant S, Tonkin E, Craddock I, Blom A, Holmes M, Judge A, Masullo A, Perello Nieto M, Song H, Whitehouse M, Flach P, Gooberman-Hill R. Toward Enhanced Clinical Decision Support for Patients Undergoing a Hip or Knee Replacement: Focus Group and Interview Study With Surgeons. JMIR Perioper Med 2023; 6:e36172. [PMID: 37093626 PMCID: PMC10167586 DOI: 10.2196/36172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The current assessment of recovery after total hip or knee replacement is largely based on the measurement of health outcomes through self-report and clinical observations at follow-up appointments in clinical settings. Home activity-based monitoring may improve assessment of recovery by enabling the collection of more holistic information on a continuous basis. OBJECTIVE This study aimed to introduce orthopedic surgeons to time-series analyses of patient activity data generated from a platform of sensors deployed in the homes of patients who have undergone primary total hip or knee replacement and understand the potential role of these data in postoperative clinical decision-making. METHODS Orthopedic surgeons and registrars were recruited through a combination of convenience and snowball sampling. Inclusion criteria were a minimum required experience in total joint replacement surgery specific to the hip or knee or familiarity with postoperative recovery assessment. Exclusion criteria included a lack of specific experience in the field. Of the 9 approached participants, 6 (67%) orthopedic surgeons and 3 (33%) registrars took part in either 1 of 3 focus groups or 1 of 2 interviews. Data were collected using an action-based approach in which stimulus materials (mock data visualizations) provided imaginative and creative interactions with the data. The data were analyzed using a thematic analysis approach. RESULTS Each data visualization was presented sequentially followed by a discussion of key illustrative commentary from participants, ending with a summary of key themes emerging across the focus group and interview data set. CONCLUSIONS The limitations of the evidence are as follows. The data presented are from 1 English hospital. However, all data reflect the views of surgeons following standard national approaches and training. Although convenience sampling was used, participants' background, skills, and experience were considered heterogeneous. Passively collected home monitoring data offered a real opportunity to more objectively characterize patients' recovery from surgery. However, orthopedic surgeons highlighted the considerable difficulty in navigating large amounts of complex data within short medical consultations with patients. Orthopedic surgeons thought that a proposed dashboard presenting information and decision support alerts would fit best with existing clinical workflows. From this, the following guidelines for system design were developed: minimize the risk of misinterpreting data, express a level of confidence in the data, support clinicians in developing relevant skills as time-series data are often unfamiliar, and consider the impact of patient engagement with data in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-021862.
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Affiliation(s)
- Sabrina Grant
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol Medical School, Bristol, United Kingdom
| | - Emma Tonkin
- Digital Health, Faculty of Engineering, Bristol, United Kingdom
| | - Ian Craddock
- Digital Health, Faculty of Engineering, Bristol, United Kingdom
| | - Ashley Blom
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom
| | - Michael Holmes
- Digital Health, Faculty of Engineering, Bristol, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol Medical School, Bristol, United Kingdom
| | | | | | - Hao Song
- Digital Health, Faculty of Engineering, Bristol, United Kingdom
| | - Michael Whitehouse
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol Medical School, Bristol, United Kingdom
| | - Peter Flach
- Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol Medical School, Bristol, United Kingdom
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Tarantino D, Theysmans T, Mottola R, Verbrugghe J. High-Intensity Training for Knee Osteoarthritis: A Narrative Review. Sports (Basel) 2023; 11:sports11040091. [PMID: 37104165 PMCID: PMC10141118 DOI: 10.3390/sports11040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disease worldwide. Exercise therapy has been identified as a first-line treatment option in patients suffering from knee OA. High-intensity training (HIT) is an innovative exercise modality with potential in improving various disease-related outcomes. The purpose of this review is to explore the impact of HIT on knee OA symptoms and physical functioning. A comprehensive search of scientific electronic databases was conducted to identify articles on the effects of HIT on knee OA. Thirteen studies were included in this review. Ten compared the effects of HIT with those of low-intensity training, moderate-intensity continuous training, or a control group. Three evaluated the effects of HIT alone. Eight reported a decrease in knee OA symptoms (especially pain), and eight reported an increase in physical functioning. HIT was shown to improve knee OA symptoms and physical functioning, but also aerobic capacity, muscle strength, and quality of life with minimal or no adverse events. However, compared with other exercise modalities, no clear superiority of HIT was found. HIT is a promising exercise strategy in patients with knee OA; nonetheless, the actual quality of evidence remains very low, and more high-quality studies are needed to confirm these promising outcomes.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Tine Theysmans
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Rosita Mottola
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Jonas Verbrugghe
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium
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M Ezzat A, Kemp JL, J Heerey J, F Pazzinatto M, De Oliveira Silva D, Dundules K, Francis M, J Barton C. Implementation of the Good Life with osteoArthritis in Denmark (GLA:D ®) program via telehealth in Australia: A mixed-methods program evaluation. J Telemed Telecare 2023:1357633X231167620. [PMID: 37082796 DOI: 10.1177/1357633x231167620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION We aimed to evaluate the implementation of the Good Life with osteoArthritis in Denmark (GLA:D®) program via telehealth in Australia using Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation framework. METHODS Using a convergent mixed-methods design, semi-structured one-on-one interviews with physiotherapist adopters and nonadopters of GLA:D® via telehealth were analyzed thematically alongside the examination of registry data (1 March 2020-10 February 2022) from patients with hip or knee osteoarthritis completing GLA:D® via telehealth (telehealth-only) or combined with in-person care (hybrid). Effectiveness was determined as changes from baseline to 3-month follow-up (mean differences, 95% confidence intervals, effect size) for Knee injury and Osteoarthritis Outcome Score (KOOS-12)/Hip disability and Osteoarthritis Outcome Score-12 (HOOS-12), and chair stand test. Group- and individual-level changes were compared to published minimally clinically important change scores. RESULTS Twenty-three interviews (12 adopters, 11 nonadopters) found key barriers/facilitators to reach and adoption, high perceived effectiveness, and strategies to support sustainability. Of 2612 registered patients, 85 (3%) and 115 (4%) completed GLA:D® via telehealth-only or hybrid model, respectively. Most effectiveness outcomes were associated with moderate-large improvements. Group-level changes exceeded minimally clinically important change values for KOOS/HOOS-quality of life and chair stand test. Nearly two out of three patients reached a minimally clinically important change for KOOS/HOOS-quality of life. With telehealth-only and hybrid delivery, 99% (n = 82) and 85% (n = 97) were satisfied/very satisfied. Physiotherapist adoption was limited (n = 128, 6%). DISCUSSION GLA:D® delivered via telehealth is effective, had high patient satisfaction, and was perceived positively by physiotherapist adopters. Addressing low reach and adoption requires further implementation strategies to facilitate greater telehealth opportunities for patients and physiotherapists.
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Affiliation(s)
- Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Marcella F Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Karen Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Matthew Francis
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Gaid D, Ahmed S, Thomas A, Bussières A. Barriers and Facilitators to Knowledge Brokering Activities: Perspectives from Knowledge Brokers Working in Canadian Rehabilitation Settings. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:87-95. [PMID: 36859412 DOI: 10.1097/ceh.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2022] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Knowledge translation experts advocate for employing knowledge brokers (KBs) to promote the uptake of research evidence in health care settings. Yet, no previous research has identified potential barriers for KBs to promote the uptake of research evidence in rehabilitation settings. This study aimed to identify the barriers and facilitators for KBs in Canadian rehabilitation settings as perceived by individuals serving as KBs. METHODS Qualitative study using semistructured telephone interviews with individuals performing KB activities in rehabilitation settings across Canada. The interview topic guide was informed by the Consolidated Framework for Implementation Research (CFIR) and consisted of 20 questions covering three domains (characteristics of individuals, inner setting, and outer settings). We conducted qualitative descriptive analysis combining deductive coding guided by the CFIR. RESULTS Characteristics of individuals included having communication skills, clinical experience, research skills, and interpersonal features, in addition to being confident and motivated and receiving training. The inner setting domain included having constant networking with stakeholders and being aware of stakeholders' needs, in addition to resources availability, leadership engagement, knowledge accessibility, prioritizing brokering activities, and monitoring KBs' performance. Finally, the outer setting domain showed that KBs need to be connected to a community of practice to promote information exchange and avoid work duplications. DISCUSSION Factors likely to hinder or promote the optimal use of KBs within Canadian rehabilitation settings include skill sets and networking abilities; organizational culture, resources, and leadership engagement; and the need for specific training for KBs and for evaluation tools to monitor their performance.
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Affiliation(s)
- Dina Gaid
- Dr. Gaid: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada. Dr. Ahmed: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada, and Research Institute McGill University Health Center, Centre for Outcomes Research and Evaluation (CORE), Montreal, Quebec, Canada. Dr. Thomas: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada, and Institute of Health Sciences Education, Montreal, Quebec, Canada. Dr. Bussières: Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada, and McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Yang L, Wang P, McGill B. The relationship between experience of knee pain and physical activity participation: A scoping review of quantitative studies. Int J Nurs Sci 2023; 10:258-267. [PMID: 37128486 PMCID: PMC10148261 DOI: 10.1016/j.ijnss.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 05/03/2023] Open
Abstract
Objectives Physical activity (PA) in people with knee pain can help to relieve pain and prevent health problems. However, engaging in regular PA is challenging for them due to chronic musculoskeletal pain. An understanding of how the experience of knee pain affects PA is important to minimize the negative effects of knee pain on participation in PA among this population. We examined the quantitative evidence describing the relationship between the experience of knee pain and participation in PA. Methods We conducted a scoping review based on the PRISMA-ScR process across 27 items and Peters' methodological framework. Searches using keywords were performed in Medline, PsycINFO, CINAHL and Scopus. Results Nine studies were included in this review. While one study clearly showed that increased knee pain increased PA, four studies indicated that knee pain decreased PA among individuals with knee pain. One study revealed that increased knee pain decreased moderate PA, but no significant difference with light intensity PA. Three studies showed that knee pain had no impact on PA. Moreover, psychological factors (catastrophizing and pain-related activity interference) and certain activities of daily living were risk factors for insufficient PA among people with knee pain. Conclusions The limited quantitative evidence on the relationship between the experience of knee pain and PA participation highlights a gap in the knowledge base. The review findings found mixed results, with a negative, positive or no relationship between knee pain and levels of PA among individuals with knee pain. The findings also suggest that the relationship can be affected by psychological factors and different levels and types of PA. Therefore, practitioners should consider multi-component interventions which aim to increase PA levels of individuals with knee pain, after considering the above mediating factors.
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Affiliation(s)
- Lu Yang
- Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Peipei Wang
- Department of Hematology, Huashan Hospital, Shanghai, China
| | - Bronwyn McGill
- Sydney School of Public Health, University of Sydney, NSW, Australia
- Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, NSW, Australia
- Corresponding author. Sydney School of Public Health, University of Sydney, NSW, Australia.
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Lisee C, Bjornsen E, Berkoff D, Blake K, Schwartz T, Horton WZ, Pietrosimone B. Changes in biomechanics, strength, physical function, and daily steps after extended-release corticosteroid injections in knee osteoarthritis: a responder analysis. Clin Rheumatol 2023:10.1007/s10067-023-06568-x. [PMID: 36929315 DOI: 10.1007/s10067-023-06568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION/OBJECTIVE To determine changes in gait biomechanics, quadricep strength, physical function, and daily steps after an extended-release corticosteroid knee injection at 4 and 8 weeks post-injection in individuals with knee osteoarthritis as well as between responders and non-responders based on changes in self-reported knee function. METHOD The single-arm, clinical trial included three study visits (baseline, 4 weeks, and 8 weeks post-injection), where participants received an extended-release corticosteroid injection following the baseline visit. Time-normalized vertical ground reaction force (vGRF), knee flexion angle (KFA), knee abduction moment (KAM), and knee extension moment (KEM) waveforms throughout stance were collected during gait biomechanical assessments. Participants also completed quadricep strength, physical function (chair-stand, stair-climb, 20-m fast-paced walk) testing, and free-living daily step assessment for 7 days following each visit. RESULTS All participants demonstrated increased KFA excursion (i.e., greater knee extension angle at heel strike and KFA at toe-off), increased KEM during early stance, improved physical function (all p < 0.001), and increased quadricep strength at 4 and 8 weeks. KAM increased throughout most of stance at 4 and 8 weeks post-injection (p < 0.001) but appears to be driven by gait changes in non-responders. Non-responders demonstrated lesser vGRF during late stance and lesser KEM and KFA throughout stance compared to responders at baseline. CONCLUSIONS Extended-release corticosteroid injections demonstrated short-term improvements in gait biomechanics, quadricep strength, and physical function for up to 4 weeks. However, non-responders demonstrated gait biomechanics associated with osteoarthritis progression prior to the corticosteroid injection, suggesting that non-responders demonstrate more deleterious gait biomechanics prior to corticosteroid injection. Key Points • Individuals with knee osteoarthritis who were treated with extended-release corticosteroid injections demonstrated improvements in gait biomechanics and physical function for 8 weeks. • Individuals with knee osteoarthritis, who walked with aberrant walking biomechanics before treatment, failed to respond to extended-release corticosteroid treatment. • Future research should determine the mechanisms contributing to the short-term changes in gait biomechanics and physical function such as reduced inflammation.
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Affiliation(s)
- Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA.
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
| | - David Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen Blake
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W Zachary Horton
- Department of Statistics, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sutton L, Jose K, Hansen E, Laslett L, Makin J, Winzenberg T, Balogun S, Aitken D. Navigating the maze of osteoarthritis treatment: A qualitative study exploring the experience of individuals with osteoarthritis in Tasmania, Australia. Musculoskeletal Care 2023; 21:264-271. [PMID: 36097647 DOI: 10.1002/msc.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Using a qualitative design this study aimed to (1) explore the experience of people living with osteoarthritis (OA), (2) gain an understanding of their navigation of the health system and, (3) explore their opinions on the role of exercise and joint replacement surgery for the management of OA. METHODS Purposive sampling was used to recruit 26 participants with knee OA, aged 45 years and over, from Tasmania, Australia. Semi-structured interviews were audio-recorded, transcribed, coded, and thematically analysed to document participant understanding and experience of OA and their opinions on the role of exercise and surgery in managing OA. RESULTS Of the 26 participants, 80% (n = 21) were female with a mean age of 66 years. The main theme identified was that individuals with knee OA were navigating a maze of OA treatments. Three related subthemes were that participants: (i) perceived their general practitioner did not have an ongoing role in their OA care, (ii) self-directed their management and, (iii) sampled from a 'smorgasbord' of treatment options, including low-value care options. Two other major themes were: the role of exercise for OA management, and surgery as a last resort. CONCLUSION Our findings suggest that OA patients may not be choosing consistent, high-value care for their OA. This highlights the importance of an evidence-based multi-disciplinary approach to guide patients to self-manage their OA and support their navigation of the health system. Reducing emphasis on the pathway to surgery and streamlining access to conservative management strategies may assist people to receive high-value care.
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Affiliation(s)
- Laura Sutton
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Emily Hansen
- School of Social Sciences, University of Tasmania, Tasmania, Australia
| | - Laura Laslett
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Jennifer Makin
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
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Baumbach L, Grønne DT, Møller NC, Skou ST, Roos EM. Changes in physical activity and the association between pain and physical activity - a longitudinal analysis of 17,454 patients with knee or hip osteoarthritis from the GLA:D® registry. Osteoarthritis Cartilage 2023; 31:258-266. [PMID: 36272673 DOI: 10.1016/j.joca.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Investigate change in physical activity following an 8-week education and exercise therapy program for patients with knee/hip osteoarthritis, focusing on those with low physical activity level. Furthermore, to evaluate associations between changes in pain intensity and physical activity. METHOD Data from the Good Life with osteoArthritis in Denmark (GLA:D®) registry, at baseline, immediately after completion, and 12 months after entering the program was used. Measures of interest were UCLA activity scale (1-10) and Visual Analog Scale for pain intensity (0-100 mm). Changes in physical activity levels (low 1-4, moderate 5-6, and high 7-10) over three time points were investigated. Asymmetric fixed effects regression models were used to evaluate the association between clinically relevant change in pain (≥15 mm) and change in physical activity level from baseline to 12 months. RESULTS 37% with low activity level at baseline (n = 4,836) and 69% of all patients (n = 17,454) reached or maintained at least a moderate physical activity level at follow-ups. Surprisingly, both an improvement (β = 1.44, P < 0.001) and a worsening (β = 1.18, P < 0.001) in pain intensity was associated with increased physical activity in low activity patients. For all patients a similar trend was observed (β = 0.51, P < 0.001 and β = 0.11, P = 0.215, respectively). CONCLUSION In low active knee or hip OA patients, a third of patients participating in an education and exercise therapy program reached and maintained at least a moderate physical activity level for 1 year. The improvement in physical activity was not dependent on pain reduction.
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Affiliation(s)
- L Baumbach
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - N C Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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Cornwall N, Swaithes L, Woodcock C, Healey EL, Hider SL. Implementation of physical activity interventions for people with inflammatory arthritis: an overview and future recommendations. Rheumatol Adv Pract 2023; 7:rkac094. [PMID: 36699546 PMCID: PMC9870707 DOI: 10.1093/rap/rkac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 01/25/2023] Open
Abstract
Regular physical activity is important for both physical and mental health. This is particularly important for people with inflammatory arthritis, because of the benefits on both disease-specific and systemic outcomes and the increased risk of comorbidities such as cardiovascular disease. Despite a wealth of evidence supporting physical activity interventions, there remains a significant gap in implementation into routine care. This overview describes what implementation is, examines why it is important to consider implementation approaches to improve uptake of physical activity, highlights factors that influence successful implementation using exemplars from both osteoarthritis and inflammatory arthritis and recommends where future research is needed.
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Affiliation(s)
| | | | | | | | - Samantha L Hider
- Correspondence to: Samantha L. Hider, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK. E-mail:
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El Haddad L, Peiris CL, Taylor NF, McLean S. Determinants of Non-Adherence to Exercise or Physical Activity in People with Metabolic Syndrome: A Mixed Methods Review. Patient Prefer Adherence 2023; 17:311-329. [PMID: 36760232 PMCID: PMC9904214 DOI: 10.2147/ppa.s383482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS. METHODS Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively. RESULTS Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants. CONCLUSION A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.
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Affiliation(s)
- Laila El Haddad
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Sionnadh McLean
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
- Correspondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email
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Hinman RS, Hall M, Comensoli S, Bennell KL. Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis. J Sci Med Sport 2023; 26:37-45. [PMID: 36463000 DOI: 10.1016/j.jsams.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management. Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.
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Affiliation(s)
- Rana S Hinman
- Department of Physiotherapy, The University of Melbourne, Australia.
| | - Michelle Hall
- Department of Physiotherapy, The University of Melbourne, Australia
| | | | - Kim L Bennell
- Department of Physiotherapy, The University of Melbourne, Australia
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Chu SF, Wang HH. Outcome Expectations and Older Adults with Knee Osteoarthritis: Their Exercise Outcome Expectations in Relation to Perceived Health, Self-Efficacy, and Fear of Falling. Healthcare (Basel) 2022; 11:57. [PMID: 36611517 PMCID: PMC9819286 DOI: 10.3390/healthcare11010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Outcome expectations are a determinant of exercise engagement and adherence. However, the factors that influence outcome expectations for exercise remain poorly understood for people with knee osteoarthritis. In this paper, a cross-sectional study was conducted by recruiting 211 older adults from three clinics in Southern Taiwan. This study explored older adults with knee osteoarthritis exercise outcome expectations and perceived health, self- efficacy, and fear of falling. The older adults completed the Outcome Expectations for Exercise Scale (OEES), the pain and physical function subscales of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Perceived Health Status Scale, the Self-Efficacy for Exercise scale (SEE- C), the Activities-Specific Balance Confidence Scale (ABC), the Geriatric Depression Scale (GDS). Multiple logistic regression models were used to determine associations between outcome expectations for exercise and physical and psychosocial outcomes in the knee OA population. Among the participants of the cross-sectional study, the mean age was 72.04 (SD = 5.53) years, and 71.6% were female. Higher outcome expectations for exercise were associated with higher physical function (OR = 0.98; 95% CI [0.96−1.99]; p = 0.007), better perceived health (OR = 1.30; 95% CI [1.12−1.51]; p < 0.001), greater self-efficacy (OR =1.03; 95% CI [1.01−1.04]; p = 0.006), and less fear of falling (OR = 3.33; 95% CI [1.21−9.19]; p = 0.020). Thus, the results indicated that outcome expectations for exercise among the participants were significantly associated with physical function, perceived health, self-efficacy, and fear of falling. These findings suggest the importance of personal factors in the design of interventions to promote exercise behavior changes among elderly patients with Knee Osteoarthritis.
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Affiliation(s)
- Su-Feng Chu
- Department of Nursing, Meiho University, Pingtung 912009, Taiwan
- College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Wiciński M, Szwedowski D, Wróbel Ł, Jeka S, Zabrzyński J. The Influence of Body Mass Index on Growth Factor Composition in the Platelet-Rich Plasma in Patients with Knee Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:40. [PMID: 36612361 PMCID: PMC9819567 DOI: 10.3390/ijerph20010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND An abnormally high body mass index is strongly associated with knee osteoarthritis. Usually, obese patients are excluded from clinical trials involving PRP intra-articular injections. Growth factors have been demonstrated to have a disease-modifying effect on KOA treatment, even though data on their influence on treatment effectiveness in obese patients are lacking. PURPOSE To prospectively compare the level of selected growth factors including transforming growth factor-b (TGF-β), epidermal growth factor (EGF), fibroblast growth factor, insulin-like growth factor-1 (IGF-1), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and fibroblast growth factor-2 (FGF-2) in platelet-rich plasma (PRP) in obese patients and patients with normal BMI. METHODS A total of 49 patients were included in the study according to inclusion and exclusion criteria. The groups strongly differed in body mass index (median values 21.6 vs. 32.15). Concentrations of growth factors were measured with an enzyme-linked immunosorbent assay. Statistical significance was determined with the Mann-Whitney U test. The compliance of the distribution of the results with the normal distribution was checked using the Shapiro-Wilk test separately for both groups. RESULTS There were no statistically significant differences in median marker levels between groups. Statistically significant Pearson correlations were observed between IGF-1 serum level and age (weak negative, r = -0.294, p = 0.041) and gender (moderate positive, r = 0.392, 0.005). CONCLUSIONS BMI does not influence the level of selected growth factors in patients with knee osteoarthritis. Obese and non-obese patients had similar compositions of PDGF, TGF-β, EGF, FGF-2, IGF-1, and VEGF. PRP can be used in both groups with similar effects associated with growth factors' influence on articular cartilage.
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Affiliation(s)
- Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Dawid Szwedowski
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Dr. A. Jurasza St. 2, 85-094 Bydgoszcz, Poland
- Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi N.P.O., 20133 Milan, Italy
| | - Łukasz Wróbel
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Sławomir Jeka
- Department of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85168 Bydgoszcz, Poland
| | - Jan Zabrzyński
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland
- Department of Pathology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
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Okura K, Shibata K, Suda T, Kimoto M, Saito A, Wakasa M, Kimura Y, Okada K. Gait-related self-efficacy is directly associated with daily step counts in individuals with knee osteoarthritis. Knee 2022; 39:124-131. [PMID: 36191399 DOI: 10.1016/j.knee.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/05/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In addition to physical factors, psychological factors such as self-efficacy (SE) reportedly affect physical activity (PA) levels in individuals with knee osteoarthritis (OA). However, the relationship between PA and SE for walking tasks in patients with knee OA remains unclear. The present study aimed to investigate the direct and indirect pathways of SE for walking tasks and the influence of previously reported factors on PA level in individuals with knee OA. METHODS A cross-sectional design was employed. Eighty-five individuals with knee OA were enrolled. The daily step count (Steps) was considered an objective level of PA. The SE for the walking task was assessed using a modified Gait Efficacy Scale (mGES). Data on gait speed (GS), the visual analog scale (VAS) score for knee pain, Kellgren-Lawrence (K-L) grade of radiographic severity of knee OA, age, and body mass index were collected. Path analysis was performed to investigate the direct and indirect effects of these variables on Steps. RESULTS After exclusion, 70 participants were included. The alternative model, which included Steps, mGES, GS, VAS, K-L grade, and age, showed a good fit. mGES and age had a direct effect on Steps (standardized path coefficients: 0.337 and -0.542, respectively), while the other variables had indirect effects. CONCLUSIONS The SE for walking tasks was directly associated with Steps representative of the PA level. This finding suggests that SE for the walking task may be important in improving PA levels in individuals with knee OA.
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Affiliation(s)
- Kazuki Okura
- Division of Rehabilitation, Akita University Hospital, Akita, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan.
| | | | - Tomohiro Suda
- Division of Rehabilitation, Akita University Hospital, Akita, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Yoshiaki Kimura
- Department of Orthopedic Surgery, Akita City Hospital, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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Norte GE, Cousins M, Hogarth DA, Knaus KR, Slater LV, Blemker SS, Hart JM. Personalized volumetric assessment of lower body muscles in patients with knee injuries: A descriptive case series. Knee 2022; 39:38-49. [PMID: 36126493 DOI: 10.1016/j.knee.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature. PURPOSE To describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies. METHODS This was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database. RESULTS There were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes. CONCLUSION Patients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.
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Affiliation(s)
- Grant E Norte
- Department of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, United States.
| | | | - Danielle A Hogarth
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Katherine R Knaus
- Department of Bioengineering, University of California at San Diego, San Diego, CA, United States
| | - Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Silvia S Blemker
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States; Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States
| | - Joseph M Hart
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Bell EC, Wallis JA, Goff AJ, Crossley KM, O'Halloran P, Barton CJ. Does land-based exercise-therapy improve physical activity in people with knee osteoarthritis? A systematic review with meta-analyses. Osteoarthritis Cartilage 2022; 30:1420-1433. [PMID: 35970256 DOI: 10.1016/j.joca.2022.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
PRIMARY OBJECTIVE Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA). DESIGN Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence. RESULTS Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71). CONCLUSION Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.
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Affiliation(s)
- E C Bell
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - J A Wallis
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia
| | - A J Goff
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - K M Crossley
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - P O'Halloran
- La Trobe University School of Psychology and Public Health, Australia
| | - C J Barton
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia
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King MG, Kemp JL, Hon R, Pizzari T, Wong J, Menz H, Taylor NF, Harms A, McClelland JA, Semciw AI. Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: protocol for a randomised feasibility trial. BMJ Open 2022; 12:e062954. [PMID: 36691129 PMCID: PMC9453946 DOI: 10.1136/bmjopen-2022-062954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The aim of this randomised feasibility trial is to determine the feasibility of conducting an adequately powered randomised controlled trial (RCT) investigating the efficacy of prefabricated contoured foot orthoses in people with hip osteoarthritis (OA). The secondary aims of the trial are to compare the effect of prefabricated contoured foot orthoses to a flat shoe insert comparator on outcomes of hip-related pain, physical activity and quality of life. We hypothesise that the demand, implementation, acceptability and practicality of foot orthoses as a treatment option for people with hip OA will be deemed feasible, informing the development of an adequately powered RCT to evaluate the efficacy and long term outcomes. METHODS AND ANALYSIS We will recruit 28 people with hip OA who will be randomised to receive either prefabricated contoured foot orthoses or flat shoe inserts to use for a 6-week period. Both groups will receive standardised education on hip OA and physical activity. The study's primary outcome is the feasibility domains of demand, implementation, acceptability and practicality. The secondary outcomes include the change in Hip Osteoarthritis Outcome Score-12, Patient Health Questionnaire-9, Brief Fear of Movement Scale for OA, Physical activity accelerometry and the Physical Activity Questionnaire-short form. Descriptive statistics will be used to describe feasibility outcomes with limited efficacy analysis used for the secondary outcomes. Linear mixed models will be used to analyse between-group differences at 6 weeks, with baseline values used as covariates, treatment allocation as a fixed factor and participant as a random factor. ETHICS AND DISSEMINATION This trial has been approved by the La Trobe University Human Research Ethics Committee (HEC20427), St. Vincent's Hospital Melbourne, Human Research Ethics Committee (HREC 266/20) and Northern Health Research Governance (NH-2021-292862). The results will be disseminated via a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER NCT05138380.
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Affiliation(s)
- Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Ryan Hon
- Northern Health, Epping, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Justin Wong
- Northern Health, Epping, Victoria, Australia
| | - Hylton Menz
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Podiatry, La Trobe University, Melbourne, Victoria, Australia, LaTrobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Anton Harms
- Northern Health, Epping, Victoria, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Ivan Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
- Northern Health, Epping, Victoria, Australia
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Ma JK, Ramachandran S, Sandhu A, Tsui K, Hoens AM, Hu D, Li LC. Tailored Interventions for Supporting Physical Activity Participation in People with Arthritis and Related Conditions: a Systematic Review. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022. [DOI: 10.1007/s40674-022-00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Bieler T, Magnusson SP, Siersma V, Rinaldo M, Schmiegelow MT, Beck T, Krifa AM, Kjær BH, Palm H, Midtgaard J. Effectiveness of promotion and support for physical activity maintenance post total hip arthroplasty-study protocol for a pragmatic, assessor-blinded, randomized controlled trial (the PANORAMA trial). Trials 2022; 23:647. [PMID: 35964101 PMCID: PMC9375375 DOI: 10.1186/s13063-022-06610-4] [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: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Total hip arthroplasty is considered an efficacious procedure for relieving pain and disability, but despite that objectively measured physical activity level remains unchanged compared to pre-surgery and is still considerably lower than that of a healthy age- and sex-matched population 6–12 months post-surgery. Since there is a graded relationship between physical activity level and functional performance, increasing physical activity may enhance the outcome of the procedure. This study aims to investigate whether promotion and support of physical activity initiated 3 months after total hip arthroplasty complementary to usual rehabilitation care can increase objective measured physical activity 6 months post-surgery. Methods The trial is designed as a pragmatic, parallel group, two-arm, assessor-blinded, superiority, randomized (1:1), controlled trial with post intervention follow-up 6 and 12 months after total hip arthroplasty. Home-dwelling, independent, and self-reliant patients with hip osteoarthritis are provisionally enrolled prior to surgery and re-screened about 2–3 months post-surgery to confirm eligibility. Baseline assessment is conducted 3 months post-surgery. Subsequently, patients (n=200) are randomized to either a 3-month, multimodal physical activity promotion/education intervention or control (no further attention). The intervention consists of face-to-face and telephone counselling, patient education material, pedometer, and step-counting journal. The primary outcome is objectively measured physical activity, specifically the proportion of patients that complete on average ≥8000 steps per day 6 months post-surgery. Secondary outcomes include core outcomes (i.e., physical function, pain, and patient global assessment) and health-related quality of life. Furthermore, we will explore the effect of the intervention on self-efficacy and outcome expectations (i.e., tertiary outcomes). Discussion By investigating the effectiveness of a pedometer-driven, face-to-face, and telephone-assisted counselling, behavior change intervention in complementary to usual rehabilitation, we hope to deliver applicable and generalizable knowledge to support physical activity after total hip arthroplasty and potentially enhance the outcome of the procedure. Trial registration www.clinicaltrials.govNCT04471532. Registered on July 15, 2020.
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Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.,Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 8, Building 8, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, building 24, entrance R, 1353, Copenhagen K, Denmark
| | - Mie Rinaldo
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Morten Torrild Schmiegelow
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Torben Beck
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | | | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Nordstjernevej 41, 2600, Glostrup, Denmark
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Patel KV, Hoffman EV, Phelan EA, Gell NM. Remotely Delivered Exercise to Rural Older Adults With Knee Osteoarthritis: A Pilot Study. ACR Open Rheumatol 2022; 4:735-744. [PMID: 35687577 PMCID: PMC9374047 DOI: 10.1002/acr2.11452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE EnhanceFitness (EF) is an evidence-based exercise program recommended for management of osteoarthritis (OA). However, access to EF is limited in rural areas. Accordingly, we evaluated the feasibility and acceptability of remotely delivered EF (tele-EF) in rural, community-dwelling older adults with symptomatic knee OA. METHODS A single-arm pilot trial of tele-EF classes was conducted. Videoconferencing was used to livestream the instructor-led, 1-hour EF classes 3 days/week for 12 weeks. Outcomes were assessed at baseline and immediately post intervention. RESULTS A total of 15 of 27 potential participants (55%) were screen eligible and enrolled into the trial. Participants had a median age of 70 years (interquartile range: 67-75), and 14 (93%) were women. The median EF class attendance rate was 91% (interquartile range: 85%-94%). Knee pain, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), improved significantly from baseline to the 12-week end point (mean difference = -11.4 [95% confidence interval (CI): -20.9 to -2.0]; P = 0.02). In addition, participants' self-reported knee function improved significantly (mean difference in KOOS function score = -11.8 [95% CI: -18.4 to -5.2]; P < 0.01) as well as their physical capacity (mean difference in Timed Up and Go test time = 1.8 seconds [95% CI: 0.2-3.4]; P = 0.03). All participants (100%) were very satisfied with tele-EF classes, and 12 participants (86%) reported that their condition had much improved or very much improved since beginning the EF exercise program. Lastly, there were no serious adverse events. CONCLUSION Findings from this pilot trial indicate that tele-EF is feasible and acceptable in rural older adults with knee OA.
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Affiliation(s)
- Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Elise V Hoffman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Health Systems and Population Health, University of Washingto, Seattle, Washington, USA
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
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Joseph KL, Dagfinrud H, Hagen KB, Nordén KR, Fongen C, Wold OM, Hinman RS, Nelligan RK, Bennell KL, Tveter AT. The AktiWeb study: feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis. Pilot Feasibility Stud 2022; 8:150. [PMID: 35859065 PMCID: PMC9296765 DOI: 10.1186/s40814-022-01110-3] [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: 05/25/2021] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient organisations may be an under-utilised resource in follow-up of patients requiring long-term exercise as part of their disease management. The purpose of this study was to explore the feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis (OA). Methods In this pre–post feasibility study, patients aged 40–80 years with hip and/or knee OA were recruited from Diakonhjemmet Hospital. The 12-week intervention was delivered through a patient organisation’s digital platform. Feasibility was evaluated by proportion of eligible patients enrolled, proportion of enrolled patients who provided valid accelerometer data at baseline, and proportion completing the cardiorespiratory exercise test according to protocol at baseline and completed follow-up assessments. Patient acceptability was evaluated for website usability, satisfaction with the initial exercise level and comprehensibility of the exercise program. Change in clinical outcomes were assessed for physical activity, cardiorespiratory fitness and patient-reported variables. Results In total, 49 eligible patients were identified and 35 were enrolled. Thirty (86%) of these attended baseline assessments and provided valid accelerometer data and 18 (51%) completed the maximal cardiorespiratory exercise test according to protocol. Twenty-two (63%) patients completed the follow-up questionnaire, and they rated the website usability as ‘acceptable’ [median 77.5 out of 100 (IQR 56.9, 85.6)], 19 (86%) reported that the initial exercise level was ‘just right’ and 18 (82%) that the exercise program was ‘very easy’ or ’quite easy’ to comprehend. Improvement in both moderate to vigorous physical activity (mean change 16.4 min/day; 95% CI 6.9 to 25.9) and cardiorespiratory fitness, VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29 to 3.36) were found in a subgroup of 8 patients completing these tests. Across all patient-reported outcomes 24–52% of the patients had a meaningful improvement (n = 22). Conclusion A web-based exercise program delivered by a patient organisation was found to be feasible and acceptable in patients with hip and/or knee OA. Trial registration ClinicalTrials.gov, NCT04084834 (registered 10 September 2019). The Regional Committee for Medical and Health Research Ethics south-east, 2018/2198. URL: Prosjekt #632074 - Aktiv med web-basert støtte. - Cristin (registered 7 June 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01110-3.
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Affiliation(s)
- Kenth Louis Joseph
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. .,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Hanne Dagfinrud
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- Division of Health Service, Norwegian Institute of Public health, Oslo, Norway
| | - Kristine Røren Nordén
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Rachel K Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Chopp-Hurley JN, Wiebenga EG, Keller HH, Maly MR. Nutrition risk, physical activity and fibre intake are associated with body composition in OA: analysis of the Canadian Longitudinal Study on Aging. BMJ Nutr Prev Health 2022; 5:191-200. [PMID: 36619336 PMCID: PMC9813624 DOI: 10.1136/bmjnph-2021-000319] [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: 05/28/2021] [Accepted: 05/31/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Sarcopenic obesity is a key feature in osteoarthritis (OA). While ideal OA treatment involves physical activity and diet, how diet influences OA pathophysiology is unclear. We explored the associations between diet, nutrition risk and physical activity with body composition in older adults with OA. Methods Baseline data from the Canadian Longitudinal Study on Aging data set were analysed. Participants with hip, knee, hand or multiple forms of OA were included in this cross-sectional analysis. Body composition measures (lean, fat and total masses (kg) and body fat percentage) were separate dependent variables. Regression analyses were conducted to explore associations between body composition with dietary intake (high calorie snack, fibre), nutrition risk (SCREEN II) and physical activity (Physical Activity Scale for the Elderly). Results 1596 participants were 66.5 (9.0) years old with a body mass index of 28.2 (5.3) kg/m2. Higher fibre cereal intake was associated with higher lean mass (unstandardised beta coefficient 0.5 (0.1, 0.9), p=0.02) and lower body fat percentage (-0.3 (-0.6, 0.0), p=0.046). Lower nutrition risk was associated with higher lean mass (0.1 (0.0, 0.1), p=0.03), lower fat mass (-0.05 (-0.1, 0.0), p=0.009) and lower body fat percentage (-0.1 (-0.1, 0.0), p<0.001). Higher physical activity was associated with higher lean mass (0.01 (0.01, 0.02), p<0.001), lower fat mass (-0.01 (0.0, 0.0), p=0.005) and lower body fat percentage (-0.01 (0.0, 0.0), p<0.001). Conclusion Greater physical activity and lower nutrition risk were associated with better body composition. While fibre intake was also associated body composition, the CIs were wide suggesting weak associations.
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Affiliation(s)
- Jaclyn N Chopp-Hurley
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Emily G Wiebenga
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada,Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Monica R Maly
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada,Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Booth G, Howarth A, Stubbs B, Ussher M. The Effectiveness of Interventions and Intervention Components for Increasing Physical Activity and Reducing Sedentary Behaviour in People With Persistent Musculoskeletal Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2022; 23:929-957. [PMID: 34856410 DOI: 10.1016/j.jpain.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
This systematic review and meta-analysis investigated the effectiveness of physical activity (PA) and sedentary behavior (SB) interventions on PA and SB levels in people with persistent musculoskeletal pain. We explored the effectiveness of behavior change techniques (BCTs), the use of behavior change theory and non-PA/SB outcomes. Randomized controlled trials of PA or SB interventions for people with persistent musculoskeletal pain were eligible. Twenty-three studies were included. Quality of evidence was assessed using the GRADE approach. Meta-analysis demonstrated a small effect for PA post-intervention (Hedge's g = .321, CI .136-.507, P = .001, very low-quality evidence). There was no effect for longer-term follow-up PA (low quality evidence) or SB outcomes (very low-quality evidence). There was a small effect for studies with low risk-of-bias at longer-term follow-up PA. Self-report PA outcomes, PA and education interventions, non-self-selected PA, a combination of supervised and unsupervised PA and a combination of individual and group-based interventions had larger effects. Heterogeneity was moderate to considerable. Risk-of-bias, assessed using Cochrane risk-of-bias tool (version two), was generally low. Five promising BCTs were identified: "adding objects to the environment," "goal setting (outcome)," "action planning," "monitoring outcome(s) of behaviour by others without feedback" and "feedback on outcome(s) of behaviour." In conclusion, there is evidence for a modest benefit for PA interventions immediately post-intervention, however the quality of evidence is very low. There was no evidence for longer-term follow-up PA or SB. Higher quality studies of PA and SB interventions that use objective measures are needed. PROSPERO registration: CRD42020180260. PERSPECTIVE: This review investigated the effects of physical activity and sedentary behavior interventions on physical activity and sedentary behavior levels in people with persistent musculoskeletal pain. Current evidence shows a modest benefit for interventions on physical activity post-intervention but not at longer-term follow-up or on sedentary behavior at any time-point, however quality of evidence is low to very low.
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Affiliation(s)
- Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK; Population Health Research Institute, St George's, University of London, London, UK.
| | - Ana Howarth
- Population Health Research Institute, St George's, University of London, London, UK
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, UK; Institute of Social Marketing and Health, University of Stirling, Stirling, UK
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Sutton L, Lahham A, Jose K, Moore M, Antony B, Grunseit A, Cleland V, Balogun S, Winzenberg T, Jones G, Aitken D. Feasibility of ‘parkrun’ for people with knee osteoarthritis: A mixed methods pilot study. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100269. [DOI: 10.1016/j.ocarto.2022.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/18/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022] Open
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Aydemir B, Huang C, Foucher KC. Strength and physical activity in osteoarthritis: The mediating role of kinesiophobia. J Orthop Res 2022; 40:1135-1142. [PMID: 34324222 PMCID: PMC8799782 DOI: 10.1002/jor.25151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
The aim of this study was to investigate the association between muscle strength and physical activity level in people with knee osteoarthritis (OA), and determine whether this association is mediated by pain-related fear of movement (kinesiophobia) and self-reported pain. Cross-sectional data from 37 subjects (age 58.8 ± 8.6 years, 25F/12M, BMI 33.5 ± 6.4 kg/m2 ) with OA of the knee were used. Isometric knee extensor and flexor muscle strength were measured using an isokinetic dynamometer. Physical activity, kinesiophobia, and pain were assessed by self-report using the University of California, Los Angeles activity rating scale, Tampa Scale for Kinesiophobia, and The Knee Injury and Osteoarthritis Outcome Score pain subscale, respectively. The associations between strength measures, physical activity, kinesiophobia, and pain scores, were modeled by performing a parallel multiple mediation analysis and the significance of mediational effects (kinesiophobia and pain) were tested using a bootstrap approach. Lower knee flexion and extension strength were associated with lower physical activity scores and these relationships were mediated by higher kinesiophobia scores (more fear) but not pain scores. Knee extension strength was directly associated with physical activity scores after controlling for kinesiophobia and pain scores. These results suggest that muscle strength can influence physical activity directly and indirectly through fear of movement. Assessing these measures together in this population may help clinicians identify patients that are more likely to avoid physical activities due to not only muscle weakness but also fear of movement.
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Affiliation(s)
- Burcu Aydemir
- Department of Kinesiology and Nutrition University of Illinois at Chicago Chicago Illinois USA
| | - Chun‐Hao Huang
- Department of Kinesiology and Nutrition University of Illinois at Chicago Chicago Illinois USA
| | - Kharma C. Foucher
- Department of Kinesiology and Nutrition University of Illinois at Chicago Chicago Illinois USA
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49
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Bowden JL, Callahan LF, Eyles JP, Kent JL, Briggs AM. Realizing Health and Well-being Outcomes for People with Osteoarthritis Beyond Health Service Delivery. Clin Geriatr Med 2022; 38:433-448. [DOI: 10.1016/j.cger.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Does a history of youth sport-related knee injury still impact accelerometer-measured levels of physical activity after 3–12 years? Phys Ther Sport 2022; 55:90-97. [DOI: 10.1016/j.ptsp.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
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