1
|
Rathbun AM, Shardell MD, Gallo JJ, Ryan AS, Stuart EA, Schuler MS, Dong Y, Beamer B, Mehta R, Peer JE, Hochberg MC. Time-varying treatment effect modification of oral analgesic effectiveness by depressive symptoms in knee osteoarthritis: an application of structural nested mean models in a prospective cohort. Int J Epidemiol 2024; 53:dyad152. [PMID: 37934603 DOI: 10.1093/ije/dyad152] [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: 10/26/2022] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Depressive symptoms are common in knee osteoarthritis (OA), exacerbate knee pain severity and may influence outcomes of oral analgesic treatments. The aim was to assess whether oral analgesic effectiveness in knee OA varies by fluctuations in depressive symptoms. METHODS The sample included Osteoarthritis Initiative (OAI) participants not treated with oral analgesics at enrolment (n = 1477), with radiographic disease at the first follow-up visit (defined as the index date). Oral analgesic treatment and depressive symptoms, assessed with the Center for Epidemiological Studies Depression [(CES-D) score ≥16] Scale, were measured over three annual visits. Knee pain severity was measured at visits adjacent to treatment and modifier using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (rescaled range = 0-100). Structural nested mean models (SNMMs) estimated causal mean differences in knee pain severity comparing treatment versus no treatment. RESULTS The average causal effects of treated versus not treated for observations without depressive symptoms showed negligible differences in knee pain severity. However, causal mean differences in knee pain severity comparing treatment versus no treatment among observations with depressive symptoms increased over time from -0.10 [95% confidence interval (CI): -9.94, 9.74] to -16.67 (95% CI: -26.33, -7.01). Accordingly, the difference in average causal effects regarding oral analgesic treatment for knee pain severity between person-time with and without depressive symptoms was largest (-16.53; 95% CI: -26.75, -6.31) at the last time point. Cumulative treatment for 2 or 3 years did not yield larger causal mean differences. CONCLUSIONS Knee OA patients with persistent depressive symptoms and chronic pain may derive more analgesic treatment benefit than those without depressive symptoms and less pain.
Collapse
Affiliation(s)
- Alan M Rathbun
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michelle D Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yu Dong
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brock Beamer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA
| | - Rhea Mehta
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason E Peer
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
- Mental Health Clinical Care Center, VA Maryland Health Care System, Baltimore, MD, USA
| | - Marc C Hochberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Medical Clinical Care Center, VA Maryland Health Care System, Baltimore, MD, USA
| |
Collapse
|
2
|
Lim YZ, Wang Y, Urquhart DM, Estee MM, Wluka AE, Heritier S, Cicuttini FM. Metformin for knee osteoarthritis with obesity: study protocol for a randomised, double-blind, placebo-controlled trial. BMJ Open 2023; 13:e079489. [PMID: 38070903 PMCID: PMC10729261 DOI: 10.1136/bmjopen-2023-079489] [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: 09/02/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Over half of the populations with knee osteoarthritis (OA) have obesity. These individuals have many other shared metabolic risk factors. Metformin is a safe, inexpensive, well-tolerated drug that has pleiotropic effects, including structural protection, anti-inflammatory and analgesic effects in OA, specifically the knee. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether metformin reduces knee pain over 6 months in individuals with symptomatic knee OA who are overweight or obese. METHODS AND ANALYSIS One hundred and two participants with symptomatic knee OA and overweight or obesity will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either metformin 2 g or identical placebo daily for 6 months. The primary outcome is reduction of knee pain [assessed by 100 mm Visual Analogue Scale (VAS)] at 6 months. The secondary outcomes are OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) responder criteria [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function and participant's global assessment (VAS)] at 6 months; change in knee pain, stiffness, function using WOMAC at 6 months and quality of life at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Alfred Hospital Ethics Committee (708/20) and Monash University Human Research Ethics Committee (28498). Written informed consent will be obtained from all the participants. The findings will be disseminated through peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12621000710820 .
Collapse
Affiliation(s)
- Yuan Z Lim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Donna M Urquhart
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Mahnuma Mahfuz Estee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| |
Collapse
|
3
|
Ginnerup-Nielsen E, Christensen R, Heitmann BL, Altman RD, March L, Woolf A, Bliddal H, Henriksen M. Prognostic value of illness perception on changes in knee pain among elderly individuals: Two-year results from the Frederiksberg Cohort study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100403. [PMID: 37671176 PMCID: PMC10475507 DOI: 10.1016/j.ocarto.2023.100403] [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: 04/14/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
Objective To investigate the prognostic value of illness perception (IP) on knee pain, quality of life (QoL) and functional level in elderly individuals reporting knee pain. Design A prospective cohort study of 1552 elderly with knee pain comparing two previously established clusters based on the Brief Illness Perception questionnaire. Cluster 1 ("Concerned optimists" [hypothesized unfavorable profile]; n = 642) perceived their knee pain as a greater threat to them than Cluster 2 ("Unconcerned confident" [hypothesized favorable profile]; n = 910). Primary outcome was the change from baseline to year 2 in the KOOS Pain subscale. Secondary outcomes were changes from baseline in quality of life (EuroQol-5 Domain and EQ VAS) and in the KOOS subscales Symptom, Activities of Daily Living, Knee-related QoL and Sports and recreation. Analyses were done on the original Intention-To-Survey (ITS) population, using repeated measures mixed linear models. Results Among the ITS population, 841 (54%) responded to the 2-year survey. There was a statistically significant but clinically irrelevant cluster difference in the 2-year change from baseline in KOOS pain (mean difference: 6.0 KOOS points [95% CI: 7.3 to -4.7]) explained by a minor improvement in Cluster 1: (6.2 points) and no changes in Cluster 2: (0.2 points). Comparable results were found across the secondary outcomes. Clinically irrelevant cluster changes in IP were seen. Conclusion In a cohort of people with knee pain, IP phenotype (i.e., Clusters) were of no prognostic value for the 2-year changes in pain, function, and QoL. Targeting IP may not be relevant in this patient population. Trial registration number and date of registration The Frederiksberg Cohort study was pre-registered at clinicaltrials.gov (NCT03472300) on March 21, 2018.
Collapse
Affiliation(s)
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Berit L. Heitmann
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roy D. Altman
- Division of Rheumatology and Immunology, University of California, Los Angeles, CA 90095, USA
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, and Kolling Institute; and Sydney Muskuloskeletal Health, University of Sydney, NSW Australia
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro TR1 3HD, UK
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| |
Collapse
|
4
|
Liao CD, Chen HC, Huang MH, Liou TH, Lin CL, Huang SW. Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials. Int J Mol Sci 2023; 24:ijms24076078. [PMID: 37047058 PMCID: PMC10094194 DOI: 10.3390/ijms24076078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Knee osteoarthritis (KOA) is associated with a high risk of sarcopenia. Both intra-articular injections (IAIs) and physical therapy (PT) exert benefits in KOA. This network meta-analysis (NMA) study aimed to identify comparative efficacy among the combined treatments (IAI+PT) in patients with KOA. Seven electronic databases were systematically searched from inception until January 2023 for randomized controlled trials (RCTs) reporting the effects of IAI+PT vs. IAI or PT alone in patients with KOA. All RCTs which had treatment arms of IAI agents (autologous conditioned serum, botulinum neurotoxin type A, corticosteroids, dextrose prolotherapy (DxTP), hyaluronic acid, mesenchymal stem cells (MSC), ozone, platelet-rich plasma, plasma rich in growth factor, and stromal vascular fraction of adipose tissue) in combination with PT (exercise therapy, physical agent modalities (electrotherapy, shockwave therapy, thermal therapy), and physical activity training) were included in this NMA. A control arm receiving placebo IAI or usual care, without any other IAI or PT, was used as the reference group. The selected RCTs were analyzed through a frequentist method of NMA. The main outcomes included pain, global function (GF), and walking capability (WC). Meta-regression analyses were performed to explore potential moderators of the treatment efficacy. We included 80 RCTs (6934 patients) for analyses. Among the ten identified IAI+PT regimens, DxTP plus PT was the most optimal treatment for pain reduction (standard mean difference (SMD) = -2.54) and global function restoration (SMD = 2.28), whereas MSC plus PT was the most effective for enhancing WC recovery (SMD = 2.54). More severe KOA was associated with greater changes in pain (β = -2.52) and WC (β = 2.16) scores. Combined IAI+PT treatments afford more benefits than do their corresponding monotherapies in patients with KOA; however, treatment efficacy is moderated by disease severity.
Collapse
Affiliation(s)
- Chun-De Liao
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Mao-Hua Huang
- Department of Biochemistry, University of Washington, Seattle, WA 98015, USA
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| |
Collapse
|
5
|
Foster NE, L E, L D, M H. Osteoarthritis year in review 2022: epidemiology & therapy. Osteoarthritis Cartilage 2023:S1063-4584(23)00730-6. [PMID: 36963607 DOI: 10.1016/j.joca.2023.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
This 'Year in Review' provides a synopsis of key research themes and individual studies from the clinical osteoarthritis (OA) field, focused on epidemiology and therapy. The electronic database search for the review was adapted from the 2021 year in review search, to increase search specificity for relevant study designs, and was conducted in Medline, Embase and medRxiv (31st March 2021 to 4th March 2022). Following screening for eligibility, studies were grouped according to their key research design, including reviews, cohorts and randomised trials. 11 key themes emerged, including the importance of several comorbidities in predicting OA incidence and prevalence, surgical approaches that can reduce the risk of post-traumatic OA, the heterogenous but nevertheless relatively stable nature of OA subgroup trajectories, the paucity of robust studies particularly of surgery for OA and the very modest benefit of many therapies under evaluation in trials. A particular interest of the authors was to consider whether new studies are helping determine how to better ensure the right patient with OA is matched to the right treatment at the right time. There are several new studies developing improved predictive models through big data analytics and machine learning which show promise, need validation, and may support new approaches to stratified care.
Collapse
Affiliation(s)
- Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia.
| | - Eriksson L
- Lars Eriksson, The University of Queensland, UQ Library, Herston Qld 4006, Queensland, Australia.
| | - Deveza L
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Rheumatology, Northern Clinical School, Royal North Shore Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Hall M
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia.
| |
Collapse
|
6
|
Petersen ET, Vind TD, Jürgens-Lahnstein JH, Christensen R, de Raedt S, Brüel A, Rytter S, Andersen MS, Stilling M. Evaluation of automated radiostereometric image registration in total knee arthroplasty utilizing a synthetic-based and a CT-based volumetric model. J Orthop Res 2023; 41:436-446. [PMID: 35532010 PMCID: PMC10084430 DOI: 10.1002/jor.25359] [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: 01/05/2022] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Radiostereometic analysis (RSA) is an accurate method for rigid body pose (position and orientation) in three-dimensional space. Traditionally, RSA is based on insertion of periprosthetic tantalum markers and manual implant contour selection which limit clinically application. We propose an automated image registration technique utilizing digitally reconstructed radiographs (DRR) of computed tomography (CT) volumetric bone models (autorsa-bone) as a substitute for tantalum markers. Furthermore, an automated synthetic volumetric representation of total knee arthroplasty implant models (autorsa-volume) to improve previous silhouette-projection methods (autorsa-surface). As reference, we investigated the accuracy of implanted tantalum markers (marker) or a conventional manually contour-based method (mbrsa) for the femur and tibia. The data are presented as mean (standard deviation). The autorsa-bone method displayed similar accuracy of -0.013 (0.075) mm compared to the gold standard method (marker) of -0.013 (0.085). The autorsa-volume with 0.034 (0.106) mm did not markedly improve the autorsa-surface with 0.002 (0.129) mm, and none of these reached the mbrsa method of -0.009 (0.094) mm. In conclusion, marker-free RSA is feasible with similar accuracy as gold standard utilizing DRR and CT obtained volumetric bone models. Furthermore, utilizing synthetic generated volumetric implant models could not improve the silhouette-based method. However, with a slight loss of accuracy the autorsa methods provide a feasible automated alternative to the semi-automated method.
Collapse
Affiliation(s)
- Emil Toft Petersen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Dahl Vind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Rasmus Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sepp de Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søren Rytter
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
7
|
Vervullens S, Meert L, Baert I, Smeets RJEM, Verdonk P, Rahusen F, Meeus M. Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care. Ann Phys Rehabil Med 2022; 66:101705. [PMID: 36115573 DOI: 10.1016/j.rehab.2022.101705] [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: 09/29/2021] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA). PURPOSE We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life. METHODS A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included. RESULTS After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies). CONCLUSION More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA. REGISTRATION NUMBER This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).
Collapse
Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; CIR Revalidatie, location Eindhoven, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium and ASTARC department, Antwerp University, Belgium
| | - Frank Rahusen
- Department of Orthopaedics, St Jans Gasthuis Weert, the Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands.
| |
Collapse
|
8
|
Cui P, Li M, Yu M, Liu Y, Ding Y, Liu W, Liu J. Advances in sports food: Sports nutrition, food manufacture, opportunities and challenges. Food Res Int 2022; 157:111258. [DOI: 10.1016/j.foodres.2022.111258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
|
9
|
Knoop J, Dekker J, van Dongen JM, van der Leeden M, de Rooij M, Peter WF, de Joode W, van Bodegom-Vos L, Lopuhaä N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TP, Ostelo RW. Stratified exercise therapy does not improve outcomes compared with usual exercise therapy in people with knee osteoarthritis (OCTOPuS study): a cluster randomised trial. J Physiother 2022; 68:182-190. [PMID: 35760724 DOI: 10.1016/j.jphys.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022] Open
Abstract
QUESTION In people with knee osteoarthritis, how much more effective is stratified exercise therapy that distinguishes three subgroups (high muscle strength subgroup, low muscle strength subgroup, obesity subgroup) in reducing knee pain and improving physical function than usual exercise therapy? DESIGN Pragmatic cluster randomised controlled trial in a primary care setting. PARTICIPANTS A total of 335 people with knee osteoarthritis: 153 in an experimental arm and 182 in a control arm. INTERVENTION Physiotherapy practices were randomised into an experimental arm providing stratified exercise therapy (supplemented by a dietary intervention from a dietician for the obesity subgroup) or a control arm providing usual, non-stratified exercise therapy. OUTCOME MEASURES Primary outcomes were knee pain severity (numerical rating scale for pain, 0 to 10) and physical function (Knee Injury and Osteoarthritis Outcome Score subscale activities of daily living, 0 to 100). Measurements were performed at baseline, 3 months (primary endpoint) and 6 and 12 months (follow-up). Intention-to-treat, multilevel, regression analysis was performed. RESULTS Negligible differences were found between the experimental and control groups in knee pain (mean adjusted difference 0.2, 95% CI -0.4 to 0.7) and physical function (-0.8, 95% CI -4.3 to 2.6) at 3 months. Similar effects between groups were also found for each subgroup separately, as well as at other time points and for nearly all secondary outcome measures. CONCLUSION This pragmatic trial demonstrated no added value regarding clinical outcomes of the model of stratified exercise therapy compared with usual exercise therapy. This could be attributed to the experimental arm therapists facing difficulty in effectively applying the model (especially in the obesity subgroup) and to elements of stratified exercise therapy possibly being applied in the control arm. REGISTRATION Netherlands National Trial Register NL7463.
Collapse
Affiliation(s)
- Jesper Knoop
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands; Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Mariette de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Wilfred Fh Peter
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Willemijn de Joode
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | | | - Kim L Bennell
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Willem F Lems
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Amsterdam UMC, location VUmc, Department of Rheumatology, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Center of Expertise Urban Vitality, Health Faculty, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | - Raymond Wjg Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| |
Collapse
|
10
|
Knoop J, de Joode JW, Brandt H, Dekker J, Ostelo RWJG. Patients' and clinicians' experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study. BMC Musculoskelet Disord 2022; 23:559. [PMID: 35681162 PMCID: PMC9178540 DOI: 10.1186/s12891-022-05496-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background We have developed a model of stratified exercise therapy that distinguishes three knee osteoarthritis (OA) subgroups (‘high muscle strength subgroup’, ‘low muscle strength subgroup’, ‘obesity subgroup’), which are provided subgroup-specific exercise therapy (supplemented by a dietary intervention for the ‘obesity subgroup’). In a large clinical trial, this intervention was found to be no more effective than usual exercise therapy. The present qualitative study aimed to explore experiences from users of this intervention, in order to identify possible improvements. Methods Qualitative research design embedded within a cluster randomized controlled trial in a primary care setting. A random sample from the experimental arm (i.e., 15 patients, 11 physiotherapists and 5 dieticians) was interviewed on their experiences with receiving or applying the intervention. Qualitative data from these semi-structured interviews were thematically analysed. Results We identified four themes: one theme regarding the positive experiences with the intervention and three themes regarding perceived barriers. Although users from all 3 perspectives (patients, physiotherapists and dieticians) generally perceived the intervention as having added value, we also identified several barriers, especially for the ‘obesity subgroup’. In this ‘obesity subgroup’, physiotherapists perceived obesity as difficult to address, dieticians reported that more consultations are needed to reach sustainable weight loss and both physiotherapists and dieticians reported a lack of interprofessional collaboration. In the ‘high muscle strength subgroup’, the low number of supervised sessions was perceived as a barrier by some patients and physiotherapists, but as a facilitator by others. A final theme addressed barriers to knee OA treatment in general, with lack of motivation as the most prominent of these. Conclusion Our qualitative study revealed a number of barriers to effective application of the stratified exercise therapy, especially for the ‘obesity subgroup’. Based on these barriers, the intervention and its implementation could possibly be improved. Moreover, these barriers are likely to account at least partly for the lack of superiority over usual exercise therapy. Trial registration The Netherlands National Trial Register (NTR): NL7463 (date of registration: 8 January 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05496-2.
Collapse
Affiliation(s)
- J Knoop
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands.
| | - J W de Joode
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands
| | - H Brandt
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands
| | - J Dekker
- Amsterdam UMC, Location VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands
| | - R W J G Ostelo
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands.,Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Amsterdam UMC, Location VUmc, Department of Epidemiology and Data Science, Amsterdam, Netherlands
| |
Collapse
|
11
|
Rockel JS, Layeghifard M, Rampersaud YR, Perruccio AV, Mahomed NN, Davey JR, Syed K, Gandhi R, Kapoor M. Identification of a differential metabolite-based signature in patients with late-stage knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100258. [DOI: 10.1016/j.ocarto.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 01/11/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
|
12
|
Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait - an exploratory and dynamic radiostereometric study. Osteoarthritis Cartilage 2022; 30:249-259. [PMID: 34757027 DOI: 10.1016/j.joca.2021.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/29/2021] [Accepted: 10/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with advanced knee osteoarthritis (KOA) frequently alter their gait patterns in an attempt to alleviate symptoms. Understanding the underlying pathomechanics and identifying KOA phenotypes are essential to improve treatments. We investigated kinematics in patients with KOA to identify subgroups of homogeneous knee joint kinematics. METHOD A total of 66 patients with symptomatic KOA scheduled for total knee arthroplasty and 15 age-matched healthy volunteers with asymptomatic, non-arthritic knees were included. We used k-means clustering to divide patients into subgroups based on dynamic radiostereometry-assessed tibiofemoral joint kinematics. Clinical characteristics such as knee ligament lesions and KOA scores were graded by magnetic resonance imaging and radiographs, respectively. RESULTS We identified four clusters that were supported by clinical characteristics. The flexion group (n = 20) consisted primarily of patients with medial KOA. The abduction group (n = 17) consisted primarily of patients with lateral KOA. The anterior draw group (n = 10) was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the highest KOA score. The external rotation group (n = 19) primarily included patients with medial collateral and posterior cruciate ligament lesions. CONCLUSION Based on tibiofemoral gait patterns, patients with advanced KOA can be divided into four subgroups with specific clinical characteristics and different KOA-affected compartments. The findings add to our understanding of how knee kinematics may affect the patient's development of different types of KOA. This may inspire improved and more patient-specific treatment strategies in the future.
Collapse
|
13
|
Nakayama K, Kato H, Ikegami S, Hayashi M, Hashimoto S, Sakai N, Takahashi J, Taneichi H. Prevalence and associated factors of primary elbow osteoarthritis in the Japanese general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry. J Shoulder Elbow Surg 2022; 31:123-132. [PMID: 34454037 DOI: 10.1016/j.jse.2021.07.015] [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: 02/15/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The epidemiology of primary elbow osteoarthritis (PEOA) remains unknown. We aimed to evaluate the prevalence and associated factors of PEOA in a cross-sectional resident cohort from a municipal registry of a Japanese town. METHODS A total of 415 residents over 50 years of age were randomly sampled from a Japanese town and were adjusted for age and gender. Those with diseases that could potentially cause a secondary osteoarthritis of the elbow were excluded. The remaining 318 subjects (150 men and 168 women) underwent bidirectional radiography of the elbow. Subjects were diagnosed with PEOA if one of their elbows was Kellgren-Lawrence (KL) grade 2 or greater. In addition, motion pain and tenderness at the elbow were examined by orthopedic surgeons. Associated factors for the PEOA were statistically analyzed. RESULTS The prevalence of PEOA was 25.2% (male, 27.3%; female, 23.2%), and the prevalence of symptomatic PEOA was 0.9%. The age-stratified prevalence of PEOA was as follows: 50-59, 6.2% (male, 5.0%; female, 7.3%); 60-69, 15.4% (male, 17.5%; female, 13.7%); 70-79, 29.5% (male, 35.3%; female, 25.0%); and 80-89, 55.9% (male, 55.6%; female, 56.3%). Age and body mass index were revealed as associated factors that increased the prevalence of PEOA with KL grade 2 or greater. The use of vibrating tools was demonstrated as an independent associated factor that increased the prevalence of PEOA with KL grade 4 in addition to the 2 aforementioned factors. CONCLUSIONS The prevalence of PEOA in Japanese subjects was 25.2% for those aged 50-89 years with a mean age of 69.2 years, most of which was asymptomatic OA without motion pain or tenderness at the elbow. Age and body mass index increased the prevalence of PEOA with KL grade 2 or greater. The prevalence of PEOA increased with age, but the disease was self-accommodated by most people.
Collapse
Affiliation(s)
- Kentaro Nakayama
- Department of Orthopaedic Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shun Hashimoto
- Department of Orthopaedic Surgery, Nagano Municipal Hospital, Nagano, Nagano, Japan
| | - Noriko Sakai
- Department of Orthopaedic Surgery, New Life Hospital, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| |
Collapse
|
14
|
The future of deep phenotyping in osteoarthritis: How can high throughput omics technologies advance our understanding of the cellular and molecular taxonomy of the disease? OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100144. [DOI: 10.1016/j.ocarto.2021.100144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
|
15
|
Griswold AJ, Correa D, Kaplan LD, Best TM. Using Genomic Techniques in Sports and Exercise Science: Current Status and Future Opportunities. Curr Sports Med Rep 2021; 20:617-623. [PMID: 34752437 DOI: 10.1249/jsr.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT The past two decades have built on the successes of the Human Genome Project identifying the impact of genetics and genomics on human traits. Given the importance of exercise in the physical and psychological health of individuals across the lifespan, using genomics to understand the impact of genes in the sports medicine field is an emerging field. Given the complexity of the systems involved, high-throughput genomics is required to understand genetic variants, their functions, and ultimately their effect on the body. Consequently, genomic studies have been performed across several domains of sports medicine with varying degrees of success. While the breadth of these is great, they focus largely on the following three areas: 1) performance; 2) injury susceptibility; and 3) sports associated chronic conditions, such as osteoarthritis. Herein, we review literature on genetics and genomics in sports medicine, offer suggestions to bolster existing studies, and suggest ways to ideally impact clinical care.
Collapse
Affiliation(s)
| | | | - Lee D Kaplan
- Department of Orthopedic Surgery, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Thomas M Best
- Department of Orthopedic Surgery, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, Miami, FL
| |
Collapse
|
16
|
Knoop J, Ostelo RWJG, van der Esch M, de Zwart A, Bennell KL, van der Leeden M, Dekker J. Construct validity of the OCTOPuS stratification algorithm for allocating patients with knee osteoarthritis into subgroups. BMC Musculoskelet Disord 2021; 22:633. [PMID: 34289827 PMCID: PMC8296670 DOI: 10.1186/s12891-021-04485-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We recently developed a model of stratified exercise therapy, consisting of (i) a stratification algorithm allocating patients with knee osteoarthritis (OA) into one of the three subgroups ('high muscle strength subgroup' representing a post-traumatic phenotype, 'low muscle strength subgroup' representing an age-induced phenotype, and 'obesity subgroup' representing a metabolic phenotype) and (ii) subgroup-specific exercise therapy. In the present study, we aimed to test the construct validity of this algorithm. METHODS Data from five studies (four exercise therapy trial cohorts and one cross-sectional cohort) were used to test the construct validity of our algorithm by 63 a priori formulated hypotheses regarding three research questions: (i) are the proportions of patients in each subgroup similar across cohorts? (15 hypotheses); (ii) are the characteristics of each of the subgroups in line with their proposed underlying phenotypes? (30 hypotheses); (iii) are the effects of usual exercise therapy in the 3 subgroups in line with the proposed effect sizes? (18 hypotheses). RESULTS Baseline data from a total of 1211 patients with knee OA were analyzed for the first and second research question, and follow-up data from 584 patients who were part of an exercise therapy arm within a trial for the third research question. In total, the vast majority (73%) of the hypotheses were confirmed. Regarding our first research question, we found similar proportions in each of the three subgroups across cohorts, especially for three cohorts. Regarding our second research question, subgroup characteristics were almost completely in line with the proposed underlying phenotypes. Regarding our third research question, usual exercise therapy resulted in similar, medium to large effect sizes for knee pain and physical function for all three subgroups. CONCLUSION We found mixed results regarding the construct validity of our stratification algorithm. On the one hand, it is a valid instrument to consistently allocate patients into subgroups that aligned our hypotheses. On the other hand, in contrast to our hypotheses, subgroups did not differ substantially in effects of usual exercise therapy. An ongoing trial will assess whether this algorithm accompanied by subgroup-specific exercise therapy improves clinical and economic outcomes.
Collapse
Affiliation(s)
- Jesper Knoop
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1105, 1081, Amsterdam, HV, Netherlands.
| | - Raymond W J G Ostelo
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1105, 1081, Amsterdam, HV, Netherlands.,Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Health Faculty, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Arjan de Zwart
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
| | - Kim L Bennell
- School of Health Sciences, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| |
Collapse
|
17
|
Kittelson AJ, Schmiege SJ, Maluf K, George SZ, Stevens-Lapsley JE. Determination of Pain Phenotypes in Knee Osteoarthritis Using Latent Profile Analysis. PAIN MEDICINE 2021; 22:653-662. [PMID: 33367906 DOI: 10.1093/pm/pnaa398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify clinical phenotypes of knee osteoarthritis (OA) using measures from the following domains: 1) multimorbidity; 2) psychological distress; 3) pain sensitivity; and 4) knee impairment or pathology. DESIGN Data were collected from 152 people with knee OA and from 31 pain-free individuals. In participants with knee OA, latent profile analysis (LPA) was applied to the following measures: normalized knee extensor strength, Functional Comorbidity Index (FCI), Pain Catastrophizing Scale (PCS), and local (knee) pressure pain threshold. Comparisons were performed between empirically derived phenotypes from the LPA and healthy older adults on these measures. Comparisons were also made between pheonotypes on pain intensity, functional measures, use of health care, and history of knee injury. RESULTS LPA resulted in a four-group solution. Compared with all other groups, group 1 (9% of the study population) had higher FCI scores. Group 2 (63%) had elevated pain sensitivity and quadriceps weakness relative to group 4 and healthy older adults. Group 3 (11%) had higher PCS scores than all other groups. Group 4 (17%) had greater leg strength, except relative to healthy older adults, and reduced pain sensitivity relative to all groups. Groups 1 and 3 demonstrated higher pain and worse function than other groups, and group 4 had higher rates of knee injury. CONCLUSION Four phenotypes of knee OA were identified using psychological factors, comorbidity status, pain sensitivity, and leg strength. Follow-up analyses supported the replicability of this phenotype structure, but future research is needed to determine its usefulness in knee OA care.
Collapse
Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Sarah J Schmiege
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Katrina Maluf
- Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Denver, Colorado, USA
| |
Collapse
|
18
|
Luo Y, Samuels J, Krasnokutsky S, Byrjalsen I, Kraus VB, He Y, Karsdal MA, Abramson SB, Attur M, Bay-Jensen AC. A low cartilage formation and repair endotype predicts radiographic progression of symptomatic knee osteoarthritis. J Orthop Traumatol 2021; 22:10. [PMID: 33687578 PMCID: PMC7943687 DOI: 10.1186/s10195-021-00572-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background Osteoarthritis (OA) is a disease with multiple endotypes. A hallmark of OA is loss of cartilage; however, it is evident that the rate of cartilage loss differs among patients, which may partly be attributed to differential capacity for cartilage repair. We hypothesize that a low cartilage repair endotype exists and that such endotypes are more likely to progress radiographically. The aim of this study is to examine the associations of level of cartilage formation with OA severity and radiographic OA progression. We used the blood-based marker PRO-C2, reflecting type II collagen formation, to assess levels of cartilage formation. Materials and methods The type II collagen propeptide PRO-C2 was measured in the serum/plasma of knee OA subjects from New York University (NYU, n = 106) and a subcohort of the phase III oral salmon calcitonin (sCT) trial SMC021-2301 (SMC, n = 147). Risk of radiographic medial joint space narrowing (JSN) over 24 months was compared between quartiles (very low, low, moderate, and high) of PRO-C2. Associations were adjusted for age, gender, BMI, race, baseline pain levels, and baseline joint space width. Results In both the NYU and SMC cohorts, subjects with low PRO-C2 levels had greater JSN compared with subjects with high PRO-C2. Mean difference in JSN between subjects with very low and high levels of PRO-C2 was 0.65 mm (p = 0.002), corresponding to a 3.4 (1.4–8.6)-fold higher risk of progression. There was no significant effect of sCT treatment, compared with placebo, on JSN over 2 years before stratification based on baseline PRO-C2. However, there were proportionately fewer progressors in the sCT arm of the very low/low PRO-C2 group compared with the moderate/high group (Chi squared = 6.5, p = 0.011). Conclusion Serum/plasma level of type II collagen formation, PRO-C2, may be an objective indicator of a low cartilage repair endotype, displaying radiographic progression and superior response to a proanabolic drug. Level of evidence Level III post hoc exploratory analysis of one longitudinal cohort and a sub-study from one phase III clinical trial.
Collapse
Affiliation(s)
- Yunyun Luo
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 207, 2730, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Samuels
- Division of Rheumatology, NYU School of Medicine and NYU Langone Orthopaedic Hospital, New York, USA
| | - Svetlana Krasnokutsky
- Division of Rheumatology, NYU School of Medicine and NYU Langone Orthopaedic Hospital, New York, USA
| | | | - Virginia B Kraus
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, USA.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, USA
| | - Yi He
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 207, 2730, Herlev, Denmark
| | - Morten A Karsdal
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 207, 2730, Herlev, Denmark
| | - Steven B Abramson
- Division of Rheumatology, NYU School of Medicine and NYU Langone Orthopaedic Hospital, New York, USA
| | - Mukundan Attur
- Division of Rheumatology, NYU School of Medicine and NYU Langone Orthopaedic Hospital, New York, USA
| | - Anne C Bay-Jensen
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 207, 2730, Herlev, Denmark.
| |
Collapse
|
19
|
Lentz TA, Hellkamp AS, Bhavsar NA, Goode AP, Manhapra A, George SZ. Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models. Mayo Clin Proc Innov Qual Outcomes 2021; 5:253-264. [PMID: 33997625 PMCID: PMC8105527 DOI: 10.1016/j.mayocpiqo.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To establish the frequency of concordant, discordant, and clinically dominant comorbidities among Medicare beneficiaries with knee osteoarthritis (KOA) and to identify common concordant condition subgroups. Participants and Methods We used a 5% representative sample of Medicare claims data to identify beneficiaries who received a diagnosis of KOA between January 1, 2012, and September 30, 2015, and matched control group without an osteoarthritis (OA) diagnosis. Frequency of 34 comorbid conditions was categorized as concordant, discordant, or clinically dominant among those with KOA and a matched sample without OA. Comorbid condition phenotypes were characterized by concordant conditions and derived using latent class analysis among those with KOA. Results The study sample included 203,361 beneficiaries with KOA and 203,361 non-OA controls. The largest difference in frequency between the two cohorts was for co-occurring musculoskeletal conditions (23.7% absolute difference), chronic pain syndromes (6.5%), and rheumatic diseases (4.5%), all with a higher frequency among those with knee OA. Phenotypes were identified as low comorbidity (53% of cohort with classification), hypothyroid/osteoporosis (27%), vascular disease (10%), and high medical and psychological comorbidity (10%). Conclusions Approximately 47% of Medicare beneficiaries with KOA in this sample had a phenotype characterized by one or more concordant conditions, suggesting that existing clinical pathways that rely on single or dominant providers might be insufficient for a large proportion of older adults with KOA. These findings could guide development of integrated KOA-comorbidity care pathways that are responsive to emerging priorities for personalized, value-based health care.
Collapse
Affiliation(s)
- Trevor A Lentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Nrupen A Bhavsar
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adam P Goode
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Ajay Manhapra
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Hampton VA Medical Center, Hampton, VA.,Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA
| | - Steven Z George
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| |
Collapse
|
20
|
Paultre K, Cade W, Hernandez D, Reynolds J, Greif D, Best TM. Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review. BMJ Open Sport Exerc Med 2021; 7:e000935. [PMID: 33500785 PMCID: PMC7812094 DOI: 10.1136/bmjsem-2020-000935] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine whether supplementation with turmeric or curcumin extract effects pain and physical function in individuals with knee osteoarthritis (OA). Second, we investigated the therapeutic response (pain and function) of turmeric compared with non-steroidal anti-inflammatory drugs (NSAIDs). Methods A search was conducted in MEDLINE, Embase, CINAHL and Cochrane Review. Inclusion criteria included randomised controlled trials reporting pain and physical function in humans with knee OA comparing turmeric therapy with NSAIDs or no therapy. Two reviewers screened 5273 abstracts. Risk of bias and quality were assessed via Cochrane Collaboration tool and CONSORT (Consolidated Standards of Reporting Trials) 2010, respectively. Results Ten studies were included in the final analysis. Eight had high methodological quality and two were categorised as good with a mean CONSORT quality score of 21.1. Nine studies had adequate sequence generation and six had adequate allocation concealment. Participants and outcome assessors were blinded in eight studies. Three of the studies compared turmeric therapy to NSAIDs. All 10 studies showed improvement in pain and function from baseline with turmeric therapy (p≤0.05). In three studies comparing turmeric to NSAIDs, there were no differences in outcome scores (p>0.05). In all studies there were no significant adverse events in the turmeric therapy group. Conclusion Compared with placebo, there appears to be a benefit of turmeric on knee OA pain and function. Based on a small number of studies the effects are similar to that of NSAIDs. Variables such as optimal dosing, frequency and formulation remain unclear at this time.
Collapse
Affiliation(s)
- Kristopher Paultre
- Department of Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida, USA.,Department of Orthopedics, University of Miami Sports Medicine Institute, Coral Gables, Florida, USA
| | - William Cade
- Department of Orthopedics, University of Miami Sports Medicine Institute, Coral Gables, Florida, USA
| | - Daniel Hernandez
- Department of Family Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - John Reynolds
- Department of Health Informatics, University of Miami School of Medicine Louis Calder Memorial Library, Miami, Florida, USA
| | - Dylan Greif
- Department of Orthopedics, University of Miami Sports Medicine Institute, Coral Gables, Florida, USA
| | | |
Collapse
|
21
|
Moore H, Corning W, van der Esch M, Roorda L, Dekker J, Groot J, Wijbenga M, Lems W, van der Leeden M. Evaluation of treatment outcome using the Patient Specific Functional Scale in knee osteoarthritis patients undergoing multidisciplinary rehabilitation. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100098. [DOI: 10.1016/j.ocarto.2020.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022] Open
|
22
|
Rathbun AM, Shardell MD, Ryan AS, Yau MS, Gallo JJ, Schuler MS, Stuart EA, Hochberg MC. Association between disease progression and depression onset in persons with radiographic knee osteoarthritis. Rheumatology (Oxford) 2020; 59:3390-3399. [PMID: 32333000 PMCID: PMC7590406 DOI: 10.1093/rheumatology/keaa141] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/24/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Osteoarthritis (OA) disease progression may lead to deteriorating psychosocial function, but it is unclear what aspects of disease severity are related to the onset of depression. This study assessed which components of OA disease progression cumulatively contribute to depression onset in persons with radiographic knee OA. METHODS Osteoarthritis Initiative participants (n = 1651) with radiographic disease (Kellgren-Lawrence grade ≥2) in one or both knees and below the screening threshold for probable depression [Center for Epidemiological Studies Depression (CES-D) scale <16] at baseline were included. Disease severity was measured from baseline to the third annual follow-up visit using joint space width, 20-meter gait speed, and the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, each categorized into quintiles. Depression onset (CES-D ≥ 16) was assessed annually at four follow-up visits. Marginal structural models that account for time-dependent confounding and attrition evaluated the association between each time-varying disease severity measure and depression onset. RESULTS Each disease severity measure exhibited a non-linear relationship concerning the probability of depression onset, with the higher quintiles generally being associated with a larger risk. The highest quintile (relative to the lowest) of joint space width and gait speed were both significantly associated with depression onset. By contrast, none of the higher pain quintiles compared with the lowest were significantly associated with the onset of depression. CONCLUSION Faster disease progression as measured by either worsening structural severity or decreasing physical performance corresponds to an increased risk of depression among individuals with radiographic knee OA.
Collapse
Affiliation(s)
| | | | - Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michelle S Yau
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marc C Hochberg
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
23
|
Identification of TGFβ signatures in six murine models mimicking different osteoarthritis clinical phenotypes. Osteoarthritis Cartilage 2020; 28:1373-1384. [PMID: 32659345 DOI: 10.1016/j.joca.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE TGFβ is a key player in cartilage homeostasis and OA pathology. However, few data are available on the role of TGFβ signalling in the different OA phenotypes. Here, we analysed the TGFβ pathway by transcriptomic analysis in six mouse models of OA. METHOD We have brought together seven expert laboratories in OA pathophysiology and, used inter-laboratories standard operating procedures and quality controls to increase experimental reproducibility and decrease bias. As none of the available OA models covers the complexity and heterogeneity of the human disease, we used six different murine models of knee OA: from post-traumatic/mechanical models (meniscectomy (MNX), MNX and hypergravity (HG-MNX), MNX and high fat diet (HF-MNX), MNX and seipin knock-out (SP-MNX)) to aging-related OA and inflammatory OA (collagenase-induced OA (CIOA)). Four controls (MNX-sham, young, SP-sham, CIOA-sham) were added. OsteoArthritis Research Society International (OARSI)-based scoring of femoral condyles and ribonucleic acid (RNA) extraction from tibial plateau samples were done by single operators as well as the transcriptomic analysis of the TGFβ family pathway by Custom TaqMan® Array Microfluidic Cards. RESULTS The transcriptomic analysis revealed specific gene signatures in each of the six models; however, no gene was deregulated in all six OA models. Of interest, we found that the combinatorial Gdf5-Cd36-Ltbp4 signature might discriminate distinct subgroups of OA: Cd36 upregulation is a hallmark of MNX-related OA while Gdf5 and Ltbp4 upregulation is related to MNX-induced OA and CIOA. CONCLUSION These findings stress the OA animal model heterogeneity and the need of caution when extrapolating results from one model to another.
Collapse
|
24
|
Shabestari M, Shabestari YR, Landin MA, Pepaj M, Cleland TP, Reseland JE, Eriksen EF. Altered protein levels in bone marrow lesions of hip osteoarthritis: Analysis by proteomics and multiplex immunoassays. Int J Rheum Dis 2020; 23:788-799. [PMID: 32383346 DOI: 10.1111/1756-185x.13843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
AIM To assess tissue level changes of proteome and cytokine profiles of subchondral bone in hip osteoarthritis (OA) affected by bone marrow lesions (BMLs). We compared significant protein level differences in osteoarthritic bone with BMLs to control bone without bone marrow lesions. METHODS Subchondral bone biopsies were taken from femoral heads of end-stage osteoarthritis patients with (BML, n = 21) and without (CON, n = 9) BMLs. Proteins were extracted through a standardized Trizol protocol and used in the subsequent analyses. Angiogenesis and bone markers were assessed using multiplex immunoassays (Luminex). Liquid chromatography tandem mass spectrometry (LC-MS/MS) was performed to detect significant differences in proteome and peptide profiles between BML and CON. RESULTS Multiplex immunoassays revealed increased tissue contents of vascular endothelial growth factors (VEGF-A/C/D), endothelin-1, angiopoietin-2 and interleukin-6 (IL-6) in bone with BMLs compared to control bone, whereas osteoprotegerin levels were reduced. Mass spectrometry demonstrated pronounced increase in the levels of hemoglobin (73-fold), serum albumin (30-fold), alpha-1-antitrypsin (9-fold), apolipoprotein A1 (4.7-fold), pre-laminin-A/C (3.7-fold) and collagen-alpha1-XII (3-fold) in BMLs, while aggrecan core protein (ACAN) and hyaluronan and proteoglycan link protein 1 (HAPL1) decreased 37- and 29-fold respectively. CONCLUSION Reduced osteoprotegerin, ACAN and HAPL1 are consistent with osteoclastic activation and high remodeling activity in BMLs. The pronounced increase in angiogenesis markers, hemoglobin and serum albumin support the presence of increased vascularity in subchondral bone affected by BMLs in OA. VEGFs and IL-6 are known nociceptive modulators, and increased levels are in keeping with pain being a clinical feature frequently associated with BMLs.
Collapse
Affiliation(s)
| | | | - Maria A Landin
- Department of Biomaterials, University of Oslo, Oslo, Norway
| | - Milaim Pepaj
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | | | - Erik F Eriksen
- Department of Endocrinology, Oslo University Hospital (Aker), Oslo, Norway.,Faculty of Medicine, Institue of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
25
|
Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement? J Clin Med 2020; 9:jcm9030632. [PMID: 32120890 PMCID: PMC7141124 DOI: 10.3390/jcm9030632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains—peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups/phenotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 ± 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33–9.93; Class 2 vs. Class 3, HR 9.23, 95%CI 4.66–18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.
Collapse
|
26
|
Berenbaum F, Walker C. Osteoarthritis and inflammation: a serious disease with overlapping phenotypic patterns. Postgrad Med 2020; 132:377-384. [PMID: 32100608 DOI: 10.1080/00325481.2020.1730669] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Globally, osteoarthritis (OA) is the most prevalent arthritic condition in those aged over 60 years. OA has a high impact on patient disability and is associated with a significant economic burden. Pain is the most common first sign of disease and the leading cause of disability. Data demonstrating the increasing global prevalence of OA, together with a greater understanding of the burden of the disease, have led to a reassessment of the seriousness of OA and calls for the designation of OA as a serious disease in line with the diseases impact on comorbidity, disability, and mortality. While OA was traditionally seen as a prototypical 'wear and tear' disease, it is now more accurately thought of as a disease of the whole joint involving cartilage together with subchondral bone and synovium. As more has become known of the pathophysiology of OA, it has become increasingly common for it to be described using a number of overlapping phenotypes. Patients with OA will likely experience multiple phenotypes during their disease. This review focuses on what we feel are three key phenotypes: post-trauma, metabolic, and aging. A greater understanding of OA phenotypes, particularly at the early stages of disease, may be necessary to improve treatment outcomes. In the future, non-pharmacological and pharmacological treatments could be tailored to patients based on the key features of their phenotype and disease pathway.
Collapse
Affiliation(s)
- Francis Berenbaum
- INSERM CRSA, Department of Rheumatology, Hospital Saint Antoine, AP-HP.Sorbonne Université , Paris, France
| | | |
Collapse
|
27
|
Carlesso LC, Neogi T. Understanding the Complexity of Pain in Osteoarthritis Through the Use of Pain Phenotyping: Current Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Molecular taxonomy of osteoarthritis for patient stratification, disease management and drug development: biochemical markers associated with emerging clinical phenotypes and molecular endotypes. Curr Opin Rheumatol 2020; 31:80-89. [PMID: 30461544 DOI: 10.1097/bor.0000000000000567] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the molecular taxonomy of osteoarthritis from the perspective of molecular biomarkers. We discuss how wet biochemical markers may be used to understand disease pathogenesis and progression and define molecular endotypes of osteoarthritis and how these correspond to clinical phenotypes. RECENT FINDINGS Emerging evidence suggests that osteoarthritis is a heterogeneous and multifaceted disease with multiple causes, molecular endotypes and corresponding clinical phenotypes. Biomarkers may be employed as tools for patient stratification in clinical trials, enhanced disease management in the primary care centres of the future and for directing more rational and targeted osteoarthritis drug development. Proximal molecular biomarkers (e.g synovial fluid) are more likely to distinguish between molecular endotypes because there is less interference from systemic sources of biomarker noise, including comorbidities. SUMMARY In this review, we have focused on the molecular biomarkers of four distinct osteoarthritis subtypes including inflammatory, subchondral bone remodelling, metabolic syndrome and senescent age-related endotypes, which have corresponding phenotypes. Progress in the field of osteoarthritis endotype and phenotype research requires a better understanding of molecular biomarkers that may be used in conjunction with imaging, pain and functional assessments for the design of more effective, stratified and individualized osteoarthritis treatments.
Collapse
|
29
|
Migliore A, Gigliucci G, Petrella RJ, Bannuru RR, Chevalier X, Maheu E, Raman R, Herrero-Beaumont G, Isailovic N, Matucci Cerinc M. It Is the Time to Think About a Treat-to-Target Strategy for Knee Osteoarthritis. Ther Clin Risk Manag 2020; 15:1479-1482. [PMID: 31920321 PMCID: PMC6935020 DOI: 10.2147/tcrm.s221562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
Abstract
Osteoarthritis (OA) is a rheumatic disease that affects the well-being of the patient, compromises physical and mental function, and affects other quality of life aspects. In the literature, several evidence-based guidelines and recommendations for the management of knee osteoarthritis (KOA) are available. These recommendations list the different therapeutic options rather than addressing a hierarchy between the treatments and defining the real target. Therefore, a question arises: are patients and physicians satisfied with the current management of KOA? Actually, the answer may be negative, thus suggesting a change in our therapeutic strategies. In this article, we address this challenge by suggesting that it is time to develop a “treat to target strategy” for KOA.
Collapse
Affiliation(s)
- A Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - G Gigliucci
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - R J Petrella
- Department of Family Medicine, School of Kinesiology Western University, Western Centre for Public Health & Family, London, Ontario, Canada
| | - R R Bannuru
- Center for Treatment Comparison and Integrative Analysis Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - X Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - E Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, Paris, France
| | - R Raman
- Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - G Herrero-Beaumont
- Joint and Bone Research Unit, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - N Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Matucci Cerinc
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
30
|
Migliore A, Gigliucci G, Alekseeva L, Avasthi S, Bannuru RR, Chevalier X, Conrozier T, Crimaldi S, Damjanov N, de Campos GC, Diracoglu D, Herrero-Beaumont G, Iolascon G, Ionescu R, Isailovic N, Jerosch J, Lains J, Maheu E, Makri S, Martusevich N, Matucci Cerinc M, Micu M, Pavelka K, Petrella RJ, Tarantino U, Raman R. Treat-to-target strategy for knee osteoarthritis. International technical expert panel consensus and good clinical practice statements. Ther Adv Musculoskelet Dis 2019; 11:1759720X19893800. [PMID: 31903099 PMCID: PMC6923692 DOI: 10.1177/1759720x19893800] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background: In this work, we aimed to establish a clinical target in the management of
knee osteoarthritis (KOA) and to propose good clinical practice (GCP)
statements for carrying out a treat-to-target strategy. Methods: A steering committee of seven experts had formulated a provisional set of
recommendations that were exposed for discussion and modification to a
technical expert panel (TEP) of 25 multidisciplinary experts from Europe,
North America, South America and Asia. The level of evidence and strength of
each recommendation was discussed. The TEP formulated overarching principles
and GCP statements based on the level of agreement for each item with a vote
using a 10-point numerical scale. Results: Two overarching principles and 10 GCP statements were formulated by the TEP.
These GCP statements suggest: treatment should achieve clinical improvement
bringing the patient to the Patient Acceptable Symptom State (PASS);
pharmacological and nonpharmacological treatment should begin as early as
possible, with an early diagnosis of symptomatic KOA; the patient should be
evaluated every 3–6 months; risk factors of KOA progression should be
identified and managed with patients at the beginning of the treatment and
monitored regularly; treatment should be adapted according to patient
phenotype and disease severity; healthy lifestyle must be promoted and
monitored. The level of agreement average ranged from 8.7 to 9.6 on
scale. Conclusions: The proposed overarching principles and GCP statements have the aim of
involving patients, general practitioners and multidisciplinary specialists
in sharing a therapeutic treat-to-target strategy for KOA management based
on the best evidence and expert opinions.
Collapse
Affiliation(s)
- Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | - Liudmila Alekseeva
- Department of Metabolic Diseases of Bone and Joints, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Sachin Avasthi
- Department of Emergency Medicine, Dr Ram Manohar Lohia Hospital, Lucknow, India
| | - Raveendhara R Bannuru
- Centre for Treatment Comparison and Integrative Analysis Division of Rheumatology, Tufts Medical Centre, Boston, MA, USA
| | | | | | - Sergio Crimaldi
- Chirurgia Ortopedica Mininvasiva e Nuove Tecnologie, Humanitas Research Hospital, Castellanza, Italy
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | | | - Demirhan Diracoglu
- Department of Physical Medicine and Rehabilitation Division of Pain Medicine, Istanbul University, Istanbul, Turkey
| | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania 'L Vanvitelli', Caserta, Italy
| | - Ruxandra Ionescu
- Department of Internal Medicine and Rheumatology Sf. Maria Hospital, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan 20089, Italy
| | - Jörg Jerosch
- Orthopaedic Department, Johanna Etienne Hospital, Neuss, Germany
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Souzi Makri
- EUPATI Graduate and Patient Advocate, Brussels, Belgium
| | - Natalia Martusevich
- Department of Rheumatology, Belorussian State Medical University, Minsk, Belarus
| | - Marco Matucci Cerinc
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mihaela Micu
- Second Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | | | - Robert J Petrella
- Department of Family Medicine, School of Kinesiology University Western Ontario, Ontario, Canada
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, 'Policlinico Tor Vergata' Foundation, Rome, Italy
| | - Raghu Raman
- Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
| |
Collapse
|
31
|
Ferreira V, Simões R, Gonçalves RS, Machado L, Roriz P. The optimal degree of lateral wedge insoles for reducing knee joint load: a systematic review and meta-analysis. Arch Physiother 2019; 9:18. [PMID: 31890292 PMCID: PMC6921534 DOI: 10.1186/s40945-019-0068-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lateral wedge insoles are traditionally used to reduce the adduction moment that crosses the knee during walking in people with medial knee osteoarthritis. However, the best degree to reduce knee joint load is not yet well established. Methods Electronic databases were searched from their inception until May 2017. Included studies reported on the immediate biomechanical effects of different degrees of lateral wedge insoles during walking in people with knee osteoarthritis. The main measures of interest relating to the biomechanics were the first and second peak of external knee adduction moment and knee adduction angular impulse. For the comparison of the biomechanical effects of different degrees of insoles, the studies were divided in three subgroups: insoles with a degree higher than 0° and equal to or lower than 5°; insoles higher than 5° and equal to or lower than 9°; and insoles higher than 9°. Eligible studies were pooled using random-effects meta-analysis. Results Fifteen studies with a total of 415 participants met all eligibility criteria and were included in the final review and meta-analysis. The overall effect suggests that lateral wedge insoles resulted in a statistically significant reduction in the first peak (standardized mean difference [SMD] -0.25; 95% confidence interval [CI] -0.36, - 0.13; P < 0.001), second peak (SMD -0.26 [95% CI -0.48, - 0.04]; P = 0.02) and knee adduction angular impulse (SMD -0.17 [95% CI -0.31, - 0.03]; P = 0.02). The test of subgroups found no statistically significant differences. Conclusion Systematic review and meta-analysis suggests that lateral wedge insoles cause an overall slight reduction in the biomechanical parameters. Higher degrees do not show higher reductions than lower degrees. Prior analysis of biomechanical parameters may be a valid option for selecting the optimal angle of wedge that best fits in knee osteoarthritis patients with the lowest possible degree.
Collapse
Affiliation(s)
- Vitor Ferreira
- 1School of Health Sciences, ESSUA - School of Health, Edificio 30, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rita Simões
- Santa Casa da Misericórdia da Mealhada, Aveiro, Portugal
| | - Rui Soles Gonçalves
- 3Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal University of Coimbra, Centre for Health Studies and Research, Coimbra, Portugal
| | - Leandro Machado
- CIF2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, Coimbra, Portugal
| | - Paulo Roriz
- CIDESD-ISMAI, INESC-TEC, LABIOMEP, Coimbra, Portugal
| |
Collapse
|
32
|
Alrowaili MG. Magnetic resonance evaluation of knee osteoarthritis among the Saudi Population. Pak J Med Sci 2019; 35:1575-1581. [PMID: 31777496 PMCID: PMC6861498 DOI: 10.12669/pjms.35.6.874] [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] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Osteoarthritis (OA) is the most prevalent worldwide joint degenerative disorder with high morbidities and disabilities. The current study aimed to investigate the prevalence of knee osteoarthritis (KOA) in Arar by using magnetic resonance imaging (MRI). Methods The prevalence of KOA was studied in Arar through MRI evaluation of randomly chosen sample from patients and their relatives attending the Prince Abdul Aziz Bin Mussad Hospital from October 2015 to November 2016. Results A total of 410 participants were enrolled in the study [328 (80%) male and 82 (20%) females]. After MRI, 163 participants [39.75% (95% CI) = 35.14 - 44.57%)] were diagnosed with KOA. The prevalence of OA was about 25.6% (95% CI = 20.8 - 31.1%) below the age of 40 years, which was found to increase by age in the enrolled volunteers. KOA prevalence was higher in females than males (75.6% and 27.7% respectively). There was a significant association between the age and genders of the participants and the prevalence of OA (p-value < 0.0001 for both variables). There was also a significant association between the age and gender of the participants and the MRI-estimated grading (p-value < 0.0001 and 0.0044 respectively). Conclusion KOA is a common disease among Arar young population, especially females. Its prevalence increases by age with higher grades of severity affecting the elderly.
Collapse
Affiliation(s)
- Majed Gorayan Alrowaili
- Dr. Majed Gorayan Alrowaili, Department of Surgery (Orthopedic Division), Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| |
Collapse
|
33
|
Knoop J, Dekker J, van der Leeden M, de Rooij M, Peter WFH, van Bodegom-Vos L, van Dongen JM, Lopuhäa N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TPM, Ostelo RWJG. Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study). PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1819. [PMID: 31778291 PMCID: PMC7187154 DOI: 10.1002/pri.1819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/20/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
Objectives Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup‐specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost‐)effectiveness of stratified exercise therapy compared with usual, “nonstratified” exercise therapy. Methods A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a “high muscle strength subgroup,” “low muscle strength subgroup,” or “obesity subgroup” and (b) subgroup‐specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3‐month (primary endpoint), 6‐month (questionnaires only), and 12‐month follow‐up, with an additional cost questionnaire at 9 months. Intention‐to‐treat, multilevel, regression analysis comparing stratified versus usual care will be performed. Conclusion This study will demonstrate whether stratified care provided by primary care PTs is effective and cost‐effective compared with usual best practice from PTs.
Collapse
Affiliation(s)
- Jesper Knoop
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joost Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marike van der Leeden
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Mariëtte de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Wilfred F H Peter
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Kim L Bennell
- School of Health Sciences, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Willem F Lems
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Pan F, Tian J, Cicuttini F, Jones G, Aitken D. Differentiating knee pain phenotypes in older adults: a prospective cohort study. Rheumatology (Oxford) 2019; 58:274-283. [PMID: 30247727 DOI: 10.1093/rheumatology/key299] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 01/13/2023] Open
Abstract
Objective To identify and validate knee pain phenotypes in an older population across different pain-related domains over 10.7 years. Methods A total of 963 participants (mean age 63 years) from a population-based older adult cohort study were studied at baseline and followed up at 2.6 (n = 875), 5.1 (n = 768) and 10.7 years (n = 563). Baseline demographic, psychological, lifestyle and comorbidities data were obtained and MRI was performed to measure knee structural pathology. WOMAC pain and pain at multiple sites were assessed by questionnaires at each time-point. Latent class analysis was used to identify knee pain phenotypes, considering sex, BMI, emotional problems, education level, comorbidities, number of painful sites and knee structural pathology. Results Three pain phenotypes were identified: Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: high prevalence of structural damage and low prevalence of emotional problems (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%). Participants within Class 1 and 2 had greater BMI, more comorbidities, a higher prevalence of radiographic knee OA and knee structural pathology compared with Class 3. Furthermore, compared with Class 2 and 3, WOMAC pain and number of painful sites were consistently greater at each time-point over 10.7 years in Class 1. Results were similar when the analyses were restricted to participants with radiographic knee OA. Conclusion Psychological and structural factors interact with each other to exacerbate pain perception, suggesting that tailored treatment approaches for older people with knee pain in clinical practice are needed.
Collapse
Affiliation(s)
- Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
35
|
Christensen JC, Kittelson AJ, Loyd BJ, Himawan MA, Thigpen CA, Stevens-Lapsley JE. Characteristics of young and lower functioning patients following total knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2019; 20:483. [PMID: 31656185 PMCID: PMC6815380 DOI: 10.1186/s12891-019-2817-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rates of total knee arthroplasty (TKA) procedures in younger, more medically complex patients have dramatically increased over the last several decades. No study has examined categorization of lower and higher functioning subgroups within the TKA patient population. Our study aimed to determine preoperative characteristics of younger patients who are lower functioning following TKA. METHODS Patients were categorized into higher and lower functioning subgroups defined using a median split of 1) postoperative Timed Up and Go (TUG) test times and 2) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale scores. A split in age (65 years) was used to further classify patients into four categories: younger lower functioning, younger higher functioning, older lower functioning and older higher functioning. Measures from preoperative domains of health, psychological, physical performance and pain severity were examined for between-group differences. RESULTS Comparing mean values, the younger lower functioning subgroup using the TUG had significantly weaker knee extensor, slower gait speed, higher body mass index and greater pain compared to other subgroups. The younger lower functioning subgroup using the WOMAC physical function subscale demonstrated higher pain levels and Coping Strategies Questionnaire-Catastrophizing Subscale scores compared to the older lower functioning subgroup. CONCLUSIONS Poorer preoperative physical performance and pain severity appear to have the largest influence on early postoperative TKA recovery in younger lower functioning patients relative to both younger and older higher functioning patients.
Collapse
Affiliation(s)
- Jesse C Christensen
- Department of Physical Medicine and Rehabilitation, Eastern Colorado Geriatric Research Education and Clinical Center, 13001 E. 17th Pl, Aurora, CO, 80045, USA. .,Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
| | - Andrew J Kittelson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Brian J Loyd
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael A Himawan
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | | | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, Eastern Colorado Geriatric Research Education and Clinical Center, 13001 E. 17th Pl, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| |
Collapse
|
36
|
Davies MAM, Kerr ZY, DeFreese JD, Arden NK, Marshall SW, Guskiewicz KM, Padua DA, Pietrosimone B. Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes. Am J Sports Med 2019; 47:2863-2870. [PMID: 31498654 DOI: 10.1177/0363546519870804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention. PURPOSE To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight. RESULTS Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05). CONCLUSION Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.
Collapse
Affiliation(s)
- Madeleine A M Davies
- Department of Health, University of Bath, Bath, UK.,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nigel K Arden
- The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Stephen W Marshall
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Darin A Padua
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
37
|
Beems MEC, Toonders SAJ, van Westrienen PE, Veenhof C, Pisters MF. Identifying subgroups based on self-management skills in primary care patients with moderate medically unexplained physical symptoms. J Psychosom Res 2019; 125:109785. [PMID: 31421323 DOI: 10.1016/j.jpsychores.2019.109785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Medically Unexplained Physical Symptoms (MUPS) are a major burden on both patients and society and frequently develop into chronic MUPS. Self-management interventions may prevent moderate MUPS from becoming chronic. Tailoring interventions to the patient population is strongly recommended. This can be facilitated by identifying subgroups based on self-management skills. This study aimed to identify these subgroups and their clinical profiles in primary care patients with moderate MUPS. METHODS A cross-sectional study was performed on baseline measurements from a randomized clinical trial (PARASOL-study). To identify subgroups based on self-management skills, a hierarchical cluster analysis was conducted for adults with moderate MUPS from primary health care centers. Self-management skills were measured with the Health education impact Questionnaire. Cluster variables were seven constructs of this questionnaire. Additionally, specific patient profiles were determined by comparing the identified clusters on the clinical variables pain, fatigue and physical functioning. RESULTS Four subgroups were identified: High-Self-Management Skills (SMS) (n = 29), Medium-SMS (n = 55), Low-SMS (n = 49) and Active & Low Distress-SMS (n = 20). The latter showed a distinctly different pattern on cluster variables, while the other subgroups differed significantly on means of the cluster variables (p < .001). On clinical variables, significant differences between subgroups were mainly found on fatigue and physical functioning. CONCLUSION This study found four specific subgroups based on self-management skills in moderate MUPS-patients. One subgroup demonstrated a distinctly different pattern on self-management skills. In other subgroups, more similar patterns on self-management skills were found that negatively correlated with pain and fatigue and positively correlated with physical functioning.
Collapse
Affiliation(s)
- M E C Beems
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Fysio Center Den Haag, The Hague, the Netherlands.
| | - S A J Toonders
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
| | - P E van Westrienen
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
| | - C Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands.
| | - M F Pisters
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
| |
Collapse
|
38
|
Blanco FJ, Camacho-Encina M, González-Rodríguez L, Rego-Pérez I, Mateos J, Fernández-Puente P, Lourido L, Rocha B, Picchi F, Silva-Díaz MT, Herrero M, Martínez H, Verges J, Ruiz-Romero C, Calamia V. Predictive modeling of therapeutic response to chondroitin sulfate/glucosamine hydrochloride in knee osteoarthritis. Ther Adv Chronic Dis 2019; 10:2040622319870013. [PMID: 31489155 PMCID: PMC6710680 DOI: 10.1177/2040622319870013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the present study, we explored potential protein biomarkers useful to predict the therapeutic response of knee osteoarthritis (KOA) patients treated with pharmaceutical grade Chondroitin sulfate/Glucosamine hydrochloride (CS+GH; Droglican, Bioiberica), in order to optimize therapeutic outcomes. METHODS A shotgun proteomic analysis by iTRAQ labelling and liquid chromatography-mass spectrometry (LC-MS/MS) was performed using sera from 40 patients enrolled in the Multicentre Osteoarthritis interVEntion trial with Sysadoa (MOVES). The panel of proteins potentially useful to predict KOA patient's response was clinically validated in the whole MOVES cohort at baseline (n = 506) using commercially available enzyme-linked immunosorbent assays kits. Logistic regression models and receiver-operating-characteristics (ROC) curves were used to analyze the contribution of these proteins to our prediction models of symptomatic drug response in KOA. RESULTS In the discovery phase of the study, a panel of six putative predictive biomarkers of response to CS+GH (APOA2, APOA4, APOH, ITIH1, C4BPa and ORM2) were identified by shotgun proteomics. Data are available via ProteomeXchange with identifier PXD012444. In the verification phase, the panel was verified in a larger set of KOA patients (n = 262). Finally, ITIH1 and ORM2 were qualified by a blind test in the whole MOVES cohort at baseline. The combination of these biomarkers with clinical variables predict the patients' response to CS+GH with a specificity of 79.5% and a sensitivity of 77.1%. CONCLUSIONS Combining clinical and analytical parameters, we identified one biomarker that could accurately predict KOA patients' response to CS+GH treatment. Its use would allow an increase in response rates and safety for the patients suffering KOA.
Collapse
Affiliation(s)
- Francisco J. Blanco
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
- RIER-Red de Inflamación y Enfermedades Reumáticas, INIBIC-CHUAC, A Coruña, Spain
- Plataforma de Proteomica-PRB3-ProteoRed/ISCIII. INIBIC – A Coruña, Spain
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas. Agrupación CICA-INIBIC, Universidad de A Coruña, A Coruña, Spain
| | - María Camacho-Encina
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Lucía González-Rodríguez
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Ignacio Rego-Pérez
- Unidad de Genómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Jesús Mateos
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Patricia Fernández-Puente
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
- Plataforma de Proteomica-PRB3-ProteoRed/ISCIII. INIBIC – A Coruña, Spain
| | - Lucía Lourido
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Beatriz Rocha
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - Florencia Picchi
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | - María T. Silva-Díaz
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| | | | | | | | - Cristina Ruiz-Romero
- Unidad de Proteómica-Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
- Grupo Terapia Celular, CIBER-BBN/ISCIII, INIBIC-CHUAC, A Coruña, Spain
| | - Valentina Calamia
- Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, Spain
| |
Collapse
|
39
|
Charlier E, Deroyer C, Ciregia F, Malaise O, Neuville S, Plener Z, Malaise M, de Seny D. Chondrocyte dedifferentiation and osteoarthritis (OA). Biochem Pharmacol 2019; 165:49-65. [DOI: 10.1016/j.bcp.2019.02.036] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/28/2019] [Indexed: 02/08/2023]
|
40
|
Wang Y, Hussain SM, Wluka AE, Lim YZ, Abram F, Pelletier JP, Martel-Pelletier J, Cicuttini FM. Association between metformin use and disease progression in obese people with knee osteoarthritis: data from the Osteoarthritis Initiative-a prospective cohort study. Arthritis Res Ther 2019; 21:127. [PMID: 31126352 PMCID: PMC6534888 DOI: 10.1186/s13075-019-1915-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/09/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To examine whether metformin use was associated with knee cartilage volume loss over 4 years and risk of total knee replacement over 6 years in obese individuals with knee osteoarthritis. METHODS This study analysed the Osteoarthritis Initiative participants with radiographic knee osteoarthritis (Kellgren-Lawrence grade ≥ 2) who were obese (body mass index [BMI] ≥ 30 kg/m2). Participants were classified as metformin users if they self-reported regular metformin use at baseline, 1-year and 2-year follow-up (n = 56). Non-users of metformin were defined as participants who did not report the use of metformin at any visit from baseline to 4-year follow-up (n = 762). Medial and lateral cartilage volume (femoral condyle and tibial plateau) were assessed using magnetic resonance imaging at baseline and 4 years. Total knee replacement over 6 years was assessed. General linear model and binary logistic regression were used for statistical analyses. RESULTS The rate of medial cartilage volume loss was lower in metformin users compared with non-users (0.71% vs. 1.57% per annum), with a difference of - 0.86% per annum (95% CI - 1.58% to - 0.15%, p = 0.02), after adjustment for age, gender, BMI, pain score, Kellgren-Lawrence grade, self-reported diabetes, and weight change over 4 years. Metformin use was associated with a trend towards a significant reduction in risk of total knee replacement over 6 years (odds ratio 0.30, 95% CI 0.07-1.30, p = 0.11), after adjustment for age, gender, BMI, Kellgren-Lawrence grade, pain score, and self-reported diabetes. CONCLUSIONS These data suggest that metformin use may have a beneficial effect on long-term knee joint outcomes in those with knee osteoarthritis and obesity. Randomised controlled trials are needed to confirm these findings and determine whether metformin would be a potential disease-modifying drug for knee osteoarthritis with the obese phenotype.
Collapse
Affiliation(s)
- Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Sultana Monira Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Yuan Z Lim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - François Abram
- Medical Imaging Research and Development, ArthroLab Inc., Montreal, Quebec, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| |
Collapse
|
41
|
Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord 2019; 20:159. [PMID: 30967128 PMCID: PMC6456984 DOI: 10.1186/s12891-019-2537-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps muscle strength and physical performance in individuals with knee OA. METHODS A three-arm single-blinded, randomized, controlled trial and intention-to-treat analysis was conducted in outpatient physiotherapy department, King Saud University, Saudi Arabia. Sixty-eight individuals (mean age, 55.6 years; 38 female) with knee OA participated. The participants in the retro or forward walking group completed 10 min of supervised retro or forward walking training in addition to usual care, 3 days/week for 6 weeks. The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score of quadriceps muscle strength and timed up and go test scores. All the outcomes were analyzed at baseline and week 6. RESULTS In total, 68 subjects participated in this 6-week randomized, controlled trial. The completion rates of the primary and secondary outcome measures at week 6 were 91, 87, and 82% in the retro walking, forward walking, and control groups, respectively. In the intention-to-treat analysis, the retro walking group had a greater reduction in pain intensity (mean changes, 1.8 versus 1; p = 0.01) and functional disability (mean changes, 4.8 versus 2.2; p = 0.008) than the control group. Similarly, the retro walking group had a greater improvement in the quadriceps muscle strength (mean changes, 1.7 kg versus 0.7 kg; p = 0.008) and the timed up and go test (mean changes, 0.6 s versus 0.1 s; p = 0.003) than the control group. CONCLUSIONS The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA. TRIAL REGISTRATION Controlled Trials ISRCTN12850845 , Registered 26 January 2015.
Collapse
Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia. .,Deparment of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China.
| | - Bibhuti Sarkar
- National Institute for the Locomotor Disabilities (Divyangjan), Kolkata, India
| | - Ashis K Paul
- Anand Vihar Hospital, Mahanadi Coalfields Limited, Sambalpur, Odisha, India
| | | |
Collapse
|
42
|
Cook CE, Décary S. Higher order thinking about differential diagnosis. Braz J Phys Ther 2019; 24:1-7. [PMID: 30723033 DOI: 10.1016/j.bjpt.2019.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses. METHODS The goal of this masterclass is to discuss the higher order thinking components of differential diagnosis. CONCLUSIONS For healthcare providers, diagnosis is one of many necessary components during the clinical decision making process and it is hallmarked by differentiation of competing structures for a definitive understanding of the underlying condition. The diagnostic process involves identifying or determining the etiology of a disease or condition through evaluation of patient history, physical examination, and review of laboratory data or diagnostic imaging; and the subsequent descriptive title of that finding. Whereas differential diagnosis is a varied skill set among all healthcare providers, the concept of a diagnosis is equally germane, regardless of one's background. In theory, a diagnosis improves the use of classification tools, improves clarity and communication, provides a trajectory of treatment, improves understanding of a person's prognosis, and in some cases, may be useful for preventative treatments. To achieve these improvements, one must have an understanding of relation of the clinical utility of tests and measures with diagnosis, and how to best implement these findings in clinical practice. This requires a deeper understanding (higher order thinking) of the role of diagnosis in the management of patients.
Collapse
Affiliation(s)
- Chad E Cook
- Division of Physical Therapy, Duke Clinical Research Institute, Duke University, Durham, NC, United States.
| | - Simon Décary
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Faculty of Medicine, Québec, Canada
| |
Collapse
|
43
|
Cluster Analysis of Obesity Disease Based on Comorbidities Extracted from Clinical Notes. J Med Syst 2019; 43:52. [DOI: 10.1007/s10916-019-1172-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
|
44
|
Knoop J, van der Leeden M, van der Esch M, de Rooij M, Peter WF, Bennell KL, Steultjens MPM, Hakkinen A, Roorda LD, Lems WF, Dekker J. Is a model of stratified exercise therapy by physical therapists in primary care feasible in patients with knee osteoarthritis? : a mixed methods study. Physiotherapy 2019; 106:101-110. [PMID: 30981515 DOI: 10.1016/j.physio.2019.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To explore the feasibility of a newly developed model of stratified exercise therapy in primary care for patients with knee osteoarthritis (OA). DESIGN Mixed method design (process, outcome and qualitative evaluation). SETTING Six physical therapy practices in primary care around Amsterdam. PARTICIPANTS Fifty eligible patients with knee OA, visiting one of the participating physical therapists (PTs). INTERVENTION Patients were allocated to a subgroup based on a simple stratification tool and received subgroup-specific, protocolized, 4-month, exercise therapy. MAIN OUTCOME MEASURES Feasibility of this model of stratified exercise therapy was explored by multiple process parameters, outcome measures (physical functioning and knee pain; at baseline and 4-months follow-up) and experiences from patients and PTs. RESULTS From 97 potentially eligible patients, fifty patients were included and allocated to the 'high muscle strength subgroup' (n=17), 'depression subgroup' (n=4), 'obesity subgroup' (n=6) or 'low muscle strength subgroup' (n=23). Three patients dropped out during the study period. PTs provided relatively low numbers of sessions (on average 10 sessions), although exceedance of the recommended maximum number of sessions did occur frequently. We found clinically relevant improvements on physical functioning and knee pain (P<0.001 for both) for the total group. In general, the model of stratified exercise therapy was considered to be easily applicable and of added value for daily practice. CONCLUSIONS Our model of stratified exercise therapy seems to be feasible in primary care, although a number of limitations were reported. Future research should determine the (cost-)effectiveness of an adapted model, compared to usual, non-stratified exercise therapy.
Collapse
Affiliation(s)
- J Knoop
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands; Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, Netherlands.
| | - M van der Leeden
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands; VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands.
| | - M van der Esch
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - M de Rooij
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - W F Peter
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - K L Bennell
- University of Melbourne, School of Health Sciences, Melbourne, Australia.
| | - M P M Steultjens
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
| | - A Hakkinen
- University of Jyväskylä, Faculty of Sports and Health Sciences, Jyväskylä, Finland.
| | - L D Roorda
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - W F Lems
- Reade, Jan van Breemen Research Institute, Amsterdam, Netherlands; VUmc, Department of Rheumatology, Amsterdam, Netherlands.
| | - J Dekker
- VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands.
| |
Collapse
|
45
|
Rockel JS, Kapoor M. The Metabolome and Osteoarthritis: Possible Contributions to Symptoms and Pathology. Metabolites 2018; 8:metabo8040092. [PMID: 30551581 PMCID: PMC6315757 DOI: 10.3390/metabo8040092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis (OA) is a progressive, deteriorative disease of articular joints. Although traditionally viewed as a local pathology, biomarker exploration has shown that systemic changes can be observed. These include changes to cytokines, microRNAs, and more recently, metabolites. The metabolome is the set of metabolites within a biological sample and includes circulating amino acids, lipids, and sugar moieties. Recent studies suggest that metabolites in the synovial fluid and blood could be used as biomarkers for OA incidence, prognosis, and response to therapy. However, based on clinical, demographic, and anthropometric factors, the local synovial joint and circulating metabolomes may be patient specific, with select subsets of metabolites contributing to OA disease. This review explores the contribution of the local and systemic metabolite changes to OA, and their potential impact on OA symptoms and disease pathogenesis.
Collapse
Affiliation(s)
- Jason S Rockel
- Arthritis Program, University Health Network, Toronto, ON M5T 2S8, Canada.
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada.
| | - Mohit Kapoor
- Arthritis Program, University Health Network, Toronto, ON M5T 2S8, Canada.
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON M1C 1A4, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M1C 1A4, Canada.
| |
Collapse
|
46
|
Rathbun AM, Shardell MD, Stuart EA, Yau MS, Gallo JJ, Schuler MS, Hochberg MC. Pain severity as a mediator of the association between depressive symptoms and physical performance in knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1453-1460. [PMID: 30092262 PMCID: PMC6397771 DOI: 10.1016/j.joca.2018.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Depressive symptoms in knee osteoarthritis (OA) are associated with increased pain severity and declines in physical performance. This study examined whether pain severity mediates the association between depressive symptoms and physical performance in persons with radiographic knee OA. METHOD Three years of annual data from participants (n = 1,463) with radiographic knee OA in the Osteoarthritis Initiative (OAI) were analyzed. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Pain severity was evaluated with the Western Ontario and McMaster Universities Arthritis Index. Physical performance was assessed via standardized gait speed. Marginal structural models were used to assess the direct (unmediated) effects of depressive symptoms on physical performance and indirect (mediated) effects through pain severity. RESULTS Direct and indirect effects for a difference in CES-D score of 0-1 were -0.0051 (95% confidence intervals (CI): -0.0053, -0.0049) and -0.0016 (95% CI: -0.0024, -0.0007) standard deviations in gait speed, respectively. Higher depressive symptom severity exhibited diminishing, incremental, direct and indirect effects and for a difference in CES-D score of 15-16 were -0.0045 (95% CI: -0.0047, -0.0042) and -0.0009 (95% CI: -0.0014, -0.0004) standard deviations in gait speed, respectively. Therefore, the magnitude of the mediated, indirect effect, was never larger than 24%. CONCLUSION Pain severity mediated approximately one-fifth of the association between depressive symptoms and physical performance in persons with radiographic knee OA, and the diminishing incremental effects may explain why unimodal treatment strategies with a single disease target are often ineffective in depressed OA patients.
Collapse
Affiliation(s)
- A M Rathbun
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore VA Medical Center, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - M D Shardell
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA.
| | - E A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - M S Yau
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
| | - J J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - M C Hochberg
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore VA Medical Center, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
47
|
Einhorn TA, Osmani FA, Sayeed Y, Karia R, Band P, Iorio R. The Role of Patient Education in Arthritis Management: The Utility of Technology. Orthop Clin North Am 2018; 49:389-396. [PMID: 30224000 DOI: 10.1016/j.ocl.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Technologies continue to shape the path of medical treatment. Orthopedic surgeons benefit from becoming more aware of how twenty-first century information technology (IT) can benefit patients. The percentage of orthopedic patients utilizing IT resources is increasing, and new IT tools are becoming utilized. These include disease-specific applications. This article highlights the opportunity for developing IT tools applicable to the growing population of patients with osteoarthritis (OA), and presents a potential solution that can facilitate the way OA education and treatment are delivered, and thereby maximize efficiency for the health care system, the physician, and the patient.
Collapse
Affiliation(s)
- Thomas A Einhorn
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Feroz A Osmani
- Department of Orthopaedic Surgery, University of Illinois at Chicago, 1740 West Taylor Street, Chicago IL 60612, USA.
| | - Yousuf Sayeed
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Raj Karia
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Philip Band
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| |
Collapse
|
48
|
Mobasheri A, Bay-Jensen AC, Gualillo O, Larkin J, Levesque MC, Henrotin Y. Soluble biochemical markers of osteoarthritis: Are we close to using them in clinical practice? Best Pract Res Clin Rheumatol 2018; 31:705-720. [PMID: 30509415 DOI: 10.1016/j.berh.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/17/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis and a major cause of pain and disability. Recent work suggests that the global burden of OA is increasing, and costs associated with treatment are expected to increase dramatically as the aging human population expands. OA is currently diagnosed using radiography, but this technique is an indirect and insensitive measure of alterations in articular cartilage and fails to measure dynamic inflammatory processes in the joint. Radiographic changes detected overtime are small and occur in only a subset (progressors) of patients with OA. Therefore, we diagnose patients with OA on the basis of a diagnostic classification that is outdated. We also use the same tools and approaches for assessing the efficacy of new pharmacological and nonpharmacological interventions. In this review, we discuss the utility of soluble biochemical markers as biomarkers of OA and discuss whether we are close to using them in clinical practice. Combining patient information, functional imaging and carefully selected panels of biomarkers can help in achieving enhanced patient stratification and lead to better designed clinical trials. Biomarkers can be used for molecular endotyping and for developing more effective and more personalized treatments that will enhance clinical care for patients with OA.
Collapse
Affiliation(s)
- Ali Mobasheri
- The D-BOARD FP7 Consortium(1), European Union; The APPROACH IMI Consortium(2), European Union; Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, United Kingdom; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.
| | - Anne-Christine Bay-Jensen
- The D-BOARD FP7 Consortium(1), European Union; The APPROACH IMI Consortium(2), European Union; Rheumatology, Biomarkers and Research, Nordic Bioscience A/S, Herlev, Denmark
| | - Oreste Gualillo
- SERGAS (Servizo Galego de Saude) and IDIS (Instituto de Investigación Sanitaria de Santiago), Research Laboratory 9, The NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Santiago University Clinical Hospital, Santiago de Compostela, 15706, Spain
| | - Jonanthan Larkin
- The APPROACH IMI Consortium(2), European Union; C3 DPU, Immunoinflammation Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, 19406, United States
| | - Marc C Levesque
- The APPROACH IMI Consortium(2), European Union; AbbVie Bioresearch Center, 100 Research Drive, Worcester, MA, 01605, United States
| | - Yves Henrotin
- The D-BOARD FP7 Consortium(1), European Union; The APPROACH IMI Consortium(2), European Union; Bone and Cartilage Research Unit, Arthropôle Liege, University of Liège, Liège, Belgium; Physical Therapy and Rehabilitation Department, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
| |
Collapse
|
49
|
Berenbaum F. Deep phenotyping of osteoarthritis: a step forward. Ann Rheum Dis 2018; 78:3-5. [DOI: 10.1136/annrheumdis-2018-213864] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
|
50
|
Hall M, Bennell KL, Beavers DP, Wrigley TV, DeVita P, Messier SP. Does frontal knee kinematics predict treatment outcomes? Exploratory analyses from the Intensive Diet and Exercise for Arthritis (IDEA) trial. Gait Posture 2018; 63:139-144. [PMID: 29730489 DOI: 10.1016/j.gaitpost.2018.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/10/2018] [Accepted: 04/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pain is a cardinal symptom of knee osteoarthritis (OA) and although conservative treatments such as exercise and diet related interventions can reduce pain, effects are modest and can be improved. Frontal plane knee joint motion has been associated with knee pain, and is suggested as a patient-specific characteristic on which to tailor interventions. RESEARCH QUESTION Does the association between baseline frontal plane knee joint kinematics and pain-relief differ among overweight and obese people with knee OA who underwent an intervention from the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial: diet-only, exercise-only, and combined diet and exercise intervention? METHODS 323 participants with knee OA were included in the analysis (77% females; 66 ± 6 years; 33.5 ± 3.7 kg/m2). At baseline, frontal plane knee joint kinematics during walking were measured using 3-dimensional gait analysis and characterised as peak varus-valgus knee angle, peak varus-valgus excursion, and peak varus angular velocity. Pain was assessed at baseline and 18-month follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. Linear regressions were performed unadjusted and adjusted for covariates to determine if the associations between baseline frontal plane knee joint kinematics and 18-month change in pain differed according to intervention. RESULTS The interaction terms between the intervention and measures of frontal plane knee joint kinematics were not statistically significant (all P ≥ 0.05). SIGNIFICANCE We found no evidence to suggest that 18-months of either exercise, diet, or a combination of diet and exercise could be more effective than the other to improve pain based on frontal plane measures of knee kinematics.
Collapse
Affiliation(s)
- Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia.
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia
| | - Daniel P Beavers
- Division of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia
| | - Paul DeVita
- Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Stephen P Messier
- Department of Health and Exercise Science, JB Snow Biomechanics Laboratory, Wake Forest University, Winston-Salem, NC, 27109, USA
| |
Collapse
|