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Zhang ZQ, Ding YW, Tao Y, Xu HC, Zhong YX, Yang K, Jiang LM. Efficacy of tissue-bone homeostasis manipulation on the gait and knee function for the patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:794. [PMID: 39379908 PMCID: PMC11460060 DOI: 10.1186/s12891-024-07896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 09/23/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) was characterized by pain and limited joint function, which seriously affected the quality of life of patients. The vast majority of KOA was closely related to degeneration of the patellofemoral joint and abnormal patellar movement trajectory. Tissue-bone homeostasis manipulation (TBHM) could correct abnormal patellar movement trajectory on the basis of loosening soft tissue. However, there was little strong evidence to verify its efficacy on the patients with KOA. The study objective was to explore the efficacy of the TBHM on gait and knee function in the patients with KOA. METHODS Sixty KOA patients were randomly assigned to either the joint mobilization (n = 30) or TBHM (n = 30) group. The joint mobilization group received joint mobilization, while the TBHM group received TBHM. For two groups, the patients participated in 30 min rehabilitation sessions thrice per week for 12 weeks. The primary outcome was biomechanical gait outcomes during walking, including step length, step velocity, double support, knee range of motion (ROM), and knee adduction moment (KAM). The secondary outcomes were the Western Ontario and McMaster Index (WOMAC) and 36-Item short- form health survey (SF-36), which reflected improvements in knee function and quality of life, respectively. At baseline and 12 weeks, evaluations were conducted and compared between groups. RESULTS After a 12-week intervention, significant group differences were observed in KAM (p = 0.018), WOMAC-Pain (p = 0.043) and WOMAC-Stiffness (p = 0.026). A noteworthy finding was the presence of a significant interaction effect between group and time specifically observed in step velocity during gait (p = 0.046), WOMAC-Function (p = 0.013) and SF-36 (p = 0.027). Further analysis revealed a significant difference in step velocity (p = 0.034), WOMAC-Function (p = 0.025) and SF-36 (p = 0.042) during post-assessment between the two groups. Moreover, a significant time effect was observed across all outcomes of the two groups (p < 0.05). CONCLUSION The TBHM intervention has better improved the gait, knee function, and quality of life in the patients with KOA. TRIAL REGISTRATION ITMCTR, ITMCTR2200005507. Registered 06/01/2022, http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=09cdadad-0aef-41ee-81bd-a8dceb63f7f5 .
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Affiliation(s)
- Zeng-Qiao Zhang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Yu-Wu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Ying Tao
- Shanghai Puxing Community Health-Care Center, Shanghai, 200136, China
| | - Hai-Chen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Ying-Xi Zhong
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China.
| | - Li-Ming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China.
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Dupuis F, Roy JS, Lachance A, Tougas A, Gagnon M, Marier-Deschênes P, Pinard AM, Massé-Alarie H. Mitigating Persistent Symptoms Following Rehabilitation in Musculoskeletal Disorders: A Scoping Review on After-discharge Strategies. Clin J Pain 2024; 40:542-556. [PMID: 38916576 DOI: 10.1097/ajp.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The majority of patients with musculoskeletal pain (62% to 64%) achieve their treatment goals upon completing rehabilitation. However, a high re-consultation rate after discharge is frequently reported. Numerous authors have recognized the necessity of secondary prevention programs (after-discharge strategy) to ensure that the gains are maintained or further pursued after the completion of a rehabilitation program. Little is known about the different strategies currently in use, and a detailed review of the existing strategies is needed for future integration into the healthcare systems. OBJECTIVE This review systematically scopes and synthesizes the after-discharge strategies reported in the literature following rehabilitation for individuals experiencing musculoskeletal pain. METHODS Four databases (OVID MEDLINE, EMBASE, Web of Sciences, and OVID PsycInfo) were screened from their inception until May 4, 2023. Literature search, screening, and extraction were performed according to the PRISMA extension for scoping review guidelines. RESULTS Different after-discharge strategies were identified and grouped into 2 main categories: (1) in-person and (2) remote strategies. In-person strategies included (1.1) in-person booster sessions and (1.2) the use of existing community programs after discharge. Remote strategies included remote strategies that (2.1) involve a health care professional service or (2.2) strategies that do not involve any health care professional service. DISCUSSION We identified various after-discharge strategies designed to sustain gains and improve patients' self-management skills following the completion of a rehabilitation program. The existence of numerous promising strategies suggests their potential suitability for various contexts.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University
| | - Anthony Lachance
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University
| | - Arielle Tougas
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University
| | - Martine Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- Library, Université Laval
| | - Pascale Marier-Deschênes
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Laval University
- Chronic Pain Service, CHU de Québec-Laval University, Quebec, Canada
| | - Hugo Massé-Alarie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale
- School of Rehabilitation Sciences, Faculty of Medicine, Laval University
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Taul-Madsen L, Hvid LG, Sellebjerg F, Christensen JR, Ratzer R, Sejbæk T, Svendsen KB, Papp V, Højsgaard Chow H, Lundbye-Jensen J, Dawes H, Dalgas U. Study protocol: effects of exercise booster sessions on preservation of exercise-induced adaptations in persons with multiple sclerosis, a multicentre randomised controlled trial-the MS BOOSTER trial. BMJ Open 2024; 14:e085241. [PMID: 39153792 PMCID: PMC11331840 DOI: 10.1136/bmjopen-2024-085241] [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: 02/09/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) causes a broad range of symptoms, with physical function being one of the most disabling consequences according to patients themselves. Exercise effectively improves lower extremity physical function. Nonetheless, it is unknown which exercise modality is most effective and it remains challenging to keep persons with MS adhering to exercise over a longer period. Therefore, the present study aims to investigate how exercise booster sessions (EBS) influence the sustainability of exercise-induced effects on physical function, and furthermore, to investigate which exercise modality (aerobic training or resistance training) is most effective in terms of improving physical function. MATERIALS AND METHODS This study is a multi-arm, parallel-group, open-label multicentre randomised controlled trial investigating the effects of EBS. Participants (n=150) are initially randomised to 12 weeks of either resistance training+usual care, aerobic training+usual care or usual care. After 12 weeks of intervention, participants in the exercise groups will again be randomised to either EBS+usual care or usual care during a 40-week follow-up period. The primary outcome is physical function (composite score based on 6-min walk test and five-time sit to stand), and the secondary outcomes are fatigue, cognition, physical activity, symptoms of depression and quality of life. ETHICS AND DISSEMINATION The study is approved by the Central Denmark Region Committees on Health Research Ethics (1-10-72-237-21) and is registered at the Danish Data Protection Agency (2016-051-000001) and at Clinicaltrials.gov (NCT04913012). All study findings will be published in scientific peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT04913012.
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Affiliation(s)
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus & Ry, Denmark
- The Danish MS Hospitals, Ry, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Centre, Rigshospitalet, Kobenhavn, Denmark
| | | | - Rikke Ratzer
- Danish Multiple Sclerosis Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Tobias Sejbæk
- Department of Neurology, Sydvestjysk Sygehus, Esbjerg, Denmark
| | | | - Viktoria Papp
- Department of Neurology, Odense Universitetshospital, Odense, Denmark
| | | | - Jesper Lundbye-Jensen
- Department of Nutrition, Exercise and Sports, Københavns Universitet, Kobenhavn, Denmark
| | - Helen Dawes
- Medical School, University of Exeter, Exeter, UK
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Ma J, Guo G, Yue H, Xie C, Xie F, Chen Z, Gu Y, Zhang S, Fang M, Yao F. Tuina on knee pain and functional decline of lower limbs for patients with mild-to-moderate knee osteoarthritis in Shanghai: protocol for a multicentre, assessor-blinded, randomised controlled trial. BMJ Open 2024; 14:e083440. [PMID: 38866576 PMCID: PMC11177681 DOI: 10.1136/bmjopen-2023-083440] [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: 12/19/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary and alternative therapy to relieve knee pain and dysfunction symptoms. However, the current evidence is insufficient to support the efficacy of Tuina therapy in addressing knee pain and improving physical function. The trial aims to compare the effectiveness of Tuina with celecoxib, which is considered as the standard treatment, and to assess its potential as an alternative therapy through changes in outcome measures. METHODS AND ANALYSIS A total of 360 KOA patients aged between 40 and 70 years and classified as Kellgren and Lawrence grades I-II will be recruited from eight subcentral hospitals. The participants will be randomly assigned to either the treatment group (Tuina, Biw) or the control group (celecoxib, Qd), with both groups undergoing a 4-week intervention phase followed by an 8-week follow-up phase. The primary outcome is the change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at week 4 compared with baseline. Secondary outcomes including WOMAC stiffness and function subscales, WOMAC total score, 36-item Short-Form Health Survey, Timed Up and Go test, Short Physical Performance Battery, gait analysis parameters and pain medication records will be assessed at weeks 4, 8 and 12. Any adverse events that occur during the trial will be promptly recorded. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2023SHL-KY-16-01, 2023SHL-KY-16-02). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2300069416.
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Affiliation(s)
- Jianwen Ma
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Chaoqun Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanjia Gu
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuaipan Zhang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Paterno MV, Fitzgerald GK. Booster visits in the management of the acute musculoskeletal injuries: Transforming care to improve outcomes-A perspective review. J Orthop Res 2024; 42:1151-1158. [PMID: 38597734 DOI: 10.1002/jor.25852] [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: 05/18/2023] [Revised: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
The current healthcare delivery system for patients with acute musculoskeletal injury is failing. Current rehabilitation management of acute musculoskeletal injury typically includes physical therapy, focused on management of impairments, with an eventual transition to functional activities and release to prior level of function. At that point, formal physical therapy is often discontinued, despite the knowledge that a high percentage of patients fail to maintain preinjury level of activity and often reduce participation in regular physical activity. Further, for those who attempt to return to prior levels of pivoting and cutting activities, there is a high second injury rate. The long-term human experience is compromised by the current model of care which terminates at the point of transition to activity. This model of care fails to meet the continued needs of these patients and may result in long term deficits and potential disability. Extended care models include intermittent follow up visits after discharge from an acute episode of care and have been efficacious and cost effective in some patient populations with musculoskeletal conditions. Specifically, a type of extended care model, labeled "booster sessions," represents an opportunity to provide structured, intermittent care to assist in a smooth transition back to function, following an acute episode of care and promote a healthier life outcome. This perspective review will discuss the opportunity to transform acute musculoskeletal care to booster visit care model in an attempt to develop a more efficacious and cost-effective system of care which could be generalizable to all musculoskeletal conditions.
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Affiliation(s)
- Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kumara MT, Cleveland RJ, Kostic AM, Weisner SE, Allen KD, Golightly YM, Welch H, Dale M, Messier SP, Hunter DJ, Katz JN, Callahan LF, Losina E. Budget impact of the Walk With Ease program for knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100463. [PMID: 38562164 PMCID: PMC10982564 DOI: 10.1016/j.ocarto.2024.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Walk With Ease (WWE) is an effective low-cost walking program. We estimated the budget impact of implementing WWE in persons with knee osteoarthritis (OA) as a measure of affordability that can inform payers' funding decisions. Methods We estimated changes in two-year healthcare costs with and without WWE. We used the Osteoarthritis Policy (OAPol) Model to estimate per-person medical expenditures. We estimated total and per-member-per-month (PMPM) costs of funding WWE for a hypothetical insurance plan with 75,000 members under two conditions: 1) all individuals aged 45+ with knee OA eligible for WWE, and 2) inactive and insufficiently active individuals aged 45+ with knee OA eligible. In sensitivity analyses, we varied WWE cost and efficacy and considered productivity costs. Results With eligibility unrestricted by activity level, implementing WWE results in an additional $1,002,408 to the insurance plan over two years ($0.56 PMPM). With eligibility restricted to inactive and insufficiently active individuals, funding WWE results in an additional $571,931 over two years ($0.32 PMPM). In sensitivity analyses, when per-person costs of $10 to $1000 were added with 10-50% decreases in failure rate (enhanced sustainability of WWE benefits), two-year budget impact varied from $242,684 to $6,985,674 with unrestricted eligibility and from -$43,194 (cost-saving) to $4,484,122 with restricted eligibility. Conclusion Along with the cost-effectiveness of WWE at widely accepted willingness-to-pay thresholds, these results can inform payers in deciding to fund WWE. In the absence of accepted thresholds to define affordability, these results can assist in comparing the affordability of WWE with other behavioral interventions.
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Affiliation(s)
- Mahima T. Kumara
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Serena E. Weisner
- Thurston Arthritis Research Center, Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Kelli D. Allen
- Durham VA Health Care System, Durham, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
- Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Heather Welch
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Melissa Dale
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Ferguson J, Fritsch A, Rhon DI, Young JL. Adverse Events Reported in Trials Assessing Manual Therapy to the Extremities: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:507-517. [PMID: 38452161 DOI: 10.1089/jicm.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective: This review aimed to describe the quality and comprehensiveness of adverse event (AE) reporting in clinical trials incorporating manual therapy (MT) as an intervention for extremity conditions using the Consolidated Standards of Reporting Trials (CONSORT)-Harms extension as the benchmark. The secondary aim was to determine whether the quality of AE reporting improved after the availability of the CONSORT reporting checklist. Design: Systematic review. Methods: A literature search was conducted using multiple databases to identify trials where MT was used to treat extremity conditions. Studies that reported AEs were identified and evaluated using the CONSORT-Harms extension. The frequency of trials reporting study AEs before and after the publication of the updated 2010 CONSORT statement was calculated, along with the categorization of how study AEs were reported. Results: Of the 55,539 studies initially identified, 220 trials met all inclusion criteria. Eighty trials (36.4%) reported AE occurrence. None of the studies that reported AEs adhered to all 10 criteria proposed by the 2010 CONSORT-Harms extension. The most commonly reported criterion was number four, which clarified how AE-related information was collected (30% of trials). The least reported criterion was number six, which describes the participant withdrawals for each arm due to AEs and the experience with the allocated treatment (1.3% of trials). The nomenclature used to describe AEs varied substantially. Fifty-nine of 76 trials (33.3%) were published after the updated CONSORT Harms-checklist was available, compared to 21 of 44 trials (46.7%) published before it was available. Conclusion: Reporting of AEs in trials investigating MT for extremity conditions is poor. Every included trial lacked adherence to all 10 criteria proposed by the CONSORT-Harms Extension. The quality and comprehensiveness of AE reporting did not improve after the most recent CONSORT update recommending AE reporting. Clinicians must obtain informed consent before performing any intervention, including MT, which requires disclosing potential risks, which could be better known with improved tracking, analyzing, and reporting of AEs. The authors recommend improved adherence to best practices for adequately tracking and reporting AEs in future MT trials.
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Affiliation(s)
- Jeffrey Ferguson
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Adam Fritsch
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Daniel I Rhon
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
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Zhu B, Ba H, Kong L, Fu Y, Ren J, Zhu Q, Fang M. The effects of manual therapy in pain and safety of patients with knee osteoarthritis: a systematic review and meta-analysis. Syst Rev 2024; 13:91. [PMID: 38504373 PMCID: PMC10949788 DOI: 10.1186/s13643-024-02467-7] [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: 06/10/2023] [Accepted: 01/21/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Manual therapy (MT) is frequently used in combination with management of osteoarthritis of the knee, but there is no consensus on the exact efficacy of this treatment strategy. The purpose of this systematic review and meta-analysis was to evaluate the pain relief and safety of MT for treatment of knee osteoarthritis (KOA). METHODS Randomized controlled trials evaluating MT in patients with KOA in major English and Chinese journals were searched in the following databases: Wanfang, China Science and Technology Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), PubMed, Embase, Web of Science, and the Cochrane Library databases through June 2023. The methodological quality and quality of evidence of the included studies were assessed using Cochrane's risk-of-bias 2 (ROB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Stata version 15.0 software. After use of Galbraith plots to exclude studies that could lead to heterogeneity, random effects models were used to analyze the remaining data and test the consistency of the findings. We used meta-regression to assess the effect of treatment period, patient age, and sex ratio on outcomes. Funnel plots and Egger's test were used to evaluate publication bias. Sensitivity analyses were used to determine the reliability of the results. RESULTS A total of 25 studies, with 2376 participants, were included in this review. The overall methodological quality of the included studies was limited. Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to usual care (SMD = 2.04, 95% CI 0.94, 3.14, I 2 = 96.3%; low evidence quality) and exercise (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%; low evidence quality) for reducing pain. In terms of improvement in visual analogue scale (VAS) scores, MT treatment beyond 4 weeks (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%) may be superior to treatments less than or equal to 4 weeks (SMD = 1.24, 95% CI 0.56, 1.95, I 2 = 94.7%). No serious adverse events associated with MT were reported. CONCLUSIONS MT may be effective at reducing pain in patients with KOA and may be more effective after a 4-week treatment period. Compared with usual care and exercise therapy, MT may be superior at reducing KOA pain in the short term (9 weeks), but its long-term efficacy requires careful consideration of evidence-based outcomes. MT appears to be safe for KOA patients, though clinicians should inform patients of the potential risk of MT-related adverse events.
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Affiliation(s)
- Bowen Zhu
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - He Ba
- Department of Integrative Oncology, Shanghai Cancer Center, Qingdao Institute, Fudan University, Qingdao, China
| | - Lingjun Kong
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangyang Fu
- Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Ren
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingguang Zhu
- Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Traditional Chinese Medicine and Massage, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Traditional Chinese Medicine and Massage, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
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Adams KR, Famuyide AO, Young JL, Maddox CD, Rhon DI. Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review. Arch Physiother 2024; 14:1-10. [PMID: 38444787 PMCID: PMC10898243 DOI: 10.33393/aop.2024.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings. Aim To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum. Methods This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains. Results Of the 36 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (75.0%), trial setting (77.8%), flexibility of intervention (58.3%), and clinical relevance of experimental and comparison intervention (47.2%). In addition, 13.9% of the trials had low risk of bias, 41.7% had high risk of bias, and 44.4% had some concerns regarding bias. Conclusions While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.
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Affiliation(s)
- Kyle R. Adams
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Physical Therapy, Baylor University, Waco, Texas - USA
| | - Ayodeji O. Famuyide
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Greater Baton Rouge Physical Therapy, Baton Rouge, Louisiana - USA
| | - Jodi L. Young
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
| | - C. Daniel Maddox
- Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, Georgia - USA
- Upstream Rehab Institute, Smyrna, Georgia - USA
| | - Daniel I. Rhon
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland - USA
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10
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Zimmerman ZE, Cleveland RJ, Kostic AM, Leifer VP, Weisner SE, Allen KD, Golightly YM, Welch H, Dale M, Messier SP, Hunter DJ, Katz JN, Callahan LF, Losina E. Walk with ease for knee osteoarthritis: A cost-effectiveness analysis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100368. [PMID: 37234863 PMCID: PMC10206185 DOI: 10.1016/j.ocarto.2023.100368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Objective The Walk With Ease (WWE) program was developed by the Arthritis Foundation to help people with arthritis learn to exercise safely and improve arthritis symptoms. We sought to establish the value of the WWE program. Methods We used the Osteoarthritis Policy (OAPol) Model, a widely published and validated computer simulation of knee osteoarthritis (OA), to assess the cost-effectiveness of WWE in knee OA. We derived model inputs using data from a workplace wellness initiative in Montana that offered WWE to state employees. Our primary outcomes were quality-adjusted life years (QALYs) and costs over a 2-year period, which we used to calculate the incremental cost-effectiveness ratio (ICER). The base case analysis was restricted to subjects who were inactive or insufficiently active (<180 min/week of PA) at baseline. We performed scenario and probabilistic sensitivity analyses to determine the impact of uncertainty in model parameters on our results. Results In the base case analysis, adding WWE to usual care resulted in an ICER of $47,900/QALY. When the program was offered without preselection by baseline activity level, the ICER for WWE + usual care was estimated at $83,400/QALY. Results of the probabilistic sensitivity analysis indicated that WWE offered to inactive or insufficiently active individuals has a 52% chance of having an ICER <$50,000/QALY. Conclusion The WWE program offers good value for inactive/insufficiently active individuals. Payers may consider including such a program to increase physical activity in individuals with knee OA.
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Affiliation(s)
- Zoe E. Zimmerman
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aleksandra M. Kostic
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Serena E. Weisner
- Thurston Arthritis Research Center; Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Kelli D. Allen
- Durham VA Health Care System, Durham, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
- Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA
| | - Heather Welch
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Melissa Dale
- Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Jeffrey N. Katz
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Dept. of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Elena Losina
- Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Jorge AES, Dantas LO, Aburquerque-Sendín F, Ferrari AV, Cunha JE, Dantas GADF, Barbosa GM, Serrão PRMDS, Salvini TDF. Photobiomodulation does not provide incremental benefits to patients with knee osteoarthritis who receive a strengthening exercises program: a randomized controlled trial. Braz J Phys Ther 2023; 27:100519. [PMID: 37572382 PMCID: PMC10440468 DOI: 10.1016/j.bjpt.2023.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND There is lack of agreement in the literature about the effectiveness of photobiomodulation (PBM) for reducing pain-related symptoms in patients with knee osteoarthritis (OA). OBJECTIVE To evaluate whether PBM, when combined to exercises, provides incremental therapeutic benefits for pain, physical function, and quality of life (QoL) in patients with knee OA. METHODS A six-month double-blind placebo-controlled randomized trial was conducted. Patients with knee OA were randomly assigned to one of three treatment groups: Exercise, Exercise plus Active PBM, or Exercise plus Placebo PBM. Treatment was provided over an eight-week period, three times per week. The primary outcomes were pain at rest and upon movement, assessed by a visual analogue scale (VAS). WOMAC global score, QoL, and a core-set of performance-based tests were measured as secondary outcomes. All outcomes were collected at baseline, immediately after treatment, and after three- and six-month post-treatment. RESULTS 127 participants were allocated as follows: Exercise, N = 41; Exercise plus Active PBM, N = 44; and Exercise plus Placebo PBM, N = 42. There was no between-groups difference in improvement in pain, physical function, and QoL for all follow-up times. However, all groups presented significant, clinically relevant improvements in pain, physical function, and QoL immediately and three months after treatment compared with baseline measures. CONCLUSION Patients with knee OA who received a strengthening exercises program did not experience incremental benefits regarding pain, physical function, or QoL when adding PBM to their therapeutic exercises.
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Affiliation(s)
| | - Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Francisco Aburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Sociosanitary Sciences, Radiology and Physical Medicine, University of Córdoba, and Maimonides Biomedical Research Institute of Cordoba, Córdoba, Spain
| | | | | | | | - Germanna Medeiros Barbosa
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Faculty of Health Sciences of Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
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Gholami Z, Faezi ST, Letafatkar A, Madreseh E. Pain neuroscience education, blended exercises and booster sessions as an effective therapy for pain, functional and psychological factors in patients with knee osteoarthritis: a study protocol for a single-blind randomised controlled trial with 2 2 factorial design during 6-month follow-up. BMJ Open 2023; 13:e070336. [PMID: 37173101 PMCID: PMC10186447 DOI: 10.1136/bmjopen-2022-070336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION This study aims to investigate whether a pain neuroscience education (PNE) combined with a blended exercises programme including aerobic, resistance, neuromuscular, breathing, stretching and balance exercises and diet education provides greater pain relief and improvement in functional and psychological factors than PNE and blended exercises alone and whether 'exercise booster sessions (EBS)' approach may improve outcomes and increase adherence in patients with knee osteoarthritis (KOA) (by telerehabilitation (TR)). METHODS AND ANALYSIS In this single-blind randomised controlled trial, 129 patients (both genders; age >40) diagnosed with KOA will be randomly assigned to one of the 22 treatment combinations as: (1) blended exercises alone (36 sessions over 12 weeks), (2) PNE alone (three sessions over 2 weeks), (3) combination of PNE with blended exercises (exercise three times a week for 12 weeks combined with three sessions of PNE) and (4) a control group. Outcome assessors will be blinded towards group allocation. The primary outcome variables are the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis (WOMAC) score. Secondary outcomes include Pain Self-Efficacy Questionnaire (PSEQ), Depression, Anxiety and Stress Scale (DASS), Tampa Scale for Kinesiophobia (TSK), Short Falls Efficacy Scale International (FES-I), Pain Catastrophising Scale (PCS), Short Form Health Survey (SF-12) and Exercise Adherence Rating Scale (EARS), 30 s sit-to-stand test (30CST), Timed Up and Go (TUG), lower limbs' muscle strength and lower limb joints' active range of motion (AROM) will be performed at baseline, 3 and 6 months' postinterventions. The primary and secondary outcomes will assess at baseline, 3 months and 6 months postinterventions.The findings will be useful in establishing an effective treatment strategy covering multiple aspects behind KOA. The study protocol is conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the healthcare systems and self-care management. Results in comparison between groups will help to clarify the most effective of mixed-method TR (blended exercise, PNE, EBS with diet education) on more improvement in pain, functional and psychological factors in patients with KOA. This study will combine some of the most critical interventions, to be able to introduce a 'gold standard therapy' in the treatment of KOA. ETHICS AND DISSEMINATION The trial has been approved by the ethics committee for research involving human subjects of the Sport Sciences Research Institute of Iran (IR.SSRC.REC.1401.021). The study findings will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER IRCTID: IRCT20220510054814N1.
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Affiliation(s)
- Zohreh Gholami
- Biomechanics and Sports Injuries, Kharazmi University - Karaj, Hesarak, Iran
| | | | - Amir Letafatkar
- Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran
| | - Elham Madreseh
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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13
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Surakanti A, Demory Beckler M, Kesselman MM. Surgical Versus Non-Surgical Treatments for the Knee: Which Is More Effective? Cureus 2023; 15:e34860. [PMID: 36923205 PMCID: PMC10010196 DOI: 10.7759/cureus.34860] [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: 12/24/2022] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Osteoarthritis is a degenerative joint disease that is extremely prevalent in society. It affects more than 25% of Americans above the age of 18 years. According to July 2020 publication by the Centers for Disease Control (CDC), osteoarthritis affects approximately 325 million Americans. One of the organs that is most affected by osteoarthritis is the knee. Over the years, we have developed non-surgical treatments, such as physical therapy (PT) and injections, and surgical treatments, such as total knee arthroplasty (TKA) and arthroscopic lavage, for knee osteoarthritis (KOA). If a patient fails with non-surgical options, which are tried first to avoid the risks of surgery, the patient may be considered for knee surgery. This article will investigate the different non-surgical options and TKA as treatment options for KOA based on current literature. The goal of this paper is to be a comprehensive resource for physicians and patients with KOA to make an informed decision. A systematic literature search was conducted using PubMed. The search terms were based on the type of treatments for KOA. To find articles that compared TKA to non-surgical treatments, the terms included "osteoarthritis", "total knee", and "non-surgical treatments," in combination. For other non-surgical treatments such as PT, weight reduction, and injections, a combination of the treatment, "osteoarthritis", and "knee" were included in the search. For the tier 1 process, any randomized controlled trials were included. Any case reports, observational studies, and cross-sectional studies were eliminated from the search. For the tier 2 review process, any articles that did not have relevance to the topic were eliminated after reading the abstracts of the articles. After review of the literature, the data seem to suggest that TKA with 12 weeks of non-surgical treatment improved pain and functionality of the knee more than just 12 weeks of non-surgical treatment when followed up at 12 and 24 months. However, non-surgical treatment before TKA delays the need for surgery. Supervised PT, either in a group or individual format, has been shown to delay TKA in 95% patients in the group that received PT at the end of one year. In addition, weight reduction has been shown as an effective strategy to improve pain and functionality in KOA patients, which decreases the urgency for surgery. Furthermore, platelet-rich plasma (PRP) injections have been shown to have long-term symptomatic relief for KOA compared to hyaluronic acid (HA) and corticosteroid injections. However, HA and corticosteroid injections are beneficial in treating KOA more than receiving no treatment. Physicians often have difficulty deciding whether to pursue conservative or surgical treatment for patients with KOA. The non-surgical treatments explored in this review - PT, injections, and weight reduction - can provide symptomatic relief and, in some cases, delay the need for surgical intervention. However, based on some randomized clinical trials mentioned in the article, patients receiving TKA have more relief, better quality of life, and improved functionality compared to non-surgical therapy. However, a critical review of this important field of debate shows that there are limited randomized controlled studies comparing the effectiveness of TKA and non-surgical treatments for KOA. We believe that this controversial topic needs further clinical investigation.
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Affiliation(s)
- Amulya Surakanti
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory Beckler
- Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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15
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Runge N, Aina A, May S. The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients With Knee or Hip Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:675-A13. [PMID: 35881705 DOI: 10.2519/jospt.2022.11062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To evaluate if there was an additional benefit of combining manual therapy (MT) and exercise therapy over exercise therapy alone on pain and function in patients with hip or knee osteoarthritis. DESIGN: Intervention systematic review LITERATURE SEARCH: We (1) searched 4 databases from inception to June 20, 2021; (2) hand searched a reference list of included trials and relevant systematic reviews; and (3) contacted 2 researchers in the field. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared MT and exercise therapy to similar exercise therapy programs alone in patients with hip or knee osteoarthritis. DATA SYNTHESIS: The data were combined using random-effects meta-analyses where appropriate. The certainty of evidence for each outcome was judged using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: We included 19 trials. There was very low to moderate certainty of evidence that MT added benefit in the short term for pain, and combined pain, function, and stiffness (WOMAC global scale), but not for performance-based function and self-reported function. In the medium term, there was low- to very-low-certainty evidence that MT added benefit for performance-based function and WOMAC global score, but not for pain. There was high-certainty evidence that MT provided no added benefit in the long term for pain and function. CONCLUSION: There was very low to moderate certainty of evidence supporting MT as an adjunct to exercise therapy for pain and WOMAC global scale, but not function in patients with knee or hip osteoarthritis in the short term. There was high certainty of evidence of no benefit for additional MT over exercise therapy alone in the long term. J Orthop Sports Phys Ther 2022;52(10):675-684. Epub: 27 July 2022. doi:10.2519/jospt.2022.11062.
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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] [MESH Headings] [Grants] [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).
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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
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17
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Fogarty AE, Burnham T, Kuo K, Tate Q, Sperry BP, Cheney C, Walega DR, Kohan L, Cohen SP, Cushman DM, McCormick ZL, Conger A. The Effectiveness of Fluoroscopically Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review. Am J Phys Med Rehabil 2022; 101:482-492. [PMID: 35006653 DOI: 10.1097/phm.0000000000001813] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT The objective was to determine the effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for painful knee osteoarthritis. Primary outcome measure was improvement in pain after 6 mos. Secondary outcomes included the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index. Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation system were used. One hundred ninety-nine publications were screened, and nine were included. Six-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 74%. When compared with intra-articular steroid injection, the probability of success was 4.5 times higher for radiofrequency ablation (relative risk = 4.58 [95% confidence interval = 2.61-8.04]). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.88, 95% confidence interval = 1.38-2.57). The group mean Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index scores improved in participants receiving genicular radiofrequency ablation compared with intra-articular steroid injection and hyaluronic acid injection. According to Grades of Recommendation, Assessment, Development, and Evaluation, there is moderate-quality evidence that fluoroscopically guided genicular radiofrequency ablation is effective for reducing pain associated with knee osteoarthritis at minimum of 6 mos. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment.
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Affiliation(s)
- Alexandra E Fogarty
- From the Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, Missouri (AEF); Division of Physical Medicine and Rehabilitation, Department of Orthopedics, University of Utah, Salt Lake City, Utah (TB, KK, QT, CC, DMC, ZLM, AC); University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California (BPS); Department of Anaesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DRW); Division of Pain Management, Department of Anaesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia (LK); Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (SPC); and Department of Surgery, Walter Reed Army Medical Center, Washington, DC (SPC)
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18
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Buzasi E, Kurakata H, Gandhi A, Birch HL, Zarnegar R, Best L. Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:214-257. [PMID: 33863859 DOI: 10.1097/j.pain.0000000000002302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Our objective was to investigate the effectiveness of booster sessions after self-management interventions as a means of maintaining self-management behaviours in the treatment of chronic musculoskeletal pain. We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, and PsychINFO. Two authors independently identified eligible trials and collected data. We calculated the odds ratio for the analyses of dichotomous data and standardised mean differences (SMDs) with 95% confidence interval (CI) for continuous variables. Our search identified 14 studies with a total of 1695 patients. All studies were at high risk of bias and provided very low quality evidence. For the primary outcomes, booster sessions had no evidence of an effect on improving patient-reported outcomes on physical function (SMD -0.13, 95% CI -0.32 to -0.06; P = 0.18), pain-related disability (SMD -0.16, 95% CI -0.36 to 0.03; P = 0.11), and pain self-efficacy (SMD 0.15, 95% CI -0.07 to 0.36; P = 0.18). For the secondary outcomes, booster sessions caused a significant reduction in patient-reported pain catastrophising (SMD -0.42, 95% CI -0.64 to -0.19; P = 0.0004) and no evidence of an effect on patient-reported pain intensity, depression, coping, or treatment adherence. There is currently little evidence that booster sessions are an effective way to prolong positive treatment effects or improve symptoms of long-term musculoskeletal conditions after self-management interventions. However, the studies were few with high heterogeneity, high risk of bias, and overall low quality of evidence. Our review argues against including booster sessions routinely to self-management interventions for the purpose of behaviour maintenance.
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Affiliation(s)
- Eva Buzasi
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Hiroshi Kurakata
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Akash Gandhi
- Division of Medicine, Northwick Park Hospital, London, United Kingdom
| | - Helen L Birch
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Roxaneh Zarnegar
- Royal National Orthopaedic Hospital, University College London, Stanmore, United Kingdom
| | - Lawrence Best
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
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19
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Patellar inward pushing method relieves knee osteoarthritis via regulating cytokines. Transpl Immunol 2022; 72:101534. [PMID: 35017095 DOI: 10.1016/j.trim.2022.101534] [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: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by pain, morning stiffness and swelling in the knee joints. And KOA is common in the elderly and seriously affects the exercise function and physical health of patients. This study aimed to explore the curative effects of patellar inward pushing method (PIPM) on KOA. MATERIAL AND METHOD In this study, we established rabbit animal models of KOA for the research by using the New Zealand white rabbits. 30 New Zealand white rabbits were divided into 5 groups by random number table method: blank group, model group, glucosamine hydrochloride (GH) group, PIPM group and PIPM combined with GH group, then the rabbits were modeled. RESULTS After 9-weeks cultured in groups, 5 ml blood was collected from the heart, and cytokines were detected. The result suggested that iNOS, NO and TNF-α were the pathogenic inflammatory factor of KOA, and aggravated cartilage damage and degeneration. Besides, this study indicated that PIPM combined with GH treatment significantly reduced the activity of inflammatory cytokines in serum and joint fluid of KOA models in rabbits. In addition, PIPM combined with GH therapy exhibited the best therapeutic effect among these treatments, which was working on KOA better than PIPM treatment alone or GH treatment alone. CONCLUSIONS PIPM could effective treat KOA via regulating cytokines, and the PIPM combined with GH therapy could be a novel therapeutic strategy of KOA.
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20
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Are manual therapy or booster sessions worthwhile in addition to exercise therapy for knee osteoarthritis: Economic evaluation and 2-year follow-up of a randomized controlled trial. Musculoskelet Sci Pract 2021; 56:102439. [PMID: 34375855 DOI: 10.1016/j.msksp.2021.102439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exercise therapy is known to be an effective intervention for patients with osteoarthritis, however the evidence is limited as to whether adding manual therapy or booster sessions are cost-effective strategies to extend the duration of benefits. OBJECTIVE To investigate the cost-effectiveness, at 2-year follow-up, of adding manual therapy and/or booster sessions to exercise therapy. DESIGN 2-by-2 factorial randomized controlled trial. METHODS Participants with knee osteoarthritis were randomly allocated (1:1:1:1) to: exercise therapy delivered in consecutive sessions within 9 weeks (control group), exercise therapy distributed over 1 year using booster sessions, exercise therapy plus manual therapy delivered within 9 weeks, and exercise therapy plus manual therapy with booster sessions. The primary outcome was incremental cost-effectiveness from health system and societal perspectives interpreted as incremental net monetary benefit (INMB). RESULTS Of 75 participants, 66 (88 %) were retained at 1-year and 40 (53 %) at 2-year follow-up. All three interventions were cost-effective from both the health system and societal perspectives (INMBs, at 0.5 × GDP/capita willingness to pay (WTP) threshold: $3278 (95%CI -3244 to 9800) and $3904 (95%CI -2823 to 10,632) respectively for booster sessions; $2941 (95%CI -3686 to 9568) and $2618 (95%CI -4005 to 9241) for manual therapy; $270 (95%CI -6139 to 6679) and $404 (95%CI -6097 to 6905) for manual therapy with booster sessions). CONCLUSION Manual therapy or booster sessions in addition to exercise therapy are cost-effective at 2-year follow-up. The evidence did not support combining both booster sessions and manual therapy in addition to exercise therapy.
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21
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Trompeter N, Gardinier JD, DeBarros V, Boggs M, Gangadharan V, Cain WJ, Hurd L, Duncan RL. Insulin-like growth factor-1 regulates the mechanosensitivity of chondrocytes by modulating TRPV4. Cell Calcium 2021; 99:102467. [PMID: 34530313 PMCID: PMC8541913 DOI: 10.1016/j.ceca.2021.102467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Both mechanical and biochemical stimulation are required for maintaining the integrity of articular cartilage. However, chondrocytes respond differently to mechanical stimuli in osteoarthritic cartilage when biochemical signaling pathways, such as Insulin-like Growth Factor-1 (IGF-1), are altered. The Transient Receptor Potential Vanilloid 4 (TRPV4) channel is central to chondrocyte mechanotransduction and regulation of cartilage homeostasis. Here, we propose that changes in IGF-1 can modulate TRPV4 channel activity. We demonstrate that physiologic levels of IGF-1 suppress hypotonic-induced TRPV4 currents and intracellular calcium flux by increasing apparent cell stiffness that correlates with actin stress fiber formation. Disruption of F-actin following IGF-1 treatment results in the return of the intracellular calcium response to hypotonic swelling. Using point mutations of the TRPV4 channel at the microtubule-associated protein 7 (MAP-7) site shows that regulation of TRPV4 by actin is mediated via the interaction of actin with the MAP-7 domain of TRPV4. We further highlight that ATP release, a down-stream response to mechanical stimulation in chondrocytes, is mediated by TRPV4 during hypotonic challenge. This response is significantly abrogated with IGF-1 treatment. As chondrocyte mechanosensitivity is greatly altered during osteoarthritis progression, IGF-1 presents as a promising candidate for prevention and treatment of articular cartilage damage.
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Affiliation(s)
- Nicholas Trompeter
- Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Joseph D Gardinier
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States; Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
| | - Victor DeBarros
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Mary Boggs
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Vimal Gangadharan
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - William J Cain
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Lauren Hurd
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Randall L Duncan
- Biomedical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States; Department of Biological Sciences, University of Delaware, Newark, DE, United States; Department of Biology, University of Michigan-Flint, Flint, MI, United States.
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22
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Taul-Madsen L, Kjeldsen T, Skou ST, Mechlenburg I, Dalgas U. Exercise booster sessions as a mean to maintain the effect of an exercise-intervention - A systematic review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1988816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Laurits Taul-Madsen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Kjeldsen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Tsokanos A, Livieratou E, Billis E, Tsekoura M, Tatsios P, Tsepis E, Fousekis K. The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:696. [PMID: 34356977 PMCID: PMC8304320 DOI: 10.3390/medicina57070696] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
Background and objectives: Osteoarthritis (OA) is among the most common degenerative diseases that induce pain, stiffness and reduced functionality. Various physiotherapy techniques and methods have been used for the treatment of OA, including soft tissue techniques, therapeutic exercises, and manual techniques. The primary aim of this systemic review was to evaluate the short-and long-term efficacy of manual therapy (MT) in patients with knee OA in terms of decreasing pain and improving knee range of motion (ROM) and functionality. Materials and Methods: A computerised search on the PubMed, PEDro and CENTRAL databases was performed to identify controlled randomised clinical trials (RCTs) that focused on MT applications in patients with knee OA. The keywords used were 'knee OA', 'knee arthritis', 'MT', 'mobilisation', 'ROM' and 'WOMAC'. Results: Six RCTs and randomised crossover studies met the inclusion criteria and were included in the final analysis. The available studies indicated that MT can induce a short-term reduction in pain and an increase in knee ROM and functionality in patients with knee OA. Conclusions: MT techniques can contribute positively to the treatment of patients with knee OA by reducing pain and increasing functionality. Further research is needed to strengthen these findings by comparing the efficacy of MT with those of other therapeutic techniques and methods, both in the short and long terms.
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Affiliation(s)
- Alexios Tsokanos
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Elpiniki Livieratou
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Evdokia Billis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Maria Tsekoura
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Petros Tatsios
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, University of West Attica (UNIWA), 12243 Athens, Greece;
| | - Elias Tsepis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Konstantinos Fousekis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
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24
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Aceituno-Gómez J, García-Madero VM, Criado-Álvarez JJ, González-González J, Gómez-Soriano J, Avendaño-Coy J. Long-term effect of high-intensity laser therapy for persistent shoulder pain: A case report. J Back Musculoskelet Rehabil 2021; 33:947-951. [PMID: 31929134 DOI: 10.3233/bmr-171044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments. CASE DESCRIPTION Ten sessions of HILT were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the initial intervention. RESULTS There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5 kg/cm2) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed. CONCLUSION Results indicate the suitability of developing new research lines which will optimize the use of HILT.
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Affiliation(s)
- Javier Aceituno-Gómez
- University General Hospital Nuestra Señora del Prado, Gerencia de Atención Integrada de Talavera de la Reina, Toledo, Spain
| | - Venancio Miguel García-Madero
- University General Hospital Nuestra Señora del Prado, Gerencia de Atención Integrada de Talavera de la Reina, Toledo, Spain
| | - Juan José Criado-Álvarez
- Primary Care Center of La Pueblanueva, Gerencia de Atención Integrada de Talavera de la Reina, Toledo, Spain.,Department of Medicine, Faculty of Health Sciences, Castilla-La Mancha University, Talavera, Spain
| | - Jaime González-González
- Department of Medicine, Faculty of Health Sciences, Castilla-La Mancha University, Talavera, Spain.,Primary Care Center of Santa Olalla, Gerencia de Atención Integrada de Talavera de la Reina, Toledo, Spain
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group, Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group, Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
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25
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George SZ, Giczewska A, Alhanti B, Lutz AD, Shanley E, Thigpen CA, Bhavsar NA. Predicting Recurrent Care Seeking of Physical Therapy for Musculoskeletal Pain Conditions. PAIN MEDICINE 2021; 22:1837-1849. [PMID: 33905514 DOI: 10.1093/pm/pnab154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Musculoskeletal pain conditions are a leading cause of pain and disability internationally and a common reason to seek health care. Accurate prediction of recurrence of health care seeking due to musculoskeletal conditions could allow for better tailoring of treatment. The aim of this project was to characterize patterns of recurrent physical therapy seeking for musculoskeletal pain conditions and to develop a preliminary prediction model to identify those at increased risk of recurrent care seeking. DESIGN Retrospective cohort. SETTING Ambulatory care. SUBJECTS Patients (n = 578,461) seeking outpatient physical therapy (United States). METHODS Potential predictor variables were extracted from the electronic medical record, and patients were placed into three different recurrent care categories. Logistic regression models were used to identify individual predictors of recurrent care seeking, and the least absolute shrinkage and selection operator (LASSO) was used to develop multivariate prediction models. RESULTS The accuracy of models for different definitions of recurrent care ranged from 0.59 to 0.64 (c-statistic), and individual predictors were identified from multivariate models. Predictors of increased risk of recurrent care included receiving workers' compensation and Medicare insurance, having comorbid arthritis, being postoperative at the time of the first episode, age range of 44-64 years, and reporting night sweats or night pain. Predictors of decreased risk of recurrent care included lumbar pain, chronic injury, neck pain, pregnancy, age range of 25-44 years, and smoking. CONCLUSION This analysis identified a preliminary predictive model for recurrence of care seeking of physical therapy, but model accuracy needs to improve to better guide clinical decision-making.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery.,Duke Clinical Research Institute
| | | | | | - Adam D Lutz
- ATI Physical Therapy, Chicago, Illinois, USA
| | | | | | - Nrupen A Bhavsar
- Division of General Internal Medicine, Duke University, Durham, North Carolina
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26
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Mazuquin B, Sunemi MMDO, E Silva MPP, Sarian LOZ, Williamson E, Bruce J. Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil. Braz J Phys Ther 2021; 25:175-185. [PMID: 32605886 PMCID: PMC7990737 DOI: 10.1016/j.bjpt.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend. OBJECTIVE The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil. METHODS Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice. RESULTS 181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities. CONCLUSION Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.
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Affiliation(s)
- Bruno Mazuquin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | | | | | - Luís Otávio Zanatta Sarian
- Centre for Integral Attention to Women's Health, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Esther Williamson
- Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
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27
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Coleman G, Dobson F, Hinman RS, Bennell K, White DK. Measures of Physical Performance. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:452-485. [PMID: 33091270 DOI: 10.1002/acr.24373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fiona Dobson
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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28
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Schmidt AM, Laurberg TB, Moll LT, Schiøttz-Christensen B, Maribo T. The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial. Clin Rehabil 2020; 35:232-241. [PMID: 33040598 PMCID: PMC7874370 DOI: 10.1177/0269215520963856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To compare the long-term effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme, in terms of back-specific disability, in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomised controlled trial. Setting: A rheumatology rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated programme (a pre-admission day, two weeks at home, two weeks inpatient followed by home-based activities, plus two 2-day inpatient booster sessions, and six-month follow-up visit) was compared with an existing programme (four-week inpatient, and six-month follow-up visit). Main measure: The primary outcome was disability measured using the Oswestry Disability Index after one year. Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). Analysis was by intention-to-treat, using linear mixed models. Results: 303 patients were assessed for eligibility of whom 165 patients (mean age 50 years (SD 13) with a mean Oswestry Disability Index score of 42 (SD 11)) were randomly allocated (1:1 ratio) to the integrated programme (n = 82) or the existing programme (n = 83). The mean difference (integrated programme minus existing programme) in disability was –0.53 (95% CI –4.08 to 3.02); p = 0.770). No statistically significant differences were found in the secondary outcomes. Conclusion: The integrated programme was not more effective in reducing long-term disability in patients with chronic low back pain than the existing programme.
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Affiliation(s)
- Anne Mette Schmidt
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus C, Denmark.,Sano, Højbjerg, Denmark.,DEFACTUM, Central Denmark Region, Aarhus C, Denmark
| | - Trine Bay Laurberg
- Sano, Højbjerg, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Thorndal Moll
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, University Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus C, Denmark.,DEFACTUM, Central Denmark Region, Aarhus C, Denmark
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Smith-Turchyn J, Mukherjee S, Richardson J, Ball E, Bordeleau L, Neil-Sztramko S, Levine O, Thabane L, Sathiyapalan A, Sabiston C. Evaluation of a novel strategy to implement exercise evidence into clinical practice in breast cancer care: protocol for the NEXT-BRCA randomised controlled trial. BMJ Open Sport Exerc Med 2020; 6:e000922. [PMID: 33178447 PMCID: PMC7642584 DOI: 10.1136/bmjsem-2020-000922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/13/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The burden of breast cancer in Canada is steadily growing. More women are surviving breast cancer, yet, survivors live with side effects for years after treatments have ended. The benefits of exercise for women with breast cancer are well established and include improvement in treatment-related physical and emotional side effects. Despite these benefits, few survivors meet exercise guidelines. Exercise programmes are needed within the cancer institution in Canada to bridge the current knowledge to practice gap. The purpose of this study is to test the effects of a novel implementation strategy that includes institution-based exercise plus self-management (SM) or SM alone versus usual care in improving exercise level, quality of life, aerobic capacity, muscle strength and use of healthcare services over 12 months for women with breast cancer receiving chemotherapy. METHODS AND ANALYSIS Participants: Women with stages I-III breast cancer undergoing chemotherapy. Intervention: Group 1: institution-based exercise and SM (8 exercise sessions plus 8 SM modules); Group 2: SM alone; Group 3: usual care. Outcomes: The primary effectiveness outcome is minutes per week of moderate to vigorous physical activity. Secondary outcomes include quality of life, aerobic capacity, muscle strength, and use of healthcare services. Randomisation: Participants will be randomised (1:1:1) to one of the three groups by a blinded statistician and will be stratified based on age of participant (<40, 40-60, and >60 years). Statistical analysis: Outcomes will be measured at baseline, post-intervention, 6-month and 12-month follow-up using an analysis of covariance to test changes between groups over time adjusted for age. ETHICS AND DISSEMINATION This study addresses a long-standing need to help women with breast cancer undergoing chemotherapy become and stay more active by implementing novel rehabilitation strategies into real-world practice. This is vital in order for this population to minimise the lingering side effects of treatment, improve function and quality of life and prevent cancer recurrence. TRIAL REGISTRATION NUMBER The study protocol (v1: July 2020) has been registered on ClinicalTrials.gov (NCT04109274).
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Affiliation(s)
| | - Som Mukherjee
- Department of Oncology, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | | | - Louise Bordeleau
- Department of Oncology, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Oren Levine
- Department of Oncology, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Arani Sathiyapalan
- Department of Oncology, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton, Canada
| | - Catherine Sabiston
- Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation. Nat Rev Rheumatol 2020; 16:434-447. [DOI: 10.1038/s41584-020-0447-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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Smith-Turchyn J, Richardson J, Tozer R, McNeely M, Thabane L. Feasibility and Effectiveness of Implementing a Novel Exercise and Self-Management Programme during Chemotherapy for Women with Breast Cancer: A Pilot Randomized Controlled Trial. Physiother Can 2020; 72:271-281. [PMID: 35110796 DOI: 10.3138/ptc-2019-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The aim of this study was to determine the feasibility and effectiveness of implementing a novel exercise and self-management programme for women with breast cancer during chemotherapy. Method: The study used a pilot implementation design with a randomized controlled trial methodology. The 26 participants were adult breast cancer survivors (Stages 1-3) undergoing chemotherapy treatment. The intervention group received eight sessions of individualized, supervised, moderate-intensity aerobic exercise, paired with self-management modules in the cancer institution; the comparison group received usual care. The primary outcome assessed was feasibility of the implementation strategies. The secondary outcomes - level of physical activity, quality of life, exercise knowledge and behaviour, and perception of health status - were assessed at baseline, post-intervention, and 2- and 4-month follow-up. Descriptive statistics were used to measure the feasibility outcomes (recruitment rate, retention rate, adherence rate, and number of adverse events). A repeated-measures analysis of covariance was used to compare the secondary outcomes between the intervention and control groups at various time points. Results: The recruitment rate was 96%, retention rate was 100%, and adherence rate was 89%. No adverse events occurred. A between-groups difference was found for levels of physical activity post-intervention (mean difference = 25.38 points on the Godin Leisure-Time Exercise Questionnaire; 95% CI: 9.34, 41.42). There were no other significant findings. Conclusions: The implementation strategy was feasible. This programme has the potential to improve women's physical activity level during chemotherapy. Further research is needed to determine strategies to help survivors maintain these results over the long term.
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Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto
| | | | - Richard Tozer
- Department of Oncology, Juravinski Cancer Centre, Hamilton, Ont
| | - Margaret McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton
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Ogura Dantas L, Serafim Jorge AE, Regina Mendes da Silva Serrão P, Aburquerque-Sendín F, de Fatima Salvini T. Cryotherapy associated with tailored land-based exercises for knee osteoarthritis: a protocol for a double-blind sham-controlled randomised trial. BMJ Open 2020; 10:e035610. [PMID: 32482668 PMCID: PMC7265131 DOI: 10.1136/bmjopen-2019-035610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION There is an unmet need to develop tailored therapeutic exercise protocols applying different treatment parameters and modalities for individuals with knee osteoarthritis (KOA). Cryotherapy is widely used in rehabilitation as an adjunct treatment due to its effects on pain and the inflammatory process. However, disagreement between KOA guidelines remains with respect to its recommendation status. The aim of this study is to verify the complementary effects of cryotherapy when associated with a tailored therapeutic exercise protocol for patients with KOA. METHODS AND ANALYSIS This study is a sham-controlled randomised trial with concealed allocation and intention-to-treat analysis. Assessments will be performed at baseline and immediately following the intervention period. To check for residual effects of the applied interventions, 3-month and 6-month follow-up assessments will be performed. Participants will be community members living with KOA divided into three groups: (1) the experimental group that will receive a tailored therapeutic exercise protocol followed by a cryotherapy session of 20 min; (2) the sham control group that will receive the same regimen as the first group, but with sham packs filled with dry sand and (3) the active treatment control group that will receive only the therapeutic exercise protocol. The primary outcome will be pain intensity according to a Visual Analogue Scale. Secondary outcomes will be the Western Ontario & McMaster Universities Osteoarthritis Index; the Short-Form Health Survey 36; the 30-s Chair Stand Test; the Stair Climb test; and the 40-m fast-paced walk test. ETHICS AND DISSEMINATION The trial was approved by the Institutional Ethics Committee of Federal University of São Carlos, São Paulo, Brazil. Registration approval number: CAAE: 65966617.9.0000.5504. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03360500.
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Affiliation(s)
- Lucas Ogura Dantas
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Ana Elisa Serafim Jorge
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | | | - Francisco Aburquerque-Sendín
- Sociosanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Cordoba, Andalucía, Spain
- Instituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Andalucía, Spain
| | - Tania de Fatima Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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S Jorge AE, O Dantas L, M S Serrão PR, Alburquerque-Sendín F, Salvini TF. Photobiomodulation therapy associated with supervised therapeutic exercises for people with knee osteoarthritis: a randomised controlled trial protocol. BMJ Open 2020; 10:e035711. [PMID: 32482669 PMCID: PMC7264996 DOI: 10.1136/bmjopen-2019-035711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Physical exercise, a cornerstone of the conservative management of knee osteoarthritis (KOA), is exhaustively recommended by important clinical guidelines. A strength therapeutic exercise program (STEP) relieves pain, improves physical function and ultimately ameliorates quality of life (QoL). Furthermore, photobiomodulation (PBM) has been used as an adjunct treatment for people with KOA; however, there are still controversial recommendations regarding its use on this population. Thus, we hypothesised that PBM, when associated with a STEP protocol on patients with KOA, could induce better clinical outcomes than a STEP protocol alone. METHODS AND ANALYSIS The study is a 6-month triple-blind placebo-controlled randomised clinical trial with intention-to-treat analysis. The trial will include 120 people with clinic and radiographic signs of KOA. The intervention consists of a supervised STEP and PBM protocols conducted over an 8-week intervention period. Assessments are performed at baseline, right after treatment, and 3-month and 6-month follow-up periods. The primary clinical outcome is pain intensity according to a 10 cm Visual Analogue Scale. Secondary outcomes are the global Western Ontario & McMaster Universities Osteoarthritis Index; QoL assessed by the 36-item Short-Form health survey questionnaire; and performance-based physical parameters assessed by the 30 s chair stand test; the stair climb test; and the 40 m fast-paced walk test. ETHICS AND DISSEMINATION The trial was approved by the Human Research Ethics Committee of the Federal University of São Carlos, São Paulo, Brazil (REC no 2.016.122). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Brazilian Clinical Trials Registry (U1111-1215-6510).
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Affiliation(s)
- Ana E S Jorge
- Department of Physiotherapy, Federal University of Sao Carlos, São Carlos, São Paulo, Brazil
| | - Lucas O Dantas
- Department of Physiotherapy, Federal University of Sao Carlos, São Carlos, São Paulo, Brazil
| | - Paula R M S Serrão
- Department of Physiotherapy, Federal University of Sao Carlos, São Carlos, São Paulo, Brazil
| | - Francisco Alburquerque-Sendín
- Department of Sociosanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Instituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Andalucía, Spain
| | - Tania F Salvini
- Department of Physiotherapy, Federal University of Sao Carlos, São Carlos, São Paulo, Brazil
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Kendall JC, Vindigni D, Polus BI, Azari MF, Harman SC. Effects of manual therapies on stability in people with musculoskeletal pain: a systematic review. Chiropr Man Therap 2020; 28:13. [PMID: 32070377 PMCID: PMC7027250 DOI: 10.1186/s12998-020-0300-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Chronic musculoskeletal pain is associated with reduced balance performance and falls risk. Manual therapies are commonly used interventions for musculoskeletal pain. There is emerging evidence that manual therapies may improve balance. The aim of this systematic review was to examine the effectiveness of manual therapies for musculoskeletal pain on measures of static and dynamic stability. Methods Six electronic databases were searched using pre-defined eligibility criteria and two independent reviewers assessed all identified records. Risk of bias was assessed using the 12-item Cochrane Risk of Bias assessment by two authors independently and any discrepancies resolved through consensus. Meta-analysis was conducted when three or more studies used the same outcome measures including gait speed, timed up and go test, step test and sit-to-stand test. Results Twenty-six studies were included in the analysis. Both spinal and extremity musculoskeletal pain conditions were represented. Manual therapies included manipulation, mobilisation and massage. The most common intervention compared to manual therapy was exercise. Outcome measures included both clinical and objective measures of stability. Overall the risk of bias was reported as generally low or unclear. Conclusion Improvement in stability measures were reported in studies comparing manual therapy in the short term, but not long-term follow-up. There was no clear association between significant pain reduction and measures of stability. Further prospective studies are recommended to investigate whether manual therapies should be part of an integrative healthcare plan for risk of falls management and when a transition from manual therapy to more active interventions should occur for long term management.
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Affiliation(s)
- Julie C Kendall
- Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia.
| | - Dein Vindigni
- Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Barbara I Polus
- School of Engineering, RMIT University, Bundoora, VIC, 3083, Australia
| | - Michael F Azari
- Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia.,Private practice, Melbourne, Australia
| | - Samantha C Harman
- Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
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Schmidt AM, Schiøttz-Christensen B, Foster NE, Laurberg TB, Maribo T. The effect of an integrated multidisciplinary rehabilitation programme alternating inpatient interventions with home-based activities for patients with chronic low back pain: a randomized controlled trial. Clin Rehabil 2020; 34:382-393. [PMID: 31912752 PMCID: PMC7029437 DOI: 10.1177/0269215519897968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio). Setting: A rheumatology inpatient rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay. Main measures: Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). A complete case analysis was performed. Results: A total of 303 patients were assessed for eligibility of whom 165 (mean age: 50 years (SD 13) and mean Oswestry Disability Index score 42 (SD 11)) were randomized (83 to existing rehabilitation programme and 82 to integrated rehabilitation programme). Overall, 139 patients provided the 26-week follow-up data. Baseline demographic and clinical characteristics were comparable between programmes. The between-group difference in the Oswestry Disability Index score when adjusting for the corresponding baseline score was −0.28 (95% confidence interval (CI): −4.02, 3.45) which was neither statistically nor clinically significant. No significant differences were found in the secondary outcomes. Conclusion: An integrated rehabilitation programme was no more effective than an existing rehabilitation programme at the 26-week follow-up.
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Affiliation(s)
- Anne Mette Schmidt
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark.,Sano, Højbjerg, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Lillebælt Hospital, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Nadine E Foster
- Clinical Trials Unit, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Trine Bay Laurberg
- Sano, Højbjerg, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Tate Q, Conger A, Burnham T, Cushman DM, Kendall R, Schneider B, McCormick ZL. The Effectiveness and Safety of Genicular Nerve Radiofrequency Ablation for the Treatment of Recalcitrant Knee Pain Due to Osteoarthritis: a Comprehensive Literature Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00246-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Patient and Parent Perceptions of Rehabilitation Factors That Influence Outcomes After Anterior Cruciate Ligament Reconstruction and Clearance to Return to Sport in Adolescents and Young Adults. J Orthop Sports Phys Ther 2019; 49:576-583. [PMID: 30759359 DOI: 10.2519/jospt.2019.8608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Wide variation in outcomes after anterior cruciate ligament reconstruction (ACLR) exists among adolescents and young adults. However, little evidence is available regarding key rehabilitation factors that may be driving these differences. OBJECTIVE To explore patient and parent perceptions of key rehabilitation drivers related to outcomes after ACLR. METHODS In this qualitative study, which used an interpretive phenomenological methodology, semi-structured interviews were conducted with patients who had returned to sport after ACLR and with their parents. The interviews asked about respondents' experience with physical therapy and how it related to their outcomes after ACLR. The interviews were recorded, transcribed, and coded. Themes were then identified using open and axial coding processes. RESULTS There were 3 primary themes that patients and parents perceived as key factors influencing their rehabilitation outcomes after ACLR: (1) patient attributes (ie, motivation, confidence, accountability, access to resources, and social support), (2) physical therapist-patient relationship qualities (physical therapist as guide, motivator, booster of confidence, fosterer of perseverance, and coordinator of care), and (3) elements of the system (ie, availability and utilization of therapy visits, clinic environment, and coordination among care providers). CONCLUSION Patient and parent perspectives of key drivers that influence ACLR rehabilitation outcomes include patient, therapist, and system factors. Developing specific strategies to target these factors may enhance patient and parent perceptions of the experience. The awareness gained from these results provides a foundation for future studies examining how these factors affect outcomes and how to improve rehabilitation after ACLR. LEVEL OF EVIDENCE Therapy, level 3. J Orthop Sports Phys Ther 2019;49(8):576-583. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8608.
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Abbott JH, Wilson R, Pinto D, Chapple CM, Wright AA. Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis Cartilage 2019; 27:424-434. [PMID: 30553932 DOI: 10.1016/j.joca.2018.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the clinical- and cost-effectiveness at 2-year follow-up of providing individual, supervised exercise physiotherapy and/or manual physiotherapy in addition to usual medical care. METHOD People with hip or knee osteoarthritis meeting the American College of Rheumatology clinical diagnostic criteria were randomised (1:1, concealed, assessor-blinded) to four groups: usual medical care; supervised exercise physiotherapy; manual physiotherapy; or combined exercise and manual physiotherapy. Physiotherapy group participants were provided 10 50-min treatment sessions including booster sessions at 4 and 13 months, in addition to usual care. The primary outcome at 2-year follow-up was incremental cost-utility ratio (ICUR) of each physiotherapy intervention in addition to usual care, compared with usual care alone, from the health system and societal perspectives. To allow interpretation of negative ICURs, we report incremental net benefit (INB). The primary clinical outcome was the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS Of 206 patients, 186 (90·3%) were retained at 2-year follow-up. Exercise physiotherapy and manual physiotherapy dominated usual care, demonstrating cost savings; combined therapy did not. Exercise therapy had the highest incremental net benefits (INBs), statistically significant at all willingness-to-pay (base-case: societal New Zealand (NZ)$6,312, 95%CI 334 to 12,279; health system NZ$8,065, 95%CI 136 to 15,994). Clinical improvements were superior to usual care only in the exercise physiotherapy group (-28.2 WOMAC points, 95%CI -49.2 to -7.1). No serious adverse events were recorded. CONCLUSION Individually supervised exercise therapy is cost-effective and clinically effective in addition to usual medical care at 2-year follow-up, and leads to cost savings for the health system and society. TRIAL REGISTRATION Prospectively registered with the Australian NZ Clinical Trials Registry, reference ACTRN12608000130369.
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Affiliation(s)
- J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - R Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - D Pinto
- College of Health Sciences, Program in Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - C M Chapple
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, 9054, New Zealand.
| | - A A Wright
- Department of Physical Therapy, High Point University, High Point, NC, USA.
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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.
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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.
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Stensgaard Stoltze J, Rasmussen J, Skipper Andersen M. On the biomechanical relationship between applied hip, knee and ankle joint moments and the internal knee compressive forces. Int Biomech 2018. [PMCID: PMC7857478 DOI: 10.1080/23335432.2018.1499442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mechanical devices are common treating methods for knee osteoarthritis. It has the purpose of reducing the internal joint forces and unloading the damaged structure. The reduction is often achieved by alterations in the frontal plan, shifting the contact force from one compartment to the other, leaving the total compressive force unchanged. The aim of this study was to investigate how internal knee joint forces depend on applied external moments during gait. Musculoskeletal models of the gait of 10 healthy subjects were developed in the AnyBody Modelling System and used to simulate applied joint moments about different axes (load cases), each with the magnitude to compensate the net moment about the respective axis by a specified percentage. For each load case, the total, medial and lateral knee compressive force were computed and compared with a baseline case with no external moments applied. Among the investigated moments, hip flexion-extension, knee flexion-extension and ankle plantarflexion-dorsiflexion moment compensations have the most positive impact on the total knee joint compressive force, and combining the 3, each with a 40% compensation of the muscle moments, reduced the first peak by 23.6%, the second by 30.6% and the impulse by 28.6% with respect to no applied moments.
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Affiliation(s)
| | - John Rasmussen
- Material and Production, Aalborg University , Aalborg, Denmark
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41
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Lynch AD, Bove AM, Ammendolia C, Schneider M. Individuals with lumbar spinal stenosis seek education and care focused on self-management-results of focus groups among participants enrolled in a randomized controlled trial. Spine J 2018; 18:1303-1312. [PMID: 29246847 DOI: 10.1016/j.spinee.2017.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/10/2017] [Accepted: 11/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment. PURPOSE The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding different nonsurgical treatments. These factors were considered within the context of each treatment received as a part of the parent randomized controlled trial (RCT). STUDY DESIGN Focus group study of RCT participants. PATIENT SAMPLE Convenience sample of 50 individuals with LSS (28 female, average age 73±7.7 years) from an RCT participated in one of six focus groups. Focus groups consisted of patients previously randomized to one of three nonsurgical treatments: (1) medical care; (2) community-based group exercise; and (3) clinic-based manual therapy and individualized exercise. OUTCOME MEASURES Experiences, opinions, and preferences of individuals with LSS who participated in an RCT. Inter-coder agreement for qualitative analysis was conducted with kappa statistics. METHODS Participants discussed their experiences and perceptions regarding study treatment and their general experience with LSS using open-ended questions provided by a facilitator. Transcripts were coded according to modified grounded theory in an open approach, using codes that addressed the primary focus group discussion topics (primary coding) and codes for emerging topics (secondary coding). Secondary coding sought to identify themes concerning living with LSS and seeking treatment that were emergent from the focus groups. This study was funded by the Patient-Centered Research Outcomes Institute. The authors report no conflicts of interest. RESULTS Three themes related to medical treatment and symptom management arose from analyses: (1) an emotional response to LSS; (2) a desire for education about LSS and motivation to pursue education from any available source; and (3) a desire for individualized care based on self-management techniques and lifestyle changes. Emotional responses were more evident in individuals receiving medical care, whereas the other two themes were consistent across all three treatment groups. CONCLUSIONS The chronic pain associated with LSS may result in negative emotional responses. Individuals with LSS may believe misinformation and information from nonmedical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with LSS.
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Affiliation(s)
- Andrew D Lynch
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA.
| | - Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College St, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
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Anwer S, Alghadir A, Zafar H, Brismée JM. Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy 2018; 104:264-276. [PMID: 30030035 DOI: 10.1016/j.physio.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA). DATA SOURCES Four databases (PubMed, Web of Science, CENTRAL, and CINAHL) were searched. STUDY SELECTION Trials were required to compare OMT alone or OMT in combination with exercise therapy, with exercise therapy alone or control. DATA EXTRACTION Data extraction and risk assessment were done by two independent reviewers. Outcome measures were visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, WOMAC function score, WOMAC global score, and stairs ascending-descending time. RESULTS Eleven randomized controlled trials were included (494 subjects), four of which had a PEDro score of 6 or higher, indicating adequate quality. The results of the meta-analysis indicated that reduction of VAS score in OMT compared with the control group was statistically insignificant (SDM: -0.59; 95% CI: -1.54 to -0.36; P=0.224). The reduction of VAS score in OMT compared with exercise therapy group was statistically significant (SDM: -0.78; 95% CI: -1.42 to -0.17; P=0.013). The reduction of WOMAC pain score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.79; 95% CI: -1.14 to -0.43; P=0.001). Similarly, the reduction of WOMAC function score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.85; 95% CI: -1.20 to -0.50; P=0.001). However, the reduction of WOMAC global score in OMT compared with the exercise therapy group was statistically insignificant (SDM: -0.23; 95% CI: -0.54 to -0.09; P=0.164). The reduction of stairs ascending-descending time in OMT compared with the exercise therapy group was statistically significant (SDM: -0.88; 95% CI: -1.48 to -0.29; P=0.004). CONCLUSIONS This review indicated OMT compared with exercise therapy alone provides short-term benefits in reducing pain, improving function, and physical performance in patients with knee OA. REVIEW REGISTRATION PROSPERO 2016:CRD42016032799.
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Affiliation(s)
- Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Hamayun Zafar
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:439-447. [PMID: 29669488 DOI: 10.2519/jospt.2018.7877] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Osteoarthritis (OA) of the hip and knee is among the leading causes of global disability, highlighting the need for early, targeted, and effective treatment. The benefits of exercise therapy in people with hip and knee OA are substantial and supported by high-quality evidence, underlining that it should be part of first-line treatment in clinical practice. Furthermore, unlike other treatments for OA, such as analgesia and surgery, exercise therapy is not associated with risk of serious harm. Helping people with OA become more physically active, along with structured exercise therapy targeting symptoms and impairments, is crucial, considering that the majority of people with hip and knee OA do not meet physical activity recommendations. Osteoarthritis is associated with a range of chronic comorbidities, including type 2 diabetes, cardiovascular disease, and dementia, all of which are associated with chronic low-grade inflammation. Physical activity and exercise therapy not only improve symptoms and impairments of OA, but are also effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Patient education may be crucial to ensure long-term adherence and sustained positive effects on symptoms, impairments, physical activity levels, and comorbidities. J Orthop Sports Phys Ther 2018;48(6):439-447. Epub 18 Apr 2018. doi:10.2519/jospt.2018.7877.
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Bove AM, Lynch AD, Ammendolia C, Schneider M. Patients' experience with nonsurgical treatment for lumbar spinal stenosis: a qualitative study. Spine J 2018; 18:639-647. [PMID: 28870836 DOI: 10.1016/j.spinee.2017.08.254] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. Research into optimal nonsurgical treatment approaches for LSS is lacking. PURPOSE The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of nonsurgical LSS treatments regarding the interventions they received, factors contributing to adherence to the interventions, and methods of outcomes assessment. STUDY DESIGN/SETTING This study used a qualitative focus group design conducted at an academic research center. PATIENT SAMPLE Individuals participating in a randomized clinical trial (RCT) for non-surgical LSS treatment were invited to discuss their study treatments and general experiences with LSS. The three treatment arms in the study were medical care, community-based group exercise, and clinic-based manual therapy and individual exercise. OUTCOME MEASURES Following coding of qualitative data, kappa statistic was used to calculate agreement between observers. Themes were identified and agreed upon by both coders. METHODS This study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Fifty individuals (28 women, mean age 73±7.7 years) participated in a focus group. Two focus groups based on modified grounded theory were held for participants of each of the three treatment arms, for a total of six focus groups. Discussion topics included perceived effectiveness of the assigned treatment, suggestions for improvement, barriers and facilitators to completing treatment, and opinions of research outcome measures. RESULTS Several themes were evident across all treatment groups. First, patients prefer individualized treatment that is tailored to their specific impairments and functional limitations. They also want to learn self-management strategies to rely less upon formal health care providers. Participants consistently stated that exercise improved their pain levels and physical function. However, they noted that these effects are temporary, so commitment to exercising long-term is important. Common barriers to completing the assigned LSS treatment included transportation issues and other comorbid health conditions. All three treatment groups cited perceived treatment benefit as a strong facilitator to continuing treatment. In addition, the ability of the health care provider to relate to the patient and listen to the patient's concerns was a common facilitator. Within the community-based group exercise treatment arm, most individuals continued group exercise after study completion, and social support was often mentioned as a facilitator to continuing treatment. Medical care was most often associated with minimal to no effect of treatment. CONCLUSIONS Many individuals with LSS report barriers to accessing non-surgical treatment, but may also be willing to commit to a long-term treatment strategy that includes exercise. Social support from others with LSS and from health care providers with good communication skills may facilitate compliance with treatment recommendations.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA.
| | - Andrew D Lynch
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
| | - Carlo Ammendolia
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Rebecca MacDonald Centre, Mount Sinai Hospital, 60 Murray St, Suite 225, Toronto, Ontario M5T 3L9, Canada
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219, USA
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The Influence of Exercise Dosing on Outcomes in Patients With Knee Disorders: A Systematic Review. J Orthop Sports Phys Ther 2018; 48:146-161. [PMID: 29320945 DOI: 10.2519/jospt.2018.7637] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear. Large variations exist in exercise prescription, and research related to specific dosing variables for knee osteoarthritis, patellar tendinopathy, and patellofemoral pain is sparse. Objectives To identify specific doses of exercise related to improved outcomes of pain and function in individuals with common knee disorders, categorized by effect size. Methods Five electronic databases were searched for studies related to exercise and the 3 diagnoses. Means and standard deviations were used to calculate effect sizes for the exercise groups. The overall quality of evidence was assessed using the Physiotherapy Evidence Database scale. Results Five hundred eighty-three studies were found after the initial search, and 45 were included for analysis after screening. Physiotherapy Evidence Database scale scores were "fair" quality and ranged from 3 to 8. For knee osteoarthritis, 24 total therapeutic exercise sessions and 8- and 12-week durations of exercise were parameters most often associated with large effects. An exercise frequency of once per week was associated with no effect. No trends were seen with exercise dosing for patellar tendinopathy and patellofemoral pain. Conclusion This review suggests that there are clinically relevant exercise dosing variables that result in improved pain and function for patients with knee osteoarthritis, but optimal dosing is still unclear for patellar tendinopathy and patellofemoral pain. Prospective studies investigating dosing parameters are needed to confirm the results from this systematic review. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(3):146-161. Epub 10 Jan 2018. doi:10.2519/jospt.2018.7637.
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Schiphof D, van den Driest JJ, Runhaar J. Osteoarthritis year in review 2017: rehabilitation and outcomes. Osteoarthritis Cartilage 2018; 26:326-340. [PMID: 29330103 DOI: 10.1016/j.joca.2018.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs). DESIGN A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1st 2016 to May 15th 2017 using the terms 'osteoarthritis', 'randomized controlled trial', and 'systematic review'. Inclusion criteria were: clinically or radiologically diagnosed patients with OA, rehabilitation treatment, RCT or SRs. A selection of the included studies is discussed based on study quality and perceived importance to the field; including those that are innovative, inform the direction of the field or generate controversy. Methodological quality of the included studies was assessed using the PEDro-scale for RCTs and the Amstar guideline for SRs. RESULTS From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields. CONCLUSIONS Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.
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Affiliation(s)
- D Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - J J van den Driest
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Bove AM, Smith KJ, Bise CG, Fritz JM, Childs JD, Brennan GP, Abbott JH, Fitzgerald GK. Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial. Phys Ther 2018; 98:16-27. [PMID: 29088393 PMCID: PMC7207326 DOI: 10.1093/ptj/pzx104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited information exists regarding the cost-effectiveness of rehabilitation strategies for individuals with knee osteoarthritis (OA). OBJECTIVE The study objective was to compare the cost-effectiveness of 4 different combinations of exercise, manual therapy, and booster sessions for individuals with knee OA. DESIGN This economic evaluation involved a cost-effectiveness analysis performed alongside a multicenter randomized controlled trial. SETTING The study took place in Pittsburgh, Pennsylvania; Salt Lake City, Utah; and San Antonio, Texas. PARTICIPANTS The study participants were 300 individuals taking part in a randomized controlled trial investigating various physical therapy strategies for knee OA. INTERVENTION Participants were randomized into 4 treatment groups: exercise only (EX), exercise plus booster sessions (EX+B), exercise plus manual therapy (EX+MT), and exercise plus manual therapy and booster sessions (EX+MT+B). MEASUREMENTS For the 2-year base case scenario, a Markov model was constructed using the United States societal perspective and a 3% discount rate for costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated to compare differences in cost per QALY gained among the 4 treatment strategies. RESULTS In the 2-year analysis, booster strategies (EX+MT+B and EX+B) dominated no-booster strategies, with both lower health care costs and greater effectiveness. EX+MT+B had the lowest total health care costs. EX+B cost[Formula: see text]1061 more and gained 0.082 more QALYs than EX+MT+B, for an incremental cost-effectiveness ratio of[Formula: see text]12,900/QALY gained. LIMITATIONS The small number of total knee arthroplasty surgeries received by individuals in this study made the assessment of whether any particular strategy was more successful at delaying or preventing surgery in individuals with knee OA difficult. CONCLUSIONS Spacing exercise-based physical therapy sessions over 12 months using periodic booster sessions was less costly and more effective over 2 years than strategies not containing booster sessions for individuals with knee OA.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh PA 15219,Address all correspondence to Dr Bove at:
| | - Kenneth J Smith
- Section of Decision Sciences, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christopher G Bise
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
| | - Julie M Fritz
- Department of Physical Therapy, College of Health, University of Utah, Salt Lake City, Utah
| | - John D Childs
- Evidence in Motion, San Antonio, and Doctoral Program in Physical Therapy, Baylor University, Waco, Texas
| | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - G Kelley Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
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Applying the Evidence for Exercise Prescription in Older Adults with Knee Osteoarthritis. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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