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Kiadaliri A, Hörder H, Lohmander LS, Dahlberg LE. Weekly pain trajectories among people with knee or hip osteoarthritis participating in a digitally delivered first-line exercise and education treatment. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:291-299. [PMID: 38127991 DOI: 10.1093/pm/pnad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Digital self-management programs are increasingly used in the management of osteoarthritis (OA). Little is known about heterogeneous patterns in response to these programs. We describe weekly pain trajectories of people with knee or hip OA over up to 52-week participation in a digital self-management program. METHODS Observational cohort study among participants enrolled between January 2019 and September 2021 who participated at least 4 and up to 52 weeks in the program (n = 16 274). We measured pain using Numeric Rating Scale (NRS 0-10) and applied latent class growth analysis to identify classes with similar trajectories. Associations between baseline characteristics and trajectory classes were examined using multinomial logistic regression and dominance analysis. RESULTS We identified 4 pain trajectory classes: "mild-largely improved" (30%), "low moderate-largely improved" (34%), "upper moderate-improved" (24%), and "severe-persistent" (12%). For classes with decreasing pain, the most pain reduction occurred during first 20 weeks and was stable thereafter. Male sex, older age, lower body mass index (BMI), better physical function, lower activity impairment, less anxiety/depression, higher education, knee OA, no walking difficulties, no wish for surgery and higher physical activity, all measured at enrolment, were associated with greater probabilities of membership in "mild-largely improved" class than other classes. Dominance analysis suggested that activity impairment followed by wish for surgery and walking difficulties were the most important predictors of trajectory class membership. CONCLUSIONS Our results highlight the importance of reaching people with OA for first-line treatment prior to developing severe pain, poor health status and a wish for surgery.
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Affiliation(s)
- Ali Kiadaliri
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, 221 85 Lund, Sweden
- Joint Academy®, 211 34 Malmö, Sweden
| | - Helena Hörder
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, 221 85 Lund, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, 221 85 Lund, Sweden
- Joint Academy®, 211 34 Malmö, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, 221 85 Lund, Sweden
- Joint Academy®, 211 34 Malmö, Sweden
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Deere R, Chowdhury E, Tabor A, Thompson D, Bilzon JLJ. The effects of upper- vs. lower-body aerobic exercise on perceived pain in individuals with chronic knee pain: a randomised crossover trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1277482. [PMID: 38124706 PMCID: PMC10731310 DOI: 10.3389/fpain.2023.1277482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background and objectives Some patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise. Methods A total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m2) who suffered from chronic knee pain for ≥3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD. Results VAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (-1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted. Conclusion An acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain.
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Affiliation(s)
- Rachel Deere
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Enhad Chowdhury
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
| | - Abby Tabor
- Faculty of Health and Applied Sciences, University of West England, Bristol, United Kingdom
| | - Dylan Thompson
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
| | - James L. J. Bilzon
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
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Fosdahl MA, Berg B, Risberg MA, Øiestad BE, Holm I. Body Mass Index, Quality of Life and Activity Limitation Trajectories over 2 Years in Patients with Knee or Hip Osteoarthritis: A Dual Trajectory Approach Based on 4265 Patients Included in the AktivA Quality Register. J Clin Med 2023; 12:7094. [PMID: 38002706 PMCID: PMC10672133 DOI: 10.3390/jcm12227094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Recent studies claim that weight-neutral approaches emphasizing physical activity might be as effective as weight-loss-centered approaches for improving pain and physical function in patients with knee and hip osteoarthritis. The objectives were to identify distinctive groups of individuals with similar BMI, quality of life and activity limitation trajectories over two years, to compare the overall differences between BMI trajectory groups for baseline variables and to explore the probabilities of the quality of life and activity limitation trajectory groups conditional on the BMI group. (2) Methods: Baseline data for age, gender, BMI, quality of life, activity limitations, pain, general health, knee or hip osteoarthritis and follow-up data on BMI, quality of life and activity limitations at 3, 12 and 24 months were retrieved from the "Active with osteoarthritis" (AktivA) electronic quality register. Group-based trajectory modeling was used to identify distinct trajectories for BMI, quality of life and activity limitations. (3) Results: 4265 patients were included in the study. Four distinct BMI trajectories were identified, normal weight (31%), slightly overweight (43%), overweight (20%) and obese (6%). At baseline, there were highly significant differences between all BMI groups, pain increased and age and general health decreased with higher BMI. Irrespective of weight category, minimal changes in BMI were found over the two-year follow-up period. Over 80% of the participants showed moderate-to-considerable improvements both in quality of life and activity limitations. (4) Conclusions: Almost 70% of the participants belonged to the overweight trajectories. Despite no significant weight reduction over the two years, eight in every 10 participants improved their quality of life and reduced their activity limitations after participating in the AktivA program.
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Affiliation(s)
- Merete Aarsland Fosdahl
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Clinical Neurosciences for Children, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Science, Oslo Metropolitan University, 0130 Oslo, Norway;
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Sports Medicine, Norwegian School of Sport Sciences, 0863 Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0130 Oslo, Norway;
| | - Inger Holm
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Interdisciplinary Health Sciences, Medical Faculty, University of Oslo, 0318 Oslo, Norway
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4
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Costa D, Lopes DG, Cruz EB, Henriques AR, Branco J, Canhão H, Rodrigues AM. Trajectories of physical function and quality of life in people with osteoarthritis: results from a 10-year population-based cohort. BMC Public Health 2023; 23:1407. [PMID: 37480019 PMCID: PMC10362599 DOI: 10.1186/s12889-023-16167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To identify long-term trajectories of physical function and health-related quality of life (HRQoL) among people with hip and/or knee osteoarthritis (HKOA) and the sociodemographic, lifestyle, and clinical factors associated with different trajectories. METHODS Participants with HKOA from the EpiDoC study, a 10-year follow-up (2011-2021) population-based cohort, were considered. Sociodemographic, lifestyle, and clinical variables were collected at baseline in a structured interview and clinical appointment. Physical function and HRQoL were evaluated with the Health Assessment Questionnaire (HAQ) and EuroQoL, respectively, at baseline and the three follow-ups. Group-based trajectory modeling identified physical function and HRQoL trajectories. Multinomial logistic regression analyzed the associations between the covariates of interest and trajectory assignment (p < 0.05). RESULTS We included 983 participants with HKOA. We identified three trajectories for each outcome: "consistently low disability" (32.0%), "slightly worsening moderate disability" (47.0%), and "consistently high disability" (21.0%) for physical function; "consistently high HRQoL" (18.3%), "consistently moderate HRQoL" (48.4%) and "consistently low HRQoL" (33.4%) for HRQoL. Age ≥ 75 years, female sex, multimorbidity, and high baseline clinical severity were associated with higher risk of assignment to poorer physical function and HRQoL trajectories. Participants with high education level and with regular physical activity had a lower risk of assignment to a poor trajectory. Unmanageable pain levels increased the risk of assignment to the "consistently moderate HRQoL" trajectory. CONCLUSION Although the trajectories of physical function and HRQoL remained stable over 10 years, approximately 70% of people with HKOA maintained moderate or low physical function and HRQoL over this period. Modifiable risk factors like physical activity, multimorbidity and clinical severity were associated with poorer physical function and HRQoL trajectories. These risk factors may be considered in tailored healthcare interventions.
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Affiliation(s)
- Daniela Costa
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - David G Lopes
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduardo B Cruz
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Ana R Henriques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaime Branco
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Serviço de Reumatologia Do Hospital Egas Moniz, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana M Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Rheumatology Unit, Hospital Dos Lusíadas, Lisbon, Portugal
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Cagnin A, Choinière M, Bureau NJ, Durand M, Mezghani N, Gaudreault N, Hagemeister N. Targeted exercises can improve biomechanical markers in individuals with knee osteoarthritis: A secondary analysis from a cluster randomized controlled trial. Knee 2023; 40:122-134. [PMID: 36423400 DOI: 10.1016/j.knee.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is not clear whether exercise therapy significantly improves knee biomechanics during gait in osteoarthritis (OA) patients. This study aimed to determine whether targeted exercises based on a knee kinesiography exam improve biomechanical markers (BMs) compared with conventional primary care (CPC) management. METHODS This was a secondary analysis of a cluster randomized controlled trial in which patients were assigned to one of three groups: (1) Control (CPC), (2) Exercise, and (3) Exercise&Education. Fourteen known BMs in knee OA patients were assessed. The primary outcome was the global evolution ratio (GER), which was calculated as the sum of improved BMs over the sum of deteriorated BMs 6 months after baseline assessment. GER scores were categorized with three different sets of cut-off values into clinical levels: (a) Deteriorated, (b) Stabilized, and (c) Improved. Ordinal logistic regressions were performed on the per-protocol population to determine whether there was a relationship between group assignment and GER levels. RESULTS Of the 221 eligible participants, 163 were included. Two different regression models showed that patients from Group 3 (Exercise&Education) were 2.5-times more likely to be in an upper GER level (i.e., Stabilized or Improved) than patients from the control group (both odds ratio (OR) > 2.46, Wald Χ2(1) ≥ 7.268, P ≤ 0.01). They also reported significantly more improvement in pain and function (Knee Injury and Osteoarthritis Outcome Score, both P ≤ 0.01). CONCLUSIONS Results suggest that targeted exercises can improve biomechanical markers in knee OA patients compared with CPC treatment. Further studies are needed to confirm these findings and refine the biomechanical markers to address to maximize patients' clinical outcomes.
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Affiliation(s)
- Alix Cagnin
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Madeleine Durand
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Neila Mezghani
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université TÉLUQ, #1105, Montreal, Quebec, Canada
| | - Nathaly Gaudreault
- Faculté de Médecine et des Sciences de la Santé, School of Rehabilitation, Sherbrooke Research and Development Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicola Hagemeister
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada.
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Hattori T, Ohga S, Shimo K, Niwa Y, Tokiwa Y, Matsubara T. Predictive Value of Pain Sensitization Associated with Response to Exercise Therapy in Patients with Knee Osteoarthritis: A Prospective Cohort Study. J Pain Res 2022; 15:3537-3546. [PMID: 36394057 PMCID: PMC9653041 DOI: 10.2147/jpr.s385910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/10/2022] [Indexed: 05/01/2024] Open
Abstract
PURPOSE Knee osteoarthritis (KOA) is a degenerative disease with inflammation, becoming persistent as it progresses, resulting in reduced quality of life. Exercise is the recommended treatment for KOA; however, the extent of pain reduction with exercise is heterogeneous and the prognostic implications of baseline factors in patients undergoing exercise are still unknown. This study examined the association between the response to exercise therapy and clinical outcomes, radiologic severity, and pain sensitization, and investigated the optimal predictive value for the effectiveness of exercise. PATIENTS AND METHODS Demographics, radiologic severity, pressure pain threshold (PPT), and temporal summation of pain (TSP) at the knee, tibia, and forearm were assessed at baseline. The pain numeric rating scale (NRS) was assessed before and after 12 weeks of exercise. Patients were divided into responder/non-responder groups according to recommended criteria: responder, ≥30% reduction in pain; non-responder, <30% reduction in pain, and each variable was compared between the groups. The area under the curve (AUC) and cutoff points were determined by receiver operating characteristic curve analysis. RESULTS Sixty-five patients were categorized as responders and 26 as non-responders. In the non-responder group, baseline NRS (P<0.01), pain duration (P<0.01), and TSP at the knee (P<0.001) and tibia (P<0.05) were significantly higher, and PPT at the knee (P<0.001), tibia (P<0.001), and forearm (P<0.001) were significantly lower, than those in the responder group; however, no significant differences between groups were found in other demographics and radiologic severity. The variables that showed moderate or better predictive ability (AUC≥0.7) were PPT at the knee (cutoff points: 241.5 kPa), tibia (307.5 kPa), forearm (318.5 kPa), and TSP at the knee (15.5 mm). CONCLUSION Our findings suggest that pain sensitization is associated with the response to exercise therapy. Furthermore, we provide clinically predictive values for PPT and TSP in predicting the outcome to exercise in KOA.
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Affiliation(s)
- Takafumi Hattori
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
- Department of Rehabilitation, Maehara Orthopedics Rehabilitation Clinic, Obu, Aichi, Japan
| | - Satoshi Ohga
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
| | - Kazuhiro Shimo
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
| | - Yuto Niwa
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
| | - Yuji Tokiwa
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
| | - Takako Matsubara
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
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Lin PL, Yu LF, Kuo SF, Wang XM, Lu LH, Lin CH. Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial. BMC Geriatr 2022; 22:809. [PMID: 36266615 PMCID: PMC9585859 DOI: 10.1186/s12877-022-03498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated. Methods Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention. Results Participants’ functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10–5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10−5), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10−5), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η2 = 0.17–0.42), than those in the CON group after the intervention. Conclusions Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach. Trial registration The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).
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Affiliation(s)
- Pei-Ling Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Lee-Fen Yu
- Department of Nursing, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Fen Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, Wenzhou, China
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan. .,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
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8
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Pain Sensitization and Neuropathic Pain-like Symptoms Associated with Effectiveness of Exercise Therapy in Patients with Hip and Knee Osteoarthritis. Pain Res Manag 2022; 2022:4323045. [PMID: 36071945 PMCID: PMC9444422 DOI: 10.1155/2022/4323045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Pain sensitization and neuropathic pain-like symptoms are some of the common pain symptoms in patients with lower limbs, including hip and knee, osteoarthritis (HOA/KOA). Exercise therapy has been the first-line treatment; however, the effects differ for each patient. This prospective cohort study investigated the relationship between the effectiveness of exercise therapy and pretreatment characteristics (radiologic severity, pain sensitization, and neuropathic pain-like symptoms) of patients with HOA/KOA. We assessed the pain intensity using a numerical rating scale (NRS) before and after 12 weeks of exercise therapy in patients with HOA/KOA (n = 101). Before treatment, the Kellgren–Lawrence (K-L) grade; minimum joint space width (mJSW); pressure pain threshold (PPT) and temporal summation of pain (TSP) at the affected joint, tibia, and forearm; Central Sensitization Inventory-9; and painDETECT questionnaire (PDQ) were assessed. Cluster analysis was based on the pretreatment NRS and change in NRS with exercise therapy to identify the subgroups of pain reduction. The pretreatment characteristics of each cluster were compared. According to the results of the cluster analyses, patients in cluster 1 had severe pain that did not improve after exercise therapy, patients in cluster 2 had severe pain that improved, and those in cluster 3 had mild pain that improved. The patients in cluster 1 exhibited lower PPT at all measurement sites, higher TSP at the affected joint, and higher PDQ scores than those in other clusters. There was no difference in the K-L grade and mJSW among the clusters. The subgroup with severe pain and pain sensitization or neuropathic pain-like symptoms at pretreatment, even with mild joint deformity, may have difficulty in achieving improvement in pain after 12 weeks of exercise therapy. These findings could be useful for prognosis prediction and for planning exercise therapy and combining with other treatment.
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Robbins SM, Teoli A. Clinician's Commentary on Hoteit et al. 1. Physiother Can 2022; 74:276-277. [PMID: 37325216 PMCID: PMC10262830 DOI: 10.3138/ptc-2020-0093-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Shawn M Robbins
- Associate Professor Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada;
| | - Anthony Teoli
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada;
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Song J, Wei L, Cheng K, Lin Q, Xia P, Wang X, Wang X, Yang T, Chen B, Ding A, Sun M, Chen A, Li X. The Effect of Modified Tai Chi Exercises on the Physical Function and Quality of Life in Elderly Women With Knee Osteoarthritis. Front Aging Neurosci 2022; 14:860762. [PMID: 35721018 PMCID: PMC9204295 DOI: 10.3389/fnagi.2022.860762] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is the leading cause of pain and stiffness, affecting older adults’ physical function and quality of life. As a form of mind-body exercise, Tai Chi has been recommended as an exercise prescription for KOA patients. This study examined the effects and continuation of modified Tai Chi exercises on physical function and quality of life in elderly women with KOA. Methods We conducted a single-blind, randomized controlled trial (RCT) on 40 older women with KOA. The participants were randomized to a 12 weeks Tai Chi or control group. The Tai Chi group attended a kind of modified Tai Chi training sessions three times per week; the control group attended wellness education sessions once a week. The primary outcome was the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Secondary outcomes were the Berg Balance Scale (BBS), Timed Up and Go (TUG), Short-Form 36 (SF-36), Pittsburgh Sleep Quality of Index (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Results After the 12-weeks the Tai Chi group showed significan improvement in the WOMAC pain (mean difference, −5.09 points, p = 0.001), WOMAC stiffness (mean difference, −3.60 points, p = 0.002), WOMAC physical function (mean difference, −11.21 points, p = 0.001) compared to the control group. In addition, the Tai Chi group had also significant improvement in the BBS (mean difference, 1.70 points, p = 0.008), TUG (mean difference, −0.52s, p = 0.001), SF-36PCS (mean difference, 7.60 points, p = 0.001), MCS (mean difference, 7.30 points, p = 0.001), PSQI (mean difference, −3.71 points, p = 0.001), SDS (mean difference, −5.37 points, p = 0.025) and SAS (mean difference, −5.06 points, p = 0.002). Conclusion The modified Tai Chi exercises are an effective treatment for improved physical function and quality of life in elderly women with KOA. Clinical Trial Registration The trial was registered in Chinese Clinical Trial Registry (ChiCTR2000040721), http://www.chictr.org.cn/edit.aspx?pid=65419&htm=4.
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Affiliation(s)
- Jiulong Song
- Department of Sports and Health, Nanjing Sport Institute, Nanjing, China
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lijun Wei
- Maigaoqiao Community Health Service Center, Nanjing, China
| | - Kai Cheng
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Xia
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xinwei Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoju Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ting Yang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Baoyi Chen
- Maigaoqiao Community Health Service Center, Nanjing, China
| | - Aimei Ding
- Maigaoqiao Community Health Service Center, Nanjing, China
| | - Mingyi Sun
- Department of Tourism and Social Management, Nanjing Xiaozhuang University, Nanjing, China
| | - Anliang Chen
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Anliang Chen Xueping Li
| | - Xueping Li
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Anliang Chen Xueping Li
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Meta-Analysis of Elderly Lower Body Strength: Different Effects of Tai Chi Exercise on the Knee Joint-Related Muscle Groups. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:8628182. [PMID: 34976101 PMCID: PMC8716219 DOI: 10.1155/2021/8628182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether lower body strength such as keen extension and flexion strength may be improved by Tai Chi exercise in older adults from the perspective of evidence-based medicine. METHODS Databases of PubMed, Embase, and Cochrane Library were searched up to July 1, 2021. Randomized clinical trials are adopted to compare Tai Chi exercise with sedentary behavior or other low intensity exercise in terms of influence on lower body strength rehabilitation, especially keen extension and flexion strength in people aged over 60. A meta-analysis was performed to discuss outcomes of lower body strength, knee muscle strength, and knee extension/flexion strength. RESULTS A total of 25 randomized trials involving 1995 participants fulfilled the inclusion criteria. (1) Tai Chi exercise significantly improved elderly lower body strength (-0.54, [-0.81, -0.28], p < 0.00001, I 2 = 74%), but there was no differential improvement in the strength of the knee joints (0.10, [-0.02, 0.23], p=0.11, I 2 = 34%). (2) Elderly individual lower body strength declined with age, while this trend was suppressed by Tai Chi exercise (-0.35, [0.14, 0.56], p=0.001, I 2 = 70%). (3) Although Tai Chi exercise did no significantly improve the large muscle group of knee joint extensor like quadriceps femoris (3.15, [-0.69, 6.99], p=0.24, I 2 = 26%), it showed marked enhancement to the strength of deep small muscle group of knee joint flexor (10.25, [6.90, 13.61], p < 0.00001, I 2 = 0%). The heterogeneity might be caused by distinguished measurements of muscle strength. Therefore, Tai Chi exercise specifically enhanced some certain muscle strength of knee joints and improved muscle fitness rehabilitation as well as function activity for elderly. CONCLUSIONS In this RCT meta-analysis, Tai Chi exercise has positive effects on lower body strength of elderly. Although no obvious improvement on the knee extensor is observed, it may be used as a rehabilitation treatment for training stable deep muscle groups to improve the knee flexion strength significantly.
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Buus AAØ, Laugesen B, El-Galaly A, Laursen M, Hejlesen OK. The potential of dividing the oxford knee score into subscales for predicting clinically meaningful improvements in pain and function of patients undergoing total knee arthroplasty. Int J Orthop Trauma Nurs 2021; 45:100919. [PMID: 35313190 DOI: 10.1016/j.ijotn.2021.100919] [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] [Received: 10/02/2021] [Revised: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subdividing the Oxford Knee Score (OKS) into a pain component scale (OKS-PCS) and a function component scale (OKS-FCS) for predicting clinically meaningful improvements may provide a basis for identifying patients in need of enhanced support from health care professionals to manage pain and functional challenges following total knee arthroplasty. AIM To assess the potential of dividing the OKS into subscales for predicting clinically meaningful improvements in pre- and postoperative pain and function by comparing two different versions of extracting pain and function derived from the OKS. METHODS This retrospective observational cohort study included 201 patients undergoing total knee arthroplasty. Multiple logistic regression analysis was applied for binary classification of whether patients achieved clinically meaningful improvements in pain and function. RESULTS The best overall version for predicting clinically meaningful improvements had an area under the receiver operating characteristic curve of 0.79 for both pain and function, whereas Nagelkerke's R2 was 0.322 and 0.334, respectively. CONCLUSION The findings indicate that it is reasonable to subdivide the OKS into subscales for predicting clinically meaningful improvements in pain and function. However, more studies are needed to compare various types of classification algorithms in larger patient populations.
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Affiliation(s)
- Amanda A Ø Buus
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Britt Laugesen
- Nursing Research Unit, Aalborg University Hospital & Center for Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Center for Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders El-Galaly
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ole K Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Chen PY, Song CY, Yen HY, Lin PC, Chen SR, Lu LH, Tien CL, Wang XM, Lin CH. Impacts of tai chi exercise on functional fitness in community-dwelling older adults with mild degenerative knee osteoarthritis: a randomized controlled clinical trial. BMC Geriatr 2021; 21:449. [PMID: 34332537 PMCID: PMC8325845 DOI: 10.1186/s12877-021-02390-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Degenerative osteoarthritis (OA) often leads to pain and stiffness of the affected joints, which may affect the physical performance and decrease the quality of life of people with degenerative knee OA. Compared to traditional exercise, tai chi is a safe exercise with slow movements which can facilitate physical functioning and psychological well being, and might be suitable for improving the physical activities of older adults with knee OA. Therefore, this study investigated the impacts of tai chi exercise on the functional fitness of community-dwelling older adults with degenerative knee OA. Methods Sixty-eight community-dwelling older adults with knee OA were recruited from the local community to participate in this randomized controlled clinical trial. All subjects were randomly assigned to either an TCE group that practiced tai chi exercise (TCE) (n = 36) or a control group (CON) (n = 32) that received regular health education programs twice per week for 12 weeks. Outcome measurements were determined using functional fitness tests before and after the intervention, including a 30-s chair stand (number of repeats), 30-s arm-curl (number of repeats), 2-min step (number of steps), chair sit-and-reach (reaching distance, cm), back-scratch flexibility (distance between hands, cm), single-leg stand (time, s), functional reach (reaching distance, cm), 8-foot up-and-go (time, s), and 10-m walk tests (time, s). Pre-post comparisons of functional fitness were analyzed using the ANCOVA test with SPSS software version 18.0. Results Results revealed that participants’ functional fitness in the TCE group had significantly higher adjusted mean post-tests scores than that in the CON group after the intervention, including the 8-foot up-and-go (s) (mean difference [MD]=-2.92 [-3.93, -1.91], p = 2.39*10− 7), 30-s arm curl (MD = 4.75 (2.76, 6.73), p = 1.11*10− 5), 2-min step (MD = 36.94 [23.53, 50.36], p = 7.08*10− 7), 30-s chair stand (MD = 4.66 [2.97, 6.36], p = 6.96*10− 7), functional-reach (MD = 5.86 [3.52, 8.20], p = 4.72*10− 6), single-leg stand with eyes closed (MD = 3.44 [1.92, 4.97], p = 2.74*10− 5), chair sit-and-reach (MD = 3.93 [1.72, 6.15], p = 0.001), and single-leg stand with eyes opened (MD = 17.07 [6.29, 27.85], p = 0.002), with large effect sizes (η²=0.14 ~ 0.34). Conclusions Community-dwelling older adults with knee OA in the TCE group had better functional fitness performances after the 12-week tai chi intervention than those receiving only health education.
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Affiliation(s)
- Po-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China
| | - Hsin-Yen Yen
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Pi-Chu Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Su-Ru Chen
- Post-Baccalaureate Program in Nursing and School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chen-Li Tien
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic Collage, Wenzhou, China
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, 11031, Taipei, Taiwan, Republic of China. .,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 250 Wu-Xing Street, 11031, Taipei, Taiwan, Republic of China.
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15
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Effects of an Exercise Therapy Targeting Knee Kinetics on Pain, Function, and Gait Kinetics in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. Adapt Phys Activ Q 2021; 38:377-395. [PMID: 33785660 DOI: 10.1123/apaq.2020-0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022] Open
Abstract
In this study, the effects of an exercise therapy comprising yoga exercises and medial-thrust gait (YogaMT) on lower-extremity kinetics, pain, and function in patients with medial knee osteoarthritis were investigated. Fifty-nine patients were randomly allocated to three treatment groups: (a) the YogaMT group practiced yoga exercises and medial thrust gait, (b) the knee-strengthening group performed quadriceps- and hamstring-strengthening exercises, and (c) the treadmill walking group practiced normal treadmill walking in 12 supervised sessions. The adduction and flexion moments of the hip, knee, and ankle; pain intensity; and 2-min walking test were assessed before and after treatment and at 1-month follow-up. The YogaMT group experienced a significant reduction in knee adduction moment. All groups showed significant improvement in pain and function. The YogaMT may reduce medial knee load in patients with knee osteoarthritis in the short term. A larger clinical trial is required to investigate the long-term outcomes of this intervention.
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On a Trajectory for Success-9 in Every 10 People With a Degenerative Meniscus Tear Have Improved Knee Function Within 2 Years After Treatment: A Secondary Exploratory Analysis of a Randomized Controlled Trial. J Orthop Sports Phys Ther 2021; 51:289-297. [PMID: 33971735 DOI: 10.2519/jospt.2021.10025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify trajectories of patient-reported knee function over 5 years in patients with degenerative meniscal tears, and to explore whether baseline characteristics were associated with trajectories of sport and recreational function. DESIGN Prospective cohort study. METHODS We conducted a secondary exploratory analysis of the Odense-Oslo Meniscectomy Versus Exercise randomized controlled trial. Patient-reported knee function was assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 3 months, 1 year, 2 years, and 5 years. We used group-based trajectory modeling to identify subgroups of patients who followed distinctive patterns of change. Multinomial logistic regression was used to examine the associations of patient demographics, knee function, and disease-related factors with KOOS sport and recreational function subscale trajectories. RESULTS The analysis of data from a sample of 140 participants identified 3 trajectories for all KOOS subscales: (1) low, minimal improvement (10%-12% of the participants), (2) moderate, gradual improvement (20%-36%), and (3) high, early improvement (53%-70%). Baseline prognostic factors for deteriorating function in sport and recreational activities were higher body mass index, poorer mental health, greater knee pain, lower perceived knee function, poorer quadriceps and hamstrings muscle strength, poorer functional performance, more meniscal extrusion, and radiographic signs of knee osteoarthritis. CONCLUSION We found 3 distinct trajectories of patient-reported knee function over 5 years: (1) low, minimal improvement, (2) moderate, gradual improvement, and (3) high, early improvement. Nine in every 10 participants improved at least gradually over 2 years after diagnosis of a degenerative meniscal tear. J Orthop Sports Phys Ther 2021;51(6):289-297. Epub 10 May 2021. doi:10.2519/jospt.2021.10025.
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Wieczorek M, Rotonda C, Guillemin F, Rat AC. What Have We Learned From Trajectory Analysis of Clinical Outcomes in Knee and Hip Osteoarthritis Before Surgery? Arthritis Care Res (Hoboken) 2020; 72:1693-1702. [PMID: 31529685 DOI: 10.1002/acr.24069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/10/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The past decade has seen a rapid increase in the publication of studies using trajectory analysis to describe the course of osteoarthritis (OA) symptoms. The aim of this systematic review was to describe the distinct trajectories for OA outcomes and the predictors of these trajectories. METHODS Medline and PsycInfo databases were searched for relevant studies. Selection criteria were 1) patients ≥18 years of age, 2) patients at high risk of or diagnosed with knee or hip OA, 3) studies aiming to identify homogeneous subgroups with distinct trajectories of clinical outcomes, and 4) methodology and analysis designed to identify trajectories (longitudinal design and repeated measures). The search was limited to publications in English or French. RESULTS Of the 5,177 abstracts retrieved, 44 studies met the inclusion criteria; 21 described the disease progression before surgery. The most frequent outcomes were pain and physical function. Up to 6 trajectories of pain were found for hip and knee OA. For function, between 1 and 5 trajectories were identified for knee OA. Low educational level, high body mass index, and high number of comorbidities were the most reported predictors of bad evolution. CONCLUSION Although studies were heterogeneous (outcome, subgroup number, and composition), they revealed stable OA trajectories over time. This finding suggests that OA is a chronic disease that does not inevitably worsen in terms of patient-reported symptoms.
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Affiliation(s)
| | | | - Francis Guillemin
- Université de Lorraine, EA 4360 Apemac, and Inserm, CHRU Nancy, Université de Lorraine, CIC-1433 Epidémiologie Clinique, Nancy, France
| | - Anne-Christine Rat
- Université de Lorraine, EA 4360 Apemac, Nancy, and, University of Caen Normandy, Rheumatology Department, Caen, France
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Primeau CA, Birmingham TB, Moyer RF, O'Neil KA, Werstine MS, Alcock GK, Giffin JR. Trajectories of perceived exertion and pain over a 12-week neuromuscular exercise program in patients with knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1427-1431. [PMID: 32828912 DOI: 10.1016/j.joca.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exercise programs rely on the overload principle, yet patients with knee osteoarthritis (OA) may not adequately progress exercises due to fear of exacerbating symptoms. OBJECTIVE To describe trajectories for perceived exertion and exercise-induced knee pain during a neuromuscular exercise program for patients with knee OA. DESIGN Participants with knee OA completed a 12-week neuromuscular exercise program consisting of weekly supervised sessions plus home exercises. During each supervised session, the Borg's rating of perceived exertion (RPE; 6 = no exertion, 20 = maximal exertion) and knee pain (pre, post, max) using Numeric Rating Scales (NRS; 0 = no pain, 10 = worst imaginable pain) were completed. Mean changes in RPE and pain from weeks 1-12 were calculated. Mixed effects regression was used to investigate trajectories over time (weeks) for RPE, and maximum pain (pre-to-max) and pain-change (pre-to-post) during exercise. RESULTS 56 patients (95%) completed the program. From week 1-12, RPE increased by 2.6 (95%CI, 1.7 to 3.5), from 'somewhat hard' to 'very hard', while max pain decreased by 1.0 NRS (95%CI, 0.5 to 1.3) and pain-change decreased by 0.9 NRS (95%CI, 0.4 to 1.3). Linear mixed effects regression showed a quadratic increase for RPE over time until between weeks 9 and 10, then RPE plateaued. Maximum pain decreased linearly over time. Pain-change showed a quadratic decrease over time until approximately week 9, then pain-change plateaued. CONCLUSIONS In patients with knee OA participating in a 12-week neuromuscular exercise program, perceived exertion during exercise progressed from 'somewhat hard' to 'very hard' at 9 weeks, while exercise-induced knee pain decreased. Patients were able to work harder while experiencing decreases rather than increases in pain.
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Affiliation(s)
- C A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - R F Moyer
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - K A O'Neil
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - M S Werstine
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - G K Alcock
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - J R Giffin
- Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University Ontario, London, ON, Canada.
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Improving osteoarthritis care by digital means - Effects of a digital self-management program after 24- or 48-weeks of treatment. PLoS One 2020; 15:e0229783. [PMID: 32130276 PMCID: PMC7056265 DOI: 10.1371/journal.pone.0229783] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Osteoarthritis (OA) is highly prevalent in older adults and a growing cause of disability. Easily accessible first-line treatment of OA is increasingly important. Digital self-management programs have in recent years become available. Evidence of short-term effects of such programs are abundant, yet reports on long-term benefits and adherence to treatment are scarce. The current study’s objective was to investigate the long-term pain and function outcomes of people with hip or knee OA participating in a digital self-management programme. Methods and findings In this longitudinal cohort study, individuals with hip and knee OA, from the register of a digital self-management program and with 0-24-week (n = 499) or 0-48-week adherence (n = 138), were included. The treatment effect in terms of monthly pain (NRS, 0–10 worst to best) and physical function (30-second chair stand test (30CST), number of repetitions) change were investigated using a mixed model, controlling for the effect of age, body mass index (BMI), gender and index joint. For the 24-week sub-sample, pain NRS decreased monthly by -0.43 units (95% CI -0.51, -0.35, mean knee pain from 5.6 to 3.1, and hip pain from 5.9 to 3.8) and 30CST repetitions increased monthly by 0.76 repetitions (95% CI 0.64, 0.89 mean for knee from 10.0 to 14.3, and for hip from 10.9 to 14.8). For the 48-week sub-sample, pain decreased monthly by -0.39 units (95% CI -0.43, -0.36, mean knee pain from 5.7 to 3.2, and hip pain from 5.8 to 3.8), and repetitions increased by 0.72 repetitions (95% CI 0.65, 0.79, mean repetitions for knee from 10.3 to 14.4, and for hip from 11.1 to 14.9). There were no clinically relevant effects on the improvement of pain or function by any covariate (age, sex, index joint). The lack of a control group and randomization limit our ability to explain the mechanisms of the observed results. Conclusions Continuously participating in a digital OA treatment program for 6 or 12 months was associated with a clinically important decrease in joint pain and increased physical function, in hip and knee OA. Future research should follow OA-related outcomes in participants that end their treatment to explore when and why that decision was made.
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Deveza LA, Nelson AE, Loeser RF. Phenotypes of osteoarthritis: current state and future implications. Clin Exp Rheumatol 2019; 37 Suppl 120:64-72. [PMID: 31621574 PMCID: PMC6936212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
In the most recent years, an extraordinary research effort has emerged to disentangle osteoarthritis heterogeneity, opening new avenues for progressing with therapeutic development and unravelling the pathogenesis of this complex condition. Several phenotypes and endotypes have been proposed albeit none has been sufficiently validated for clinical or research use as yet. This review discusses the latest advances in OA phenotyping including how new modern statistical strategies based on machine learning and big data can help advance this field of research.
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Affiliation(s)
- Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, NSW, Australia.
| | - Amanda E Nelson
- Department of Medicine, University of North Carolina at Chapel Hill, and Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Richard F Loeser
- Department of Medicine, University of North Carolina at Chapel Hill, and Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Young JJ, Kopansky-Giles D, Ammendolia C. Multimodal non-surgical intervention for individuals with knee osteoarthritis: a retrospective case series. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2019; 63:92-99. [PMID: 31564747 PMCID: PMC6743648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The purpose of this study is to review the pain and functional outcomes of a multimodal intervention in three patients with knee osteoarthritis (OA). This study explores how manual therapy can be delivered within an evidence-based framework for the management of knee OA. METHODS Medical records were reviewed for three patients with knee OA who underwent a standardized multimodal intervention including education, exercise, and manual therapy. Changes in pain intensity and function from baseline to post-intervention were calculated and compared to thresholds for minimal clinically important differences. RESULTS One participant met the threshold for clinically significant improvement in pain and two participants for function. No adverse events were reported. CONCLUSION Combined education, exercise, and manual therapy delivered over a 6-week period improved function in two of the three patients reviewed. Higher quality research is required to explore whether this multimodal intervention may improve outcomes in individuals with knee OA.
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Affiliation(s)
- James J. Young
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Carlo Ammendolia
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, ON
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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James RJE, Walsh DA, Ferguson E. Trajectories of pain predict disabilities affecting daily living in arthritis. Br J Health Psychol 2019; 24:485-496. [PMID: 30955252 PMCID: PMC6916370 DOI: 10.1111/bjhp.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Indexed: 01/21/2023]
Abstract
Purpose To examine the interplay between pain and disability in arthritis when adjusting for patient heterogeneity in pain progression. There is consistent evidence to suggest that people experience osteoarthritis heterogeneously, with subgroups of people having different trajectories of pain. However, at present it is unclear how these pain trajectories are related to functional disability. We ask the question: Do levels of disability track changes in pain across different pain trajectories? Methods Secondary analysis of a subset (n = 889) from a cohort of older English adults, representative of the general population (the English Longitudinal Study of Ageing). The relationship between pain and functional disability was compared in three domains of disability: mobility, activities of daily living (ADL) and instrumental ADL. These represent increasingly complex forms of self‐care required for independent living. Data analysis compared the heterogeneous analysis of pain (different trajectories) and disability compared to treating pain as a simpler homogenous construct. Results On a population level, pain was significantly positively correlated with increased disability in all three domains, and the relationship remained stable over time. However, when heterogeneity was examined respondents whose pain improved did not show a corresponding improvement in disability in two domains (ADL and mobility). Conclusions These findings highlight how, for some people, alleviating pain, the main symptom of arthritis, might not prevent the persistence or progression of disability. Even when pain improves, further interventions that improve disability are likely to be required. Statement of contribution What is already known on this subject? Pain and functional limitation in daily living are common symptoms of arthritis. Arthritis pain is heterogeneous – there are trajectories of people whose pain gets better or worse. However, to date no study has looked at the relationship between trajectories of arthritis pain and functional disability outside of the minority of people with rheumatoid arthritis.
What does this study add? Treating pain as heterogeneous explained disability better than treating pain as a single entity. Respondents in a trajectory of worsening pain reported functional disability in two domains (mobility and activities of daily living) also got worse over time. People in a trajectory of decreasing pain over time did not experience a reduction in disability, despite pain being the most common reason for why people limit their daily functioning. This suggests further intervention is required for people with arthritis, even when the most visible symptoms have been alleviated.
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Affiliation(s)
- Richard J E James
- School of Psychology, University of Nottingham, UK.,Arthritis UK Pain Centre, School of Medicine, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK
| | - David A Walsh
- Arthritis UK Pain Centre, School of Medicine, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK.,Academic Rheumatology, School of Medicine, University of Nottingham, UK
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, UK.,Arthritis UK Pain Centre, School of Medicine, University of Nottingham, UK
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Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, Graven-Nielsen T, Polli A. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. THE JOURNAL OF PAIN 2019; 20:1249-1266. [PMID: 30904519 DOI: 10.1016/j.jpain.2019.03.005] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/24/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
Abstract
Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand; Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand.
| | - Jo Nijs
- Pain in Motion International Research Group(#); Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Timothy Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Kelli Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea Polli
- Pain in Motion International Research Group(#); Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
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