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Seifeldein GS, Haseib A, Hassan HA, Ahmed G. Correlation of knee ultrasonography and Western Ontario and McMaster University (WOMAC) osteoarthritis index in primary knee osteoarthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0029-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lee AC, Harvey WF, Han X, Price LL, Driban JB, Bannuru RR, Wang C. Pain and functional trajectories in symptomatic knee osteoarthritis over up to 12 weeks of exercise exposure. Osteoarthritis Cartilage 2018; 26:501-512. [PMID: 29391277 PMCID: PMC5871586 DOI: 10.1016/j.joca.2018.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/28/2017] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is the recommended treatment for knee osteoarthritis (OA). However, heterogeneous patterns in treatment response are poorly understood. Our purpose was to identify pain and functional trajectories from exercise interventions in knee OA, and to determine their association with baseline factors. METHODS Prospective cohort of 171 participants (mean age 61 years; BMI 32 kg/m2, 71% female; 57% white) with symptomatic knee OA from a randomized trial comparing 12-week Tai Chi and Physical Therapy. We analyzed weekly Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores using group-based trajectory models. Associations between baseline factors and trajectories were examined using multinomial logistic regression. RESULTS We identified four pain trajectories: Lower-Early Improvement (43%), Moderate-Early Improvement (32%), Higher-Delayed Improvement (15%), and Higher-No Improvement (10%). We found similar trajectories for function, except that the lower function trajectories diverged into gradual (12%) or delayed-improvement (15%). Compared with the Lower-Early Improvement pain trajectory, moderate and higher trajectories were associated with poorer physical and psychosocial health. A similar pattern of associations were found among the function trajectories. CONCLUSIONS We found four distinct trajectories for pain and function over up to 12-weeks of exercise interventions. While most participants experienced improvements over a short-term exposure, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care in knee OA.
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Affiliation(s)
- Augustine C. Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - William F. Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Xingyi Han
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Jeffrey B. Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Raveendhara R. Bannuru
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA,Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
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Lee AC, Harvey WF, Price LL, Han X, Driban JB, Iversen MD, Desai SA, Knopp HE, Wang C. Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis. PM R 2018; 10:712-723. [PMID: 29407226 DOI: 10.1016/j.pmrj.2018.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Therapeutic exercise is a currently recommended nonpharmacological treatment for knee osteoarthritis (KOA). The optimal treatment dose (frequency or duration) has not been determined. OBJECTIVE To examine dose-response relationships, minimal effective dose, and baseline factors associated with the timing of response from 2 exercise interventions in KOA. DESIGN Secondary analysis of a single-blind, randomized trial comparing 12-week Tai Chi and physical therapy exercise programs (Trial Registry #NCT01258985). SETTING Urban tertiary care academic hospital PARTICIPANTS: A total of 182 participants with symptomatic KOA (mean age 61 years; BMI 32 kg/m2, 70% female; 55% white). METHODS We defined dose as cumulative attendance-weeks of intervention, and treatment response as ≥20% and ≥50% improvement in pain and function. Using log-rank tests, we compared time-to-response between interventions, and used Cox regression to examine baseline factors associated with timing of response, including physical and psychosocial health, physical performance, outcome expectations, self-efficacy, and biomechanical factors. MAIN OUTCOME MEASURES Weekly Western Ontario and McMasters Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores. RESULTS Both interventions had an approximately linear dose-response effect resulting in a 9- to 11-point reduction in WOMAC pain and a 32- to 41-point improvement in function per attendance-week. There was no significant difference in overall time-to-response for pain and function between treatment groups. Median time-to-response for ≥20% improvement in pain and function was 2 attendance-weeks and for ≥50% improvement was 4-5 attendance-weeks. On multivariable models, outcome expectations were independently associated with incident function response (hazard ratio = 1.47, 95% confidence interval 1.004-2.14). CONCLUSIONS Both interventions have approximately linear dose-dependent effects on pain and function; their minimum effective doses range from 2-5 weeks; and patient perceived benefits of exercise influence the timing of response in KOA. These results may help clinicians to optimize patient-centered exercise treatments and better manage patient expectations. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Augustine C Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Lori Lyn Price
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Xingyi Han
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Jeffrey B Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Maura D Iversen
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Sima A Desai
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Hans E Knopp
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA.,Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
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Lee AC, Harvey WF, Price LL, Han X, Driban JB, Wong JB, Chung M, McAlindon TE, Wang C. Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis. Arch Phys Med Rehabil 2017; 98:2265-2273.e1. [PMID: 28506776 DOI: 10.1016/j.apmr.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association between baseline mindfulness and response from exercise interventions in knee osteoarthritis (OA). DESIGN Cohort study; responder analysis of a clinical trial subset. SETTING Urban tertiary care academic hospital. PARTICIPANTS Participants with symptomatic, radiographic knee OA (N=86; mean age, 60y; 74% female; 48% white). INTERVENTIONS Twelve weeks (twice per week) of Tai Chi or physical therapy exercise. MAIN OUTCOME MEASURES Treatment response was defined using Osteoarthritis Research Society International criteria indicating meaningful improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC function, or Patient Global Assessment scores. At baseline, participants completed the Five Facet Mindfulness Questionnaire (mean total score, 142±17) and were grouped into 3 categories of total mindfulness: higher, medium, or lower. Relative risk (RR) ratios were used to compare treatment response across groups. RESULTS Participants with higher total mindfulness were 38% (95% confidence interval [CI], 1.05-1.83) more likely to meet responder criteria than those with lower mindfulness. We found no significant difference between medium and lower mindfulness groups (RR=1.0; 95% CI, 0.69-1.44). Among the 5 mindfulness facets, medium acting-with-awareness was 46% (95% CI, 1.09-1.96) more likely to respond than lower acting-with-awareness, and higher acting-with-awareness was 34% more likely to respond, but this did not reach significance (95% CI, 0.97-1.86). CONCLUSIONS In this study, higher mindfulness, primarily driven by its acting-with-awareness facet, was significantly associated with a greater likelihood of response to nonpharmacologic exercise interventions in knee OA. This suggests that mindfulness-cultivating interventions may increase the likelihood of response from exercise.
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Affiliation(s)
- Augustine C Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Xingyi Han
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Jeffrey B Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - John B Wong
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Mei Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Timothy E McAlindon
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.
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Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage 2017; 25:647-653. [PMID: 27940216 DOI: 10.1016/j.joca.2016.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the proportion of isolated patellofemoral osteoarthritis (PFOA) compared to tibiofemoral osteoarthritis (TFOA) in middle-aged participants with early osteoarthritis (OA) symptoms of the knee; to describe the natural course of PFOA compared with that of TFOA and to identify whether patients with PFOA have a different phenotype compared to patients with TFOA, or with combined PFOA and TFOA (combined osteoarthritis (COA)). DESIGN Participants with early OA symptoms of the knee were selected, completed questionnaires, underwent physical examination, and had knee radiographs at baseline, and at 2 and 5 years follow-up. Based on radiographs, participants were classified as having isolated TFOA, isolated PFOA, COA, or no radiographic OA. Multivariate logistic regression was used to identify participant characteristics associated with a specific group of OA at 2 years follow-up. RESULTS The cohort comprised 845 participants (mean age 55.9 years). At baseline, 116 had PFOA, none had TFOA or COA. Of these 116 participants, 66.3% had developed COA at 5 years follow-up. At 2 years follow-up, PFOA, TFOA and COA were present in 77 (10.8%), 39 (5.5%) and 83 (11.6%) participants, respectively. Multivariate regression analyses at 2 years follow-up showed that participants with radiographic PFOA or TFOA were not significantly different from each other with respect to signs and symptoms. CONCLUSIONS These results suggest that OA is more likely to start in the patellofemoral joint and then progress to COA in individuals with symptoms of early knee OA. No differences in TFOA and PFOA phenotypes were determined with respect to signs and symptoms.
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Eyles JP, Mills K, Lucas BR, Williams MJ, Makovey J, Teoh L, Hunter DJ. Can We Predict Those With Osteoarthritis Who Will Worsen Following a Chronic Disease Management Program? Arthritis Care Res (Hoboken) 2016; 68:1268-77. [PMID: 26749177 DOI: 10.1002/acr.22836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify predictors of worsening symptoms and overall health of the treated hip or knee joint following 26 weeks of a nonsurgical chronic disease management program for hip and knee osteoarthritis (OA) and to examine the consistency of these predictors across 3 definitions of worsening. METHODS This prospective cohort study followed 539 participants of the program for 26 weeks. The 3 definitions of worsening included symptomatic worsening based on change in the Western Ontario and McMaster Universities Osteoarthritis Index Global score (WOMAC-G) measuring pain, stiffness, and function; a transition scale that asked about overall health of the treated hip or knee joint; and a composite outcome including both. Multivariate logistic regression models were constructed for the 3 definitions of worsening. RESULTS Complete data were available for 386 participants: mean age was 66.3 years, 69% were female, 85% reported knee joint pain as primary symptom (signal joint), 46% were waitlisted for total joint arthroplasty (TJA). TJA waitlist status, signal joint, 6-Minute Walk Test (6MWT), depressive symptoms, pain, and age were independently associated with at least 1 definition of worsening. TJA waitlist status and 6MWT remained in the multivariate models for the transition and composite definitions of worsening. CONCLUSION Participants reporting worsening on the transition scale did not consistently meet the WOMAC-G definition of worsening symptoms. TJA waitlist status was predictive of the composite definition of worsening, a trend apparent for the transition definition. However, variables that predict worsening remain largely unknown. Further research is required to direct comprehensive and targeted management of patients with hip and knee OA.
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Affiliation(s)
- Jillian P Eyles
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Mills
- Macquarie University, Sydney, New South Wales, Australia
| | - Barbara R Lucas
- Royal North Shore Hospital, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew J Williams
- Royal North Shore Hospital, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Joanna Makovey
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Laurence Teoh
- North Shore Hospital, Takapuna, Auckland, New Zealand
| | - David J Hunter
- Royal North Shore Hospital, and Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
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Razek AAKA, El-Basyouni SR. Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis. Clin Rheumatol 2015; 35:997-1001. [PMID: 26089198 DOI: 10.1007/s10067-015-2990-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 12/19/2022]
Abstract
The aim of this work was to assess the reproducibility of ultrasound findings of knee osteoarthritis and to correlate ultrasound findings with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Prospective study was conducted upon 80 patients (56 F, 24 M; mean age 57 years) with primary osteoarthritis of knee joint. All patients underwent clinical assessment with calculation of WOMAC and high-resolution ultrasound of the knee joint. The ultrasound images were analyzed for cartilage thinning, osteophytes, synovial effusion, synovial proliferation, popliteal cyst, and meniscal protrusion. Image analysis was performed by two readers and linear regression analysis was used to determine association of ultrasound findings with WOMAC. There was excellent inter-observer agreement of both readers for cartilage thinning (k = 0.99, P = 0.001), osteophytes (k = 0.94, P = 0.001), synovial effusion (k = 0.98, P = 0.001), synovial thickening (k = 0.96, P = 0.001), popliteal cyst (k = 1.00, P = 0.001), and meniscal protrusion (k = 0.86, P = 0.001). There was significant association of WOMAC with cartilage changes (t = 3.406, 3.302, P = 0.001), osteophytes (t = 3.841, 3.006, P = 0.001), and synovial effusion (t = 4.140 and 2.787, P = 0.05) of both readers. We concluded that ultrasound is a reproducible method for assessment of knee osteoarthritis and well correlated with WOMAC.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Elgomheryia Street, Mansoura, 35512, Egypt.
| | - Sherif Refaat El-Basyouni
- Department of Rheumatology and Rehabilitation, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Eyles JP, Lucas BR, Patterson JA, Williams MJ, Weeks K, Fransen M, Hunter DJ. Does clinical presentation predict response to a nonsurgical chronic disease management program for endstage hip and knee osteoarthritis? J Rheumatol 2014; 41:2223-31. [PMID: 25225284 DOI: 10.3899/jrheum.131475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify baseline characteristics of participants who will respond favorably following 6 months of participation in a chronic disease management program for hip and knee osteoarthritis (OA). METHODS This prospective cohort study assessed 559 participants at baseline and following 6 months of participation in the Osteoarthritis Chronic Care Program. Response was defined as the minimal clinically important difference of an 18% and 9-point absolute improvement in the Western Ontario and McMaster Universities Arthritis Index global score. Multivariate logistic regression modeling was used to identify predictors of response. RESULTS Complete data were available for 308 participants. Those who withdrew within the study period were imputed as nonresponders. Three variables were independently associated with response: signal joint (knee vs hip), sex, and high level of comorbidity. Index joint and sex were significant in the multivariate model, but the model was not a sensitive predictor of response. CONCLUSION Strong predictors of response to a chronic disease management program for hip and knee OA were not identified. The significant predictors that were found should be considered in future studies.
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Affiliation(s)
- Jillian P Eyles
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Barbara R Lucas
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Jillian A Patterson
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Matthew J Williams
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Kate Weeks
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - Marlene Fransen
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney
| | - David J Hunter
- From the Physiotherapy Department and Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School; Kolling Institute of Medical Research; Institute of Bone and Joint Research; University of Sydney, Sydney; Physiotherapy Department, Wollongong Hospital, Wollongong, New South Wales, Australia.J.P. Eyles, BAppSc(Phty); B.R. Lucas, MPH, FACP, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; J.A. Patterson, BScAdv(Hons), MBiostat, Kolling Institute of Medical Research; M.J. Williams, BAppSc(Phty), Physiotherapy Department, Royal North Shore Hospital; K. Weeks, BAppSc(Phty), Physiotherapy Department, Wollongong Hospital; M. Fransen, PhD, MPH, University of Sydney; D.J. Hunter, MBBS, PhD, FRACP, Department of Rheumatology, Royal North Shore Hospital; Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney.
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Mills K, Hunter DJ. Patellofemoral joint osteoarthritis: an individualised pathomechanical approach to management. Best Pract Res Clin Rheumatol 2014; 28:73-91. [PMID: 24792946 DOI: 10.1016/j.berh.2014.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patellofemoral joint integrity is maintained by an optimal interaction of passive, dynamic and structural restraints. Disruption of these mechanics can lead to structural joint damage and subsequent patellofemoral osteoarthritis, which is a prevalent and disabling condition with few effective conservative management strategies. Due to the influential role of biomechanics in this disease, targeting the specific pathomechanics exhibited by an individual is logical to improve their likelihood of a positive treatment outcome. This review summarises the effect of different pathomechanical factors on the presence and progression of patellofemoral osteoarthritis. It then presents a synthesis of mechanical effect of treatment strategies specifically addressing these pathomechanics. Identifying the pathomechanics and clinical characteristics of individuals with patellofemoral osteoarthritis that respond to treatment may assist in the development of individualised treatment strategies that alleviate symptoms and slow structural damage.
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Affiliation(s)
- Kathryn Mills
- Physiotherapy, Department of Human Sciences, Macquarie University, Sydney, Australia.
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia; Kolling Institute, University of Sydney, Sydney, Australia.
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