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Olson KL, Eccleston C. Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar. THE JOURNAL OF PAIN 2024:104647. [PMID: 39103008 DOI: 10.1016/j.jpain.2024.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PERSPECTIVE: This focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.
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Affiliation(s)
- KayLoni L Olson
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island.
| | - Christopher Eccleston
- Research Department for Health, University of Bath, Bath, England; Centre for Pain Research, University of Bath, Bath, England
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Ribeiro DC, Lamb SE, Abbott JH. Mediators of the effects of exercise and manual therapy for people with knee and hip osteoarthritis: A secondary, exploratory analysis of the MOA trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100431. [PMID: 38304412 PMCID: PMC10832273 DOI: 10.1016/j.ocarto.2023.100431] [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: 04/19/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Objective To explore whether pain beliefs and functional strength mediate the treatment effect of manual therapy (MT) and exercise therapy (ET) on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) composite scores and its subscales in individuals with hip and/or knee osteoarthritis in the MOA trial. Design Secondary analysis of a randomised controlled trial that compared the incremental effects of supervised MT and ET in addition to usual care in patients with osteoarthritis of the hip or knee. 206 participants enrolled in the MOA trial were analysed. The primary outcome measure was the WOMAC composite score after 1 year. Results Pain belief mediated the effect of MT (b: -10.7, 95 % CI: -22.3, -0.9), ET (b: -14.5 95%CI: -26.0, -4.4). Functional strength did not mediate the effect of MT, ET, or MT + ET. Mediation sensitivity analyses suggest findings are likely to change if small confounding between those mediators and WOMAC composite score is present. Conclusions We identified possible mediators of MT and ET. Future confirmatory studies could be designed to assess the mechanisms through which manual therapy and exercise cause improvements in pain and function scores in patients with hip or knee osteoarthritis.
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Affiliation(s)
- Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Sarah E. Lamb
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - J. Haxby Abbott
- Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand
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Lawford BJ, Hinman RS, McManus F, Lamb KE, Egerton T, Keating C, Brown C, Oliver K, Bennell KL. How Does Exercise, With and Without Diet, Improve Pain and Function in Knee Osteoarthritis? A Secondary Analysis of a Randomized Controlled Trial Exploring Potential Mediators of Effects. Arthritis Care Res (Hoboken) 2023; 75:2316-2327. [PMID: 37128836 PMCID: PMC10952828 DOI: 10.1002/acr.25140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To explore the mediators of effects of two 6-month telehealth-delivered exercise programs, including exercise with and without weight-loss diet, on pain and function improvements in knee osteoarthritis (OA). METHODS Secondary analysis of 345 participants from a 3-arm randomized controlled trial of exercise (Exercise program) and exercise plus diet (Diet + Exercise program) versus information (Control program) was conducted. Outcomes were changes in pain (11-point numeric rating scale) and function (Western Ontario and McMaster Universities Osteoarthritis Index [score range 0-68]) at 12 months. Potential mediators were change at 6 months in attitudes toward self-management, fear of movement, arthritis self-efficacy, weight, physical activity, and willingness for knee surgery. For the Diet + Exercise program versus the Exercise program, only change in weight was evaluated. RESULTS Possible mediators of the Exercise program versus the Control program included reduced fear of movement (accounting for -1.11 units [95% confidence interval (95% CI) -2.15, -0.07] improvement in function) and increased arthritis self-efficacy (-0.40 units [95% CI -0.75, -0.06] reduction in pain, -1.66 units [95% CI -3.04, -0.28] improvement in function). The Diet + Exercise program versus the Control program mediators included reduced fear of movement (-1.13 units [95% CI -2.17, -0.08] improvement in function), increased arthritis self-efficacy (-0.77 units [95% CI -1.26, -0.28] reduction in pain, -5.15 units [95% CI -7.34, -2.96] improvement in function), and weight loss (-1.20 units [95% CI -1.73, -0.68] reduction in pain, -5.79 units [95% CI -7.96, -3.63] improvement in function). Weight loss mediated the Diet + Exercise program versus the Exercise program (-0.89 units [95% CI -1.31, -0.47] reduction in pain, -4.02 units [95% CI -5.77, -2.26] improvement in function). CONCLUSION Increased arthritis self-efficacy, reduced fear of movement, and weight loss may partially mediate telehealth-delivered exercise program effects, with and without diet, on pain and/or function in knee OA. Weight loss may partially mediate the effect of diet and exercise compared to exercise alone.
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Affiliation(s)
| | | | - Fiona McManus
- The University of MelbourneMelbourneVictoriaAustralia
| | - Karen E. Lamb
- The University of MelbourneMelbourneVictoriaAustralia
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Kostic AM, Leifer VP, Selzer F, Hunter DJ, Paltiel AD, Chen AF, Robinson MK, Neogi T, Collins JE, Messier SP, Edwards RR, Katz JN, Losina E. Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity. Arthritis Care Res (Hoboken) 2023; 75:1752-1763. [PMID: 36250415 PMCID: PMC10375659 DOI: 10.1002/acr.25044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Class III obesity (body mass index >40 kg/m2 ) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost-effectiveness of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR. METHODS Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long-term clinical benefits, costs, and cost-effectiveness of weight-loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight-loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality-adjusted life expectancy (QALE), and incremental cost-effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty. RESULTS LSG increased QALE by 1.64 quality-adjusted life-years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost-effective in 67% of iterations at a willingness-to-pay threshold of $50,000/QALY. CONCLUSION For patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.
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Affiliation(s)
- Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Faith Selzer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - A. David Paltiel
- Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Antonia F. Chen
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Malcolm K. Robinson
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jamie E. Collins
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Beller J, Epping J, Sperlich S, Tetzlaff J. Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015? SAGE Open Med 2023; 11:20503121231184012. [PMID: 37435099 PMCID: PMC10331346 DOI: 10.1177/20503121231184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany? Methods We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time. Results We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations. Conclusion Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.
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Mihalko WM, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Richey PA. The Association of Total Knee Arthroplasty With Weight Loss in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2023; 38:S81-S87.e2. [PMID: 36933679 PMCID: PMC10200753 DOI: 10.1016/j.arth.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Patients who have obesity seldom lose weight after total knee arthroplasty (TKA). The Look AHEAD (Action for Health in Diabetes) trial randomized patients with type 2 diabetes who were overweight or had obesity to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). METHODS Of the total 5,145 participants enrolled who had a median 14-year follow-up, a subset of 4,624 met inclusion criteria. The ILI aimed at achieving and maintaining a 7% weight loss and included weekly counseling the first 6 months, with decreasing frequency thereafter. This secondary analysis was undertaken to determine what effects a TKA had on patients participating in a known successful weight loss program and specifically if there was a negative impact on weight loss or their Physical Component Score. RESULTS The analysis suggests that the ILI remained effective for maintaining or losing weight after TKA. Participants in ILI had significantly greater percent weight loss than those in DSE both before and after TKA (ILI-DSE before TKA: -3.6% (-5.0, -2.3); after TKA: -3.7% (-4.1, -3.3); both P < .0001). When comparing percent weight loss before to after TKA, there was no significant difference within either the DSE or ILI group (least square means ± standard error ILI: -0.36% ± 0.3, P = .21; DSE: -0.41% ± 0.29, P = .16). Physical Component Scores improved after TKA (P < .001), but no difference was found between TKA ILI and DSE groups before or after surgery. CONCLUSION Participants who had a TKA did not have an altered ability to adhere to intervention goals to maintain weight loss or obtain further weight loss. The data suggest patients who have obesity can lose weight after TKA on a weight loss program.
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Affiliation(s)
- William M. Mihalko
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H. Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L. Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of St. Augustine for Health Sciences, Austin, TX
| | - Phyllis A. Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Lima YL, Lee H, Klyne DM, Dobson FL, Hinman RS, Bennell KL, Hall M. How Do Nonsurgical Interventions Improve Pain and Physical Function in People With Osteoarthritis? A Scoping Review of Mediation Analysis Studies. Arthritis Care Res (Hoboken) 2023; 75:467-481. [PMID: 35866717 PMCID: PMC10952794 DOI: 10.1002/acr.24983] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Nonsurgical interventions are recommended for osteoarthritis (OA). However, how interventions change pain and physical function is unclear. Therefore, the objectives of this scoping review were to 1) identify what potential mediators of nonsurgical interventions on pain and physical function have been evaluated and 2) summarize the findings according to intervention, joint, and outcome. METHODS We searched Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Scopus databases. Studies were included if they conducted a mediation analysis on a randomized controlled trial evaluating a nonsurgical intervention on OA of any joint. Outcomes were pain and physical function. RESULTS Nine knee OA studies, evaluating diet plus exercise, exercise, unloading shoes, high-expectation communication during acupuncture, and telephone-based weight loss plus exercise were identified. Except for weight loss and self-efficacy, putative mediators (knee muscle perfusion/extensor strength/adduction moment, systemic inflammatory biomarkers, physical activity, dietary intake, and pain beliefs) were evaluated by single studies. Ten mediators partially mediated intervention (diet plus exercise, exercise, high-expectation communication) effects on pain and physical function. Eight mediators were common to pain and function (reduced weight, increased knee extensor strength, and increased self-efficacy). Constant knee flexor muscle perfusion partially mediated exercise effects on pain, and knee pain relief partially mediated exercise effects on function. CONCLUSION In knee OA, some evidence suggests that the benefits of 1) diet and exercise are mediated through changes in body weight, systemic inflammation, and self-efficacy; 2) exercise is mediated through changes in knee muscle strength and self-efficacy; and 3) high-expectation communication style is mediated through changes in self-efficacy.
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Affiliation(s)
- Yuri Lopes Lima
- The University of MelbourneVictoriaAustralia
- Present address:
Griffith UniversityQueenslandAustralia
| | - Hopin Lee
- University of Oxford, Oxford, UK, and University of NewcastleNewcastleAustralia
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Afunugo WE, Li CY, Chou LN, Ward F, Snih SA. Pain, obesity, and physical function in Mexican American older adults during 20 years of follow-up. PM R 2023; 15:331-341. [PMID: 35322569 PMCID: PMC9500111 DOI: 10.1002/pmrj.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pain remains largely undertreated in older adults irrespective of health care setting. Mexican American adults in the United States have a high age-adjusted prevalence of obesity. However, the association of pain and obesity with physical function is understudied in this population. OBJECTIVE To examine the association of co-occurring pain and obesity with physical function over 20 years of follow-up in a cohort of older Mexican Americans who scored ≥7 (moderate to high) in the Short Physical Performance Battery (SPPB) test and were nondisabled at baseline. DESIGN Longitudinal population-based study. SETTING Community-dwelling older adults from Southwestern United States. PARTICIPANTS Mexican American adults age 65 years and older. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Physical function was assessed with the SPPB test (standing balance, timed 8-ft walk, and five repeated timed chair stands). Participants at baseline were divided into four groups: no pain-no obesity (n = 869), obesity only (n = 282), pain only (n = 216), and pain-obesity (n = 159). Generalized Estimating Equation models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of lower performance in physical function over 20 years as a function of pain-obesity grouping. RESULTS Participants with pain only (OR = 1.61, 95% CI = 1.34-1.95) and with co-occurring pain and obesity (OR = 2.32, 95% CI = 1.83-2.95) had significantly greater odds of physical function impairment over those with no pain-no obesity or obesity only, after controlling for all covariates. CONCLUSION Older Mexican American adults were at high risk for physical function impairment over time if they had pain or co-occurring pain and obesity. Early assessment and proper pain management as well as maintaining a healthy weight may reduce declines in physical function in older Mexican American adults.
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Affiliation(s)
- Wilma E. Afunugo
- School of Medicine. The University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- Department of Occupational Therapy. The University of Texas Medical Branch, Galveston, TX, USA
| | - Lin-Na Chou
- Department of Preventive Medicine and Population Health. The University of Texas Medical Branch, Galveston, TX, USA
| | - Frank Ward
- Department of Nutrition, Metabolism, and Rehabilitation Sciences. The University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Nutrition, Metabolism, and Rehabilitation Sciences. The University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics & Palliative Medicine/Department of Internal Medicine. The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging. The University of Texas Medical Branch, Galveston, TX, USA
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What Are the Mechanisms of Action of Cognitive-Behavioral, Mind-Body, and Exercise-based Interventions for Pain and Disability in People With Chronic Primary Musculoskeletal Pain?: A Systematic Review of Mediation Studies From Randomized Controlled Trials. Clin J Pain 2022; 38:502-509. [PMID: 35686580 DOI: 10.1097/ajp.0000000000001047] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/10/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This systematic review examined studies that used mediation analysis to investigate the mechanisms of action of cognitive-behavioral, mind-body, and exercise-based interventions for pain and disability in people with chronic primary musculoskeletal pain. MATERIALS AND METHODS We searched 5 electronic databases for articles that conducted mediation analyses of randomized controlled trials to either test or estimate indirect effects. RESULTS We found 17 studies (n=4423), including 90 mediation models examining the role of 22 putative mediators on pain or disability, of which 4 had partially mediated treatment effect; 8 had mixed results, and 10 did not mediate treatment effect. The conditions studied were chronic whiplash-associated pain, chronic low back pain, chronic knee pain, and mixed group of chronic primary musculoskeletal pain. DISCUSSION We observed that several of the studies included in our systematic review identified similar mechanisms of action, even between different interventions and conditions. However, methodological limitations were common. In conclusion, there are still substantial gaps with respect to understanding how cognitive-behavioral, mind-body, and exercise-based interventions work to reduce pain and disability in people with chronic primary musculoskeletal pain.
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Khan FM, Tran A, Wong PKW, Aiyedipe S, Loya MF, Cristescu MM, Gonzalez FM. Management of uncomplicated total knee arthroplasty chronic pain and stiffness utilizing cooled radiofrequency ablation: a single institution pilot study. Skeletal Radiol 2022; 51:1215-1223. [PMID: 34727207 DOI: 10.1007/s00256-021-03944-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study is to introduce cooled radiofrequency ablation technical feasibility as an alternative percutaneous image-guided treatment of chronic pain and stiffness in the setting of uncomplicated total knee arthroplasty. MATERIAL AND METHOD This retrospective pilot study includes a total of 19 consecutive patients experiencing persistent chronic pain after total knee arthroplasty, without underlying hardware complications who had failed conservative care. Patients initially underwent anesthetic blocks of the genicular nerve branches to determine C-RFA candidacy. After adequate response to the anesthetic blocks (> 50% immediate pain relief), patients were subjected to cooled radiofrequency ablations 2-3 weeks later. Treatment response was evaluated utilizing clinically validated questionnaires (KOOS, the Knee Injury and Osteoarthritis Outcome Score) and visual analog scale (VAS) to assess pain severity, stiffness, functional activities of daily living, and use of pain medication. Follow-up outcome scores were collected up to 1 year after C-RFA procedure. RESULT A total of 21 knees were treated consecutively between 4/2019 and 1/2020 (mean age 70.5 years; 5 M:14F). The mean total KOOS score improved significantly from baseline at 35.0 ± 14.0 to 64.2 ± 14.7 at a mean of 10.2 months after treatment (p < 0.0001), with significant improvement in mean stiffness score from 44.8 ± 16.7 to 68.8 ± 20 (p < 0.0001). The mean VAS score improved significantly from baseline at 8.30 ± 1.1 to 2.45 ± 1.8 (p < 0.0001). No major complications were encountered. No patients went on to receive re-treatment, surgical revision, or other intervention. CONCLUSION Image-guided genicular nerve cooled radiofrequency ablation offers a promising alternative in treating chronic pain/stiffness in the setting of uncomplicated TKA.
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Affiliation(s)
- Fiza M Khan
- Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA
| | - Philip Kin-Wai Wong
- Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Samuel Aiyedipe
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed F Loya
- Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mircea M Cristescu
- Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Felix M Gonzalez
- Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
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Tran A, Reiter DA, Cruz AR, Gonzalez FM. Genicular Nerve Ablation Review Using Cooled-Radiofrequency Nerve Ablation. Semin Intervent Radiol 2022; 39:130-137. [PMID: 35781999 DOI: 10.1055/s-0042-1745797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Osteoarthritis (OA) is globally the most prevalent joint disease and causes patients great pain, limited joint mobility, and psychological distress. Short- and long-term therapies like steroid injections and arthroplasty exist, respectively. Joint arthroplasty can effectively treat symptomatic end-stage OA, but most patients do not go through with surgery because they are not qualified, have comorbidities, or do not wish to undergo surgery. As a result, patients can turn to opioid agonists for pain relief, which contributes to the growing opioid epidemic that mars our communities. Cooled radiofrequency ablation (C-RFA) is an effective treatment modality that can alleviate the pain associated with moderate to severe OA, especially in patients who have tried and failed conservative therapy. This review article elucidates the benefits of C-RFA, while also walking through the technical steps to performing the procedure. For patients suffering from debilitating joint OA, especially of the knee, C-RFA is a minimally invasive procedure that ensures pain relief.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, Georgia
| | - David A Reiter
- Department of Radiology and Imaging Sciences, and Orthopedics, Emory University School of Medicine, Atlanta, Georgia
| | - Anna R Cruz
- Department of Rehabilitation Medicine and Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia
| | - Felix M Gonzalez
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Lyman KS, Athinarayanan SJ, McKenzie AL, Pearson CL, Adams RN, Hallberg SJ, McCarter JP, Volek JS, Phinney SD, Andrawis JP. Continuous care intervention with carbohydrate restriction improves physical function of the knees among patients with type 2 diabetes: a non-randomized study. BMC Musculoskelet Disord 2022; 23:297. [PMID: 35351093 PMCID: PMC8961996 DOI: 10.1186/s12891-022-05258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background In a previous study, we assessed a novel, remotely monitored carbohydrate restricted diet regimen including nutritional ketosis in patients with type 2 diabetes and reported significant improvements in weight, glycemic control, abdominal fat and inflammation from baseline to 2 years. Knee outcome measures were collected as a secondary outcome in the trial. This study aims to assess the effect of this intervention on knee functional scores and to identify if changes in weight, central abdominal fat (CAF), glycemic status and high sensitivity C-reactive protein (hsCRP) were associated with its improvement. Methods This prospective analysis included continuous care intervention (CCI, n = 173) and usual care (UC, n = 69) trial participants with type 2 diabetes that reported knee pain at baseline. Knee outcome measures included the Knee injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, activities of daily living (ADL), sports and recreation function, and knee-related quality of life subscales, and total KOOS score were assessed from baseline to 2 years. Missing data at each time point were replaced with multiple imputation under the assumption of missing at random. To assess if the primary analysis of the knee scores changed under plausible missing not at random assumptions, sensitivity analysis was also performed using pattern mixture models. In CCI, we also assessed factors associated with the improvement of knee scores. Results In the primary analysis, CCI participants demonstrated a statistically significant improvement in total KOOS and all KOOS individual subscale scores at 1 year and maintained through 2 years as opposed to UC patients who showed no significant changes from baseline to 2 years. The significant improvement in total KOOS and its individual subscale scores from baseline to 2 years remained relatively stable in CCI in the sensitivity analysis under different missing not at random scenarios confirming the robustness of the findings from the primary analysis. Approximately 46% of the CCI participants met the 10 points minimal clinically important change at 2 years. A reduction in CAF was associated with improvement in total KOOS and KOOS ADL, while a decrease in hsCRP was associated with improvement in KOOS symptoms scores. Conclusion A very low carbohydrate intervention including nutritional ketosis resulted in significant improvements in knee pain and function among patients with T2D. The improvements in knee function were likely secondary to a reduction in central adiposity and inflammation. Future research on the applicability of this intervention in radiographically confirmed OA patients is important. Trial registration Clinical trial registration: NCT02519309 (10/08/2015). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05258-0.
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Tran A, Reiter DA, Prologo JD, Cristescu M, Gonzalez FM. Review of Extraosseous Applications of Thermal Ablation in the Treatment of Moderate to Severe Large Joint Osteoarthritis. Semin Musculoskelet Radiol 2021; 25:745-755. [PMID: 34937115 DOI: 10.1055/s-0041-1735474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA) is the most common joint disease worldwide, leading to significant pain, restricted range of motion, and disability. A gap exists between short- and long-term symptom-relieving therapies. Although arthroplasty is an effective treatment for symptomatic end-stage disease, most patients ultimately do not receive a joint replacement due to suboptimal surgical qualifications, comorbidities, or an aversion to surgery. The lack of additional treatment options in this setting makes opioid agonists a commonly used pharmacologic agent, contributing to the addiction epidemic that greatly afflicts our communities. Cooled radiofrequency ablation (CRFA) has arisen as a treatment modality in the setting of moderate to severe OA among patients refractory to conservative management, generally showing greater efficacy compared with other existing strategies. This review focuses on the benefits of CRFA and its technical feasibility as a management option among patients experiencing debilitating large joint OA with limited clinical options.
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Affiliation(s)
- Andrew Tran
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David A Reiter
- Department of Radiology and Imaging Sciences, and Orthopedics, Emory University School of Medicine, Atlanta, Georgia
| | - J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mircea Cristescu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Felix M Gonzalez
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Tan BY, Thach T, Munro YL, Skou ST, Thumboo J, Car J, Car LT. Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12757. [PMID: 34886480 PMCID: PMC8657138 DOI: 10.3390/ijerph182312757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/21/2023]
Abstract
Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore 768024, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Tivona Thach
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Soren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark;
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, 4200 Slagelse, Denmark
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
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Driver S, Douglas M, Reynolds M, McShan E, Swank C, Dubiel R. A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury. Brain Inj 2021; 35:1075-1085. [PMID: 34324396 DOI: 10.1080/02699052.2021.1953596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.
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Affiliation(s)
- Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Megan Douglas
- Rehabilitation Research Department, Baylor Scott and White Research Institute, Dallas, Texas
| | - Megan Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Evan McShan
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Randi Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
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Glass NL, Bellettiere J, Jain P, LaMonte MJ, LaCroix AZ. Evaluation of Light Physical Activity Measured by Accelerometry and Mobility Disability During a 6-Year Follow-up in Older Women. JAMA Netw Open 2021; 4:e210005. [PMID: 33620446 PMCID: PMC7903251 DOI: 10.1001/jamanetworkopen.2021.0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Almost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous-intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown. OBJECTIVE To determine the association of light-intensity physical activity and incident mobility disability among older women. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health study, an ancillary study of the Women's Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women's Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability, and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019. EXPOSURES Light-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days. MAIN OUTCOMES AND MEASURES Incident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up. RESULTS A total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction). CONCLUSIONS AND RELEVANCE In this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.
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Affiliation(s)
- Nicole L Glass
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Purva Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
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Godziuk K, Prado CM, Beaupre L, Jones CA, Werle JR, Forhan M. A critical review of weight loss recommendations before total knee arthroplasty. Joint Bone Spine 2020; 88:105114. [PMID: 33278590 DOI: 10.1016/j.jbspin.2020.105114] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Increased infection risk after total knee arthroplasty (TKA) in patients with a higher body mass index (BMI), particularly a BMI ≥40kg/m2, suggests that BMI reduction (through weight loss) prior to TKA may be important. However, the impact of weight loss on TKA risk reduction is unclear. Furthermore, weight loss could have detrimental consequences with respect to muscle loss and development of sarcopenic obesity, whereby a potential weight loss paradox in adults with advanced knee OA and obesity may be present. Using a critical review approach, we examined the current evidence supporting weight loss in adults with obesity and advanced knee osteoarthritis (OA). We focused on three key areas: (1) TKA complication risk with severe obesity compared to obesity (BMI ≥40kg/m2 versus 30.0-39.9kg/m2); (2) weight loss recommendations for individuals with advanced knee OA; and (3) TKA outcomes after pre-surgical weight loss. METHODS Medline and CINAHL databases were examined from Jan 2010 to May 2020 to identify high-level and/or clinically-influential evidence (systematic reviews, meta-analyses and clinical practice guidelines). RESULTS The literature does not show a clear relationship between weight loss and reduction in TKA complications, and no indication that a patients' individual risk is lowered by reducing their BMI from a threshold of ≥40kg/m2 to ≤39.9kg/m2. Studies that have found a benefit of weight loss for knee OA have not included patients with higher BMIs (≥40kg/m2) or more advanced knee OA. Furthermore, there is unclear evidence of a benefit of pre-surgical weight loss on TKA outcomes. These are important evidence gaps, suggesting that recommendations for BMI reduction prior to TKA should be tempered by the current uncertainty in the literature. CONCLUSION Evidence to support a benefit of weight loss prior to TKA is lacking. Until knowledge gaps are clarified, it is recommended that practitioners consider individual patient needs and risk before recommending weight loss (and therefore BMI reduction).
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Affiliation(s)
- Kristine Godziuk
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 - 114 Street, 2-64 Corbett Hall, T6G 2G4 Edmonton, AB, Canada.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jason R Werle
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 - 114 Street, 2-64 Corbett Hall, T6G 2G4 Edmonton, AB, Canada
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Charen DA, Solomon D, Zubizarreta N, Poeran J, Colvin AC. Examining the Association of Knee Pain with Modifiable Cardiometabolic Risk Factors. Arthritis Care Res (Hoboken) 2020; 73:1777-1783. [PMID: 32799426 DOI: 10.1002/acr.24423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE There is a well-established link between obesity and knee osteoarthritis, and recent research has implicated diabetes as a potential cause of cartilage degeneration. This study uses the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors. METHODS A retrospective cross-sectional study of the NHANES database from 1999 to 2004 was performed. The main outcome was any knee pain and bilateral knee pain. Main effects of interest were body mass index (BMI), and hemoglobin A1c (HbA1c). We additionally assessed various patient factors including age, race, poverty, gender and smoking status. Multivariable logistic regression models and interaction terms were analyzed. RESULTS Data on 12,900 patients was included. In the main adjusted analysis, the modifiable risk factors associated with any knee pain were: overweight (OR 0.91; 95% CI 0.85, 0.97), obesity (OR 1.54; 95% CI 1.42, 1.66), glycemic control (OR 1.20; 95% CI 1.03, 1.38), and current smokers (OR 1.15; 95% CI 1.05, 1.27), all p<0.05. These same factors remain significant for bilateral knee pain. Subgroup analysis showed patients under 65 years old have a 5% increase in risk of any knee pain as their body mass index increases, but patients 65 years and older have a 10% increase in risk. CONCLUSION This study confirms the association of knee pain with increased weight, glycemic control, current smoking and age. Most of these risk factors can be modified in patients with knee pain and should be discussed when providing conservative treatment options.
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Affiliation(s)
- Daniel A Charen
- Leni and Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Solomon
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicole Zubizarreta
- Leni and Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni and Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexis C Colvin
- Leni and Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Karasavvidis T, Hirschmann MT, Kort NP, Terzidis I, Totlis T. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. J Exp Orthop 2020; 7:52. [PMID: 32686011 PMCID: PMC7369444 DOI: 10.1186/s40634-020-00271-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To provide evidence-based recommendations for patients with severe knee osteoarthritis (OA), who had their knee surgery postponed due to the COVID-19 pandemic. Methods PubMed/Medline, Scopus and Cochrane Central databases were systematically reviewed for studies reporting outcomes of home-based treatments for knee OA. Due to between-study differences in treatment strategy and reporting methods the results were not pooled and findings of the current review were presented in a narrative manner. Results The comprehensive literature search yielded 33 eligible studies that were included in this review. Management is performed at home and consists of exercise, proper nutrition, physical therapy and use of corrective and assistive orthotics. Virtual education on self-management strategies should be part of coping with knee OA. Initiating an exercise programme involving gymnastics, stretching, home cycling and muscle strengthening is highly recommended. Obese patients are encouraged to set weight loss goals and adopt a healthy diet. Potential benefits but weak evidence has been shown for the use of knee braces, sleeves, foot orthotics or cushioned footwear. Walking aids may be prescribed, when considered necessary, along with the provision of instructions for their use. Conclusion When bridging the time to rescheduled surgery, it is essential to use appropriate home-based tools for the management of knee OA if pain is to be reduced and need for analgesics or opioid use is to be diminished while maintaining or even improving the functioning and avoiding further limitation of range of motion and subsequent muscular atrophies. Finally, none of these treatments may completely substitute for the life-changing effect of a total knee arthroplasty in patients with severe knee OA. Hence, the subsequent goal is to gradually and safely reinstate elective surgery.
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Affiliation(s)
- Theofilos Karasavvidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Basel, Switzerland
| | - Nanne P Kort
- CortoClinics, Steeg 6E, 5482 WN, Schijndel, The Netherlands
| | - Ioannis Terzidis
- Thessaloniki Minimally Invasive Surgery Orthopaedic Center, St. Luke's Hospital, 55236, Panorama, Greece
| | - Trifon Totlis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece. .,Thessaloniki Minimally Invasive Surgery Orthopaedic Center, St. Luke's Hospital, 55236, Panorama, Greece.
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Richey PA, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Coday M, Thomas F, Lewis CE, Mihalko WM. Association of the Intensive Lifestyle Intervention With Total Knee Replacement in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2020; 35:1576-1582. [PMID: 32085906 PMCID: PMC7247950 DOI: 10.1016/j.arth.2020.01.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Evidence has established obesity as a risk factor for total knee replacement (TKR) due to osteoarthritis. Obesity is a risk factor for TKR. Randomized trials such as Look AHEAD (Action for Health in Diabetes) have shown long-term successful weight loss with an intensive lifestyle intervention (ILI). It is unknown, however, if intentional weight loss can reduce the risk of TKR. METHODS Look AHEAD randomized persons aged 45-76 with type 2 diabetes who had overweight or obesity to either an ILI to achieve/maintain 7% weight loss or to standard diabetes support and education (DSE). Reported knee pain was assessed using the Visual Analog Scale and Western Ontario McMaster University Osteoarthritis Index questionnaire in 5125 participants without previous TKR. Cox proportional hazard regression was used to model differences in risk of TKR in relation to randomization group assignment (ILI vs DSE) along with baseline body mass index category and baseline knee pain as potential confounders from baseline through Look AHEAD-Extension. RESULTS Baseline mean ± SD Western Ontario McMaster University Osteoarthritis Index knee pain scores did not differ by treatment assignment (ILI: 3.6 ± 2.9, DSE: 3.9 ± 3.0, P = .08); as expected due to randomization. During follow up, the 631 (12%) participants who reported having a TKR were more likely to have been heavier (P < .001) and older (P < .001) at enrollment, but risk of TKR did not differ by treatment group assignment (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.91-1.25, P = .43). Heterogeneity of treatment effect was observed according to baseline knee pain (interaction P = .02). In persons without knee pain at baseline, there was a 29% reduced risk of TKR in ILI compared to DSE (HR 0.71, 95% CI 0.52-0.96). However, in persons with knee pain at baseline, there was no statistically significant association of treatment assignment with respect to subsequent TKR incidence (HR 1.11, 95% CI 0.92-1.33). CONCLUSION Findings suggest that intensive lifestyle change including physical activity, dietary restriction and behavioral changes to achieve weight loss for prevention of TKR may be most effective in preventing TKR prior to the development of knee pain.
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Affiliation(s)
- Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN; Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - William M Mihalko
- Department of Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN
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Martenstyn J, King M, Rutherford C. Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review. J Behav Med 2020; 43:873-891. [PMID: 32060765 DOI: 10.1007/s10865-020-00140-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
Abstract
Previous reviews explored weight loss-induced metabolic changes in overweight and obese adults with type 2 diabetes (T2D) but did not report on the impact on patient-reported outcomes (PROs). This systematic review investigated the effect of weight loss interventions on weight loss and PROs in overweight and obese adults with T2D. We searched three electronic databases from inception to March 2018 for randomised controlled trials (RCTs) of weight loss interventions in overweight and obese (according to BMI) adults aged ≥ 18 years reporting changes in PROs from baseline to at least one follow-up assessment during or post-intervention. One reviewer screened abstracts, performed data extraction, and conducted the narrative synthesis, with 25% cross-checking by a second reviewer. We extracted data relating to sample characteristics, intervention and comparison conditions, weight loss, and change in PROs. We identified 540 papers of which 23 met eligibility reporting on 19 RCTs. Four types of interventions (diet, surgery, pharmacological, and multi-component lifestyle interventions) significantly reduced weight. Weight loss was consistently associated with improvements in sexual and physical function across all intervention types, with diet and multi-component lifestyle interventions producing more substantial improvements than surgical or pharmacological interventions. Findings for other PROs, such as HRQOL and depressive symptoms, were inconsistent across studies and intervention types. The four weight loss interventions can be prescribed to engender weight loss in overweight and obese adults with T2D, with multi-component lifestyle interventions generating substantial improvements in physical and sexual function, perhaps due to the potency of exercise in improving PROs.
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Affiliation(s)
- Jordan Martenstyn
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia
| | - Madeleine King
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia.
- Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia.
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23
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Sheu WHH, Chan SP, Matawaran BJ, Deerochanawong C, Mithal A, Chan J, Suastika K, Khoo CM, Nguyen HM, Linong J, Luk A, Yoon KH. Use of SGLT-2 Inhibitors in Patients with Type 2 Diabetes Mellitus and Abdominal Obesity: An Asian Perspective and Expert Recommendations. Diabetes Metab J 2020; 44:11-32. [PMID: 32097996 PMCID: PMC7043991 DOI: 10.4093/dmj.2019.0208] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.
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Affiliation(s)
- Wayne Huey Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Bien J Matawaran
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Chaicharn Deerochanawong
- Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, The Medicity, Gurgaon, India
| | - Juliana Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Ketut Suastika
- Department of Internal Medicine, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Chin Meng Khoo
- Department of Medicine, National University Health System, Singapore
| | - Huu Man Nguyen
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ji Linong
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking, China
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Kun Ho Yoon
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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24
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Co-Morbidities and Sex Differences in Long-Term Quality-of-Life Outcomes among Patients with and without Diabetes after Total Knee Replacement: Five-Year Data from Registry Study. J Clin Med 2019; 9:jcm9010019. [PMID: 31861688 PMCID: PMC7019834 DOI: 10.3390/jcm9010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
Improved understanding of quality-of-life (QoL) outcomes can provide valuable information on intervention effectiveness and guide better patient care. The aim of this study was to examine whether QoL trajectories differ between patients with and without diabetes and identify to what extent patient characteristics are related to poor QoL outcomes after total joint replacement (TKR). Multilevel modelling was used to analyse long-term QoL patterns of patients undergoing TKR between 2006 and 2011. Patient-reported QoL at baseline and up to 5 years post-surgery were included. Of the 1553 TKR patients, one-fifth (n = 319) had diabetes. Despite there being no significant differences in QoL at baseline, patients with diabetes consistently reported lower QoL (on average by 0.028, p < 0.001) and did not improve to the same level as patients without the disease following surgery. Compared to males, females had significantly lower QoL (by 0.03, p < 0.001). Other baseline patient characteristics associated with important differences in QoL included presence of respiratory disease and mental health disorder. Patients with diabetes exhibit significantly poorer QoL compared to patients without diabetes, particularly among females. Knowledge of risk factors that impact on QoL can be useful for clinicians in identifying characteristics related to poor QoL outcomes and be used to guide patient-centered care.
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25
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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26
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DeRogatis M, Anis HK, Sodhi N, Ehiorobo JO, Chughtai M, Bhave A, Mont MA. Non-operative treatment options for knee osteoarthritis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S245. [PMID: 31728369 PMCID: PMC6828999 DOI: 10.21037/atm.2019.06.68] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a prevalent and debilitating condition for which a wide range of non-surgical treatment options are available. Although there is plethora of literature investigating their safety and efficacy, for many treatment modalities, a consensus has not yet been reached concerning efficacy. Therefore, it is essential for practitioners to understand the risks and benefits of the available treatments for the successful management of knee OA. This study explored the efficacy of non-surgical treatment options for knee OA including: (I) non-steroidal anti-inflammatory drugs (NSAIDs); (II) weight loss; (III) intra-articular injections; (IV) physical therapy; and (V) bracing. METHODS A comprehensive literature review of studies between 1995 and 2018 was conducted using the electronic databases PubMed and EBSCO Host. Searches were performed using the following terms: total knee arthroplasty (TKA); cyclooxygenase-2 inhibitors; bracing; physical therapy; weight loss; knee; treatment; therapeutics; OA; intra-articular injection; hyaluronic acid; corticosteroid; and alternatives. The initial search yielded 7,882 reports from which 545 relevant studies were identified. After full-text analysis, 43 studies were included for this analysis. RESULTS NSAIDs are most effective when used continuously and may be used in conjunction with other forms of treatment for knee OA as they have been shown to provide some pain relief as well as functional improvements. Weight loss is a safe and effective way to improve knee pain, function, and stiffness without adverse effects. However, it can be very challenging for obese patients with knee OA due to their limited mobility and lack of adherence to a low-calorie diet. Intra-articular injections have had mixed results, with findings from recent studies indicating long-term outcomes to be equivocal. Physical therapy leads to significant improvements in pain and function. Decreased compliance with physical therapy is thought to be due to high copayments, pain with activities, lacks of transportation, and high time commitments. Brace modalities have demonstrated significant pain and functional improvements and prolongations of the time to TKA. Additionally, they limit the need for other treatment modalities which are associated with greater risks. CONCLUSIONS NSAIDs, weight loss, intraarticular injections, and physical therapy have all been shown to be effective non-surgical treatment options for knee OA. However, these options have some limitations, and are best when used in conjunction. Bracing for knee OA is a noninvasive, non-pharmacologic option which can significantly reduce pain and improve function with minimal adverse effects. Therefore, a combination of knee braces along with other non-operative modalities should be one mainstay of treatment in conjunction with other treatment modalities to reduce pain, improve function, stiffness, and mobility in knee OA.
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Affiliation(s)
- Michael DeRogatis
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anil Bhave
- Department of Physical Therapy, Sinai Hospital, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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27
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Mirmaroofi N, Ghahramanian A, Behshid M, Jabbarzadeh F, Onyeka TC, Asghari-Jafarabadi M, Ganjpour-Sales J. Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis. Niger J Clin Pract 2019; 22:460-468. [PMID: 30975948 DOI: 10.4103/njcp.njcp_437_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to determine the relationship between pain of osteoarthritis (OA) and body mass index (BMI), age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in a cohort of Iranian women. SUBJECTS AND METHODS In total, 150 women with advanced knee OA, candidates for arthroplasty in Tabriz, in the Northwest of Iran were enrolled into the study. A convenience sampling method was used, and data was collected using demographic form, short-form McGill pain questionnaire, pain self-efficacy questionnaire, self-efficacy for exercise, and functional activities scales. RESULTS The present pain intensity of 74.7% of women was described as excruciating with mean (±SD) score 9.58 (±0.77) in the visual analogue scale. The majority of the women had a low self-efficacy for pain, exercise, and functional activities with means of 31.8, 17.28, and 57.63 respectively. There was a significant inverse relationship between sensory and affective components of pain and self-efficacy for pain control and functional activities (P < 0.001). The sensory and affective components of pain was related to age (P < 0.05), pain control self-efficacy (P < 0.01), and BMI (P < 0.05). A great majority of the women (79.33%) used complementary medicine (CM) for pain management. Those who used CM reported lower pain and higher self-efficacy (P < 0.01). CONCLUSION The findings of this study suggest that life style modification and pain management education of women with OA and nurses on non-pharmacological interventions as well as integration of these into nursing care is essential.
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Affiliation(s)
- N Mirmaroofi
- Department of Orthopaedics, Shohada Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Ghahramanian
- Department of Medical Surgical, Nursing and Midwifery Faculty, Haematology and Oncology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Behshid
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - F Jabbarzadeh
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - T C Onyeka
- Department of Anaesthesia/Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - M Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - J Ganjpour-Sales
- Department of Orthopaedics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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28
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Williams A, Lee H, Kamper SJ, O'Brien KM, Wiggers J, Wolfenden L, Yoong SL, Hodder RK, Robson EK, Haskins R, McAuley JH, Williams CM. Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese. Clin Rehabil 2019; 33:1088-1097. [PMID: 30808203 DOI: 10.1177/0269215519831419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. METHODS We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). RESULTS The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. CONCLUSIONS Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.
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Affiliation(s)
- Amanda Williams
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Hopin Lee
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia.,4 Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,5 Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Steven J Kamper
- 3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia.,6 School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Kate M O'Brien
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - John Wiggers
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Sze L Yoong
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Emma K Robson
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Robin Haskins
- 7 Outpatient Services, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - James H McAuley
- 4 Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,8 School of Medical Sciences, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Christopher M Williams
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
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29
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Li JS, Tsai TY, Clancy MM, Li G, Lewis CL, Felson DT. Weight loss changed gait kinematics in individuals with obesity and knee pain. Gait Posture 2019; 68:461-465. [PMID: 30611976 PMCID: PMC6599530 DOI: 10.1016/j.gaitpost.2018.12.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obesity is a mechanical risk factor for osteoarthritis. In individuals with obesity, knee joint pain is prevalent. Weight loss reduces joint loads, and therefore potentially delays disease progression; however, how the knee joint responds to weight loss in individuals with obesity and knee pain is not clear. RESEARCH QUESTION To assess the effect of weight loss on knee joint kinematics during gait in individuals with obesity and knee pain. METHODS We recruited individuals with obesity (BMI ≥ 35) and knee pain who were participating in a weight loss program which included bariatric surgery or medical management. At baseline and 1 year follow-up, participants walked on a treadmill, and their knee joint kinematics were assessed using a dual-fluoroscopic imaging system and subject-specific magnetic resonance imaging knee joint models. Gait changes were represented by change in range of tibiofemoral motion, i.e., excursions in flexion-extension, adduction-abduction, internal-external rotation, anterior-posterior translation, medial-lateral translation, and superior-inferior translation during gait. RESULTS Twelve individuals with obesity and knee pain completed the gait analysis at baseline and 1 year follow-up. Participants lost on average 10.4% (standard deviation: 17.2%) of their baseline body weight. Reduction in body weight was associated with increased range of flexion-extension (r = -0.75, p < 0.01) and decreased range of adduction-abduction (r = 0.60, p = 0.04) during gait. The reduction in body weight was also associated with self-reported pain decrease (r = 0.62, p = 0.04); however, the change in pain was not significantly associated with kinematic changes. SIGNIFICANCE Weight loss was associated with improved gait kinematics in the sagittal and frontal planes. The change in gait pattern in individuals with obesity and knee pain was not associated with the change in pain given a reduction in body weight.
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Affiliation(s)
- Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, United States; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States; Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Harvard Medical School and Newton-Wellesley Hospital, Newton, Massachusetts, United States.
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Margaret M Clancy
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Harvard Medical School and Newton-Wellesley Hospital, Newton, Massachusetts, United States
| | - Cara L Lewis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, United States; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States
| | - David T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States; NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
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30
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Godfrey KM, Bullock AJ, Dorflinger LM, Min KM, Ruser CB, Masheb RM. Pain and modifiable risk factors among weight loss seeking Veterans with overweight. Appetite 2018; 128:100-105. [PMID: 29885382 DOI: 10.1016/j.appet.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Overweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. Modifiable risk factors, such as eating behaviors and mental health symptoms, may be important to understand this relationship and improve interventions in Veterans. DESIGN Cross-sectional. SETTING Veterans Health Administration Medical Center outpatient clinic. SUBJECTS The sample of Veterans (N = 126) was mostly male (89.7%), White (76%), and non-Hispanic (94%) with average age of 61.9 years (SD = 8.5) and average body mass index (BMI) of 38.5 (SD = 7.5). METHODS Veterans referred for weight loss treatment (MOVE!) at VA Connecticut completed self-report questionnaires, and electronic medical records were reviewed. RESULTS Mean self-reported pain rating was 4.5 out of 10 (SD = 2.3). Moderate to severe pain was endorsed by 60% of the sample. Veterans with higher pain intensity and interference reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms (all p's < 0.01). However, pain intensity and interference were not associated with BMI. CONCLUSIONS For Veterans seeking behavioral weight loss treatment, higher pain intensity and interference were associated with more severe eating disorder, sleep, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment.
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Affiliation(s)
- Kathryn M Godfrey
- The Drexel University Center for Weight, Eating and Lifestyle Science, Philadelphia, PA, USA
| | | | | | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA.
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31
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Cooper L, Ryan CG, Ells LJ, Hamilton S, Atkinson G, Cooper K, Johnson MI, Kirwan JP, Martin D. Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review. Obes Rev 2018; 19:989-1007. [PMID: 29781096 DOI: 10.1111/obr.12686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/14/2018] [Indexed: 01/25/2023]
Abstract
Worldwide prevalence of adult overweight and obesity is a growing public health issue. Adults with overweight/obesity often have chronic musculoskeletal pain. Using a mixed-methods review, we aimed to quantify the effectiveness and explore the appropriateness of weight loss interventions for this population. Electronic databases were searched for studies published between 01/01/90 and 01/07/16. The review included 14 randomized controlled trials that reported weight and pain outcomes and three qualitative studies that explored perceptions of adults with co-existing overweight/obesity and chronic musculoskeletal pain. The random-effects pooled mean weight loss was 4.9 kg (95%CI:2.9,6.8) greater for intervention vs control. The pooled mean reduction in pain was 7.3/100 units (95%CI:4.1,10.5) greater for intervention vs control. Study heterogeneity was substantial for weight loss (I2 = 95%, tau = ±3.5 kg) and pain change (I2 = 67%, tau = ±4.1%). Meta-regression slopes for the predictors of study quality, mean age and baseline mean weight on mean study weight reduction were shallow and not statistically significant (P > 0.05). The meta-regression slope between mean pain reduction and mean weight lost was shallow, and not statistically significant, -0.09 kg per unit pain score change (95%CI:-0.21,0.40, P = 0.54). Meta-synthesis of qualitative findings resulted in two synthesized findings; the importance of healthcare professionals understanding the effects of pain on ability to control weight and developing management/education programmes that address comorbidity.
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Affiliation(s)
- L Cooper
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
| | - C G Ryan
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
| | - L J Ells
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
| | - S Hamilton
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
| | - G Atkinson
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
| | - K Cooper
- The Scottish Centre for Evidenced-Based, Multi-professional Practice: A Joanna Briggs Institute Centre of Excellence, School of Health Sciences, Robert Gordon University, UK
| | - M I Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, UK
| | - J P Kirwan
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Martin
- School of Health and Social Care, Teesside University, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, UK
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Delahanty LM, Chang Y, Levy DE, Porneala B, Dushkin A, Bissett L, Goldman V, Perrotta J, Rodriguez AR, Chase B, LaRocca R, Wheeler A, Wexler DJ. Design and participant characteristics of a primary care adaptation of the Look AHEAD Lifestyle Intervention for weight loss in type 2 diabetes: The REAL HEALTH-diabetes study. Contemp Clin Trials 2018; 71:9-17. [PMID: 29803816 DOI: 10.1016/j.cct.2018.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS The REAL HEALTH -Diabetes Study is a practice-based clinical trial that adapted the Look AHEAD lifestyle intervention for implementation in primary care settings. The trial will compare the effectiveness and cost-effectiveness of in-person group lifestyle intervention, telephone group lifestyle intervention, and individual medical nutrition therapy (MNT), the current recommended standard of care in type 2 diabetes. The primary outcome is percent weight loss at 6 months with outcomes also measured at 12, 18, 24 (intervention completion), and 36 months. Here, we describe the adaptation, trial design, implementation strategies, and baseline characteristics of enrolled participants. METHODS The study is a three-arm, patient-level, randomized trial conducted in three community health centers (CHCs) and one diabetes practice affiliated with one academic medical center. RESULTS The study used existing clinical infrastructure to recruit participants from study sites. Strategies for successful conduct of the trial included partnering with health-center based co-investigator clinicians, engaging primary care providers, and accommodating clinical workflows. Of 248 eligible patients who attended a screening visit, 211 enrolled, with 70 randomly assigned to in-person group lifestyle intervention, 72 to telephone group lifestyle intervention, and 69 to MNT. The cohort was 55% female, 29% non-white, with mean age 62 years and mean BMI 35 kg/m2. Enrollment rates were higher at CHC sites. CONCLUSIONS A practice-based randomized trial of a complex behavioral lifestyle intervention for type 2 diabetes can be implemented in community health and usual clinical settings. Participant and provider engagement was higher at local CHC sites reflecting the study implementation focus. CLINICAL TRIAL REGISTRATION NCT02320253.
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Affiliation(s)
- Linda M Delahanty
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Douglas E Levy
- Harvard Medical School, Boston, MA, United States; Mongan Institute Health Policy Center, MGH, Boston, MA, United States
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Amy Dushkin
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Laurie Bissett
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Valerie Goldman
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Jeanna Perrotta
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Anthony Romeo Rodriguez
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Barbara Chase
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Chelsea Health Center, Boston, MA, United States
| | - Rajani LaRocca
- Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Charlestown Health Center, Boston, MA, United States
| | - Amy Wheeler
- Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Revere Health Center, Boston, MA, United States
| | - Deborah J Wexler
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Baldwin JN, McKay MJ, Burns J, Hiller CE, Nightingale EJ, Moloney N. What are the similarities and differences between healthy people with and without pain? Scand J Pain 2018; 18:39-47. [PMID: 29794286 DOI: 10.1515/sjpain-2017-0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Knowledge of pain characteristics among the healthy population or among people with minimal pain-related disability could hold important insights to inform clinical practice and research. This study investigated pain prevalence among healthy individuals and compared psychosocial and physical characteristics between adults with and without pain. METHODS Data were from 1,000 self-reported healthy participants aged 3-101 years (1,000 Norms Project). Single-item questions assessed recent bodily pain ("none" to "very severe") and chronic pain (pain every day for 3 months in the previous 6 months). Assessment of Quality of Life (AQoL) instrument, New Generalised Self-Efficacy Scale, International Physical Activity Questionnaire, 6-min walk test, 30-s chair stand and timed up-and-down stairs tests were compared between adults with and without pain. RESULTS Seventy-two percent of adults and 49% of children had experienced recent pain, although most rated their pain as mild (80% and 87%, respectively). Adults with recent pain were more likely to be overweight/obese and report sleep difficulties, and had lower self-efficacy, AQoL mental super dimension scores and sit-to-stand performance, compared to adults with no pain (p<0.05). Effect sizes were modest (Cohen's d=0.16-0.39), therefore unlikely clinically significant. Chronic pain was reported by 15% of adults and 3% of children. Adults with chronic pain were older, more likely to be overweight/obese, and had lower AQoL mental super dimension scores, 6-min walk, sit-to-stand and stair-climbing performance (p<0.05). Again, effect sizes were modest (Cohen's d=0.25-0.40). CONCLUSIONS Mild pain is common among healthy individuals. Adults who consider themselves healthy but experience pain (recent/chronic) display slightly lower mental health and physical performance, although these differences are unlikely clinically significant. IMPLICATIONS These findings emphasise the importance of assessing pain-related disability in addition to prevalence when considering the disease burden of pain. Early assessment of broader health and lifestyle risk factors in clinical practice is emphasised. Avenues for future research include examination of whether lower mental health and physical performance represent risk factors for future pain and whether physical activity levels, sleep and self-efficacy are protective against chronic pain-related disability.
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Affiliation(s)
- Jennifer N Baldwin
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand, Tel.: +64 921 9999 ext 7157.,The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Marnee J McKay
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Joshua Burns
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia.,Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), Sydney, New South Wales, Australia
| | - Claire E Hiller
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | | | - Niamh Moloney
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Chinekesh A, Hoseini SA, Shahbolaghi FM, Motlagh ME, Eftekhari MB, Ardalan G, Djalalinia S. A Comprehensive Health Plan: The Lifestyle Affecting Factors in Iranian Youth. Int J Prev Med 2018; 9:1. [PMID: 29416837 PMCID: PMC5787877 DOI: 10.4103/ijpvm.ijpvm_309_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/07/2017] [Indexed: 11/06/2022] Open
Abstract
Background: Factors affecting lifestyle become one of the most priorities of the research field, especially in adolescents and youth. Using a qualitative approach, this study aimed to understand what factors are affecting young people's healthy lifestyle. Methods: Using the conventional content analysis, and used the semi-structured in-depth interviews, we conducted a qualitative study to elicit the youth opinion considering their lifestyle affecting factors. Initially, purposeful sampling method was considered for data collection. Participants were selected from volunteered youths 18–30 years whom were selected from the Tehran city. Inclusion criteria for the participants were; (a) willingness to participate in the study, and (b) ability to express experiences. Results: According to findings, although the majority of participants agreed on the important role of lifestyle related behaviors in their healthy life, the lack of essential motivation and the pressure of educational assignments remove it from their daily program priorities. The most important barrier to observing the healthy lifestyle was expressed as; the acceptance of the concept by the individual and the social and economic potential of the individual. It was also suggested that practical interventions should focus on improving more participator engagement of all of the related stakeholders. Conclusions: We proposed the participatory strategies for youth healthy lifestyle promotion. Through which based on a specific needs the assessment of different target groups, designing, development, and implementation of health programs led to more effective interventions.
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Affiliation(s)
- Ahdieh Chinekesh
- Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Seyed Ali Hoseini
- Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohammad Esmael Motlagh
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran.,Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Gelayol Ardalan
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, EMRI, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
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Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract 2017; 29:S3-S14. [PMID: 29024553 PMCID: PMC6088226 DOI: 10.1002/2327-6924.12510] [Citation(s) in RCA: 319] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022]
Abstract
Background and Purpose The aims of this article are to review the effects of obesity on health and well‐being and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss. Methods Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,” “diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.” Conclusions Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs. Implications for Practice With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐management strategies deployed in clinical practice.
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Affiliation(s)
- Sharon M Fruh
- College of Nursing, University of South Alabama, Mobile, Alabama
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36
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Weight loss in the prevention and treatment of diabetes. Prev Med 2017; 104:120-123. [PMID: 28757449 DOI: 10.1016/j.ypmed.2017.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022]
Abstract
The American Diabetes Association nutrition and lifestyle recommendations for prediabetes and type 2 diabetes focus on losing 7% of body weight and increasing physical activity to at least 150minperweek. This emphasis is largely based on results of the Diabetes Prevention Program (DPP) and Look AHEAD (Action for Health in Diabetes) clinical trials. DPP demonstrated that a lifestyle intervention aimed at 7% weight loss and 150min of activity per week reduced diabetes incidence by 58% after 2.8years of follow-up and resulted in sustained improvements in hemoglobinA1c, blood pressure and lipid levels. After 15years of follow-up, DPP's lifestyle intervention sustained a 27% risk reduction in progression to diabetes. Look AHEAD's lifestyle intervention significantly reduced hemoglobinA1c, blood pressure, triglycerides, and the amount and costs of medications needed to treat these conditions when compared with diabetes support and education. Other clinical and psychological benefits achieved with lifestyle intervention were greater reductions in c-reactive protein, less self-reported retinopathy, reduced risk of nephropathy, less sexual dysfunction, decreased incidence of urinary incontinence and fatty liver, remission of sleep apnea, better physical functioning, less knee pain, more remission of diabetes, reduced incidence of depression, less body image dissatisfaction and improved quality-of-life. A number of DPP translation studies have demonstrated weight losses of 4 to 7% at 6month and 1year follow-up which has led to Medicare coverage for CDC recognized DPP lifestyle programs starting in April 2018. Translation studies of Look AHEAD using a variety of delivery formats are underway.
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37
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Heidari M, Borujeni MB, Borujeni MG, Shirvani M. Relationship of Lifestyle with Academic Achievement in Nursing Students. J Clin Diagn Res 2017; 11:JC01-JC03. [PMID: 28511411 PMCID: PMC5427337 DOI: 10.7860/jcdr/2017/24536.9501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A healthy lifestyle is one of the main factor in maintaining the health of people in society. With regard to the role of youth and students in public health, they must complete and follow a training program on lifestyle related factors. One of the main aim of the training centres is to improve the academic achievement of students. AIM This study was designed to determine the correlation of lifestyle with academic achievement in nursing students. MATERIALS AND METHODS This was a cross-sectional study, wherein all nursing students of School of Borujen Nursing were selected by census sampling. Data gathering tool was Walker's lifestyle questionnaire which was modified for the purpose of the study. To evaluate the educational status of students, final grade point average was considered as an indicator of academic achievement. To analyze the data, SPSS version 16.0, and descriptive and analytical tests were used. RESULTS The results indicated that most subjects (61.01%) displayed moderate levels of lifestyle. Pearson's correlation coefficient showed the significant positive relationship between lifestyle and academic achievement (p=0.03 and r=0.628). CONCLUSION To improve the academic achievement of students, in addition to the cognitive abilities-perception, their lifestyle should also be considered. Therefore, it is suggested to incorporate lifestyle education in the curriculum of nursing students so as to improve their lifestyle.
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Affiliation(s)
- Mohammad Heidari
- Lecturer, Department of Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Marzieh Borjian Borujeni
- M.Sc. Student, Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansureh Ghodusi Borujeni
- Lecturer, Department of Nursing, Abadeh Medical Sciences Branch, Islamic Azad University, Abadeh, Iran
| | - Mina Shirvani
- Lecturer, Department of Nursing, Borujen Nursing Faculty, Shahrekord University of Medical Sciences, Shahrekord, Iran
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38
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Huebner JL, Landerman LR, Somers TJ, Keefe FJ, Guilak F, Blumenthal JA, Caldwell DS, Kraus VB. Exploratory secondary analyses of a cognitive-behavioral intervention for knee osteoarthritis demonstrate reduction in biomarkers of adipocyte inflammation. Osteoarthritis Cartilage 2016; 24:1528-34. [PMID: 27090577 PMCID: PMC4992604 DOI: 10.1016/j.joca.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 02/03/2016] [Accepted: 04/02/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of pain coping skills training (PCST) and a lifestyle behavioral weight management (BWM) program on inflammatory markers and biomarker associations with pain and function in the OA LIFE study. METHOD Serum samples were available from a subset (N = 169) of the overweight or obese knee OA participants in the OA LIFE study that evaluated: PCST, BWM, combined PCST + BWM, or standard care (SC). Inflammatory markers (hsCRP, IL-1ra, IL-1β, IL-6, IL-8, TNF-α, TNFRI, TNFRII, and hyaluronic acid (HA)), and adipokines (leptin and adiponectin) were measured before and after the 24-week treatment period. Biomarkers were assessed for effects of treatment and for associations with change in weight, pain and disability (unadjusted and adjusted for age, race, sex, baseline body mass index (BMI), and baseline biomarker concentration). RESULTS PCST + BWM was associated with significant reductions in hsCRP (P = 0.0014), IL-6 (P = 0.0075), and leptin (P = 0.0001). After adjustment, there was a significant effect of PCST + BWM on changes in leptin (b = -0.19, P = 0.01) and IL-6 (b = -0.25, P = 0.02) relative to SC. Reductions in leptin and IL-6 were significantly correlated with reductions in weight, BMI and Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain; reductions in IL-6 were correlated with improvements in WOMAC and Arthritis Impact Measurement Scales (AIMS) physical function. By mediation analyses, weight loss was responsible for 54% of the change in IL-6 and all of the change in leptin. CONCLUSIONS OA-related inflammatory markers were reduced by a 24-week combined PCST + BWM intervention. This suggests that the inflammatory state can be successfully modified in the context of a readily instituted clinical intervention with a positive clinical outcome.
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Affiliation(s)
- J L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - L R Landerman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - T J Somers
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - F J Keefe
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - F Guilak
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - J A Blumenthal
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
| | - D S Caldwell
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - V B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Cooper L, Ryan C, Ells LJ, Hamilton S, Atkinson G, Cooper K, Johnson MI, Kirwan JP, Martin D. Weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain: a mixed methods systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:57-67. [PMID: 27532463 PMCID: PMC5206660 DOI: 10.11124/jbisrir-2016-002725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this mixed methods review is to develop an aggregated synthesis of qualitative and quantitative data on weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision making.The objective of the quantitative component of this review is to quantify the effectiveness of weight-loss interventions on weight, pain and physical and/or psychosocial function in overweight/obese adults with chronic musculoskeletal pain.The objectives of the qualitative component of this review are to explore the perceptions and experiences of overweight/obese adults with chronic musculoskeletal pain of the link between their weight and pain, and the effectiveness and appropriateness of weight-loss interventions and sustainability of weight-loss efforts.
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Affiliation(s)
- Lesley Cooper
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Cormac Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Louisa Jane Ells
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Sharon Hamilton
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Greg Atkinson
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Kay Cooper
- The Scottish Centre for Evidenced-Based, Multi-professional Practice: a Collaborating Centre of the Joanna Briggs Institute, Robert Gordon University, Aberdeen
| | | | - John P. Kirwan
- Lerner Research Institute, Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
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40
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Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Reg Anesth Pain Med 2015; 40:91-111. [PMID: 25650632 DOI: 10.1097/aap.0000000000000218] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. Good evidence shows that weight reduction can alleviate pain and diminish pain-related functional impairment. However, inadequate pain control can be a barrier to effective lifestyle modification and rehabilitation. This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.
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41
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Neiberg RH, Rejeski JJ, Applegate WB, Clark JM, Knowler WC, Bray GA, Espeland MA, Cheskin LJ. Self-Reported Gastrointestinal Symptoms in Type 2 Diabetes Improve With an Intensive Lifestyle Intervention: Results From the Action for Health in Diabetes (Look AHEAD) Clinical Trial. Clin Diabetes 2015; 33:181-8. [PMID: 26487792 PMCID: PMC4608270 DOI: 10.2337/diaclin.33.4.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In Brief This article reports on an investigation of whether an intensive lifestyle intervention (ILI) would reduce gastrointestinal symptoms over 4 years of follow-up for participants in the Action for Health in Diabetes (Look AHEAD) trial compared to a diabetes support and education (DSE) group. Look AHEAD is a randomized, multicenter trial comparing overweight and obese adults with type 2 diabetes treated with ILI versus DSE. ILI, and weight loss in general, had beneficial effects on gastrointestinal (GI) symptoms, with some variability in the strength of the effect depending on the specific symptom and time course. Potential modifiers were analyzed, yet ILI retained an association with improvement in GI symptoms.
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Affiliation(s)
- Rebecca H. Neiberg
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jared J. Rejeski
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - William B. Applegate
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanne M. Clark
- Departments of Medicine and Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - George A. Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Mark A. Espeland
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lawrence J. Cheskin
- Departments of Medicine and Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
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42
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White DK, Neogi T, Rejeski WJ, Walkup MP, Lewis CE, Nevitt MC, Foy CG, Felson DT. Can an intensive diet and exercise program prevent knee pain among overweight adults at high risk? Arthritis Care Res (Hoboken) 2015; 67:965-71. [PMID: 25692781 DOI: 10.1002/acr.22544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE It is unclear whether an intensive program of weight loss combined with exercise prevents the onset of knee pain among those at high risk. We examined whether an intensive lifestyle intervention (ILI) prevents incident knee pain compared with a diabetes mellitus support and education (DSE) comparison group among overweight adults with diabetes mellitus. METHODS We conducted a secondary analysis of the Action for Health in Diabetes (Look AHEAD) study, which is a randomized intervention trial of adults who were obese and had type 2 diabetes mellitus starting in 2001. We studied a subcohort of 2,889 subjects who reported no knee pain at baseline but were at high risk due to obesity. Risk ratios (RRs) were calculated to examine the association of ILI versus DSE with incident knee pain at year 1 and year 4. All analyses were adjusted for potential confounders. RESULTS Age, sex, and body mass index were similar among ILI and DSE participants with no knee pain at baseline. At year 1, ILI participants were 15% less likely to develop knee pain compared with DSE participants (RR 0.85, 95% confidence interval 0.74-0.98). At year 4, this difference decreased to 5% and was no longer statistically significant. CONCLUSION An ILI of diet and exercise may prevent the development of knee pain among those at high risk in the short term. Health care providers may consider recommending diet and exercise as a means to prevent the development of knee pain among those at high risk.
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Affiliation(s)
- Daniel K White
- University of Delaware, Newark, and Sargent College, Boston University, Boston, Massachusetts
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | | | - Capri G Foy
- Wake Forest University, Winston-Salem, North Carolina
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester, Manchester, UK
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Masheb RM, Lutes LD, Kim HM, Holleman RG, Goodrich DE, Janney CA, Kirsh S, Higgins DM, Richardson CR, Damschroder LJ. Weight loss outcomes in patients with pain. Obesity (Silver Spring) 2015; 23:1778-84. [PMID: 26237112 DOI: 10.1002/oby.21160] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/27/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether the presence or severity of pain is predictive of suboptimal weight loss outcomes in behavioral weight management programs. METHODS This is a secondary data analysis comparing weight loss among participants with overweight/obesity who participated in a 12-month randomized controlled trial. Of the 481 participants randomized, 394 (81.9%) had available pain data and were categorized by Pain Type (back pain, arthritis pain, both, or neither) and Pain Severity (no pain, moderate pain, or severe pain). Dietary and physical activity outcomes were also explored. RESULTS High rates of moderate and severe (80.2%), and back and arthritis (72.6%), pain were observed. Linear mixed models showed significant differences in % weight loss among Pain Severity, but not Pain Type, groups. Patients with severe pain lost significantly less weight (-0.1 kg, 95% CI = -1.5, -1.2) compared to those with either moderate or no pain (-1.9 kg, 95% CI = -2.5, -1.3; -2.1 kg, 95% CI = -3.3, -1.0, respectively). Patients with arthritis pain lost a significant amount of weight despite only minor improvements in walking distance. CONCLUSIONS Pain severity, but not pain type, is predictive of suboptimal weight loss outcomes.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lesley D Lutes
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Susan Kirsh
- Office of Primary Care, VA Central Office, Washington, DC, and Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Diana M Higgins
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Caroline R Richardson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Quicke JG, Foster NE, Thomas MJ, Holden MA. Is long-term physical activity safe for older adults with knee pain?: a systematic review. Osteoarthritis Cartilage 2015; 23:1445-56. [PMID: 26003947 DOI: 10.1016/j.joca.2015.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/24/2015] [Accepted: 05/10/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether long-term physical activity is safe for older adults with knee pain. DESIGN A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least 3 months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)). RESULTS Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR. CONCLUSIONS Long-term therapeutic exercise lasting 3 to 30 months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014:CRD42014006913.
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Affiliation(s)
- J G Quicke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - M J Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - M A Holden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
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Delahanty LM, Dalton KM, Porneala B, Chang Y, Goldman VM, Levy D, Nathan DM, Wexler DJ. Improving diabetes outcomes through lifestyle change--A randomized controlled trial. Obesity (Silver Spring) 2015; 23:1792-9. [PMID: 26260043 DOI: 10.1002/oby.21172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare a diabetes group lifestyle intervention (GLI) with dietitian referral for medical nutrition therapy (RD) for weight loss in the usual care setting. METHODS Randomized clinical trial was conducted with 57 primary care patients with type 2 diabetes and body mass index (BMI) >25 kg/m(2) who received either a dietitian-led 19-week GLI adapted from the Look AHEAD study or RD. Outcome measures include 6-month and 1-year weight loss, changes in medications, glycemic control, cardiac risk factors, and cost analysis. RESULTS Patients were mean age 61, 59% male, and 32% non-white, and they weighed 97 kg with mean HbA1c 8.2%. At 6 months, 46% of GLI vs. 21% of RD lost ≥5% body weight (P = 0.04), with mean weight loss 6.6 (SD 7.0) kg with GLI and 2.1 (3.5) kg in RD (P = 0.004). HbA1c improved by 0.70 (1.13) vs. 0.39 (1.51) in GLI vs. RD (P = 0.4), respectively, and 82% vs. 38% stopped or reduced diabetes medications (P < 0.001). Weight loss remained significantly greater in GLI compared to RD at 1 year. GLI program cost was $578 per participant. CONCLUSIONS An affordable GLI achieved significantly more weight loss and medication reduction than RD in primary care patients with type 2 diabetes.
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Affiliation(s)
- Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen M Dalton
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, Massachusetts, USA
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Valerie M Goldman
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, Massachusetts, USA
| | - Douglas Levy
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Nathan
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah J Wexler
- Department of Medicine, Massachusetts General Hospital Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Batsis JA, Zbehlik A, Barre LK, Bynum JPW, Pidgeon D, Bartels SJ. Impact of obesity on disability, function, and physical activity: data from the Osteoarthritis Initiative. Scand J Rheumatol 2015; 44:495-502. [PMID: 26083472 PMCID: PMC4651723 DOI: 10.3109/03009742.2015.1021376] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. METHOD Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. RESULTS Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. CONCLUSIONS Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.
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Affiliation(s)
- John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
| | - Alicia Zbehlik
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Laura K. Barre
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Julie PW Bynum
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Dawna Pidgeon
- Department of Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756
| | - Stephen J. Bartels
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
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Abstract
Look AHEAD (Action for Health in Diabetes) was a randomized controlled trial that examined the impact of long-term participation in an intensive weight loss intervention on cardiovascular disease (CVD) morbidity and mortality in people with type 2 diabetes (T2D). The results from this trial suggest that intensive lifestyle interventions are effective in helping patients to achieve management of cardiovascular risk factors and reducing the need to initiate medication usage to manage these conditions, though the benefits in terms of the prevention of CVD morbidity and mortality beyond those achieved through aggressive medical management of hypertension and dyslipidemia is not clear. Additional benefits of participation in an intensive lifestyle intervention such as lowered chronic kidney disease risk, blood pressure, medication usage, improved sleep apnea, and partial remission of diabetes are discussed.
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Kirkman MS. Osteoarthritis progression: is diabetes a culprit? Osteoarthritis Cartilage 2015; 23:839-40. [PMID: 25827972 DOI: 10.1016/j.joca.2015.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 02/02/2023]
Affiliation(s)
- M Sue Kirkman
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Abstract
Diabetes now affects more than 29 million Americans, and more than 9 million of these people do not know they have diabetes. In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes and is the focus of this article. Lifestyle intervention is part of the initial treatment as well as the ongoing management of type 2 diabetes. Lifestyle intervention encompasses a healthful eating plan, physical activity, and often medication to assist in achievement of glucose, lipid, and blood pressure goals. Patient education and self-care practices are also important aspects of disease management.
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Affiliation(s)
- Alison B Evert
- Diabetes Education Programs, Diabetes Care Center, University of Washington Medical Center, 4245 Roosevelt Way Northeast, 3rd Floor, Seattle, WA 98105, USA.
| | - Michael C Riddell
- Muscle Health Research Center, School of Kinesiology and Health Science, Bethune College, York University, 4700 Keele Street, 3rd Floor, Toronto, Ontario M3J1P3, Canada
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50
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Quintrec JLL, Verlhac B, Cadet C, Bréville P, Vetel JM, Gauvain JB, Jeandel C, Maheu E. Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature. Open Rheumatol J 2014; 8:89-95. [PMID: 25489352 PMCID: PMC4258698 DOI: 10.2174/1874312901408010089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient's age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients. METHODS Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles. RESULTS We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients. PHYSICAL EXERCISE 8 TRIALS was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation. AQUATIC EXERCISE 5 TRIALS was as effective as land-based exercise. WEIGHT LOSS 2 TRIALS only patients under diet + exercise had significant improvement on symptoms. CONCLUSION Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.
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Affiliation(s)
- Jean-Laurent Le Quintrec
- Service de Médecine Gériatrique 3 [Department of Geriatric Medicine 3], Hôpital Sainte-Périne (A.P-H.P), Paris, France
| | - Bernard Verlhac
- Pôle Vieillissement, réadaptation et Accompagnement [Centre for the Aged, Rehabilitation and Support], Hôpital Paul Brousse (A.P-H.P) Villejuif, France
| | | | - Philippe Bréville
- Service de Rhumatologie [Department of Rheumatology], Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Jean B Gauvain
- Centre de Médecine Interne Gériatrique [Centre for Geriatric Internal Medicine], Centre Hospitalier régional, Orléans, France
| | - Claude Jeandel
- Service de Médecine interne et Gériatrie [Department of Internal and Geriatric Medicine], Montpellier, France
| | - Emmanuel Maheu
- Service de Rhumatologie, Rheumatology Department, Medical Office / Hôpital Saint Antoine -A.P-H.P, Paris, France
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