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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Understanding the biopsychosocial knee osteoarthritis pain experience: an ecological momentary assessment. Pain Rep 2024; 9:e1172. [PMID: 39015820 PMCID: PMC11249513 DOI: 10.1097/pr9.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/27/2024] [Accepted: 05/27/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Psychological, social, and lifestyle factors contribute to the knee osteoarthritis (OA) pain experience. These factors could be measured more accurately using smartphone ecological momentary assessment (EMA). Objectives The objective of this study was to characterise the pain experiences of those with knee OA by a smartphone EMA survey and explain how momentary psychological and social states influence knee OA pain experiences. Methods A smartphone EMA survey was designed and piloted. Eligible participants completed smartphone EMA assessing the knee OA pain experience 3 times daily for 2 weeks. Descriptive statistics were used to characterise factors involved in knee OA pain followed by the development of mixed-effects location scale models to explore heterogeneity and relationships between symptoms involved in the knee OA pain experience. Results Eighty-six community-dwelling volunteers with knee OA were recruited. Pain, psychosocial, and lifestyle factors involved in knee OA pain experience were heterogeneous and variable. Those with greater variability in pain, fatigue, negative affect, and stress had worse levels of these symptoms overall. In addition, fatigue, negative affect, stress, anxiety, loneliness, and joint stiffness demonstrated within-person relationships with knee OA pain outcomes. Conclusions Knee OA pain is a heterogeneous biopsychosocial condition. Momentary experiences of psychological, social, fatigue, and joint stiffness explain individual and between-individual differences in momentary knee OA pain experiences. Addressing these momentary factors could improve pain and functional outcomes in those with knee OA. Validation studies, including individuals with more severe knee OA presentations, are required to support findings and guide clinical interventions to improve outcomes for those with knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, USA
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Tan Yijia B, Goff A, Lang KV, Tham Yen Yu S, Su Khaing Myint Zu D, Munro YL, Yang SY, Callahan LF, Bowden JL, Briggs AM, Hunter DJ. Psychosocial factors in knee osteoarthritis: Scoping review of evidence and future opportunities. Osteoarthritis Cartilage 2024:S1063-4584(24)01214-7. [PMID: 38851526 DOI: 10.1016/j.joca.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/03/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Identify, describe and produce an evidence map of studies investigating psychosocial factors association with, or effect on, clinical outcomes for people with knee osteoarthritis. METHODS Scoping review of interventional and observational studies was performed. Medline (Ovid), Embase (Ovid), Cumulated Index in Nursing and Allied Health Literature, PsycInfo and Web of Science were searched on the 15th May 2023. Screening, data extraction and analysis was performed by two independent researchers. Extracted information included characteristics of studies plus which psychosocial factors were used to investigate association with, or effect on, clinical outcome(s). Descriptive statistics summarized the study design, temporal trend, geographic distribution, frequency of each psychosocial factor and whether associations/effects were observed. RESULTS 23,065 records were screened, with 108 studies selected. Eighty-two percent of studies (n = 89/108) were cross-sectional in design. Number of studies increased over time and spanned 28 countries. Most research originated from the Americas region (55 %, 59/108). Twenty-four psychosocial factors (11 psychological, 13 social) were identified. Depression (47 %, n = 48/102) and education (28 %, n = 29/102) were the most frequently reported psychological and social factors, respectively. Psychological factors were often reported to have an association with/effect on pain (81 %, n = 71/88) and physical function (75 %, n = 56/74). Social factors were less frequently reported to have an association with or effect on pain (57 %, n = 46/81) and physical function (50 %, n = 18/36). CONCLUSION Psychosocial factors are often associated with clinical outcomes for people with knee osteoarthritis. High-quality longitudinal studies examining a wide range of psychosocial factors across diverse cultural and geographical settings are key to continue informing the development of biopsychosocial models of care.
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Affiliation(s)
- Bryan Tan Yijia
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Anthony Goff
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | | | | | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, National Healthcare Group, Singapore
| | - Leigh F Callahan
- Thurson Arthritis Research Centre, University of North Carolina, United States of America
| | - Jocelyn L Bowden
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia; Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew M Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia; Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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Tan BY. CORR Insights®: What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis? Clin Orthop Relat Res 2024; 482:645-647. [PMID: 38416421 PMCID: PMC10936974 DOI: 10.1097/corr.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore , Singapore
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Bowden JL, Hunter DJ, Mills K, Allen K, Bennell K, Briggs AM, Dziedzic K, Hinman RS, Kim JS, Martinez N, Quicke JG, Tan Yijia B, van der Esch M, Verges J, Eyles J. The OARSI Joint Effort Initiative: Priorities for osteoarthritis management program implementation and research 2024-2028. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100408. [PMID: 37771392 PMCID: PMC10522998 DOI: 10.1016/j.ocarto.2023.100408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Objective The Joint Effort Initiative (JEI) is an international collaboration of clinicians, researchers, and consumer organisations with a shared vision of improving the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify JEI's future priorities and guide direction. Design A two-part international survey to prioritise topics of importance to our membership and research stakeholders. Survey one presented a list of 40 topics under 5 themes. Consenting participants were asked to choose their top three topics in each theme. A short list of 25 topics was presented in survey two. Participants were asked to rank the importance (100-point NRS scale, 100 = highest priority). Response frequency (median, IQR) was used to rank the top priorities by theme. Results Ninety-five participants completed survey one (61% female, 48% clinicians) and 57 completed survey two. The top ranked topic/s were:i. Promotion and advocacy: support training for health professionals (median 85, IQR 24).ii. Education and training: incorporating behaviour change into OAMPs (80, 16), advanced OA skills (80, 30), and integration of OA education into clinical training (80, 36).iii. Improving OAMPs delivery: regular updates on changes to best-evidence OA care (84, 24).iv. Future research: improve uptake of exercise, physical activity, and weight-loss (89, 16).v. Enhancing relationships, alliances, and shared knowledge: promote research collaborations (81, 30), share challenges and opportunities for OAMP implementation (80, 23). Conclusions These topics will set the JEI's research and collaboration agenda for the next 5 years and stimulate ideas for others working in the field.
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Affiliation(s)
- Jocelyn L. Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Kathryn Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Kelli Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Durham Department of Veterans Affairs Health Care System, USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - K. Dziedzic
- Impact Accelerator Unit, School of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nina Martinez
- Department of Research and Development, Osteoarthritis Foundation International, Barcelona, Spain
| | - Jonathan G. Quicke
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Bryan Tan Yijia
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - Josep Verges
- President of the Osteoarthritis Foundation International, Barcelona, Spain
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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Yeo JY, Lim CJ, Tan BY. Adaptation and validation of the chronic illness-related shame scale among patients with knee osteoarthritis in Singapore. BMC Musculoskelet Disord 2023; 24:633. [PMID: 37542211 PMCID: PMC10401795 DOI: 10.1186/s12891-023-06707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/07/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is one of the most common and disabling conditions worldwide. A neglected aspect of knee OA is its psychosocial impact, such as shame. However, assessment tools to measure shame among patients diagnosed with knee OA are lacking. In this study, the psychometric properties of the Chronic Illness-related Shame Scale (CISS) were evaluated among knee OA patients in Singapore. METHODS Adaptations were made to CISS for use among the knee OA population. An exploratory factor analysis (EFA) was performed to analyze the factor structure. Cronbach's Alpha and corrected item-total correlations were used to evaluate the internal consistency. Spearman correlation coefficient was used to test the correlation between CISS and Patient Health Questionnaire-4 (PHQ-4) to determine the validity of the instrument. RESULTS The EFA yielded a one-factor structure, with an eigenvalue of 4.78 explaining 68.25% of variance. Cronbach Alpha was 0.92, which indicated good internal consistency. The Spearman correlation revealed a significant correlation between CISS and PHQ-4. CONCLUSIONS The adapted CISS is a valid and reliable instrument to measure shame for knee OA patients. Both research and clinical settings can benefit from the use of the adapted CISS for assessing shame among knee OA patients.
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Affiliation(s)
- Jia Ying Yeo
- Department of Rehabilitation Services, Yishun Health, National Healthcare Group, 90 Yishun Central, 768828, Singapore
| | - Chien Joo Lim
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, 2 Yishun Central 2, 768024, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, 11 Jalan Tan Tock Seng, 308433, Singapore.
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Jain R. CORR Insights®: A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population. Clin Orthop Relat Res 2023; 481:885-886. [PMID: 36652691 PMCID: PMC10097574 DOI: 10.1097/corr.0000000000002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Rina Jain
- Orthopedic Surgeon, Orthopedic Medical Group of San Diego, San Diego, CA, USA
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Albornoz-Cabello M, Ibáñez-Vera AJ, Barrios-Quinta CJ, Lara-Palomo IC, Cardero-Durán MDLÁ, Espejo-Antúnez L. Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12062348. [PMID: 36983348 PMCID: PMC10051503 DOI: 10.3390/jcm12062348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.
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Affiliation(s)
| | | | | | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
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Tan BY, Goh ZZS, Lim CJ, Pereira MJ, Yang SY, Tan KG, Tan ACK, Liang P, Abbott JH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, Car J. Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study. BMC Musculoskelet Disord 2023; 24:104. [PMID: 36750930 PMCID: PMC9903549 DOI: 10.1186/s12891-023-06207-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and healthcare utilization in patients with knee OA. Secondary aims are to explore the mediation and directional relationships and the role it plays in predicting the discordance between self-reported measures (SRM), physical-performance measures (PPMs) and objective clinical parameters. METHODS A multi-centre prospective cohort study of community ambulant knee OA patients seeking treatment in the tertiary healthcare institutions in Singapore will be conducted. Patients with secondary arthritis, significant cognitive impairment, severe medical comorbidities or previous knee arthroplasty will be excluded. Primary clinical outcome measure is the Knee injury and OA Outcome Score-12 (KOOS-12). Baseline characteristics include sociodemographic status, arthritis status including symptom duration and radiographic severity, comorbidities and functional status through Charlson Comorbidities Index (CCI), Barthel Index (BI) and Parker Mobility Score (PMS). Psychosocial variables include social support, kinesiophobia, negative affect, self-efficacy, injustice, chronic illness shame and the built environment. Clinical outcomes include quality of life, physical performance, global assessment, satisfaction and physical activity levels. Productivity and healthcare utilization will be assessed by a modified OA Cost and Consequences Questionnaire (OCC-Q) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Variables will be collected at baseline, 4, 12 months and yearly thereafter. Regression, mediation and structural equation modelling will be used for analysis. DISCUSSION Results will allow contextualization, identification, and phenotyping of the critical (and potentially modifiable) psychosocial parameters that predict positive clinical outcomes in the OA population to guide optimization and refinement of healthcare and community. This will facilitate: 1. identification of high-risk knee OA subpopulations that will likely experience poor outcomes and 2. formulation of targeted multidisciplinary comprehensive approaches to address these psychosocial factors to optimize non-surgical treatment care, maximize functional outcomes and create more value-based care model for knee OA. ETHICS AND DISSEMINATION The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore.
| | | | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore
| | - Michelle Jessica Pereira
- grid.466910.c0000 0004 0451 6215Health Services Outcome Research, National Healthcare Group, Singapore, Singapore
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, Singapore, Singapore
| | - Kelvin Guoping Tan
- grid.240988.f0000 0001 0298 8161Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alvin Chin Kwong Tan
- grid.415203.10000 0004 0451 6370Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Phyllis Liang
- grid.59025.3b0000 0001 2224 0361Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - J. Haxby Abbott
- grid.29980.3a0000 0004 1936 7830Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew M. Briggs
- grid.1032.00000 0004 0375 4078Faculty of Health Sciences, Curtin School of Allied Health and Curtin enAble Institute, Curtin University, Perth, WA Australia
| | - David J. Hunter
- grid.412703.30000 0004 0587 9093Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Soren T. Skou
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julian Thumboo
- grid.163555.10000 0000 9486 5048Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Josip Car
- grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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