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Surmacz K, Ribeiro-Castro AL, Anderson MB, Van Andel D, Redfern RE, Duwelius PJ. A Retrospective Study on the Feasibility of Using Low-burden Patient-reported Pain Scores to Track Recovery and Outcomes After Total Joint Replacement. Arthroplast Today 2024; 26:101297. [PMID: 38352707 PMCID: PMC10862395 DOI: 10.1016/j.artd.2023.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/27/2023] [Accepted: 11/05/2023] [Indexed: 02/16/2024] Open
Abstract
Background Patients undergo total joint arthroplasty to improve function and resolve pain. Patient-reported outcome measures (PROMs) are often sought to determine the success of total joint arthroplasty but are time-consuming and patient response rates are often low. This study sought to determine whether pain numeric rating scores (NRSs) were associated with PROMs and objective mobility outcomes. Methods This is a retrospective review of data in patients who utilized a smartphone-based care management application prior to and following total joint arthroplasty. NRS, Hip Disability and Osteoarthritis Outcome Score, Joint Replacement and Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and objective mobility data (step counts, gait speed, and gait asymmetry) were collected preoperatively and at 30 and 90 days postoperatively. Quantile regression was performed to evaluate the correlations between NRS and PROMs. Results Total knee arthroplasty patients reported higher NRS than total hip arthroplasty patients postoperatively. NRS was significantly correlated with gait speed preoperatively and at 30 and 90 days postoperatively on quantile regression. Gait asymmetry was significantly associated with NRS at 30 days postoperatively. Regression results suggested significant correlations between NRS and PROMs scores; Hip Disability and Osteoarthritis Outcome Score, Joint Replacement, -0.46 (95% confidence interval: -0.48 to -0.44, P < .001) and Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, -0.38 (95% confidence interval: -0.40 to -0.36, P < .001). Conclusions NRS is correlated with both objective and subjective measures of function in patients undergoing arthroplasty. Simple pain ratings may be a valid measurement to help predict functional outcomes when collection of traditional PROMs is not feasible.
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Affiliation(s)
- Karl Surmacz
- Technology and Data Solutions, Zimmer Biomet, London, UK
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Fary C, Cholewa J, Abshagen S, Van Andel D, Ren A, Anderson MB, Tripuraneni K. Stepping Beyond Counts in Recovery of Total Hip Arthroplasty: A Prospective Study on Passively Collected Gait Metrics. SENSORS (BASEL, SWITZERLAND) 2023; 23:6538. [PMID: 37514832 PMCID: PMC10383890 DOI: 10.3390/s23146538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but are time-intensive and previously could only be performed in a lab. Smartphone sensor data and algorithmic advances presently allow for the passive collection of qualitative gait metrics. The purpose of this prospective study was to observe the recovery of physical function following THA by assessing passively collected pre- and post-operative gait quality metrics. This was a multicenter, prospective cohort study. From six weeks pre-operative through to a minimum 24 weeks post-operative, 612 patients used a digital care management application that collected gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-sample t-test. Recovery was defined as the post-operative week when the respective gait metric was no longer statistically inferior to the pre-operative value. To control for multiple comparison error, significance was set at p < 0.002. Walking speeds and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-post-operative (p < 0.001). Walking speed (1.00 ± 0.14 m/s, p = 0.04), step length (0.58 ± 0.06 m/s, p = 0.02), asymmetry (14.5 ± 19.4%, p = 0.046), and double support percentage (31.6 ± 1.5%, p = 0.0089) recovered at 9, 8, 7, and 10 weeks post-operative, respectively. Walking speed, step length, asymmetry, and double support all recovered beyond pre-operative values at 13, 17, 10, and 18 weeks, respectively (p < 0.002). Functional recovery following THA can be measured via passively collected gait quality metrics using a digital care management platform. The data suggest that metrics of gait quality are most negatively affected two weeks post-operative; recovery to pre-operative levels occurs at approximately 10 weeks following primary THA, and follows a slower trajectory compared to previously reported step count recovery trajectories.
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Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, VIC 3011, Australia
| | | | | | | | - Anna Ren
- Zimmer Biomet, Warsaw, IN 46580, USA
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Fary C, Cholewa J, Abshagen S, Van Andel D, Ren A, Anderson MB, Tripuraneni KR. Stepping beyond Counts in Recovery of Total Knee Arthroplasty: A Prospective Study on Passively Collected Gait Metrics. SENSORS (BASEL, SWITZERLAND) 2023; 23:5588. [PMID: 37420754 DOI: 10.3390/s23125588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023]
Abstract
Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m/s, p = 0.063) and double support percentage recovered at week 24 (32%, p = 0.089). Asymmetry percentage was recovered at 13 weeks (14.0%, p = 0.23) and was consistently superior to pre-operative values at week 19 (11.1% vs. 12.5%, p < 0.001). Step length did not recover during the 24-week period (0.60 m vs. 0.59 m, p = 0.004); however, this difference is not likely clinically relevant. The data suggests that gait quality metrics are most negatively affected two weeks post-operatively, recover within the first 24-weeks following TKA, and follow a slower trajectory compared to previously reported step count recoveries. The ability to capture new objective measures of recovery is evident. As more gait quality data is accrued, physicians may be able to use passively collected gait quality data to help direct post-operative recovery using sensor-based care pathways.
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Affiliation(s)
- Cam Fary
- Epworth Foundation, Richmond 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne 3011, Australia
| | | | | | | | - Anna Ren
- Zimmer Biomet, Warsaw, IN 46580, USA
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King SW, Eltayeb M, van Duren BH, Jain S, Kerry J, Pandit HG, Palan J. “Wearable Sensors to Guide Remote Rehabilitation Following Knee Arthroplasty Surgery”. Indian J Orthop 2022; 57:624-634. [PMID: 37128555 PMCID: PMC10147850 DOI: 10.1007/s43465-022-00785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Background Total knee arthroplasty requires effective rehabilitation to achieve optimal results, but institutions often rely on unsupervised home exercises due to cost constraints. Wearable sensors have become increasingly popular as a potential method of monitoring patients remotely to ensure efficacy and compliance. This review assesses the current evidence for their use in remotely monitored rehabilitation following knee arthroplasty. Methods A systematic review of the literature from 1st January 2000 to 17th February 2022 was undertaken. Devices were categorised as joint-specific or physical activity sensors. Studies were classified as those providing remotely supervised rehabilitation as an additional or as an alternative intervention. Results Remotely supervised rehabilitation using wearable sensors demonstrated similar outcomes when provided as an alternative to standard care in most studies. One group found improved outcomes for knee-specific sensors compared with standard care. There were improved physical activity and healthcare resource use outcomes described in the literature where sensors were used in addition to standard care. Discussion This review found evidence for the use of wearable sensors in remotely supervised rehabilitation following knee arthroplasty surgery. This included methodological heterogeneity, differing definitions of standard care, and variable follow-up periods. Robust randomised control trial data with a longer follow-up period are needed.
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Affiliation(s)
- Samuel W. King
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Momin Eltayeb
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Bernard H. van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Sameer Jain
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Joel Kerry
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Hemant G. Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Jeya Palan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
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van Wissen MAT, Berger MAM, Schoones JW, Gademan MGJ, van den Ende CHM, Vliet Vlieland TPM, van Weely SFE. Reporting quality of interventions using a wearable activity tracker to improve physical activity in patients with inflammatory arthritis or osteoarthritis: a systematic review. Rheumatol Int 2022; 43:803-824. [PMID: 36454326 PMCID: PMC10073167 DOI: 10.1007/s00296-022-05241-x] [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: 09/19/2022] [Accepted: 10/23/2022] [Indexed: 12/03/2022]
Abstract
AbstractTo assess the reporting quality of interventions aiming at promoting physical activity (PA) using a wearable activity tracker (WAT) in patients with inflammatory arthritis (IA) or hip/knee osteoarthritis (OA). A systematic search was performed in eight databases (including PubMed, Embase and Cochrane Library) for studies published between 2000 and 2022. Two reviewers independently selected studies and extracted data on study characteristics and the reporting of the PA intervention using a WAT using the Consensus on Exercise Reporting Template (CERT) (12 items) and Consolidated Standards of Reporting Trials (CONSORT) E-Health checklist (16 items). The reporting quality of each study was expressed as a percentage of reported items of the total CERT and CONSORT E-Health (50% or less = poor; 51–79% = moderate; and 80–100% = good reporting quality). Sixteen studies were included; three involved patients with IA and 13 with OA. Reporting quality was poor in 6/16 studies and moderate in 10/16 studies, according to the CERT and poor in 8/16 and moderate in 8/16 studies following the CONSORT E-Health checklist. Poorly reported checklist items included: the description of decision rule(s) for determining progression and the starting level, the number of adverse events and how adherence or fidelity was assessed. In clinical trials on PA interventions using a WAT in patients with IA or OA, the reporting quality of delivery process is moderate to poor. The poor reporting quality of the progression and tailoring of the PA programs makes replication difficult. Improvements in reporting quality are necessary.
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Affiliation(s)
- M A T van Wissen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - M A M Berger
- The Hague University of Applied Sciences, The Hague, The Netherlands
| | - J W Schoones
- Directorate of Research Policy (Walaeus Library), Leiden, The Netherlands
| | - M G J Gademan
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - C H M van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - S F E van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Östlind E, Ekvall Hansson E, Eek F, Stigmar K. Experiences of activity monitoring and perceptions of digital support among working individuals with hip and knee osteoarthritis - a focus group study. BMC Public Health 2022; 22:1641. [PMID: 36042425 PMCID: PMC9426251 DOI: 10.1186/s12889-022-14065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Mobile health (mHealth), wearable activity trackers (WATs) and other digital solutions could support physical activity (PA) in individuals with hip and knee osteoarthritis (OA), but little is described regarding experiences and perceptions of digital support and the use of WAT to self-monitor PA. Thus, the aim of this study was to explore the experiences of using a WAT to monitor PA and the general perceptions of mHealth and digital support in OA care among individuals of working age with hip and knee OA. Methods We conducted a focus group study where individuals with hip and knee OA (n = 18) were recruited from the intervention group in a cluster-randomized controlled trial (C-RCT). The intervention in the C-RCT comprised of 12-weeks use of a WAT with a mobile application to monitor PA in addition to participating in a supported OA self-management program. In this study, three focus group discussions were conducted. The discussions were transcribed and qualitative content analysis with an inductive approach was applied. Results The analysis resulted in two main categories: A WAT may aid in optimization of PA, but is not a panacea with subcategories WATs facilitate PA; Increased awareness of one’s limitations and WATs are not always encouraging, and the second main category was Digital support is an appreciated part of OA care with subcategories Individualized, early and continuous support; PT is essential but needs to be modernized and Easy, comprehensive, and reliable digital support. Conclusion WATs may facilitate PA but also aid individuals with OA to find the optimal level of activity to avoid increased pain. Digital support in OA care was appreciated, particularly as a part of traditional care with physical visits. The participants expressed that the digital support should be easy, comprehensive, early, and continuous. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14065-0.
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Affiliation(s)
- Elin Östlind
- Department of Health Sciences, Lund University, Lund, Sweden. .,Dalby Health Care Center, Region Skåne, Sweden.
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
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Bieler T, Magnusson SP, Siersma V, Rinaldo M, Schmiegelow MT, Beck T, Krifa AM, Kjær BH, Palm H, Midtgaard J. Effectiveness of promotion and support for physical activity maintenance post total hip arthroplasty-study protocol for a pragmatic, assessor-blinded, randomized controlled trial (the PANORAMA trial). Trials 2022; 23:647. [PMID: 35964101 PMCID: PMC9375375 DOI: 10.1186/s13063-022-06610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Total hip arthroplasty is considered an efficacious procedure for relieving pain and disability, but despite that objectively measured physical activity level remains unchanged compared to pre-surgery and is still considerably lower than that of a healthy age- and sex-matched population 6–12 months post-surgery. Since there is a graded relationship between physical activity level and functional performance, increasing physical activity may enhance the outcome of the procedure. This study aims to investigate whether promotion and support of physical activity initiated 3 months after total hip arthroplasty complementary to usual rehabilitation care can increase objective measured physical activity 6 months post-surgery. Methods The trial is designed as a pragmatic, parallel group, two-arm, assessor-blinded, superiority, randomized (1:1), controlled trial with post intervention follow-up 6 and 12 months after total hip arthroplasty. Home-dwelling, independent, and self-reliant patients with hip osteoarthritis are provisionally enrolled prior to surgery and re-screened about 2–3 months post-surgery to confirm eligibility. Baseline assessment is conducted 3 months post-surgery. Subsequently, patients (n=200) are randomized to either a 3-month, multimodal physical activity promotion/education intervention or control (no further attention). The intervention consists of face-to-face and telephone counselling, patient education material, pedometer, and step-counting journal. The primary outcome is objectively measured physical activity, specifically the proportion of patients that complete on average ≥8000 steps per day 6 months post-surgery. Secondary outcomes include core outcomes (i.e., physical function, pain, and patient global assessment) and health-related quality of life. Furthermore, we will explore the effect of the intervention on self-efficacy and outcome expectations (i.e., tertiary outcomes). Discussion By investigating the effectiveness of a pedometer-driven, face-to-face, and telephone-assisted counselling, behavior change intervention in complementary to usual rehabilitation, we hope to deliver applicable and generalizable knowledge to support physical activity after total hip arthroplasty and potentially enhance the outcome of the procedure. Trial registration www.clinicaltrials.govNCT04471532. Registered on July 15, 2020.
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Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.,Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 8, Building 8, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, building 24, entrance R, 1353, Copenhagen K, Denmark
| | - Mie Rinaldo
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Morten Torrild Schmiegelow
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Torben Beck
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | | | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Nordstjernevej 41, 2600, Glostrup, Denmark
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Mooiweer Y, Stevens M, van den Akker-Scheek I. Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior. Eur Rev Aging Phys Act 2022; 19:7. [PMID: 35227191 PMCID: PMC8903715 DOI: 10.1186/s11556-022-00285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/01/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives Regular physical activity (PA) is considered important after total hip and knee arthroplasty (THA/TKA). Objective was to systematically assess literature on recommendations given by healthcare professionals to persons after THA and TKA and to provide an overview of existing interventions to stimulate PA and sports participation. Methods A systematic review with a narrative synthesis including articles published between January 1995 and January 2021 reporting on recommendations and interventions. The PubMed, Embase, CINAHL and PsycInfo databases were systematically searched for original articles reporting on physical activity and sports recommendations given by healthcare professionals to persons after THA and TKA, and articles reporting on interventions/programs to stimulate a physically active lifestyle after rehabilitation or explicitly defined as part of the rehabilitation. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The review was registered in Prospero (PROSPERO:CRD42020178556). Results Twenty-one articles reported on recommendations. Low-impact activities were allowed. Contact sports, most ball sports, and martial arts were not recommended. One study informed on whether health-enhancing PA recommendations were used to stimulate persons to become physically active. No studies included recommendations on sedentary behavior. Eleven studies reported on interventions. Interventions used guidance from a coach/physiotherapist; feedback on PA behavior from technology; and face-to-face, education, goal-setting, financial incentives and coaching/financial incentives combined, of which feedback and education seem to be most effective. For methodological quality, 18 out of 21 (86%) articles about recommendations and 7 out of 11 (64%) articles about interventions scored yes on more than half of the MMAT questions (0–5 score). Conclusion There is general agreement on what kind of sports activities can be recommended by healthcare professionals like orthopedic surgeons and physiotherapists. No attention is given to amount of PA. The same is true for limiting sedentary behavior. The number of interventions is limited and diverse, so no conclusions can be drawn. Interventions including provision of feedback about PA, seem to be effective and feasible. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00285-1.
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Affiliation(s)
- Yvet Mooiweer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands.
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
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Effects of physical activity interventions using wearables to improve objectively-measured and patient-reported outcomes in adults following orthopaedic surgical procedures: A systematic review. PLoS One 2022; 17:e0263562. [PMID: 35167599 PMCID: PMC8846530 DOI: 10.1371/journal.pone.0263562] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/24/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To synthesize evidence on physical activity interventions that used wearables, either alone or in combination with education or rehabilitation, in adults following orthopaedic surgical procedures. METHODS PubMed, CINAHL, PsycINFO and EMBASE were searched for randomized controlled trials of wearable-based interventions from each database's inception to August 2021 in patients undergoing orthopaedic surgery. Relevant outcomes included physical activity, physical function, pain, psychological distress, or general health. PEDro scale scoring ranges from 0 to 10 and was used to appraise studies as high (≥7), moderate (5-6), or poor (<5) quality. RESULTS Of 335 articles identified, 6 articles met eligibility criteria. PEDro scores ranged from 2 to 6, with 3 studies of moderate quality and 3 of poor quality. Studies included patients undergoing total knee (number; n = 4) or total knee or hip (n = 1) arthroplasty and lumbar disc herniation surgery (n = 1). In addition to wearables, intervention components included step diary (n = 2), motivational interviewing (n = 1), goal setting (n = 2), tailored exercise program (n = 2), or financial incentives (n = 1). Interventions were delivered in-person (n = 2), remotely (n = 3) or in a hybrid format (n = 1). Intervention duration ranged from 6 weeks to 6 months. Compared to controls, 3 moderate quality studies reported greater improvement in steps/day; however, 1 moderate and 2 poor quality studies showed no between-group difference in physical function, pain, or quality of life. No serious adverse events related to the use of wearable were reported. CONCLUSIONS The effects of physical activity interventions using wearables, either delivered in-person or remotely, appear promising for increasing steps per day after joint arthroplasty; however, this finding should be viewed with caution since it is based on 3 moderate quality studies. Further research is needed to determine the therapeutic effects of using wearables as an intervention component in patients undergoing other orthopaedic surgical procedures. TRIAL REGISTRATION PROSPERO Registration Number: CRD42020186103.
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Objectively Measured Physical Activity, Sedentary Behavior and Functional Performance before and after Lower Limb Joint Arthroplasty: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10245885. [PMID: 34945181 PMCID: PMC8709318 DOI: 10.3390/jcm10245885] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022] Open
Abstract
Patients after joint arthroplasty tend to be less physically active; however, studies measuring objective physical activity (PA) and sedentary behavior (SB) in these patients provide conflicting results. The aim of this meta-analysis was to assess objectively measured PA, SB and performance at periods up to and greater than 12 months after lower limb arthroplasty. Two electronic databases (PubMed and Medline) were searched to identify prospective and cross-sectional studies from 1 January 2000 to 31 December 2020. Studies including objectively measured SB, PA or specific performance tests in patients with knee or hip arthroplasty, were included in the analyses both pre- and post-operatively. The risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). After identification and exclusion, 35 studies were included. The data were analyzed using the inverse variance method with the random effects model and expressed as standardized mean difference and corresponding 95% confidence intervals. In total, we assessed 1943 subjects with a mean age of 64.9 (±5.85). Less than 3 months post-operative, studies showed no differences in PA, SB and performance. At 3 months post-operation, there was a significant increase in the 6 min walk test (6MWT) (SMD 0.65; CI: 0.48, 0.82). After 6 months, changes in moderate to vigorous physical activity (MVPA) (SMD 0.33; CI: 0.20, 0.46) and the number of steps (SMD 0.45; CI: 0.34, 0.54) with a large decrease in the timed-up-and-go test (SMD −0.61; CI: −0.94, −0.28) and increase in the 6MWT (SMD 0.62; CI: 0.26–0.98) were observed. Finally, a large increase in MVPA (SMD 0.70; CI: 0.53–0.87) and a moderate increase in step count (SMD 0.52; CI: 0.36, 0.69) were observed after 12 months. The comparison between patients and healthy individuals pre-operatively showed a very large difference in the number of steps (SMD −1.02; CI: −1.42, −0.62), but not at 12 months (SMD −0.75; −1.89, 0.38). Three to six months after knee or hip arthroplasty, functional performance already exceeded pre-operative levels, yet PA levels from this time period remained the same. Although PA and functional performance seemed to fully restore and exceed the pre-operation levels at six to nine months, SB did not. Moreover, PA remained lower compared to healthy individuals even longer than twelve months post-operation. Novel rehabilitation protocols and studies should focus on the effects of long-term behavioral changes (increasing PA and reducing SB) as soon as functional performance is restored.
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A Brief Intervention of Physical Activity Education and Counseling in Community Rehabilitation: A Feasibility Randomized Controlled Trial. J Aging Phys Act 2021; 30:753-760. [PMID: 34853185 DOI: 10.1123/japa.2021-0256] [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: 06/30/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
This study aimed to assess the feasibility of delivering a brief physical activity (PA) intervention to community rehabilitation clients. Participants were randomized to receive one session of stage-of-change-based PA education and counseling in addition to written educational material, or education material alone. Outcomes were measured at baseline and 3 months; the primary outcome was feasibility, measured by the percentage of those who were eligible, consented, randomized, and followed-up. A total of 123 individuals were both eligible and interested in participating, 32% of those screened on admission to the program. Forty participants consented, and 35 were randomized, with mean age 72 years (SD = 12.2). At baseline, 66% had recently commenced or intended to begin regular PA in the next 6 months. A total of 30 participants were followed-up. It is feasible to deliver education and counseling designed to support the long-term adoption of regular PA to community rehabilitation clients. Further refinement of the protocol is warranted (ACTRN12617000519358).
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Master H, Castillo R, Wegener ST, Pennings JS, Coronado RA, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Archer KR. Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery. BMC Musculoskelet Disord 2021; 22:883. [PMID: 34663295 PMCID: PMC8522146 DOI: 10.1186/s12891-021-04622-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Methods We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes. Results The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator. Conclusions The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04622-w.
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Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renan Castillo
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine M Haug
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Bakaa N, Chen LH, Carlesso L, Richardson J, Macedo L. Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 2021; 22:602. [PMID: 34193139 PMCID: PMC8247251 DOI: 10.1186/s12891-021-04460-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). Pre-registration OSF:https://osf.io/9ku8a/ Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04460-w.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
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Master H, Pennings JS, Coronado RA, Bley J, Robinette PE, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Wegener ST, Archer KR. How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery? Arch Phys Med Rehabil 2021; 102:1873-1879. [PMID: 34175276 DOI: 10.1016/j.apmr.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether early postoperative walking is associated with "best outcome" and no opioid use at 1 year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice. DESIGN Secondary analysis from randomized controlled trial. SETTING Two academic medical centers in the United States. PARTICIPANTS We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition (N=248). A total of 212 participants (mean age, 62.8±11.4y, 53.3% female) had valid walking data at baseline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Disability (Oswestry Disability Index), back and leg pain (Brief Pain Inventory), and opioid use (yes vs no) were assessed at baseline and 1 year after surgery. "Best outcome" was defined as Oswestry Disability Index ≤20, back pain ≤2, and leg pain ≤2. Steps/day (walking) was assessed with an accelerometer worn for at least 3 days and 10 h/d at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and "best outcome" and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes. RESULTS Each additional 1000 steps/d at 6 weeks after spine surgery was associated with 41% higher odds of achieving "best outcome" (95% confidence interval [CI], 1.15-1.74) and 38% higher odds of no opioid use (95% CI, 1.09-1.76) at 1 year. Walking ≥3500 steps/d was associated with 3.75 times the odds (95% CI, 1.56-9.02) of achieving "best outcome" and 2.37 times the odds (95% CI, 1.07-5.24) of not using opioids. CONCLUSIONS Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/d threshold may serve as an initial recommendation during early postoperative counseling.
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Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jordan Bley
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Payton E Robinette
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Christine M Haug
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN.
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Östlind E, Sant'Anna A, Eek F, Stigmar K, Ekvall Hansson E. Physical activity patterns, adherence to using a wearable activity tracker during a 12-week period and correlation between self-reported function and physical activity in working age individuals with hip and/or knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:450. [PMID: 33992121 PMCID: PMC8126142 DOI: 10.1186/s12891-021-04338-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/06/2021] [Indexed: 04/16/2023] Open
Abstract
Background A majority of individuals with osteoarthritis (OA) are insufficiently physically active. Self-monitoring with wearable activity trackers (WAT) could promote physical activity (PA), and increased knowledge of PA patterns and adherence to using a WAT is needed. The aim of this study was to describe PA patterns and adherence to WAT-use during an intervention among participants of working age with hip and/or knee OA. The study further explores the correlation between self-reported joint function and PA. Methods Individuals of working age with hip and/or knee OA who used a WAT, Fitbit Flex 2, for 12 weeks were included. Participants monitored their PA in the Fitbit-app. An activity goal of 7,000 steps/day was set. Steps and minutes in light (L), moderate and vigorous (MV) PA were collected from the Fitbit. Self-reported joint function (HOOS/KOOS) was completed. Data was analyzed with linear mixed models and Spearman’s rank correlation. Results Seventy-five participants (45–66 years) walked on average 10 593 (SD 3431) steps/day, spent 248.5 (SD 42.2) minutes in LPA/day, 48.1 (SD 35.5) minutes in MVPA/day, 336.0 (SD 249.9) minutes in MVPA/week and used the Fitbit for an average of 88.4 % (SD 11.6) of the 12-week period. 86.7 % took > 7,000 steps/day and 77.3 % spent > 150 min in MVPA/week. Mean daily steps/week decreased significantly over the 12 weeks (β-coefficient − 117, 95 % CI -166 to -68, p = < 0.001) as well as mean daily minutes in LPA/week (β-coefficient − 2.3, 95 % CI -3.3 to -1.4, p = < 0.001), mean daily minutes in MVPA/week (β-coefficient − 0.58, 95 % CI -1.01 to -0.16, p = 0.008) and mean adherence to Fitbit-use per week (β-coefficient − 1.3, 95 % CI -1.8 to -0.8, p = < 0.001). There were no significant correlations between function (HOOS/KOOS) and PA. Conclusions The majority of participants reached 7,000 steps/day and the recommended 150 min in MVPA per week. However, PA decreased slightly but gradually over time. Adherence to using the Fitbit was high but also decreased during the intervention. Understanding PA patterns and the use of a Fitbit to promote PA could be beneficial in tailoring interventions for individuals with hip and/or knee OA.
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Affiliation(s)
- Elin Östlind
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden. .,Dalby healthcare center, Region Skåne, Lund, Sweden.
| | | | - Frida Eek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
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Miller MJ, Pak SS, Keller DR, Barnes DE. Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic. Phys Ther 2020; 101:5930367. [PMID: 33284318 PMCID: PMC7665714 DOI: 10.1093/ptj/pzaa193] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective was to evaluate implementation of telehealth physical therapy in response to COVID-19 and identify implementation strategies to maintain and scale up telehealth physical therapy within a large urban academic medical center. METHODS The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework was used to evaluate telehealth physical therapy implementation. Patient-level data were extracted from electronic medical records between March 16, 2020, and May 16, 2020 (implementation phase). Reach was defined as the proportion of physical therapy sessions completed via telehealth. Effectiveness was assessed using a patient-reported satisfaction survey with a 5-point Likert scale. Adoption was defined as the proportion of physical therapists who used telehealth. Implementation was assessed through qualitative analysis of patient and clinician perspectives to identify emergent themes, retrospectively classify strategies used during the implementation phase, and prospectively identify evidence-based strategies to increase telehealth maintenance and scale-up. Maintenance of telehealth was defined as the proportion of patients who indicated they would attend another telehealth session. RESULTS There were 4548 physical therapy sessions provided by 40 therapists from March 22, 2020, to May 16, 2020, of which 3883 (85%) were telehealth. Ninety-four percent of patients were satisfied. All physical therapists (100%) used telehealth technology at least once. Retrospectively classified and prospectively identified evidence-based strategies were organized into 5 qualitative themes that supported implementation: organizational factors (policies, preexisting partnerships), engaging external stakeholders (satisfaction survey), champions (clinician leaders), clinician education (dynamic, ongoing training), and process (promote adaptability, small tests of change). Ninety-two percent of patients reported they would attend another telehealth session. CONCLUSION Findings from this study suggest that implementation of telehealth physical therapy during the COVID-19 pandemic was feasible and acceptable in this setting. IMPACT These results can be used to guide future health policy, quality improvement, and implementation science initiatives to expand the use and study of telehealth for physical therapy.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, and Division of Geriatrics, University of California, San Francisco, 1500 Owens Street, Box 0736, San Francisco, CA 94158, USA,Address all correspondence to Dr Miller at:
| | - Sang S Pak
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Daniel R Keller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral Sciences, and Department of Epidemiology and Biostatistics, University of California, San Francisco; and San Francisco VA Health Care System, San Francisco, California, USA
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Ringeval M, Wagner G, Denford J, Paré G, Kitsiou S. Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e23954. [PMID: 33044175 PMCID: PMC7589007 DOI: 10.2196/23954] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status. OBJECTIVE The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes. METHODS A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components. RESULTS Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95% CI 475.89-1425.18; P<.001) and moderate-to-vigorous physical activity (MD 6.16, 95% CI 2.80-9.51; P<.001), a significant decrease in weight (MD -1.48, 95% CI -2.81 to -0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD -10.62, 95% CI -35.50 to 14.27; P=.40 and standardized MD -0.11, 95% CI -0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component. CONCLUSIONS The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019145450; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145450.
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Affiliation(s)
- Mickael Ringeval
- École des Sciences de la Gestion, Université du Québec à Montréal, Montreal, QC, Canada
| | - Gerit Wagner
- Research Chair in Digital Health, HEC Montreal, Montreal, QC, Canada
| | - James Denford
- Department of Management, Faculty of Social Sciences and Humanities, Royal Military College of Canada, Kingston, ON, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montreal, Montreal, QC, Canada
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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Elmagboul N, Coburn BW, Foster J, Mudano A, Melnick J, Bergman D, Yang S, Chen L, Filby C, Mikuls TR, Curtis JR, Saag K. Physical activity measured using wearable activity tracking devices associated with gout flares. Arthritis Res Ther 2020; 22:181. [PMID: 32746893 PMCID: PMC7398057 DOI: 10.1186/s13075-020-02272-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/20/2020] [Indexed: 02/09/2023] Open
Abstract
Objective To determine the feasibility and validity of using wearable activity trackers to test associations between gout flares with physical activity and sleep. Methods Participants with physician-diagnosed gout, hyperuricemia (≥ 6.8 mg/dl), current smartphone use, and ≥ 2 self-reported flares in the previous 6 months were enrolled. Physical activity, heart rate, and sleep data were obtained from wearable activity trackers (Fitbit Charge HR2). Daily compliance was defined by the availability of sufficiently complete activity data at least 80% of the day. Associations of weekly gout flares with sleep and activity were measured by comparing flare-related values to average sleep and steps per day. We used mixed linear models to account for repeated observations. Results Forty-four participants enrolled; 33 met the criteria for minimal wear time and flare reporting, with activity tracker data available for 60.5% of all total study days. Mean ± SD age was 48.8 ± 14.9 years; 85% were men; 15% were black; 88% were on allopurinol or febuxostat, and 30% reported ≥ 6 flares in the prior 6 months. Activity trackers captured 204 (38%) person-weeks with flares and 340 (62%) person-weeks without flares. Mean ± SD daily step count was significantly lower (p < 0.0001) during weeks with gout flares (5900 ± 4071) than during non-flare periods (6972 ± 5214); sleep however did not differ. Conclusion The pattern of wear in this study illustrates reasonable feasibility of using such devices in future arthritis research. The use of these devices to passively measure changes in physical activity patterns may provide an estimate of gout flare occurrence and duration. Trial registration NCT, NCT02855437. Registered 4 August 2016
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Affiliation(s)
- Nada Elmagboul
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Brian W Coburn
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jeffrey Foster
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Amy Mudano
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Joshua Melnick
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Debra Bergman
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Shuo Yang
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Lang Chen
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Cooper Filby
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Kenneth Saag
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Physical Activity Interventions After Hip or Knee Joint Replacement: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Ando S, Higuchi Y, Kitagawa T, Murakami T, Todo E. Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults. J Aging Phys Act 2020; 28:343-351. [PMID: 31722294 DOI: 10.1123/japa.2019-0099] [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: 03/22/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022]
Abstract
This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.
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21
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Coenen P, Hulsegge G, Daams JG, van Geenen RC, Kerkhoffs GM, van Tulder MW, Huirne JA, Anema JR, Kuijer PP. Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis. BMJ Open Sport Exerc Med 2020; 6:e000664. [PMID: 32341795 PMCID: PMC7173989 DOI: 10.1136/bmjsem-2019-000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Orthopaedic surgery is primarily aimed at improving function and pain reduction. Additional integrated care may enhance patient’s participation in sports and work, possibly improving performance of physical activities and quality of life (QoL). We aimed to assess the effectiveness of integrated care among orthopaedic surgery patients. Design Systematic review with meta-analysis. Data source Medline, EMBASE and CINAHL (until 17 June 2019). Eligibility for selecting studies We searched for controlled studies on integrated care interventions consisting of active referral to case managers, rehabilitation with participation-based goals and/or e/mHealth, with outcomes of sports and work participation, performance of physical activities and/or QoL. Outcomes were normalised to 0–100 scales and statistically pooled. Results Seventeen articles (n=2494) of moderate quality were included reporting on patients receiving back, upper limb, knee or hip surgery. Only one study reported on return to sports and found no significant benefit. For return to work, one study did (90% vs 82%) and one did not (relative risk=1.18 (0.80 to 1.70)) observe significant benefits. Integrated care showed small effects for improving performance of physical activities (2.69 (–0.20 to 5.58); eight studies, n=1267) and QoL (2.62 (1.16 to 5.05); nine studies, n=1158) compared with usual care. Summary/Conclusion We found insufficient and inconsistent evidence for the effectiveness of integrated care for orthopaedic surgery patients regarding sport and work participation. Small effects were found for performance of physical activities and QoL. High quality research on integrated care focusing on sports and work participation is needed before integrated care can be implemented for orthopaedic surgery patients.
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Affiliation(s)
- Pieter Coenen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Gerben Hulsegge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,The Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - Joost G Daams
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam, The Netherlands
| | - Rutger C van Geenen
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Gino M Kerkhoffs
- Amsterdam UMC, Academic Medical Center, Vrije Universiteit Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS) AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Amsterdam Movement Sciences research institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith A Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Paul Kuijer
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam Movement Sciences research institute, Amsterdam, The Netherlands
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22
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Christiansen MB, Thoma LM, Master H, Voinier D, Schmitt LA, Ziegler ML, LaValley MP, White DK. Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement. Arthritis Care Res (Hoboken) 2020; 72:661-668. [PMID: 30908867 DOI: 10.1002/acr.23882] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR). METHODS People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. RESULTS Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group. CONCLUSION A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.
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23
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Hoorntje A, Witjes S, Kuijer PPFM, Bussmann JBJ, Horemans HLD, Kerkhoffs GMMJ, van Geenen RCI, Koenraadt KLM. Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial. J Arthroplasty 2020; 35:706-711. [PMID: 31740103 DOI: 10.1016/j.arth.2019.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Especially in younger knee osteoarthritis patients, the ability to perform physical activity (PA) after knee arthroplasty (KA) is of paramount importance, given many patients' wish to return to work and perform demanding leisure time activities. Goal Attainment Scaling (GAS) rehabilitation after KA may improve PA because it uses individualized activity goals. Therefore, our aim was to objectively quantify PA changes after KA and to compare GAS-based rehabilitation to standard rehabilitation. METHODS Data were obtained from the randomized controlled ACTION trial, which compares standard rehabilitation with GAS-based rehabilitation after total and unicompartmental KA in patients <65 years of age. At 2 time points, preoperatively and 6 months postoperatively, 120 KA patients wore a validated 3-dimensional accelerometer for 1 consecutive week. Data were classified as sedentary (lying, sitting), standing, and active (walking, cycling, running). Repeated measures analysis of variance was used to compare PA changes over time. RESULTS Complete data were obtained for 97 patients (58% female), with a mean age of 58 years (±4.8). For the total group, we observed a significant increase in PA of 9 minutes (±37) per day (P = .01) and significant decrease in sedentary time of 20 minutes (±79) per day (P = .02). There was no difference in standing time (P = .11). There was no difference between the control group and the intervention group regarding changes in PA, nor between the total KA group and the unicompartmental KA group. CONCLUSION We found a small but significant increase in overall PA after KA, but no difference between GAS-based rehabilitation and standard rehabilitation. Likely, enhanced multidisciplinary perioperative strategies are needed to further improve PA after KA.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ICONE Orthopaedics and Sports Traumatology, Schijndel, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Herwin L D Horemans
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
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24
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Najm A, Gossec L, Weill C, Benoist D, Berenbaum F, Nikiphorou E. Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review. JMIR Mhealth Uhealth 2019; 7:e14730. [PMID: 31769758 PMCID: PMC6904900 DOI: 10.2196/14730] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. OBJECTIVE This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. METHODS A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. RESULTS Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. CONCLUSIONS The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients' willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory.
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Affiliation(s)
- Aurélie Najm
- Department of Rheumatology, Nantes University Hospital, Nantes, France.,INSERM UMR 1238, Nantes University of Medicine, Nantes, France
| | - Laure Gossec
- INSERM UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Rheumatology department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Catherine Weill
- Bibliothèque interuniversitaire de Santé, Paris Descartes University, Paris, France
| | - David Benoist
- Bibliothèque interuniversitaire de Santé, Paris Descartes University, Paris, France
| | - Francis Berenbaum
- Department of rheumatology, Sorbonne Université, INSERM CRSA Saint-Antoine, AP-HP, Saint Antoine Hospital, Paris, France
| | - Elena Nikiphorou
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, Paris, France
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25
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Hawke LJ, Shields N, Dowsey MM, Choong PFM, Taylor NF. Effectiveness of behavioural interventions on physical activity levels after hip or knee joint replacement: a systematic review. Disabil Rehabil 2019; 42:3573-3580. [PMID: 31067136 DOI: 10.1080/09638288.2019.1603328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To evaluate the effect of behavioural interventions on levels of physical activity after hip or knee joint replacement.Materials and methods: A systematic review with meta-analysis of randomised controlled trials to determine the effectiveness of behavioural interventions to increase physical activity levels after hip or knee joint replacement. Six databases were searched. Standardised mean differences (SMD) were calculated. The GRADE approach was used to evaluate the level of evidence of each meta-analysis.Results: From a yield of five trials, physical activity was quantified as active minutes per day, daily energy expenditure and daily steps. There was low to moderate-quality evidence from three meta-analyses with observed positive effects that could not conclude whether behavioural interventions increased physical activity in active minutes per day (SMD = 0.18, 95% CI -0.14, 0.51), daily energy expenditure (SMD = 0.31, 95% CI -0.24, 0.87) or daily steps (MD = 844.7, 95% CI -178.6, 1,868.0).Conclusions: The effectiveness of behavioural interventions to address the low levels of physical activity levels observed after hip or knee joint replacement remains uncertain.Implications for rehabilitationPhysical activity levels after hip or knee joint replacements fail to meet recommended daily activity guidelines, increasing the associated risk of cardiovascular disease and early mortality.Rehabilitation interventions that target behaviour change may have an impact in increasing physical activity levels after hip or knee joint replacement surgery.The optimal type and timing of behavioural interventions to effectively increase physical activity levels in this cohort remains unclear.Rehabilitation professionals are advised to highlight the benefits of meeting physical activity recommendations (150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity per week) to people who have undergone hip or knee joint replacement, and that behavioural intervention may support patients to meet these recommendations.
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Affiliation(s)
- Lyndon J Hawke
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Michelle M Dowsey
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia.,The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia.,The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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26
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Pfeufer D, Gililland J, Böcker W, Kammerlander C, Anderson M, Krähenbühl N, Pelt C. Training with biofeedback devices improves clinical outcome compared to usual care in patients with unilateral TKA: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:1611-1620. [PMID: 30334150 DOI: 10.1007/s00167-018-5217-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Biofeedback following total knee arthroplasty (TKA) seems to be a feasible approach to improve rehabilitation, outcomes, mobility and reduce pain. This systematic review gives the practicing orthopedic surgeon a summary of what is available and how biofeedback affects clinical outcomes. METHODS We reviewed the current literature regarding methods, devices and effects of biofeedback in patients who underwent total knee arthroplasty. Embase, Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to May 2018 for the following keywords: Biofeedback OR Feedback AND Total Knee Arthroplasty OR TKA. Data were extracted according to a predefined setting (see Protocol for systematic review on PROSPEO). Devices used for biofeedback were recorded. Demographics, training methods and effects were also collected. RESULTS The search resulted in 380 potentially eligible studies from which 11 met all inclusion criteria including 7 randomized controlled trials (RCTs), 3 cohort studies, and 1 cross-sectional study. A total of 416 patients with unilateral TKA were included, with an average of 37.8 patients per study. In patients with TKA, significant improvements in activity scores or pain were reported by 9 of 11 studies. Only two of the studies reported no significant influence of the feedback on the chosen outcome parameters. Devices for biofeedback varied between studies and included the use of a goniometer, force plate, balance board, treadmill, and/or electromyography (EMG). The most common type of feedback was visual followed by audio, with one study mentioning that the audio mode was preferred by the patients as it was easier to handle. Overall, 5 out of 6 different methods demonstrated a potential value for improving mobility and decreasing pain. CONCLUSIONS This review suggests that biofeedback in early postoperative rehabilitation after TKA is effective in improving gait symmetry, reducing pain and increasing activity level. It should be noted that the great variety of devices used for feedback limits comparisons between studies. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Daniel Pfeufer
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA. .,Department of Traumatology, Munich University Hospital LMU, Munich, Germany.
| | - Jeremy Gililland
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Wolfgang Böcker
- Department of Traumatology, Munich University Hospital LMU, Munich, Germany
| | | | - Mike Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher Pelt
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
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27
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Davergne T, Pallot A, Dechartres A, Fautrel B, Gossec L. Use of Wearable Activity Trackers to Improve Physical Activity Behavior in Patients With Rheumatic and Musculoskeletal Diseases: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2019; 71:758-767. [PMID: 30221489 DOI: 10.1002/acr.23752] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/11/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Wearable activity trackers (WATs) could be a promising strategy to improve physical activity in patients with rheumatic and musculoskeletal diseases (RMDs). The aim was to assess the adherence to and effectiveness of WATs to increase physical activity levels in patients with RMDs. METHODS A systematic review was performed to identify all cohorts and controlled trials evaluating WATs in patients with RMDs, published between 2000 and 2018, by searching Medline, Embase, PsycINFO, and Cochrane. Data collected pertained to adherence, effectiveness on physical activity, or effectiveness on symptoms (pain, function, quality of life, or fatigue). Meta-analyses were performed with a random effects model. RESULTS Of 2,806 references, 17 studies were included, with a total of 1,588 patients: 8 studies (47%) in osteoarthritis, 5 (29%) in low-back pain, and 3 (18%) in inflammatory arthritis. Adherence assessed in 4 studies was high (weighted mean ± SD time worn was 92.7% ± 4.6%). A significant increase in physical activity was noted (mean difference 1,520 steps [95% confidence interval (95% CI) 580, 2,460], I² = 77%; or 16 minutes [95% CI 2, 29] of moderate-to-vigorous physical activity, I² = 0%). A significant increase in pain was found for long interventions (>8 weeks) (standardized mean difference 0.25 [95% CI 0.07, 0.43], I² = 0%). CONCLUSION WATs in patients with RMDs had a high short-term adherence, with a significant increase in the number of steps and time spent in moderate-to-vigorous physical activity, although pain should be monitored. WATs may be an effective option to increase physical activity in this at-risk population.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, GRC-UPMC 08, and Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S 1136, Paris, France
| | - Adrien Pallot
- Institut de Formation en Masso-Kinésithérapie CEERRF, Saint-Denis, and Institut d'Ingénierie de la Santé, Université de Picardie Jules Verne, Amiens, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Unité de Recherche Clinique PSL-CFX, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, GRC-UPMC 08, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S 1136, and Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Laure Gossec
- Sorbonne Université, GRC-UPMC 08, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S 1136, and Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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28
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Correia FD, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I, Molinos M, Teixeira L, Tulha J, Seabra R, Lains J, Bento V. Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study. JMIR Rehabil Assist Technol 2019; 6:e13111. [PMID: 30816849 PMCID: PMC6416534 DOI: 10.2196/13111] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/23/2022] Open
Abstract
Background Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. Objective This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. Methods The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. Results A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group. Conclusions The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. Trial Registration ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252
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Affiliation(s)
- Fernando Dias Correia
- SWORD Health, Porto, Portugal.,Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | | | | | | | | | | | | | - Laetitia Teixeira
- Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - José Tulha
- Orthopaedics Department, Hospital da Prelada - Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Rosmaninho Seabra
- Orthopaedics Department, Hospital da Prelada - Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Virgílio Bento
- SWORD Health, Porto, Portugal.,Engineering Department, University Institute of Maia - ISMAI, Maia, Portugal
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Kline PW, Melanson EL, Sullivan WJ, Blatchford PJ, Miller MJ, Stevens-Lapsley JE, Christiansen CL. Improving Physical Activity Through Adjunct Telerehabilitation Following Total Knee Arthroplasty: Randomized Controlled Trial Protocol. Phys Ther 2019; 99:37-45. [PMID: 30329126 PMCID: PMC6314331 DOI: 10.1093/ptj/pzy119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
Background Physical activity remains low and nearly unchanged from preoperative levels following total knee arthroplasty (TKA), and this is thought to underlie long-term functional limitations, secondary health problems, and higher health care costs after TKA. Objective Our objective is to determine whether a telehealth-based intervention could improve physical activity and functional outcomes after TKA. Design The design is a 2-arm, parallel, assessor-blinded, randomized controlled trial with baseline, midintervention, postintervention, and 6-month follow-up assessments. Setting The setting is one academic medical center and one Veterans Affairs health care system. Participants One hundred US military veterans (aged 50-85 years) scheduled for unilateral TKA will participate in this study. Intervention The telehealth-based intervention to change physical activity behavior will be delivered through 10 sessions each of 30 minutes over a 12-week period. Participants will be provided with a wearable physical activity monitor to receive feedback on step count and guide goal-setting. Control participants will receive telehealth-based education on nonbehavioral aspects of health for the same frequency and duration as the intervention group. For both groups, telehealth sessions will occur concurrently with standardized outpatient rehabilitation. Measurements The primary outcome will be change in physical activity, assessed as daily step counts measured using an accelerometer-based sensor. Secondary outcomes will be measured using the Life-Space Assessment questionnaire and change in physical function (30-Second Chair-Stand Test, Timed "Up & Go" Test, Six-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey). Limitations Participant and interventionist blinding is not possible. Conclusions This trial will assess the efficacy of a novel behavior-change intervention to improve physical activity and physical function in patients after TKA. Effective physical activity behavior change could provide clinicians with a technique to augment current practice and resolve poor physical activity outcomes, long-term health problems, and high costs following TKA.
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Affiliation(s)
- Paul W Kline
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 13121 East 17th Ave, Room 3106, MS C244, Aurora, CO 80045 (USA)
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes; and Division of Geriatric Medicine, School of Medicine, University of Colorado
| | - William J Sullivan
- Geriatric Research Education and Clinical Center, Eastern Colorado Healthcare System, and Department of Physical Medicine and Rehabilitation, University of Colorado
| | | | - Matthew J Miller
- Geriatric Research Education and Clinical Center, Eastern Colorado Healthcare System, and Department of Physical Medicine and Rehabilitation, University of Colorado
| | - Jennifer E Stevens-Lapsley
- Geriatric Research Education and Clinical Center, Eastern Colorado Healthcare System, and Department of Physical Medicine and Rehabilitation, University of Colorado
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center, Eastern Colorado Healthcare System, and Department of Physical Medicine and Rehabilitation, University of Colorado
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