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Ramalho RC, Fernandes TD, Peraro FDF, Pugliese GM, Arliani GG, Ferreira GF. ULTRASOUND-GUIDED GENICULAR NERVE BLOCK FOR KNEE OSTEOARTHRITIS: A CASE SERIES. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e277781. [PMID: 39086844 PMCID: PMC11288321 DOI: 10.1590/1413-785220243203e277781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 08/02/2024]
Abstract
Objective Knee genicular nerve blocks have been a topic of discussion among various types of treatment for knee osteoarthritis. This study aims to evaluate the pain and function of patients diagnosed with knee osteoarthritis after undergoing ultrasound-guided genicular nerve blockade using pharmacological agents. Methods The study included 36 patients diagnosed with knee osteoarthritis, comprising 17 bilateral cases, totaling 53 knees undergoing UGNB using a mixture of triamcinolone, ropivacaine, and lidocaine under ultrasound guidance. Epidemiological data, pain outcomes measured by the Visual Analog Scale (VAS), and function assessed using the Western Ontario and McMaster Universities (WOMAC) score were evaluated before and after 12 weeks of the procedure. Results The mean age was 75.5 years (standard deviation of 9.4 years), with a predominance of females and right-sided involvement. There was a mean reduction of 3.0 points in VAS (p < 0.001) and 15.4 points in WOMAC (p < 0.001). Two cases reported only minor and transient complications related to the procedure (skin anesthesia and edema). Conclusion Ultrasound-guided genicular nerve blockade using pharmacological agents demonstrated pain reduction and improved function with a low complication rate after 12 weeks in patients with knee gonarthrosis. Level of Evidence IV, Case Series.
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Zhang H, Wang J, Shuai T, Li K, Nie Y. Effects of Long-Term Walking Exercise on Structural Progression, Symptoms, and Extensor Muscle Strength in Patients With Mild or at High Risk of Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Am J Phys Med Rehabil 2024; 103:603-610. [PMID: 38206636 DOI: 10.1097/phm.0000000000002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The aim of the study is to assess the relationship between walking exercise and medial joint space narrowing progression, symptoms, and knee extensor muscle strength in early knee osteoarthritis patients. METHODS This nested cohort study within the Osteoarthritis Initiative included participants aged 50 yrs and older with knee osteoarthritis (Kellgren-Lawrence grades 0-2). Walking exercisers were identified using a modified Historical Physical Activity Survey Instrument. Differences in medial joint space narrowing, Knee Injury and Osteoarthritis Outcome Score, and knee extensor muscle strength were evaluated through the three-way analysis of variance. RESULTS Among 896 participants, 83.4% reported walking exercise. Female walkers showed significant improvements in symptoms (Knee Injury and Osteoarthritis Outcome Score-pain: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-symptom: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-quality of life: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-function, sports, and recreational activities: P = 0.007). Similar results were observed in male walkers (Knee Injury and Osteoarthritis Outcome Score-pain: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-symptom: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-quality of life: P = 0.001; Knee Injury and Osteoarthritis Outcome Score-function, sports, and recreational activities: P = 0.009). Walkers showed significantly increased knee extensor muscle strength at 24 mos (female: P < 0.001; male: P = 0.003). Female nonwalkers had significantly decreased knee extensor muscle strength at 24 mos ( P < 0.001). Walkers showed significant improvement in medial joint space narrowing (odds ratio = 1.1, 95% confidence interval = 1.0-1.2) and Kellgren-Lawrence grade (OR = 1.0, 95% CI = 1.0-1.1) compared with nonwalkers. CONCLUSIONS Walking exercise prevents structural progression and improves symptoms. Meanwhile, the increased knee extensor muscle strength in all walkers further supports the validity of recommending walking exercises for early-stage knee osteoarthritis patients.
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Affiliation(s)
- Hui Zhang
- From the West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, China (HZ, JW, KL); Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China (HZ, JW, YN); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (TS); Med-X Center for Informatics, Sichuan University, Chengdu, China (KL); and Shanghai Artificial Intelligence Laboratory, Shanghai, PR China (KL)
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Ceballos-Laita L, Lahuerta-Martín S, Carrasco-Uribarren A, Cabanillas-Barea S, Hernández-Lázaro H, Pérez-Guillén S, Jiménez-del-Barrio S. Strength Training vs. Aerobic Training for Managing Pain and Physical Function in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 12:33. [PMID: 38200939 PMCID: PMC10778769 DOI: 10.3390/healthcare12010033] [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: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Strength training (ST) and aerobic training (AT) are the most recommended interventions in patients with knee OA. These recommendations are supported by high-quality evidence, but it is still unknow whether one type of exercise is superior to the other. Thus, the aim was to investigate whether one type of exercise (ST or AT) is superior to the other for improving pain and physical function in patients with knee osteoarthritis. (2) Methods: A systematic review and meta-analysis was carried out following the PRISMA statement. The search strategy was conducted in PubMed, PEDro, Scopus, Web of Science and Cochrane Library databases. Randomized controlled trials comparing ST and AT on pain intensity and physical function in patients with knee osteoarthritis were included. Methodological quality and risk of bias were assessed with a PEDro scale and risk-of-bias tool, respectively. The certainty of evidence was evaluated using GRADE guidelines. (3) Results: Four studies (6 publications) were included. The qualitative and quantitative synthesis showed that ST produces no more improvement in pain intensity (SMD after intervention: 0.02; 95%CI: -0.15, 0.19; I2: 0%; three studies; 426 patients) and physical function (SMD after intervention: 0.07; 95%CI: -0.10, 0.24; I2: 0%; three studies; 426 patients) compared to AT in patients with knee osteoarthritis. The certainty of evidence was rated as very low. (4) Conclusions: Both type of exercises showed clinical benefits in people with knee osteoarthritis, but no differences between ST and AT were found.
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Affiliation(s)
- Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Silvia Lahuerta-Martín
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Andoni Carrasco-Uribarren
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Sara Cabanillas-Barea
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Héctor Hernández-Lázaro
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
| | - Silvia Pérez-Guillén
- Department of Physical Therapy, Faculty of Health Sciences, International University of Catalonia, 08195 Sant Cugat del Vallès, Spain; (S.C.-B.); (S.P.-G.)
| | - Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (L.C.-L.); (S.L.-M.); (H.H.-L.); (S.J.-d.-B.)
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Feng Y, Wu Y, Liu H, Bao T, Wang C, Wang Z, Huang J, Jiang Y, He C, Zhu S. Effect of the telemedicine-supported multicomponent exercise therapy in patients with knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2023; 24:729. [PMID: 37964273 PMCID: PMC10647045 DOI: 10.1186/s13063-023-07749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION The rising prevalence of knee osteoarthritis is placing a considerable strain on the global healthcare system. To address this issue, telemedicine-supported multicomponent exercise therapy has emerged as a promising approach. This therapy combines exercise, patient education, and health coaching to empower knee osteoarthritis patients to manage their condition from the comfort of their homes. Nevertheless, there are some existing limitations in the current research on this approach, including challenges related to patient compliance and the absence of objective evaluation methods. METHODS AND ANALYSIS Patients diagnosed with knee osteoarthritis, who have not undergone knee surgery in the past year, will be recruited for a randomized controlled trial. The trial will include an intervention group and a control group. The intervention group will receive an mHealth app-based multicomponent exercise therapy, consisting of exercise therapy, patient education, and health coaching. Meanwhile, the control group will receive usual care, involving drug therapy and patient education. The primary outcome of the trial will be the measurement of pain intensity, assessed using a visual analog scale at baseline and at 4, 8, and 12 weeks of the post-intervention. To analyze the data, a two-factor, four-level repeated measures ANOVA will be used if the assumptions of homogeneity of variance and sphericity are met. If not, a mixed effects model will be employed. DISCUSSION The aim of the study is to evaluate the effectiveness of multicomponent exercise therapy aimed at enhancing pain self-management for knee osteoarthritis patients in the comfort of their own homes. The intervention incorporate wearable devices equipped with advanced deep learning systems to monitor patients' adherence to the prescribed at-home exercise regimen, as well as to track changes in outcomes before and after the exercise sessions. The findings from this trial have the potential to enhance both the accessibility and quality of care provided to knee osteoarthritis patients, offering valuable insights for future improvements in their treatment and management. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR2300073688. Registered on 19 July 2023, https://www.chictr.org.cn/bin/project/edit?pid=199707 . World Health Organization International Clinical Trials Registry Platform, https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2300073688 .
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Affiliation(s)
- Yuan Feng
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Yan Wu
- Department of Postgraduate Students, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- College of Marxism, Sichuan University, Chengdu, China
| | - Huizhen Liu
- Centre for Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Tianjie Bao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Chongyang Wang
- Department of Computer Science and Technology, Tsinghua University, No. 30, Shuangqing Road, Beijing, Haidian District, China
| | - Zezhang Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Jielei Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Yiwei Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China.
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
| | - Siyi Zhu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China.
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
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Kijowski R, Fritz J, Deniz CM. Deep learning applications in osteoarthritis imaging. Skeletal Radiol 2023; 52:2225-2238. [PMID: 36759367 PMCID: PMC10409879 DOI: 10.1007/s00256-023-04296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
Deep learning (DL) is one of the most exciting new areas in medical imaging. This article will provide a review of current applications of DL in osteoarthritis (OA) imaging, including methods used for cartilage lesion detection, OA diagnosis, cartilage segmentation, and OA risk assessment. DL techniques have been shown to have similar diagnostic performance as human readers for detecting and grading cartilage lesions within the knee on MRI. A variety of DL methods have been developed for detecting and grading the severity of knee OA and various features of knee OA on X-rays using standardized classification systems with diagnostic performance similar to human readers. Multiple DL approaches have been described for fully automated segmentation of cartilage and other knee tissues and have achieved higher segmentation accuracy than currently used methods with substantial reductions in segmentation times. Various DL models analyzing baseline X-rays and MRI have been developed for OA risk assessment. These models have shown high diagnostic performance for predicting a wide variety of OA outcomes, including the incidence and progression of radiographic knee OA, the presence and progression of knee pain, and future total knee replacement. The preliminary results of DL applications in OA imaging have been encouraging. However, many DL techniques require further technical refinement to maximize diagnostic performance. Furthermore, the generalizability of DL approaches needs to be further investigated in prospective studies using large image datasets acquired at different institutions with different imaging hardware before they can be implemented in clinical practice and research studies.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, New York University Grossman School of Medicine, 660 First Avenue, 3Rd Floor, New York, NY, 10016, USA.
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, 660 First Avenue, 3Rd Floor, New York, NY, 10016, USA
| | - Cem M Deniz
- Department of Radiology, New York University Grossman School of Medicine, 660 First Avenue, 3Rd Floor, New York, NY, 10016, USA
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Sattler L, Kan A, Hing W, Vertullo C. The addition of structured lifestyle modifications to a traditional exercise program for the management of patients with knee osteoarthritis: A systematic review and meta-analysis of randomised trials. Musculoskelet Sci Pract 2023; 68:102858. [PMID: 37793243 DOI: 10.1016/j.msksp.2023.102858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Guidelines recommend exercise for the management of knee osteoarthritis (OA), however, recently it has been suggested that including additional lifestyle modifications with a traditional exercise program may elicit greater benefits than exercise alone. OBJECTIVES To investigate the influence of the addition of lifestyle modifications to a traditional exercise program, with respect to functional outcomes and quality of life among individuals with knee OA. DESIGN Systematic review and meta-analysis. METHODS Four databases were searched to identify randomised controlled trials comparing an exercise program, which included the addition of lifestyle modifications, to an exercise program alone in individuals with knee OA. Methodological quality of included studies was assessed via the PEDro scale. Results synthesis through meta-analysis using a random effects model was conducted to determine the pooled effect on eligible outcomes and a GRADE approach was utilised to rate the certainty of evidence. RESULTS Meta-analysis of seven studies showed the inclusion of lifestyle modifications to an exercise program can further decrease pain intensity (SMD -0.68 [95% CI -1.26 to -0.10]), improve joint stiffness (MD -0.69 [95% CI -1.21, -0.17]) and increase physical function (MD -1.26 s ([95% CI -1.34, -1.17]) at six-months. Individual results showed improvements in quality of life with the addition of lifestyle modifications, however, this was not demonstrated through meta-analysis. CONCLUSION This systematic review supports the inclusion of additional lifestyle modifications to a traditional exercise program, for pain intensity, joint stiffness and physical function for individuals with knee OA. TRIAL REGISTRATION PROSPERO registration number: CRD42021279594.
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Affiliation(s)
- Larissa Sattler
- Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Adrian Kan
- Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Christopher Vertullo
- Institution: Knee Research Australia, 8-10 Carrara Street, Benowa, QLD, 4217, Australia.
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Lee EL, Jang MH, Lee BJ, Han SH, Lee HM, Choi SU, Shin MJ. Home-Based Remote Rehabilitation Leads to Superior Outcomes for Older Women With Knee Osteoarthritis: A Randomized Controlled Trial. J Am Med Dir Assoc 2023; 24:1555-1561. [PMID: 37699531 DOI: 10.1016/j.jamda.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES To examine the effects of a home-based lower-extremity strengthening exercise program in community-dwelling older women with knee osteoarthritis. DESIGN Randomized controlled trial. SETTING AND PARTICIPANTS Women aged ≥60 years with knee osteoarthritis and Kellgren-Lawrence grade 1 or 2 on anteroposterior/lateral radiographs of both knee joints. METHODS Patients (n = 36) were randomly divided into experimental (EG) and control (CG) groups. The EG performed home-based remote rehabilitation lower-extremity strengthening exercises for 8 weeks, whereas the CG received no intervention. Assessment was performed at baseline and week 8. The primary outcome was the five-times sit-to-stand test (FTSST) result. Secondary outcomes included timed up-and-go (TUG) test results, knee extensor and flexor strength, quadriceps (rectus femoris) muscle activity, skeletal muscle index, blood pressure (BP), visual analog scale (VAS) scores, C-reactive protein level, and erythrocyte sedimentation rate. RESULTS A statistically significant difference in the FTSST times was observed between the groups after 8 weeks of intervention (EG: 7.95 ± 1.08 seconds, CG: 10.01 ± 2.03 seconds, P < .001). In the EG, the TUG test score decreased by 0.75 ± 0.80 seconds (P = .002), right and left knee flexor strength increased by 4.69 ± 6.05 kg (P = .007) and 3.98 ± 6.98 kg (P = .038), respectively, and the right knee extensor root mean square (RMS) ratio increased by 1.24 ± 0.39 (P = .027). Additionally, systolic and diastolic BP decreased by 9.50 ± 10.75 mm Hg (P = .005) and 4.25 ± 4.91 mm Hg (P = .003), respectively. In the CG, the VAS scores decreased by 9.10 ± 13.68 mm (P = .022). CONCLUSIONS AND IMPLICATIONS The home-based exercise program using a remote rehabilitation medical device was effective in improving lower extremity strength and function in community-dwelling older women with knee osteoarthritis. This finding suggests that the remote rehabilitation medical device may be used as an alternative to exercise interventions for patients with knee osteoarthritis.
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Affiliation(s)
- Eun-Lee Lee
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Myung Hun Jang
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Sang Hun Han
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | | | | | - Myung Jun Shin
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Pusan, Republic of Korea.
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Cao H, Zhou XC, Li H, Wang M, Wu W, Zou J. Exercise for osteoarthritis: A global articles bibliometric analysis from 1975 to 2021. Sci Sports 2023; 38:488-497. [DOI: 10.1016/j.scispo.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
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Drummen SJJ, Balogun S, Lahham A, Bennell K, Hinman RS, Callisaya M, Cai G, Otahal P, Winzenberg T, Wang Z, Antony B, Munugoda IP, Martel-Pelletier J, Pelletier JP, Abram F, Jones G, Aitken D. A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk. Clin Rheumatol 2023; 42:1409-1421. [PMID: 36692651 PMCID: PMC10102100 DOI: 10.1007/s10067-022-06477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes. METHOD This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures. RESULTS Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: - 38.7 mm [95% CI - 47.1 to - 30.3] versus usual care group: 4.3 mm [- 4.9 to 13.4]). CONCLUSIONS This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial. TRIAL REGISTRATION NUMBER 12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.
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Affiliation(s)
- S J J Drummen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
| | - S Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
- Australian National University, Canberra, Australia
| | - A Lahham
- Monash University, Melbourne, Australia
| | - K Bennell
- The University of Melbourne, Melbourne, Australia
| | - R S Hinman
- The University of Melbourne, Melbourne, Australia
| | - M Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
- Monash University, Melbourne, Australia
| | - G Cai
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - P Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Z Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - I P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - J P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - F Abram
- Medical Imaging Research & Development, ArthroLab Inc, Montreal, QC, Canada
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
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Rajamohan HR, Wang T, Leung K, Chang G, Cho K, Kijowski R, Deniz CM. Prediction of total knee replacement using deep learning analysis of knee MRI. Sci Rep 2023; 13:6922. [PMID: 37117260 PMCID: PMC10147603 DOI: 10.1038/s41598-023-33934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
Current methods for assessing knee osteoarthritis (OA) do not provide comprehensive information to make robust and accurate outcome predictions. Deep learning (DL) risk assessment models were developed to predict the progression of knee OA to total knee replacement (TKR) over a 108-month follow-up period using baseline knee MRI. Participants of our retrospective study consisted of 353 case-control pairs of subjects from the Osteoarthritis Initiative with and without TKR over a 108-month follow-up period matched according to age, sex, ethnicity, and body mass index. A traditional risk assessment model was created to predict TKR using baseline clinical risk factors. DL models were created to predict TKR using baseline knee radiographs and MRI. All DL models had significantly higher (p < 0.001) AUCs than the traditional model. The MRI and radiograph ensemble model and MRI ensemble model (where TKR risk predicted by several contrast-specific DL models were averaged to get the ensemble TKR risk prediction) had the highest AUCs of 0.90 (80% sensitivity and 85% specificity) and 0.89 (79% sensitivity and 86% specificity), respectively, which were significantly higher (p < 0.05) than the AUCs of the radiograph and multiple MRI models (where the DL models were trained to predict TKR risk using single contrast or 2 contrasts together as input). DL models using baseline MRI had a higher diagnostic performance for predicting TKR than a traditional model using baseline clinical risk factors and a DL model using baseline knee radiographs.
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Affiliation(s)
| | - Tianyu Wang
- Center for Data Science, New York University, 60 5th Ave, New York, NY, 10011, USA
| | - Kevin Leung
- Courant Institute of Mathematical Sciences, New York University, 251 Mercer St, New York, NY, 10012, USA
| | - Gregory Chang
- Department of Radiology, New York University Langone Health, 660 1st Ave, New York, NY, 10016, USA
| | - Kyunghyun Cho
- Center for Data Science, New York University, 60 5th Ave, New York, NY, 10011, USA
- Courant Institute of Mathematical Sciences, New York University, 251 Mercer St, New York, NY, 10012, USA
| | - Richard Kijowski
- Department of Radiology, New York University Langone Health, 660 1st Ave, New York, NY, 10016, USA
| | - Cem M Deniz
- Department of Radiology, New York University Langone Health, 660 1st Ave, New York, NY, 10016, USA.
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Langone Health, 650 First Avenue, Room 418, New York, NY, 10016, USA.
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11
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Rosadi R, Wu PT, You YL, Kuo LC, Lin CF. Effectiveness of Combined Exercise and Physiotherapy Intervention in Improving Functional Activity of Patients with Knee Osteoarthritis in Muslim Pray Movements. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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12
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Klinedinst NJ, Huang W, Nelson AK, Resnick B, Renn C, Kane MA, Dorsey SG. Protein Changes After 6 weeks of Walking and the Relationship to Pain in Adults with Knee Osteoarthritis. Biol Res Nurs 2023; 25:65-75. [PMID: 36050838 DOI: 10.1177/10998004221117179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Knee osteoarthritis (KOA) affects 22.9% of individuals over the age of 40 and causes significant pain and disability. Pain is the most prevalent and troublesome symptom of KOA leading patients to seek medical interventions for relief. Knee osteoarthritis pain has both peripheral and central mechanisms that vary by individual. Non-pharmacological pain management strategies such as walking is the first step in reducing KOA pain. However, initiation of a walking regime can induce knee pain for some and the mechanism by which habitual walking reduces KOA pain is unclear. Purpose: The purpose of this study was to use a discovery proteomics approach and quantitative sensory testing (QST) to determine the molecular changes that occur after habitual walking and their relationship to pain sensitivity. Research Design and Study Sample: We conducted a pre-test/post-test study using QST to measure neurophysiological parameters at the knee and contralateral forearm and examined platelet protein signatures before and after 6 weeks of walking 3 days per week for 30 minutes among six adults with KOA and six healthy controls. Results: Knee pain sensitivity did not change significantly after 6 weeks of walking among either KOA or healthy participants. However, forearm pressure pain sensitivity decreased for both groups after walking, indicating reduction in central pain pathways. Protein signatures showed downregulation of immune and inflammatory, pathways among KOA participants after walking which were upregulated in healthy controls. Conclusion: These differences may contribute differences in centralized pain thresholds seen between KOA and healthy participants.
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Affiliation(s)
| | - Weiliang Huang
- 15513University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Amy K Nelson
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
| | - Barbara Resnick
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
| | - Cynthia Renn
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
| | - Maureen A Kane
- 15513University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Susan G Dorsey
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
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13
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Wang XY, Xie SH, Zhang YJ, Zhu SY, Zhang RS, Wang L, Feng Y, Wu WR, Xiang D, Liao Y, He CQ. Effect of IoT-based power cycling and quadriceps training on pain and function in patients with knee osteoarthritis: A randomized controlled trial protocol. Medicine (Baltimore) 2022; 101:e31841. [PMID: 36550804 PMCID: PMC9771366 DOI: 10.1097/md.0000000000031841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic musculoskeletal disease affecting the entire joint. Exercise therapy is the core treatment plan for non-surgical treatment of KOA, and tele-rehabilitation is also applied to KOA, but there is a lack of research on the comparison of pain and function recovery between different exercise methods combined Internet respectively. The study aims to compare the effects of power cycling and quadriceps training combined with online guidance separately on KOA mitigation of pain, recovery of function, quality of life, and adherence of participants in the community, compared to the control group. METHODS This study is a single-blind, 12-week parallel randomized controlled trial. Seventy-two participants aged ≥ 50 years with KOA will be randomized into either the power cycling group, the quadriceps group or the control group. The intervention will be performed three times per week during 12 weeks. Outcome measures will be assessed at baseline, and at 4, 8, and 12 weeks after allocation. The primary outcome will be self-reported pain, assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcomes will include mitigation of knee pain, quality of life, improvement of functional physical performance, adherence of participants. DISCUSSION By summarizing the study's strengths and limitations, this trial results may guide tele-rehabilitation of KOA in the community.Trial registration: The study was registered in the clinical trial registry ChiCTR2200059255, 27/04/2022.
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Affiliation(s)
- Xiao-yi Wang
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Su-hang Xie
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yu-jia Zhang
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine, The First People’s Hospital of Shuangliu District, Chengdu West China (Airport) Hospital, Sichuan University, Chengdu, P.R. China
| | - Si-yi Zhu
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Rui-shi Zhang
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lin Wang
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yuan Feng
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Wei-ran Wu
- Department of Rehabilitation Medicine, People’s Hospital of Qingbaijiang District, Chengdu, P.R. China
| | - Dan Xiang
- The Retired Office of Sichuan University, Chengdu, P.R. China
| | - Yuan Liao
- The Retired Office of Sichuan University, Chengdu, P.R. China
| | - Cheng-qi He
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P.R. China
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
- *Correspondence: Cheng-qi He, Rehabilitation Medicine Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, P.R. China (e-mail: )
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14
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How Physical Activity Affects Knee Cartilage and a Standard Intervention Procedure for an Exercise Program: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10101821. [PMID: 36292268 PMCID: PMC9602429 DOI: 10.3390/healthcare10101821] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cartilage degeneration with the natural aging process and the role of physical activity on cartilage wellness is still not clear. The objective of the present review was to understand how different physical activity interventions affect the cartilage and to propose a Standard Operating Procedure for an exercise program to maintain knee joint health; (2) Methods: Articles were collected on three different electronic databases and screened against the eligibility criteria. Results were collected in tables and the main outcomes were discussed narratively; (3) Results: A total of 24 studies have been included after the screening process and aerobic, strength, flexibility, postural balance, and mobility interventions were detected. Different protocols and types of interventions were adopted by the authors; (4) Conclusions: Physical activity interventions have mainly positive outcomes on cartilage structure, but the protocols adopted are different and various. A Standard Operating Procedure has been proposed for a physical intervention focalized on cartilage wellness that could be adopted as an intervention in the clinical setting. Furthermore, the creation of a standardized protocol wants to help scientific research to move in the same direction.
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15
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A Novel Mobile App-based Neuromuscular Electrical Stimulation Therapy for the Management of Knee Osteoarthritis: Results From an Extension Study of a Randomized, Double-blind, Sham-controlled, Multicenter Trial. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00004. [PMID: 36094457 PMCID: PMC9470129 DOI: 10.5435/jaaosglobal-d-22-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022]
Abstract
Mobile app-based neuromuscular electrical stimulation (NMES) is a promising treatment of knee osteoarthritis as previously demonstrated in a 12-week, randomized, double-blind, sham-controlled, multicenter trial (parent study).
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16
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Moulaei K, Sheikhtaheri A, Nezhad MS, Haghdoost A, Gheysari M, Bahaadinbeigy K. Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods. Arch Public Health 2022; 80:196. [PMID: 35999548 PMCID: PMC9400266 DOI: 10.1186/s13690-022-00952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities.
Methods
This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed.
Results
A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively.
Conclusion
Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.
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17
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Kim K, Koo KM. Influence of Different Exercise Types on Health-Related Quality-of-Life in Men With Depressive Disorder in South Korea. Front Public Health 2022; 10:811168. [PMID: 35359762 PMCID: PMC8964042 DOI: 10.3389/fpubh.2022.811168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to determine the influence of different exercise types on health-related quality of life (QOL) in men with depressive disorder (DD) in South (S) Korea. The data of 385 men aged 19 with DD were collected in S. Korea. The Euro Quality of Life 5 Dimensions (EQ-5D) index and Korea National Health and Nutrition Examination Survey (KNHANES) questionnaires were used to establish the purpose of this study. Furthermore, the complex sampling model was applied to investigate the influence of different exercise types on health-related QOL in participants. When reviewing the outcomes, the strength exercise and walking had significant influences on health-related QOL in men with DD in S. Korea. However, the flexibility exercise did not have a significant influence on them. Based on the results, strength exercise and walking were effective exercise types to increase levels of health-related QOL in men with DD in S. Korea.
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Affiliation(s)
- Kyungjin Kim
- Department of Adapted Physical Activity, Korea Nazarene University, Cheonan-si, South Korea
| | - Kyo-Man Koo
- Department of Adapted Physical Education, Baekseok University, Cheonan-si, South Korea
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18
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Morita Y, Ito H, Kawaguchi S, Nishitani K, Nakamura S, Kuriyama S, Sekine Y, Tabara Y, Matsuda F, Matsuda S. Physical and financial impacts caused by the COVID-19 pandemic exacerbate knee pain: A longitudinal study of a large-scale general population. Mod Rheumatol 2022; 33:373-380. [PMID: 35353896 PMCID: PMC8992315 DOI: 10.1093/mr/roac022] [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: 12/02/2021] [Revised: 01/11/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain. METHODS We analysed the pre- and post-COVID-19 longitudinal data set of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 data set was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analysed for correlation analyses with changes in KSS. RESULTS Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = .008), low educational level (p < .001), and undesirable financial impact (p = .030) were independently associated with knee pain exacerbation. CONCLUSION The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.
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Affiliation(s)
- Yugo Morita
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- *Correspondence: Hiromu Ito; ; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan
| | - Shuji Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihiro Sekine
- Research Center for Advanced Policy Studies, Institute of Economic Research, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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19
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Lavin KM, Coen PM, Baptista LC, Bell MB, Drummer D, Harper SA, Lixandrão ME, McAdam JS, O’Bryan SM, Ramos S, Roberts LM, Vega RB, Goodpaster BH, Bamman MM, Buford TW. State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions. Compr Physiol 2022; 12:3193-3279. [PMID: 35578962 PMCID: PMC9186317 DOI: 10.1002/cphy.c200033] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.
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Affiliation(s)
- Kaleen M. Lavin
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Human Health, Resilience, and Performance, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Paul M. Coen
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Liliana C. Baptista
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret B. Bell
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Devin Drummer
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara A. Harper
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Manoel E. Lixandrão
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeremy S. McAdam
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samia M. O’Bryan
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sofhia Ramos
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Lisa M. Roberts
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick B. Vega
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Marcas M. Bamman
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Human Health, Resilience, and Performance, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Thomas W. Buford
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Effects of Golden Plaster on Knee Osteoarthritis: A Multicenter Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4205648. [PMID: 35154343 PMCID: PMC8828341 DOI: 10.1155/2022/4205648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Abstract
Background Golden plaster is the preferred and most commonly used in China for pain reduction in patients with knee osteoarthritis (OA). However, there was no evidence-based medical evidence about its effect in relieving pain of knee OA patients. Here, a multicenter randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy and safety of golden plaster for the improvement of pain relief and function's obstacle in patients with knee OA. Methods 320 patients with knee OA were enrolled at four hospitals and randomly divided into the treatment group and the control group with 160 subjects in each group. Patients in treatment group were treated with golden plaster, and those in control group with placebo plaster. The study cycle in both groups was 21 days. Patient visits were documented before treatment and 7-, 14-, and 21-day follow-ups after treatment. The outcomes included VAS score, WOMAC score, and adverse events. Results Compared to the control group, the VAS score in the treatment group was significantly decreased after treatment with golden plaster for 7 days, 14 days, and 21 days. Compared to the control group, the WOMAC score in the treatment group was significantly decreased 14 days and 21 days. The incidence rate of adverse events had no statistical difference between both the groups. Conclusions In conclusion, our study, for the first time by carrying on the double-blind and placebo-controlled randomized trial, showed that golden plaster can effectively alleviate the pain of knee and improve the physical function in the patients with knee OA. This trial is registered with ChiCTR-TRC-13003418.
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Abstract
Osteoarthritis, characterized by the breakdown of articular cartilage and other joint structures, is one of the most prevalent and disabling chronic diseases in the United States. Magnetic resonance imaging is a commonly used imaging modality to evaluate patients with joint pain. Both two-dimensional fast spin-echo sequences (2D-FSE) and three-dimensional (3D) sequences are used in clinical practice to evaluate articular cartilage. The 3D sequences have many advantages compared with 2D-FSE sequences, such as their high in-plane spatial resolution, thin continuous slices that reduce the effects of partial volume averaging, and ability to create multiplanar reformat images following a single acquisition. This article reviews the different 3D imaging techniques available for evaluating cartilage morphology, illustrates the strengths and weaknesses of 3D approaches compared with 2D-FSE approaches for cartilage imaging, and summarizes the diagnostic performance of 2D-FSE and 3D sequences for detecting cartilage lesions within the knee and hip joints.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
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22
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Huckleby J, Williams F, Ramos R, Nápoles AM. The effects of race/ethnicity and physician recommendation for physical activity on physical activity levels and arthritis symptoms among adults with arthritis. BMC Public Health 2021; 21:1564. [PMID: 34407795 PMCID: PMC8371891 DOI: 10.1186/s12889-021-11570-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Among U.S. adults with physician-diagnosed arthritis, we examined the association of 1) participant race/ethnicity with meeting physical activity guidelines and arthritis symptoms, and 2) the association of receipt of a physician exercise recommendation with physical activity levels and arthritis symptoms, and whether race/ethnicity moderates these associations. METHODS Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014 from 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0-10; higher score = more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics. RESULTS Adjusting for covariates, African Americans were more likely (AOR = 1.27; 95% CI 1.12, 1.43) and Asians were less likely (AOR = 0.75; 95% CI 0.61, 0.92) than Whites to meet muscle strengthening activity guidelines. Compared to Whites, African Americans (B = 0.48; 95% CI 0.24, 0.72) and Latinos (B = 0.44; 95% CI 0.15, 0.72) reported more severe, while Asians reported less severe (B = -0.68; 95% CI -1.22, - 0.14) joint pain. Controlling for covariates, physician exercise recommendation was associated with meeting aerobic (AOR = 1.20; 95% CI 1.11, 1.30) and strengthening (AOR = 1.21; 95% CI 1.11, 1.33) guidelines, regardless of race/ethnicity except for a weak negative association with meeting strengthening guidelines (AOR = 0.85; CI 0.74-0.99) among Latinos. CONCLUSIONS Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.
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Affiliation(s)
- Jeremy Huckleby
- Medical Resident Scholar Program, National Institutes of Health and National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| | - Rose Ramos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
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23
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Kılıç F, Demirgüç A, Arslan SA, Keskin ED, Aras M. The effect of aerobic exercise training on postmenopausal patients with knee osteoarthritis. J Back Musculoskelet Rehabil 2021; 33:995-1002. [PMID: 32894239 DOI: 10.3233/bmr-191712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a common musculoskeletal problem encountered in the postmenopausal period. OBJECTIVE This study aimed to determine the impact of aerobic exercise on functional limitation, exercise tolerance, and performance tests in postmenopausal women with knee OA. METHODS A total of 50 women (aged between 48-78) with grade 2-3 knee OA according to the Kellgren-Lawrence radiographic scale were enrolled. OA-specific physical performance tests (40 m Fast-Paced Walk Test (40mFPWT), 30 s Chair Stand Test (30sCST), Stair Climb Test (9-step SCT)), six-minute walk test (6MWT), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS) were performed. Fifty patients were randomized to either the treatment or control groups. The treatment group received an additional aerobic exercise training along with a combined physiotherapy program for six weeks. The aerobic exercise program was carried out by the same physiotherapist every weekday (five days) for six weeks. The control group only received a combined physiotherapy program for six weeks. RESULTS The post-treatment comparisons of the two groups yielded similar SCT results (p> 0.05), while VAS scores, the results of all performance tests, WOMAC scores, and the distance covered in 6MWT were significantly higher in the treatment group (p< 0.05). CONCLUSIONS Consequently, this study provides an insight into the efficacy of the aerobic exercise program applied along with a combined physiotherapy program in postmenopausal women with knee OA.
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Affiliation(s)
- Filiz Kılıç
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, Kirikkale University, Kirikkale, Turkey
| | - Arzu Demirgüç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sanko University, Gaziantep, Turkey
| | - Saniye Aydoğan Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kirikkale University, Kirikkale, Turkey
| | - Esra Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, Kirikkale University, Kirikkale, Turkey
| | - Müyesser Aras
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Effects of Different Types of Physical Activity on Health-Related Quality-of-Life in Korean Women with Depressive Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094639. [PMID: 33925522 PMCID: PMC8123788 DOI: 10.3390/ijerph18094639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Depressive disorder is a frequent psychological illness and causes community health problems for many women. It was found that the health-related quality of life (HRQoL) score of many women was altered due to mental and physical problems. Physical activity (PA) might effectively improve the responses of the HRQoL of women with depressive disorder. Therefore, the study aimed to identify the effects of different types of PA (e.g., walking, strength exercise, flexibility exercise) on the responses of the HRQoL of Korean women with depressive disorder. A sample of 1315 Korean women aged 19 or older with a depressive disorder was accumulated. The Korea National Health and Nutrition Examination Survey (KNHANES) and Euro Quality of Life-5 Dimensions (EQ-5D index score) were used. The characteristics of the participants were analyzed by the complex sample in frequency analysis. Furthermore, the complex sample general linear model was used to determine the effects of different types of PA on the HRQoL of Korean women with depressive disorder. In the results, there was a statistically significant difference between the groups who participated for one to two days, who participated for three to four days, and who did not participate in walking at all. In the flexibility exercise, there was a statistically significant difference in the group who participated for three to four days from the group who did not participate at all. However, there was no statistically significant difference in the strength exercise. In conclusion, the walking and flexibility exercises were effective physical activities (PAs) to improve the responses to the HRQoL of Korean women with depressive disorder.
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Flowers DW, Brewer W, Mitchell K, Ellison J. Why are we neglecting the core muscles in patients with knee osteoarthritis? A narrative review of the literature. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1907947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel W. Flowers
- Program in Physical Therapy, LSU Health-Shreveport, Shreveport, Louisiana, USA
| | - Wayne Brewer
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Jennifer Ellison
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
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Reza MK, Shaphe MA, Qasheesh M, Shah MN, Alghadir AH, Iqbal A. Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis. J Pain Res 2021; 14:127-138. [PMID: 33531832 PMCID: PMC7847368 DOI: 10.2147/jpr.s285297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The current study aimed to determine the efficacy of specified manual therapies in combination with a supervised exercise protocol for managing pain intensity and functional disability in patients with knee osteoarthritis. METHODS The study was based on a two-arm parallel-group randomized controlled trial design, including a total of 32 participants with knee osteoarthritis randomly divided into groups A and B. Group A received a supervised exercise protocol; however, group B received specified manual therapies in combination with a supervised exercise protocol. Pain and functional disability were measured with the numeric pain rating scale (NPRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Data were collected at baseline (pre-intervention), 2 weeks, and 4 weeks post-intervention. To evaluate the efficacy of specific manual therapies with supervised exercise compared to supervised exercise alone, an unpaired t-test and repeated measures ANOVA were used to analyze the data, keeping the level of significance at p<0.05. RESULTS A significant (p<0.05) mean difference (∆MD) was found within group A and group B for both outcomes when we compared their baseline scores with 2-week (group A, NPRS: ∆MD=-1.56 and WOMAC: ∆MD=14.94; group B, NPRS: ∆MD=2.06 and WOMAC: ∆MD=22.19) and 4-week post-intervention scores (group A, NPRS: ∆MD=0.62 and WOMAC: ∆MD=6.75; group B, NPRS: ∆MD=0.75 and WOMAC: ∆MD=11.12). In addition, significant mean differences (p<0.05) reported for both outcomes when we compared their scores between groups A and B at 2 weeks (∆MD: NPRS=0.69; WOMAC=10.87) and 4 weeks post-intervention (∆MD: NPRS=0.31; WOMAC=8.00). Furthermore, a post hoc Scheffe analysis for the outcomes NPRS and WOMAC revealed the superiority of group B over group A. CONCLUSION The specified manual therapies, in combination with a supervised exercise protocol, were found to be more effective than a supervised exercise protocol alone for improving pain and functional disability in patients with knee osteoarthritis.
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Affiliation(s)
| | | | | | | | - Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Amir Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Chusyd DE, Nagy TR, Golzarri-Arroyo L, Dickinson SL, Speakman JR, Hambly C, Johnson MS, Allison DB, Brown JL. Adiposity, reproductive and metabolic health, and activity levels in zoo Asian elephant ( Elephas maximus). J Exp Biol 2021; 224:224/2/jeb219543. [PMID: 33500325 DOI: 10.1242/jeb.219543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
Abstract
Many captive Asian elephant populations are not self-sustaining, possibly due in part to obesity-related health and reproductive issues. This study investigated relationships between estimated body composition and metabolic function, inflammatory markers, ovarian activity (females only) and physical activity levels in 44 Asian elephants (n=35 females, n=9 males). Deuterium dilution was used to measure total body water from which fat mass (FM) and fat-free mass (FFM) could be derived to estimate body composition. Serum was analyzed for progestagens and estradiol (females only), deuterium, glucose, insulin and amyloid A. Physical activity was assessed by an accelerometer placed on the elephant's front leg for at least 2 days. Relative fat mass (RFM) - the amount of fat relative to body mass - was calculated to take differences in body size between elephants into consideration. Body fat percentage ranged from 2.01% to 24.59%. Male elephants were heavier (P=0.043), with more FFM (P=0.049), but not FM (P>0.999), than females. For all elephants, estimated RFM (r=0.45, P=0.004) was positively correlated with insulin. Distance walked was negatively correlated with age (r=-0.46, P=0.007). When adjusted for FFM and age (P<0.001), non-cycling females had less fat compared with cycling females, such that for every 100 kg increase in FM, the odds of cycling were 3 times higher (P<0.001). More work is needed to determine what an unhealthy amount of fat is for elephants; however, our results suggest higher adiposity may contribute to metabolic perturbations.
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Affiliation(s)
- Daniella E Chusyd
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA .,Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Department of Epidemiology and Biostatistics, Indiana University-Bloomington, Bloomington, IN 47405, USA
| | - Tim R Nagy
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Nathan Shock Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, Bloomington, IN 47405, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, Bloomington, IN 47405, USA
| | - John R Speakman
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK.,Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101 China
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Maria S Johnson
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, Bloomington, IN 47405, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
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Freire MRDM, da Silva PMC, Azevedo AR, Silva DS, da Silva RBB, Cardoso JC. Comparative Effect between Infiltration of Platelet-rich Plasma and the Use of Corticosteroids in the Treatment of Knee Osteoarthritis: A Prospective and Randomized Clinical Trial. Rev Bras Ortop 2020; 55:551-556. [PMID: 33093718 PMCID: PMC7575359 DOI: 10.1016/j.rbo.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to analyze the efficacy of platelet-rich plasma obtained from the peripheral, autologous blood of the patients in pain complaints reduction and functional improvement of knee osteoarthritis compared with the standard treatment with injectable corticosteroid, such as triamcinolone. Methods The patients were followed-up clinically at the preinfiltrative visit, with quantitative evaluation using the Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Kellgren and Lawrence scales. In addition, they were reevaluated with the same scales after 1 month and 6 months of intervention with 2.5 mL of triamcinolone acetate or 5 mL of platelet-rich plasma. The study was performed on 50 patients with knee osteoarthritis treated at the Medical Specialty Center and randomly divided into equivalent samples for each therapy. Results The present study verified the reduction of pain scores, such as the WOMAC score, and elevations of functional scales, such as the KSS, evidenced in 180 days when using platelet-rich plasma, a therapy that uses the autologous blood of the patient and has fewer side effects. Conclusion Although both platelet-rich plasma and corticosteroid therapies have been shown to be effective in the reduction pain complaints and functional recovery, there was a statistically significant difference between them at 180 days. According to the results obtained, platelet-rich plasma presented longer-lasting effects within 180 days in the treatment of knee osteoarthritis.
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Affiliation(s)
| | | | - Arthur Rangel Azevedo
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (Iamspe), São Paulo, SP, Brazil
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A Self-Efficacy Reinforcement Stretching Exercise Program for Community-Dwelling Older Women With Osteoarthritis: A Pilot Study. Rehabil Nurs 2020; 46:11-23. [PMID: 32932424 DOI: 10.1097/rnj.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated the effectiveness of the Self-Efficacy Reinforcement Stretching Exercise Program to improve osteoarthritis (OA)-related symptoms in older women with OA. DESIGN A quasi-experimental design was used in this study. METHODS The experimental group participated in the Self-Efficacy Reinforcement Stretching Exercise Program, a 6-week program composed of stretching exercises and self-efficacy reinforcement strategies, whereas the control group did not. All participants were assessed on pain; joint stiffness; physical function disability; body mass index; depression; and quality of life at the beginning, end, and 4 weeks after the program ended. FINDINGS After participation, the experimental group had significantly less joint stiffness, physical function disability, and depression scores and significantly higher self-efficacy and quality of life than the control group. CONCLUSIONS This intervention program led to an improvement in OA-related symptoms, self-efficacy, and quality of life in older women with OA. CLINICAL RELEVANCE The sustained effects of acquired exercise behaviors that persisted up to 4 weeks after the program ended could be of interest to rehabilitation nurses and other healthcare professionals.
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Varga MG, Rata AL. The effect of a group exercise program on functional performance of patients with moderate knee osteoarthritis. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. The aim of this study was to evaluate the effects of a weekly group exercise program on the functional performance of patients with knee osteoarthritis. Material and methods. Patients (aged 51-78 years) with knee osteoarthritis Kellgren-Lawrence grade II-III were included in an exercise program. The exercise sessions were held once-a week, for six months, being supervised by a physical therapist. The scope of the program was to increase the mobility, muscular strength and balance. The physical function outcome was assessed using the Short Physical Performance Battery (SPPB) in two moments – before and after participating in the exercise program. Results. All patients completed the group exercise program. The SPPB score at the time of inclusion in the study was 8.33 ± 1.9. After six months of exercising in the weekly group exercise program, the score increased significantly at 9.07 ± 1.73 (p<0.0001). Conclusions. In conclusion, participating in a group-based exercise program for six months have been proved to have beneficial outcomes in physical performance in patients with knee osteoarthritis.
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Affiliation(s)
| | - Andreea Luciana Rata
- 2. Department of Vascular Surgery, „Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
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Baker K, LaValley MP, Brown C, Felson DT, Ledingham A, Keysor JJ. Efficacy of Computer-Based Telephone Counseling on Long-Term Adherence to Strength Training in Elderly Patients With Knee Osteoarthritis: A Randomized Trial. Arthritis Care Res (Hoboken) 2020; 72:982-990. [PMID: 31074576 PMCID: PMC10521167 DOI: 10.1002/acr.23921] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether the Boston Overcoming Osteoarthritis through Strength Training Telephone-Linked Communication (BOOST-TLC) program, a novel telephone-based, motivational, strength-training exercise-adherence counseling intervention, improved adherence to a strength-training exercise program over 2 years. METHODS Participants were recruited for this 2-year, single-blind, parallel-arm randomized controlled trial from knee osteoarthritis patient registries, community newspapers, and online websites in Massachusetts. Eligibility criteria included age 50 years or older, painful knee osteoarthritis, and ability to use a telephone. Exclusion criteria included medical conditions precluding exercise, inflammatory arthritis, current regular strength training, planned knee replacement surgery, dementia, inability to follow exercise instructions, and inability to use the TLC system. After participating in a group exercise class, participants were randomized to receiving motivational telephone calls through the BOOST-TLC program for 24 months or the control. Both control and intervention participants received a monthly automated phone message reminder to continue the program. Exercise adherence was ascertained by a single self-report item scored 0-10, where 10 represented complete adherence. Outcomes were evaluated at 6, 12, 18, and 24 months. RESULTS A total of 104 subjects were randomized, and 89 subjects (44 control, 45 TLC) completed the 24-month follow-up. There was no significant difference in adherence at 24 months between groups (mean for control group 4.01 [95% confidence interval (95% CI) 3.03, 4.99], mean for TLC subjects 3.63 [95% CI 2.70, 4.56]; P = 0.57). CONCLUSION In those with knee osteoarthritis who had participated in an exercise program, frequent motivational telephone reminders did not increase adherence to strength-training exercise.
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Rezaei S, Mohammadhossini S, Karimi Z, Yazdanpanah P, Zarei Nezhad M, Ghafarian Shirazi HR. Effect of 8-Week Aerobic Walking Program on Sexual Function in Women with Rheumatoid Arthritis. Int J Gen Med 2020; 13:169-176. [PMID: 32494186 PMCID: PMC7231853 DOI: 10.2147/ijgm.s252591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Sexual dysfunction is a little-addressed condition in patients with rheumatoid arthritis. Aerobic exercises, including walking, can help alleviate this dysfunction. This study aimed to determine the effect of an 8-week aerobic walking program on sexual function ine patients with rheumatoid arthritis. Methodology This clinical trial was conducted on 51 patients with rheumatoid arthritis. At first, patients were selected through nonprobability sampling. They were then allocated into intervention and control groups using block randomization. The walking intervention was performed based on the frequency–intensity–time–type principle forg 8 consecutive weeks. Rosen’s Female Sexual Function Index was used for data collection before, immediately after, and 4 weeks after the intervention. Data collected were analyzed with SPSS 22 using descriptive and inferential statistics and 95% CI. Findings Mean sexual function scores before, after, and 4 weeks after intervention were 17.66±4, 22.88±4.7, and 24.39±5.1 in the intervention group and 17.60±4.24, 17.27±4.66, and 17.39±4.39 in the control group, respectively. Test results showed a significant intergroup difference in mean sexual function score (p<0.05). Conclusion Based on our results, an 8-week aerobic walking program is recommended as an effective way to improve sexual function in women with rheumatoid arthritis.
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Affiliation(s)
- Sara Rezaei
- Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sima Mohammadhossini
- Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zohreh Karimi
- Department of Operating Room, School of Paramedicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Parviz Yazdanpanah
- Physical Medicine and Rehabilitation, Yasuj University of Medical Sciences, Yasuj, Iran
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Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports Med 2020; 49:743-761. [PMID: 30830561 PMCID: PMC6459784 DOI: 10.1007/s40279-019-01082-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations. Objectives The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks. Methods We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865). Findings We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65). Conclusion The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation. Electronic supplementary material The online version of this article (10.1007/s40279-019-01082-0) contains supplementary material, which is available to authorized users.
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Ryu M, Lee S, Kim H, Baek WC, Kimm H. Effect of Aerobic Physical Activity on Health-Related Quality of Life in Middle Aged Women with Osteoarthritis: Korea National Health and Nutrition Examination Survey (2016-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020527. [PMID: 31947669 PMCID: PMC7013511 DOI: 10.3390/ijerph17020527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/12/2022]
Abstract
Background: There have been few studies reporting the association between health-related quality of life (HRQoL) and osteoarthritis (OA) in female subjects performing aerobic exercise or not. The aim of this study is to compare HRQoL between OA patients and non-OA subjects in middle aged Korean women (40–59 years) with/without aerobic physical activity, and also to identify an association between EQ-5D instrument based HRQoL and OA controlling for aerobic exercise. Methods: This study used the cross-sectional data, the Korea National Health and Nutrition Examination Survey (KNANES) from 2016 to 2017. We only selected those who had completed the evaluations of aerobic physical activity and osteoarthritis diagnosis. In total, 2445 middle aged women were finally selected for this study. The European quality of life-5 dimensions (EQ-5D) was used for the evaluation of HRQoL as a dependent variable. In socio-demographic factors, age, sex, income level, education level, marital status, economic activity, type of insurance and private insurance and behaviour-related factors were included. One-way analysis of variance was conducted to compare the EQ-5D index and multiple linear regression analysis was employed to identify associated factors with the EQ-5D index. Results: In total, 2445 middle aged women were included in this study, in which 2209 participants were normal (90.0%) with aerobic physical activity (no: 55.0%, yes: 45.0%) and 246 participants were diagnosed with osteoarthritis (10.0%) with aerobic physical activity (no: 56.1%, yes: 43.9%). In group 2-2 (OA with aerobic), the moderate level of muscle exercise (less than 5 days per week) showed the highest HRQoL (p < 0.05) and high level exercise showed the lowest HRQoL (p < 0.05). In menopause status, the participants under menopause status showed lower HRQoL (p < 0.05) than those not under menopause status in group 2-2 (OA with aerobic) only. Conclusions: The HRQoL of OA patients was significantly lower than that of normal participants in middle aged Korean women (40–59 years). Especially, OA patients with maintained aerobic physical activity showed significantly higher HRQoL than those without that under controlling covariates such as age, income level, education level, marital status, economic activity, type of insurance, etc.
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Affiliation(s)
- Mikyung Ryu
- Department of Sport & Leisure Studies, College of Physical Science, Kyonggi University, Suwon 16227, Korea;
- Institute on Aging, Ajou University Medical Center, Suwon 16499, Korea
| | - Sol Lee
- Department of bbko Research Center, bbko Big-Data R&D, Seoul 04146, Korea; (S.L.); (H.K.)
- Department of Health Policy and Management, Korea University, Seoul 02841, Korea
| | - Ho Kim
- Department of bbko Research Center, bbko Big-Data R&D, Seoul 04146, Korea; (S.L.); (H.K.)
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
| | - Weon-Chil Baek
- Department of Sports and Health Science, College of Human-Centered Convergence, Kyonggi University, Suwon 16227, Korea;
| | - Heejin Kimm
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1531; Fax: +82-2-365-5118
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Kim DJ. A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients. Osong Public Health Res Perspect 2020; 10:368-375. [PMID: 31897366 PMCID: PMC6927422 DOI: 10.24171/j.phrp.2019.10.6.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to investigate the physical activities, mental health, and health-related quality of life (HRQOL) of osteoarthritis patients. Methods This study was conducted using data from the first year of the 7th Korea National Health and Nutritional Examination Survey. There were 8,150 participants included in the survey, and 665 participants had been diagnosed with osteoarthritis. This study analyzed the measurements of physical activities, depression, and HRQOL in participants with osteoarthritis. Results The mean age of the participants was 67 ± 9.9 years and 83.1% were female. Participants rarely engaged in work-related physical activity, and engaged in leisure-related physical activities infrequently. Most of the participants (85.9%) did not do regular exercise, but 1/3 of the participants walked for over 10 minutes a day. "Pain/discomfort" had the least impact upon HRQOL, and among the depression subcategories, "difficult to sleep and tiredness" had the most impact. Multiple logistic regression analysis showed that an adverse HRQOL score was statistically significantly associated with "location changes/physical activities" (p < 0. 01), "depression" (p < 0.001) and "age" (p < 0.001). Conclusion Exercise programs should be in place which are manageable in everyday life for the elderly (> 65 years). Changes in daily routine so that patients become more active, should be supported by the family and community, together with assistance in managing psychological problems such as depression.
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Affiliation(s)
- Deok-Ju Kim
- Department of Occupational Therapy, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
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Schulz JM, Birmingham TB, Atkinson HF, Woehrle E, Primeau CA, Lukacs MJ, Al-Khazraji BK, Khan MCM, Zomar BO, Petrella RJ, Beier F, Appleton CT, Shoemaker JK, Bryant DM. Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:771-775. [DOI: 10.1136/bjsports-2018-100231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.
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Watt FE, Blauwet MB, Fakhoury A, Jacobs H, Smulders R, Lane NE. Tropomyosin-related kinase A (TrkA) inhibition for the treatment of painful knee osteoarthritis: results from a randomized controlled phase 2a trial. Osteoarthritis Cartilage 2019; 27:1590-1598. [PMID: 31356878 DOI: 10.1016/j.joca.2019.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/05/2019] [Accepted: 05/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the TrkA inhibitor, ASP7962, for treatment of painful knee osteoarthritis. DESIGN Phase 2a, double-blind, placebo- and naproxen-controlled, double-dummy, parallel-group study. Adults with knee osteoarthritis were randomized (2:2:1) to ASP7962 (100 mg), placebo, or naproxen (500 mg) twice daily (BID) for 4 weeks. Primary endpoint: change from baseline to Week 4 in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale score. Secondary endpoints: change from baseline to Weeks 1, 2, and End of Treatment (EoT) in WOMAC pain subscale score; change from baseline to Weeks 1, 2, 4, and EoT in WOMAC physical function and stiffness subscales, walking pain and WOMAC total scores; and change from baseline in daily average pain score. RESULTS 215 participants were randomized (ASP7962 100 mg BID, n = 85; placebo, n = 87; naproxen 500 mg BID, n = 43). No significant difference was observed between ASP7962 and placebo in change from baseline to Week 4 in WOMAC pain subscale score (-0.14; 90% 2-sided CI: -0.62, 0.34; P = 0.316); a significant difference was observed between naproxen and placebo (-0.67; 80% 2-sided CI: -1.12, -0.23; P = 0.027). No differences were observed between ASP7962 and placebo in change from baseline in any WOMAC subscale score; statistically significant changes were observed between naproxen and placebo (P ≤ 0.01, all time points for all WOMAC endpoints). ASP7962 was safe and well-tolerated. CONCLUSIONS Four-week treatment with ASP7962 (100 mg BID) did not improve pain or physical function in individuals with painful knee osteoarthritis. ClinicalTrials.gov, NCT02611466; EudraCT Number, 2014-004996-22.
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Affiliation(s)
- F E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive Headington, Oxford, UK.
| | - M B Blauwet
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - A Fakhoury
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - H Jacobs
- Formerly with Astellas Pharma Global Development, Leiden, the Netherlands.
| | - R Smulders
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - N E Lane
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA, USA.
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Nordberg RC, Mellor LF, Krause AR, Donahue HJ, Loboa EG. LRP receptors in chondrocytes are modulated by simulated microgravity and cyclic hydrostatic pressure. PLoS One 2019; 14:e0223245. [PMID: 31584963 PMCID: PMC6777824 DOI: 10.1371/journal.pone.0223245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/17/2019] [Indexed: 01/16/2023] Open
Abstract
Mechanical loading is essential for the maintenance of musculoskeletal homeostasis. Cartilage has been demonstrated to be highly mechanoresponsive, but the mechanisms by which chondrocytes respond to mechanical stimuli are not clearly understood. The goal of the study was to determine how LRP4, LRP5, and LRP6 within canonical Wnt-signaling are regulated in simulated microgravity and cyclic hydrostatic pressure, and to investigate the potential role of LRP 4/5/6 in cartilage degeneration. Rat chondrosacroma cell (RCS) pellets were stimulated using either cyclic hydrostatic pressure (1Hz, 7.5 MPa, 4hr/day) or simulated microgravity in a rotating wall vessel (RWV) bioreactor (11RPM, 24hr/day). LRP4/5/6 mRNA expression was assessed by RT-qPCR and LRP5 protein expression was determined by fluorescent immunostaining. To further evaluate our in vitro findings in vivo, mice were subjected to hindlimb suspension for 14 days and the femoral heads stained for LRP5 expression. We found that, in vitro, LRP4/5/6 mRNA expression is modulated in a time-dependent manner by mechanical stimulation. Additionally, LRP5 protein expression is upregulated in response to both simulated microgravity and cyclic hydrostatic pressure. LRP5 is also upregulated in vivo in the articular cartilage of hindlimb suspended mice. This is the first study to examine how LRP4/5/6, critical receptors within musculoskeletal biology, respond to mechanical stimulation. Further elucidation of this mechanism could provide significant clinical benefit for the identification of pharmaceutical targets for the maintenance of cartilage health.
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Affiliation(s)
- Rachel C. Nordberg
- College of Engineering, University of Missouri, Columbia, Missouri, United States of America
| | | | - Andrew R. Krause
- Sport Health and Physical Education, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - Henry J. Donahue
- Division of Musculoskeletal Sciences, Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Elizabeth G. Loboa
- College of Engineering, University of Missouri, Columbia, Missouri, United States of America
- * E-mail:
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The effects of exercise and milk-fat globule membrane (MFGM) on walking parameters in community-dwelling elderly Japanese women with declines in walking ability: A randomized placebo controlled trial. Arch Gerontol Geriatr 2019; 83:106-113. [DOI: 10.1016/j.archger.2019.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
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Allen KD, Bongiorni D, Caves K, Coffman CJ, Floegel TA, Greysen HM, Hall KS, Heiderscheit B, Hoenig HM, Huffman KM, Morey MC, Ramasunder S, Severson H, Smith B, Van Houtven C, Woolson S. STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled trial. BMC Musculoskelet Disord 2019; 20:254. [PMID: 31138256 PMCID: PMC6540433 DOI: 10.1186/s12891-019-2627-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions. METHODS / DESIGN Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA. DISCUSSION STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA. TRIAL REGISTRATION Clinicaltrials.gov, NCT02653768 (STepped Exercise Program for Knee OsteoArthritis (STEP-KOA)), Registered January 12, 2016.
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Affiliation(s)
- Kelli D. Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Dennis Bongiorni
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
| | - Kevin Caves
- Department of Biomedical Engineering, Duke University, Durham, USA
| | - Cynthia J. Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
| | | | | | - Katherine S. Hall
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, USA
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, USA
| | - Helen M. Hoenig
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
| | - Kim M. Huffman
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
- Department of Medicine, Division of Rheumatology, Duke University, Durham, USA
| | - Miriam C. Morey
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, USA
| | | | | | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Courtney Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Sandra Woolson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
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Kwon S, Kim W, Yang S, Choi KH. Influence of the type of occupation on osteoarthritis of the knee in men: The Korean National Health and Nutrition Examination Survey 2010-2012. J Occup Health 2019; 61:54-62. [PMID: 30698336 PMCID: PMC6499360 DOI: 10.1002/1348-9585.12022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/14/2023] Open
Abstract
Objectives We investigated the influence of different types of lifetime occupation on knee osteoarthritis (OA) and pain based on a nationwide survey in Korea. Methods We conducted a cross‐sectional study using Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012. Men ≥50 years old were divided into four occupational groups: white‐collar (WC) workers, pink‐collar (PC) workers, blue‐collar (BC) workers, and agribusiness and low‐level (AL) workers. The risks for knee OA and pain development according to occupation were compared to the risks in WC workers, using multiple logistic regression analyses. Results Different occupations were associated with different levels of risk for knee OA and knee pain. The risk for knee OA was higher in BC workers and in AL workers than in WC workers, in order of higher risk. The risk for severe knee OA was likewise higher in AL workers and in BC workers, in order of higher risk. The risk for chronic knee pain was higher in AL workers, BC workers, and PC workers, in order of higher risk. The risk for moderate to severe chronic knee pain was higher in AL workers and BC workers, in order of higher risk. Conclusions The results suggest that occupation might affect the development of knee OA and presence of chronic knee pain in men ≥50 years old. WC workers are least affected by knee OA and chronic knee pain, and AL and BC workers are at clearly higher risk for knee OA and chronic knee pain.
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Affiliation(s)
- Sara Kwon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord 2019; 20:159. [PMID: 30967128 PMCID: PMC6456984 DOI: 10.1186/s12891-019-2537-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps muscle strength and physical performance in individuals with knee OA. METHODS A three-arm single-blinded, randomized, controlled trial and intention-to-treat analysis was conducted in outpatient physiotherapy department, King Saud University, Saudi Arabia. Sixty-eight individuals (mean age, 55.6 years; 38 female) with knee OA participated. The participants in the retro or forward walking group completed 10 min of supervised retro or forward walking training in addition to usual care, 3 days/week for 6 weeks. The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score of quadriceps muscle strength and timed up and go test scores. All the outcomes were analyzed at baseline and week 6. RESULTS In total, 68 subjects participated in this 6-week randomized, controlled trial. The completion rates of the primary and secondary outcome measures at week 6 were 91, 87, and 82% in the retro walking, forward walking, and control groups, respectively. In the intention-to-treat analysis, the retro walking group had a greater reduction in pain intensity (mean changes, 1.8 versus 1; p = 0.01) and functional disability (mean changes, 4.8 versus 2.2; p = 0.008) than the control group. Similarly, the retro walking group had a greater improvement in the quadriceps muscle strength (mean changes, 1.7 kg versus 0.7 kg; p = 0.008) and the timed up and go test (mean changes, 0.6 s versus 0.1 s; p = 0.003) than the control group. CONCLUSIONS The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA. TRIAL REGISTRATION Controlled Trials ISRCTN12850845 , Registered 26 January 2015.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia. .,Deparment of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China.
| | - Bibhuti Sarkar
- National Institute for the Locomotor Disabilities (Divyangjan), Kolkata, India
| | - Ashis K Paul
- Anand Vihar Hospital, Mahanadi Coalfields Limited, Sambalpur, Odisha, India
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Kamada M, Kitayuguchi J, Abe T, Taguri M, Inoue S, Ishikawa Y, Bauman A, Lee IM, Miyachi M, Kawachi I. Community-wide intervention and population-level physical activity: a 5-year cluster randomized trial. Int J Epidemiol 2019; 47:642-653. [PMID: 29228255 PMCID: PMC5913653 DOI: 10.1093/ije/dyx248] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Evidence from a limited number of short-term trials indicates the difficulty in achieving population-level improvements in physical activity (PA) through community-wide interventions (CWIs). We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster randomized design. Methods We randomized 12 communities in Unnan, Japan, to either intervention (9) or control (3). Additionally, intervention communities were randomly allocated to three subgroups by different PA types promoted. Randomly sampled residents aged 40–79 years responded to the baseline survey (n = 4414; 74%) and were followed at 1, 3 and 5 years (78–83% response rate). The intervention was a 5-year CWI using social marketing to promote PA. The primary outcome was a change in recommended levels of PA. Results Compared with control communities, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference = 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. The intervention was effective for promoting all types of recommended PAs, i.e. aerobic (walking, 6.4%), flexibility (6.1%) and muscle-strengthening activities (5.7%). However, a bundled approach, which attempted to promote all forms of PAs above simultaneously, was not effective (1.3–3.4%, P ≥ 0.138). Linear dose–response relationships between the CWI awareness and changes in PA were observed (P ≤ 0.02). Pain intensity decreased in shoulder (intervention and control) and lower back (intervention only) but there was little change difference in all musculoskeletal pain outcomes between the groups. Conclusions The 5-year CWI using the focused social marketing strategy increased the population-level of PA.
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Affiliation(s)
- Masamitsu Kamada
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan.,Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan
| | - Takafumi Abe
- Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan.,Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Izumo, Shimane, Japan
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshiki Ishikawa
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Vancampfort D, Stubbs B, Firth J, Koyanagi A. Handgrip strength, chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries. Eur J Intern Med 2019; 61:96-102. [PMID: 30509483 DOI: 10.1016/j.ejim.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Handgrip strength provides a clinically validated marker of overall health and mortality risk. There are however, no multi-national population-based studies investigating the associations between handgrip strength, chronic physical conditions, and physical multimorbidity (i.e., ≥2 chronic conditions). We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six in low- and middle-income countries (LMICs). METHODS Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Eleven chronic physical conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed. Weak handgrip strength was defined as <30 kg for men and <20 kg for women. Multivariable logistic regression analysis was conducted. RESULTS The final sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). After adjustment for potential confounders, when compared to those with no chronic physical conditions, having 1, 2, 3, and ≥4 physical chronic conditions was associated with 1.22 (95%CI = 1.08-1.37), 1.29 (95%CI = 1.11-1.50), 1.41 (95%CI = 1.18-1.68), and 1.78 (95%CI = 1.46-2.18) times higher odds for weak handgrip strength. Similar associations were observed in the analyses stratified by age and sex. There was a moderate level of between-country heterogeneity in the association between weak handgrip strength and physical multimorbidity (Higgin's I2 = 67.8%) with the pooled estimate being 1.26 (95%CI = 1.06-1.50). CONCLUSION Weaker handgrip strength is associated with a range of chronic physical conditions and multimorbidity. Future research should seek to establish the predictive value of this inexpensive measure for clinical use.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hills, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box, SE5 8AF, United Kingdom
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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46
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Zhang W, Robertson WB, Zhao J, Chen W, Xu J. Emerging Trend in the Pharmacotherapy of Osteoarthritis. Front Endocrinol (Lausanne) 2019; 10:431. [PMID: 31312184 PMCID: PMC6614338 DOI: 10.3389/fendo.2019.00431] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disorder and one of the most prevalent diseases among the elderly population. Due to the limited spontaneous healing capacity of articular cartilage, it still remains challenging to find satisfactory treatment for OA. This review covers the emerging trends of pharmacologic therapies for OA such as traditional OA drugs (acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, serotonin-norepinephrine reuptake inhibitors (SNRIs), intra-articular injections of corticosteroids, and dietary supplements), which are effective in pain relief but not in reversing damage, and are frequently associated with adverse events. Alternatively, disease-modifying drugs provide promising alternatives for the management of OA. The development of these emerging OA therapeutic agents requires a comprehensive understanding of the pathophysiology of OA progression. The process of cartilage anabolism/catabolism, subchondral bone remodeling and synovial inflammation are identified as potential targets. These emerging OA drugs such as bone morphogenetic protein-7 (BMP-7), fibroblast growth factor-18 (FGF-18), human serum albumin (HSA), interleukin-1 (IL-1) inhibitor, β-Nerve growth factor (β-NGF) antibody, matrix extracellular phosphoglycoprotein (MEPE) and inverse agonist of retinoic acid-related orphan receptor alpha (RORα) etc. have shown potential to modify progression of OA with minimal adverse effects. However, large-scale randomized controlled trials (RCTs) are needed to investigate the safety and efficacy before translation from bench to bedside.
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Affiliation(s)
- Wei Zhang
- School of Medicine, Southeast University, Nanjing, China
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - William Brett Robertson
- Australian Institute of Robotic Orthopaedics, Perth, WA, Australia
- School of Surgery, The University of Western Australia, Perth, WA, Australia
- School of Science, Faculty of Science and Engineering, Curtin University, Perth, WA, Australia
- Department of Materials Science and Engineering, College of Engineering, University of North Texas, Denton, TX, United States
| | - Jinmin Zhao
- Research Centre for Regenerative Medicine, Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weiwei Chen
- Research Centre for Regenerative Medicine, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- *Correspondence: Weiwei Chen
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
- Jiake Xu
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Bartholdy C, Nielsen SM, Warming S, Hunter DJ, Christensen R, Henriksen M. Poor replicability of recommended exercise interventions for knee osteoarthritis: a descriptive analysis of evidence informing current guidelines and recommendations. Osteoarthritis Cartilage 2019; 27:3-22. [PMID: 30248500 DOI: 10.1016/j.joca.2018.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/28/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the reporting completeness of exercise-based interventions for knee osteoarthritis (OA) in studies that form the basis of current clinical guidelines, and examine if the clinical benefit (pain and disability) from exercise is associated with the intervention reporting completeness. DESIGN Review of clinical OA guidelines METHODS: We searched MEDLINE and EMBASE for guidelines published between 2006 and 2016 including recommendations about exercise for knee OA. The studies used to inform a recommendation were reviewed for exercise reporting completeness. Reporting completeness was evaluated using a 12-item checklist; a combination of the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT). Each item was scored 'YES' or 'NO' and summarized as a proportion of interventions with complete descriptions and each intervention's completeness was summarized as the percentage of completely described items. The association between intervention description completeness score and clinical benefits was analyzed with a multilevel meta-regression. RESULTS From 10 clinical guidelines, we identified 103 original studies of which 100 were retrievable (including 133 interventions with 6,926 patients). No interventions were completely described on all 12 items (median 33% of items complete; range 17-75%). The meta-regression analysis indicated that poorer reporting was associated with greater effects on pain and no association with effects on disability. CONCLUSION The inadequate description of recommended interventions for knee OA is a serious problem that precludes replication of effective interventions in clinical practice. By consequence, the relevance and usability of clinical guideline documents and original study reports are diminished. PROSPERO CRD42016039742.
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Affiliation(s)
- C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - S M Nielsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.
| | - S Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
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Vallati C, Virdis A, Gesi M, Carbonaro N, Tognetti A. ePhysio: A Wearables-Enabled Platform for the Remote Management of Musculoskeletal Diseases. SENSORS 2018; 19:s19010002. [PMID: 30577467 PMCID: PMC6339172 DOI: 10.3390/s19010002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
Technology advancements in wireless communication and embedded computing are fostering their evolution from standalone elements to smart objects seamlessly integrated in the broader context of the Internet of Things. In this context, wearable sensors represent the building block for new cyber-physical social systems, which aim at improving the well-being of people by monitoring and measuring their activities and provide an immediate feedback to the users. In this paper, we introduce ePhysio, a large-scale and flexible platform for sensor-assisted physiotherapy and remote management of musculoskeletal diseases. The system leverages networking and computing tools to provide real-time and ubiquitous monitoring of patients. We propose three use cases which differ in scale and context and are characterized by different human interactions: single-user therapy, indoor group therapy, and on-field therapy. For each use case, we identify the social interactions, e.g., between the patient and the physician and between different users and the performance requirements in terms of monitoring frequency, communication, and computation. We then propose three related deployments, highlighting the technologies that can be applied in a real system. Finally, we describe a proof-of-concept implementation, which demonstrates the feasibility of the proposed solution.
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Affiliation(s)
- Carlo Vallati
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
| | - Antonio Virdis
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
| | - Marco Gesi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia e Centro Dipartimentale di Medicina Riabilitativa "Sport and Anatomy", 56123 Pisa, Italy.
| | - Nicola Carbonaro
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
- Centro di Ricerca "E.Piaggio", 56123 Pisa, Italy.
| | - Alessandro Tognetti
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
- Centro di Ricerca "E.Piaggio", 56123 Pisa, Italy.
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Alrushud AS, Rushton AB, Bhogal G, Pressdee F, Greig CA. Effect of a combined programme of dietary restriction and physical activity on the physical function and body composition of obese middle-aged and older adults with knee OA (DRPA): protocol for a feasibility study. BMJ Open 2018; 8:e021051. [PMID: 30552242 PMCID: PMC6303593 DOI: 10.1136/bmjopen-2017-021051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/20/2018] [Accepted: 09/12/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is the most common chronic illness among older adults. Up to the submission date of this protocol, there are no published UK studies reporting the efficacy of a combined intervention programme of physical activity and dietary restriction on the musculoskeletal function of obese older adults with knee OA in spite of the clinical recommendation for exercise and diet for people with knee OA. The aim of this study is to assess the feasibility and acceptability of a combined dietary restriction and physical activity intervention programme and collect preliminary data. METHOD AND ANALYSIS This single-arm intervention study is scheduled to begin in September 2017 and conclude in November 2018. It will take place at the Royal Orthopaedic Hospital (ROH), Birmingham and the School of Sport, Exercise and Rehabilitation Sciences (SportExR), University of Birmingham. Participants will receive a physiotherapy usual care programme for knee OA for 1 month, after which they will continue to exercise in their local gym/leisure facility for 3 months. Participants will also follow dietary restriction throughout the 4-month intervention. Mixed analysis techniques will be used to analyse the quantitative and qualitative outcome measures. ETHICS AND DISSEMINATION It is approved by ROH R&D Foundation Trust and the Health Research Authority. The Consort Guidelines and checklist will be reviewed prior to generating any publications for the trial to ensure they meet the standards required for submission to high-quality peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN12906938.
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Affiliation(s)
- Asma S Alrushud
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Alison B Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing and Health, University of Birmingham, Birmingham, UK
| | - Gurjit Bhogal
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Fraser Pressdee
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Carolyn A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing and Health, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
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Centeno C, Sheinkop M, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med 2018; 16:355. [PMID: 30545387 PMCID: PMC6293635 DOI: 10.1186/s12967-018-1736-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023] Open
Abstract
Background Cell-based therapies have shown promise for the treatment of knee osteoarthritis (OA). The current study compared exercise therapy to autologous bone marrow concentrate (BMC) and platelet products for knee OA treatment. Methods Patients with symptomatic knee OA (N = 48) were randomized into either an exercise therapy control group or treatment group with injection of autologous BMC and platelet products. Patients in the control group could crossover to BMC treatment after 3 months. Clinical outcomes were documented at baseline and at 6-weeks, 3, 6, 12 and 24 months, including the Knee Society Score (KSS), Pain Visual Analogue Scale, Short Form-12 Scales (SF-12), and Lower Extremity Activity Scale (LEAS). Results All patients in the exercise group crossed over to receive BMC treatment after 3 months (N = 22 crossover). At 3 months, KSS-knee, SF-12 Physical, and LEAS improved significantly in the crossover group compared to exercise, similar to significant improvements on KSS-knee and LEAS for the treatment group (N = 26) compared to exercise group at 3 months. After BMC treatment, patients’ clinical outcome scores (except SF-12 Mental Health), were significantly improved through the 2-year follow-up compared to baseline. No serious adverse events were reported. Conclusion The use of image-guided percutaneous BMC with platelet products yielded better results than exercise therapy as an effective alternative therapy for patients with symptomatic moderate to moderate-severe osteoarthritis of the knee. Trial registration NCT02034032. https://clinicaltrials.gov/ct2/show/NCT02034032. Registered 13 January 2014
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Affiliation(s)
- Christopher Centeno
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA.,Regenexx, LLC, Des Moines, IA, USA
| | | | | | | | | | - Matthew Hyzy
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | - Michael Freeman
- CAPHRI, School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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