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Jiao S, Feng Z, Huang J, Dai T, Liu R, Meng Q. Enhanced recovery after surgery combined with quantitative rehabilitation training in early rehabilitation after total knee replacement: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:74-83. [PMID: 37934189 PMCID: PMC10938034 DOI: 10.23736/s1973-9087.23.07899-1] [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: 01/30/2023] [Revised: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The number of patients undergoing total knee replacement (TKR) is increasing yearly; however, there is still a relative lack of specific, individualized, and standardized protocols for functional exercise after TKR. Quantitative rehabilitation training was developed to improve the recovery of postoperative joint function, increase patient satisfaction, shorten the length of the hospital stay, improve the quality of life, and promote rapid patient recovery. AIM We aimed to compare the effectiveness of quantitative rehabilitation training based on the enhanced recovery after surgery (ERAS) concept with conventional rehabilitation training in the early rehabilitation of patients with TKR. DESIGN This was a single-centre, prospective, randomized controlled trial. SETTING Inpatient department. POPULATION Participants were patients who underwent unilateral total knee replacement. METHODS Based on the ERAS concept, a quantitative rehabilitation training program was developed for the quantitative group, and the control group underwent conventional rehabilitation training. Seventy-eight patients undergoing TKR were randomly divided into two blinded groups: the quantitative rehabilitation group and the conventional rehabilitation group. The analysis was performed according to per-protocol practice. The primary outcome metric was the Hospital for Special Surgery Knee Score (HSS Score), and secondary outcomes included patient satisfaction, Visual Analog Pain Score (VAS), time to get out of bed for the first time after surgery, 6-minute-walk test (6MWT), quality-of-life score (SF-36), and number of days in the hospital. The incidence of postoperative complications was also recorded. RESULTS There was no significant difference in HSS scores between the two groups before surgery (P=0.967), but the quantitative rehabilitation training group had significantly higher scores at two weeks (P=0.031), 3 months (P<0.01), and 12 months (P<0.01) after surgery than did the conventional rehabilitation training group, and both groups had higher HSS scores than before surgery. The quantitative training group had significantly higher VAS scores at 24 hours and three days postoperatively than the conventional training group (P<0.01), while there was no statistical significance at any other time points. The quantitative rehabilitation group had an earlier time to get out of bed for the first time after surgery (P<0.01), a longer 6MWT distance (P=0.028), and higher patient satisfaction and quality of life scores (SF-36) (P<0.01) that did the control group. The number of days in the hospital was lower in the quantitative training group than in the control group (P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups. CONCLUSIONS Compared with conventional rehabilitation training, quantitative rehabilitation training based on the ERAS concept was found to be safe and effective and can accelerate the recovery of joint function after surgery, shorten hospitalization time, improve patient satisfaction, and promote rapid recovery. CLINICAL REHABILITATION IMPACT The quantitative rehabilitation training based on the ERAS concept provides a new program for rehabilitation exercises after total knee arthroplasty, which is safe and reliable, accelerates the recovery of joint function, and should be considered for clinical promotion.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopedics, The Central Hospital of Xiaogan, Hubei, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Ruijia Liu
- Department of Orthopedics, Fosun Chancheng Hospital of Foshan, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China -
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Zhang H, Huang J, Alahdal M. Exosomes loaded with chondrogenic stimuli agents combined with 3D bioprinting hydrogel in the treatment of osteoarthritis and cartilage degeneration. Biomed Pharmacother 2023; 168:115715. [PMID: 37857246 DOI: 10.1016/j.biopha.2023.115715] [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: 07/09/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
Osteoarthritis (OA) is a challenging joint inflammatory disease that often leads to disability. Immunoregulatory Exosomes (Exos) have shown promise in OA and cartilage degeneration treatment. Engineering Exos to deliver therapeutic agents like Kartogenin (KGN) has displayed potential for restoring cartilage regeneration. However, challenges include the uneven distribution of Exos at the injury site and the release of Exos cargo out of chondrocytes. Hydrogel-loaded uMSC-Exo has demonstrated significant therapeutic effects in wound healing and tissue regeneration. Recently, a new version of three-dimensional (3D) bioprinting of hydrogel significantly restored cartilage regeneration in OA joints. Combining immune regulatory Exos with 3D bioprinting hydrogel (3D-BPH-Exos) holds the potential for immunomodulating cartilage tissue and treatment of OA. It can reduce intracellular inflammasome formation and the release of inflammatory agents like IL-1β, TNF-α, and INF-γ, while also preventing chondrocyte apoptosis by restoring mitochondrial functions and enhancing chondrogenesis in synovial MSCs, osteoprogenitor cells, and osteoclasts. Loading Exos with chondrogenic stimuli agents in the 3D-BPH-Exos approach may offer a faster and safer strategy for cartilage repair while better inhibiting joint inflammation than high doses of anti-inflammatory drugs and cell-based therapies. This review provides a comprehensive overview of hydrogel bioprinting and exosome-based therapy in OA. It emphasizes the potential of 3D-BPH-Exos loaded with chondrogenic stimuli agents for OA treatment, serving as a basis for further research.
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Affiliation(s)
- Hui Zhang
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen 518035, China; Department of Orthopedics, Shangrao People's Hospital, Shangrao, Jiangxi, China
| | - Jianghong Huang
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen 518035, China.
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen 518035, China; Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA.
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Wang Y, Li D, Lv Z, Feng B, Li T, Weng X. Efficacy and safety of Gutong Patch compared with NSAIDs for knee osteoarthritis: A real-world multicenter, prospective cohort study in China. Pharmacol Res 2023; 197:106954. [PMID: 37832860 DOI: 10.1016/j.phrs.2023.106954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
The Gutong Patch (GTP) is common in clinical practice for bone diseases. This study compared the efficacy and safety of GTP and nonsteroidal anti-inflammatory drugs (NSAIDs) for KOA patients from 35 medical centers assigned to GTP, selective COX-2 inhibitor (SCI), GTP + SCI, non-selective COX-2 inhibitor (NSCI), and GTP + NSCI groups. The visual analog scale (VAS) pain score, EuroQol-VAS, EuroQol 5D-3 L, time to articular pain relief / disappearance, and joint motion recovery were the efficacy assessments. Safety assessments included contact dermatitis, gastrointestinal disorders, etc. The p-value < 0.05 was considered statistically significant. After statistical analysis, the SCI and GTP + SCI groups showed better improvement of VAS than the GTP group; the time to articular pain relief in the NSCI group was shorter than that in GTP and SCI group; the time to joint motion recovery in the GTP + NSCI group was longer than that in the SCI group. Additionally, the improvement of the quality of life in all groups was significant after treatments. While the incidence of gastrointestinal adverse events in the NSAIDs group was higher than that in the GTP and GTP + NSAIDs groups. GTP and NSAIDs are effective for KOA patients, and GTP is more suitable for KOA patients with cardiovascular and gastrointestinal comorbidities. This study was approved by the Ethics Committee at Peking Union Medical College Hospital (HS-1766) and registered in the Chinese Clinical Trial Registry (ChiCTR2100046391).
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Affiliation(s)
- Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Dandan Li
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
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Teirlinck CH, Verhagen AP, van Ravesteyn LM, Reijneveld-van de Vendel EA, Runhaar J, van Middelkoop M, Ferreira ML, Bierma-Zeinstra SMA. Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100338. [PMID: 36817089 PMCID: PMC9932106 DOI: 10.1016/j.ocarto.2023.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Objective To evaluate the existing evidence on the effect of exercise therapy in patients with hip osteoarthritis (OA) compared to no treatment and explore whether a further trial will change the current evidence. Design Systematic review and cumulative meta-analysis using randomized controlled trials (RCT) to determine the effect on pain and function post-treatment, and at 6-9 months after treatment. Standardized mean difference (SMD) ≤ -0.37 was considered clinically worthwhile. Extended funnel plots were used to simulate the impact of a new trial on the pooled effect size of pain and function. Results 18 RCTs were included. Post-treatment we found a beneficial effect of exercise therapy on pain (SMD -0.38, 95% Confidence Interval (CI): 0.55 to -0.22) and function (SMD -0.31, 95% CI -0.49 to -0.11). A beneficial effect of exercise therapy on pain (SMD -0.23, 95% CI: 0.41 to -0.05) and function (SMD -0.29, 95% CI: 0.45 to -0.12) was found 6-9 months after treatment. Most effect estimates were small, and it is unclear whether these are clinically meaningful. Extended funnel plots and a simulation of a new trial showed that only a new trial with a larger effect than the current pooled effect or a trial including 74,843 participants would change the pooled effect estimate from an unclear to a clearly clinically worthwhile effect. Conclusions We found a beneficial effect of exercise therapy on pain and function in hip OA. It is unlikely a new trial added to current evidence will change the conclusion.
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Affiliation(s)
- Carolien H. Teirlinck
- Dept. General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Arianne P. Verhagen
- Dept. General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Australia
| | | | | | - Jos Runhaar
- Dept. General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Manuela L. Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Shepherd MH, Shumway J, Salvatori RT, Rhon DI, Young JL. The influence of manual therapy dosing on outcomes in patients with hip osteoarthritis: a systematic review. J Man Manip Ther 2022; 30:315-327. [PMID: 35192442 PMCID: PMC9621225 DOI: 10.1080/10669817.2022.2037193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To 1) Determine if specific dosing parameters of manual therapy are related to improved pain, disability, and quality of life outcomes in patients with hip osteoarthritis and 2) to provide recommendations for optimal manual therapy dosing based on our findings. DESIGN A systematic review of randomized controlled trials from the PubMed, CINAHL, and OVID databases that used manual therapy interventions to treat hip osteoarthritis was performed. Three reviewers assessed the risk of bias for included studies and extracted relevant outcome data based on predetermined criteria. Baseline and follow-up means and standard deviations for outcome measures were used to calculate effect sizes for within and between-group differences. RESULTS Ten studies were included in the final analyses totaling 768 participants, and half were graded as high risk of bias. Trends emerged: 1) large effect sizes were seen using long-axis distraction, mobilization and thrust manipulation, 2) mobilization with movement showed large effects for pain and range of motion, and (3) small effects were associated with graded mobilization. Durations of 10 to 30 minutes per session, and frequency 2-3 times per week for 2-6 weeks were the most common dosing parameters. CONCLUSIONS There were varied effect sizes associated with pain, function, and quality of life for both thrust and non-thrust mobilizations, and mobilization with movement into hip flexion and internal rotation. Due to the heterogeneity of MT dosage, it is difficult to recommend a specific manual therapy dosage for those with hip osteoarthritis.
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Affiliation(s)
- Mark H. Shepherd
- Department of Physical Therapy Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, USA,CONTACT Mark H. Shepherd Bellin College, Doctor of Science in Physical Therapy Program, 3201 Eaton Rd, Green Bay, WI54311, USA
| | - Joshua Shumway
- Department of Physical Therapy Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, USA
| | - Robert T. Salvatori
- Department of Physical Therapy Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, USA
| | - Daniel I. Rhon
- Department of Physical Therapy Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, USA
| | - Jodi L. Young
- Department of Physical Therapy Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, USA
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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Runge N, Aina A, May S. The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients With Knee or Hip Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:675-A13. [PMID: 35881705 DOI: 10.2519/jospt.2022.11062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To evaluate if there was an additional benefit of combining manual therapy (MT) and exercise therapy over exercise therapy alone on pain and function in patients with hip or knee osteoarthritis. DESIGN: Intervention systematic review LITERATURE SEARCH: We (1) searched 4 databases from inception to June 20, 2021; (2) hand searched a reference list of included trials and relevant systematic reviews; and (3) contacted 2 researchers in the field. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared MT and exercise therapy to similar exercise therapy programs alone in patients with hip or knee osteoarthritis. DATA SYNTHESIS: The data were combined using random-effects meta-analyses where appropriate. The certainty of evidence for each outcome was judged using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: We included 19 trials. There was very low to moderate certainty of evidence that MT added benefit in the short term for pain, and combined pain, function, and stiffness (WOMAC global scale), but not for performance-based function and self-reported function. In the medium term, there was low- to very-low-certainty evidence that MT added benefit for performance-based function and WOMAC global score, but not for pain. There was high-certainty evidence that MT provided no added benefit in the long term for pain and function. CONCLUSION: There was very low to moderate certainty of evidence supporting MT as an adjunct to exercise therapy for pain and WOMAC global scale, but not function in patients with knee or hip osteoarthritis in the short term. There was high certainty of evidence of no benefit for additional MT over exercise therapy alone in the long term. J Orthop Sports Phys Ther 2022;52(10):675-684. Epub: 27 July 2022. doi:10.2519/jospt.2022.11062.
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Thackeray A, Waring J, Hoogeboom TJ, Nijhuis-van Der Sanden MWG, Hess R, Fritz JM, Conroy MB, Fernandez ME. Implementing a Dutch Physical Therapy Intervention Into a U.S. Health System: Selecting Strategies Using Implementation Mapping. Front Public Health 2022; 10:908484. [PMID: 35899163 PMCID: PMC9309571 DOI: 10.3389/fpubh.2022.908484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.MethodsWe established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.ResultsClinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.ConclusionImplementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.
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Affiliation(s)
- Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Anne Thackeray
| | - Jackie Waring
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rachel Hess
- Division of Health System Innovation and Research, Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Zhao H, Li H, Liang S, Wang X, Yang F. T2 mapping for knee cartilage degeneration in young patients with mild symptoms. BMC Med Imaging 2022; 22:72. [PMID: 35436880 PMCID: PMC9017029 DOI: 10.1186/s12880-022-00799-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to analyze the distribution of knee cartilage degeneration in young patients with mild symptoms using quantitative magnetic resonance imaging (MRI) T2 mapping. MATERIALS AND METHODS This study included sixty six patients (case group) and twenty eight healthy volunteers (control group). The participants underwent 3.0 T conventional MRI plus a multi-echo sequence. The cartilage of each participant was divided into twenty eight subregions. We then calculated the T2 mean values and standard deviation or median and quartile range for each subregion according to whether the normal distribution was satisfied. Besides, we employed Kruskal-Wallis test to determine the statistical differences of each subregion in the control group while the Mann-Whitney U test was used to define the statistical difference between the case group and the control group and between the control group and subjects aged less than or equal to 35 years in the case group. RESULTS In the case group, age of 30 male patients was 31.5 ± 9.3 and age of 36 female patients was 35.7 ± 8.3. In the two groups, the superficial central lateral femoral region exhibited relatively high T2 values (control/case group: 49.6 ± 2.7/55.9 ± 8.8), and the deep medial patellar region exhibited relatively low T2 values (control/case group: 34.2 ± 1.3/33.5(32.2, 35.5)). Comparison of the T2 values between the case and the control group demonstrated a statistically significant increase in nine subregions (P1 < 0.05) and there were five subregions in the case group with age ≤ 35 years (P2 < 0.05). In particular, the p-values for four subregions of the patellofemoral joint were all less than 0.05 (P1 = 0.002, 0.015, 0.036, 0.005). CONCLUSION T2 values of patients were significantly different with values of healthy groups, especially in the superficial cartilage of the patellofemoral joint. It made T2 mapping helpful to early identify patients with knee cartilage degeneration.
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Affiliation(s)
- Huiyu Zhao
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, No. 5, South Seven West Road, Tiexi District, Shenyang, 110024, Liaoning, China
| | - Hongqiu Li
- The 2Th Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College, No. 5, South Seven West Road, Tiexi District, Shenyang, 110024, Liaoning, China
| | - Shuo Liang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, No. 5, South Seven West Road, Tiexi District, Shenyang, 110024, Liaoning, China
| | - Xinyue Wang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, No. 5, South Seven West Road, Tiexi District, Shenyang, 110024, Liaoning, China
| | - Feng Yang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, No. 5, South Seven West Road, Tiexi District, Shenyang, 110024, Liaoning, China.
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10
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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11
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Pozsgai M, Szabo I, Nusser N, Varnai R, Sipeky C. Overview of Registered Clinical Trials on Manual Therapy: Possible Implications of Genetic Testing for Personalized Treatment. In Vivo 2022; 36:294-305. [PMID: 34972726 DOI: 10.21873/invivo.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Manual therapy (MT) is a frequently applied intervention offering individualized treatment in the clinic. In addition to the traditional approaches of MT, measuring molecular response to MT may offer better understanding of MT outcomes in order to provide specific personalized treatment. The aim of this study was to summarize MT-related registered clinical trials, as well as to search for any evidence on MT and genetics. PATIENTS AND METHODS A comprehensive search was conducted within the Clinical Trials database with predefined keywords mining for all types of MT-related clinical trials. RESULTS From the 47 trials, 20 had results and 27 had no results. MT alleviated pain and improved function almost in all trials. One registered clinical trial had investigated molecular outcomes of MT. CONCLUSION MT is an effective and individualized treatment offering option in the management of several conditions. Interestingly, a clinical trial was found investigating molecular genetics and MT pinpointing an already existing link between genetics and MT. Therefore, further clinical trials may focus on genetics and MT for providing specific personalized treatment in future.
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Affiliation(s)
- Miklos Pozsgai
- Medical School, University of Pécs, Pécs, Hungary; .,Harkány Termal Rehabilitation Centre, Harkány, Hungary
| | - Istvan Szabo
- Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary.,Faculty of Sciences, Doctoral School of Biology and Sportbiology, University of Pécs, Pécs, Hungary
| | - Nora Nusser
- Medical School, University of Pécs, Pécs, Hungary.,Harkány Termal Rehabilitation Centre, Harkány, Hungary
| | - Reka Varnai
- Department of Primary Health Care, Medical School, University of Pécs, Pécs, Hungary
| | - Csilla Sipeky
- Institute of Biomedicine and Cancer Research Laboratories, Western Cancer Centre FICAN West, University of Turku, Turku, Finland
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12
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Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. Mayo Clin Proc 2021; 96:2435-2447. [PMID: 34481599 DOI: 10.1016/j.mayocp.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.
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Affiliation(s)
- Anil Krishnamurthy
- Department of Orthopedics and Plastic Surgery, Dayton Veterans Affairs Medical Center, Dayton, OH; Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA.
| | - Sanjog Pangarkar
- Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
| | - Jess Edison
- Department of Rheumatology ,Walter Reed National Military Medical Center, Bethesda, MD
| | - John Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - James Sall
- Office of Evidence-Based Practice, Veterans Affairs Central Office, Washington, DC
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13
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Mechlenburg I, Reimer LCU, Kjeldsen T, Frydendal T, Dalgas U. Exercise as Medicine During the Course of Hip Osteoarthritis. Exerc Sport Sci Rev 2021; 49:77-87. [PMID: 33481454 DOI: 10.1249/jes.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise is now considered medicine in numerous chronic conditions and is essentially without side effects. We hypothesize that exercise is primary, secondary, and tertiary prevention at different stages of hip osteoarthritis (preclinical, mild-moderate, and severe hip osteoarthritis) and after total hip arthroplasty.
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Affiliation(s)
| | | | | | | | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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14
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Pawłowska KM, Bochyński R, Pawłowski J, Jerzak L, Grochulska A. The impact of mobilization on hip osteoarthritis. J Back Musculoskelet Rehabil 2021; 33:817-822. [PMID: 31929135 DOI: 10.3233/bmr-181118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis is one of the most common joint disorders. It causes pain, stiffness and a decreased range of motion which have a significant impact on daily activities and gait, consequently leading to disability. OBJECTIVE The aim of this study is to compare hip mobilization with non-weight bearing exercises. METHODS A total of 57 females aged between 55-65 were divided into 2 groups. In the control group non-weight bearing exercises were conducted, whereas the research group received hip mobilization. RESULTS The Lequesne index significantly improved in the research group as compared with the control group. Hip function improved both in the control and research groups. Active hip extension increased by 0.54, while active abduction rose by 2.14 after non-weight bearing exercises. In the control group after mobilization both passive and active hip extension increased significantly by 3.53, active abduction by 5 and passive by 4.41, while active and passive internal rotation by 3.82 and 4.56, respectively. In both groups pain decreased. CONCLUSIONS Mobilization increases hip range of motion, decreases pain and improves hip function more than non-weight bearing exercises.
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Affiliation(s)
- Katarzyna Maria Pawłowska
- Department of Physiotherapy and Wellness, Institute of Health Sciences, Pomeranian University in Słupsk, 76-200 Słupsk, Poland
| | | | - Jakub Pawłowski
- Department of Physiotherapy and Wellness, Institute of Health Sciences, Pomeranian University in Słupsk, 76-200 Słupsk, Poland
| | - Leszek Jerzak
- Department of Nature Conservation, Faculty of Biological Sciences, University of Zielona Góra, 65-561 Zielona Góra, Poland
| | - Agnieszka Grochulska
- Department of Physiotherapy and Wellness, Institute of Health Sciences, Pomeranian University in Słupsk, 76-200 Słupsk, Poland
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15
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Kemp JL, Mosler AB, Hart H, Bizzini M, Chang S, Scholes MJ, Semciw AI, Crossley KM. Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain. Br J Sports Med 2020; 54:1382-1394. [PMID: 32376673 PMCID: PMC7677471 DOI: 10.1136/bjsports-2019-101690] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To report the effectiveness of physiotherapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain. DESIGN Systematic review and meta-analysis. DATA SOURCES A comprehensive, reproducible search strategy was performed on five databases in May 2019. Reference lists and grey literature were also searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Population: people aged ≥18 years with hip-related pain (with or without a diagnosis of femoroacetabular impingement syndrome). INTERVENTION(S) physiotherapist-led interventions for hip pain. Comparators: sham treatment, no treatment or other treatment (eg, hip arthroscopic surgery). OUTCOMES primary outcomes included patient-reported hip pain and function. Secondary outcomes included physical function measures. RESULTS 1722 papers were identified. After exclusion criteria were applied, 14 studies were included for analysis. They had varied risk of bias. There were no full-scale placebo-controlled randomised controlled trials (RCTs) of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favouring physiotherapist-led intervention over no treatment post-arthroscopy, to weak effects (-0.32 (95% CI 0.57 to 0.07)) favouring hip arthroscopy over physiotherapist-led treatment. CONCLUSION Physiotherapist-led interventions might improve pain and function in young and middle-aged adults with hip-related pain, however full-scale high-quality RCT studies are required. PROSPERO REGISTRATION NUMBER CRD42018089088.
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Affiliation(s)
- Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Andrea B Mosler
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Harvi Hart
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Steven Chang
- La Trobe University Library, La Trobe University, Melbourne, Victoria, Australia
| | - Mark J Scholes
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam I Semciw
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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16
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Kraus VB, Sprow K, Powell KE, Buchner D, Bloodgood B, Piercy K, George SM, Kraus WE. Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review. Med Sci Sports Exerc 2019; 51:1324-1339. [PMID: 31095089 DOI: 10.1249/mss.0000000000001944] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We conducted a systematic umbrella review to evaluate the literature relating to effects of physical activity on pain, physical function, health-related quality of life, comorbid conditions and osteoarthritis (OA) structural disease progression in individuals with lower-extremity OA. METHODS Our primary search encompassed 2011 to February 2018 for existing systematic reviews (SR), meta-analyses (MA) and pooled analyses dealing with physical activity including exercise (not mixed with any other intervention and compared to a no-activity control group). A supplementary search encompassed 2006 to February 2018 for original research related to physical activity (including exercise) and lower limb OA progression. Study characteristics were abstracted, and risk of bias was assessed. RESULTS Physical activity decreased pain and improved physical function (strong evidence) and improved health-related quality of life (moderate evidence) among people with hip or knee OA relative to less active adults with OA. There was no evidence to suggest accelerated OA progression for physical activity below 10,000 steps per day. Both physical activity equivalent to the 2008 Physical Activity Guidelines for Americans (150 min·wk of moderate-intensity exercise in bouts ≥10 min) and lower levels of physical activity (at least 45 total minutes per week of moderate-intensity) were associated with improved or sustained high function. No SR/MA addressing comorbid conditions in OA were found. Measurable benefits of physical activity appeared to persist for periods of up to 6 months following cessation of a defined program. CONCLUSIONS People with lower-extremity OA should be encouraged to engage in achievable amounts of physical activity, of even modest intensities. They can choose to accrue minutes of physical activity throughout the entire day, irrespective of bout duration, and be confident in gaining some health and arthritis-related benefits.
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Affiliation(s)
- Virginia B Kraus
- Duke Molecular Physiology Institute, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Kyle Sprow
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD
| | - Kenneth E Powell
- Georgia Department of Human Resources, Centers for Disease Control and Prevention (Retired), Atlanta, GA
| | - David Buchner
- Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign, Champaign, IL
| | | | - Katrina Piercy
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, MD
| | - Stephanie M George
- Office of Disease Prevention, National Institutes of Health, U.S Department of Health and Human Services, Rockville, MD
| | - William E Kraus
- Duke Molecular Physiology Institute, Department of Medicine, Duke University School of Medicine, Durham, NC
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17
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Wyse JJ, Ganzini L, Dobscha SK, Krebs EE, Morasco BJ. Setting Expectations, Following Orders, Safety, and Standardization: Clinicians' Strategies to Guide Difficult Conversations About Opioid Prescribing. J Gen Intern Med 2019; 34:1200-1206. [PMID: 31011964 PMCID: PMC6614300 DOI: 10.1007/s11606-019-04983-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/06/2019] [Accepted: 03/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence has continued to accumulate regarding the potential risks of treating chronic pain with long-term opioid therapy (LTOT). Clinical practice guidelines now encourage clinicians to implement practices designed to reduce opioid-related risks. Yet how clinicians implement these guidelines within the context of the patient encounter has received little attention. OBJECTIVE This secondary analysis aimed to identify and describe clinicians' strategies for managing prescription opioid misuse and aberrant behaviors among patients prescribed LTOT for chronic pain. DESIGN Individual interviews guided by a semi-structured interview protocol probed: (1) methods clinicians utilize to reduce prescription opioid misuse and address aberrant opioid-related behaviors; (2) how clinicians respond to misuse; and (3) resources and constraints faced in managing and treating misuse among their patients. PARTICIPANTS Interviews were conducted with 24 physicians and nurse practitioners, representing 22 Veterans Health Administration (VA) facilities across the USA, who had one or more patients in their clinical panels who were prescribed LTOT for the treatment of chronic non-cancer pain. APPROACH Qualitative content analysis was the analytic approach utilized. A codebook was developed iteratively following group coding and discussion. All transcripts were coded with the finalized codebook. Quotes pertaining to key themes were retrieved and, following careful review, sorted into themes, which were then further categorized into sub-themes. Quotes that exemplified key sub-themes were selected for inclusion. KEY RESULTS We detail the challenges clinicians describe in navigating conversations with patients around prescription opioid misuse, which include patient objection as well as clinician ambivalence. We identify verbal heuristics as one strategy clinicians utilize to structure these difficult conversations, and describe four heuristics: setting expectations, following orders, safety, and standardization. CONCLUSION Clinicians frequently use verbal heuristics to routinize and increase the efficiency of care management discussions related to opioid prescribing, redirect responsibility, and defuse the potential emotional charge of the encounter.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, 97239, USA.
- School of Public Health, Portland State University-Oregon Health & Science University, 840 SW Gaines Street, Portland, OR, 97239, USA.
| | - Linda Ganzini
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Erin E Krebs
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA
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18
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Abbott JH, Wilson R, Pinto D, Chapple CM, Wright AA. Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis Cartilage 2019; 27:424-434. [PMID: 30553932 DOI: 10.1016/j.joca.2018.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the clinical- and cost-effectiveness at 2-year follow-up of providing individual, supervised exercise physiotherapy and/or manual physiotherapy in addition to usual medical care. METHOD People with hip or knee osteoarthritis meeting the American College of Rheumatology clinical diagnostic criteria were randomised (1:1, concealed, assessor-blinded) to four groups: usual medical care; supervised exercise physiotherapy; manual physiotherapy; or combined exercise and manual physiotherapy. Physiotherapy group participants were provided 10 50-min treatment sessions including booster sessions at 4 and 13 months, in addition to usual care. The primary outcome at 2-year follow-up was incremental cost-utility ratio (ICUR) of each physiotherapy intervention in addition to usual care, compared with usual care alone, from the health system and societal perspectives. To allow interpretation of negative ICURs, we report incremental net benefit (INB). The primary clinical outcome was the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS Of 206 patients, 186 (90·3%) were retained at 2-year follow-up. Exercise physiotherapy and manual physiotherapy dominated usual care, demonstrating cost savings; combined therapy did not. Exercise therapy had the highest incremental net benefits (INBs), statistically significant at all willingness-to-pay (base-case: societal New Zealand (NZ)$6,312, 95%CI 334 to 12,279; health system NZ$8,065, 95%CI 136 to 15,994). Clinical improvements were superior to usual care only in the exercise physiotherapy group (-28.2 WOMAC points, 95%CI -49.2 to -7.1). No serious adverse events were recorded. CONCLUSION Individually supervised exercise therapy is cost-effective and clinically effective in addition to usual medical care at 2-year follow-up, and leads to cost savings for the health system and society. TRIAL REGISTRATION Prospectively registered with the Australian NZ Clinical Trials Registry, reference ACTRN12608000130369.
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Affiliation(s)
- J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - R Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - D Pinto
- College of Health Sciences, Program in Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - C M Chapple
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, 9054, New Zealand.
| | - A A Wright
- Department of Physical Therapy, High Point University, High Point, NC, USA.
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19
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Lawrenson PR, Crossley KM, Vicenzino BT, Hodges PW, James G, Croft KJ, King MG, Semciw AI. Muscle size and composition in people with articular hip pathology: a systematic review with meta-analysis. Osteoarthritis Cartilage 2019; 27:181-195. [PMID: 30389399 DOI: 10.1016/j.joca.2018.10.008] [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: 05/04/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To synthesise and evaluate the current evidence investigating muscle size and composition in non-inflammatory articular hip pathology. METHODS A systematic review of five electronic databases, using three concepts; articular hip pathology (e.g., osteoarthritis (OA)); hip muscles; and outcomes (e.g., muscle size and adiposity) was undertaken. Studies addressing non-inflammatory or non-traumatic articular hip pain, using measures of muscle size and adiposity were included and appraised for risk of bias. Data was extracted to calculate standardised mean differences (SMD) and pooled where possible for meta-analysis. RESULTS Thirteen cross-sectional studies were included; all studies measured muscle size and 5/13 measured adiposity. In OA, there was low to very low quality evidence of no difference in hip muscle size, compared with matched controls. In unilateral OA, there was low to very low quality evidence of smaller size in gluteus minimus (SMD -0.38; 95% confidence interval (CI) -0.74, -0.01), gluteus medius (-0.44; 95% CI: -0.83, -0.05) and gluteus maximus (-0.39; 95% CI: -0.75, -0.02) muscles in the symptomatic limb. Individual studies demonstrated non-uniform changes in muscle size in OA. No significant difference was observed in muscle size in other pathologies or in adiposity for any group. CONCLUSION There is some low quality evidence that specific hip muscles are smaller in unilateral hip OA. Variation in the magnitude of differences indicate changes in size are not uniform across all muscles or stage of pathology. Studies in larger cohorts investigating muscle size and composition across the spectrum of articular pathologies are required to clarify these findings.
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Affiliation(s)
- P R Lawrenson
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - K M Crossley
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia; La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, VIC, 3086, Australia.
| | - B T Vicenzino
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - P W Hodges
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - G James
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - K J Croft
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, VIC, 3086, Australia.
| | - A I Semciw
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, 4072, Australia; La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, VIC, 3086, Australia.
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20
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Freke MD, Crossley KM, Russell T, Sims KJ, Semciw A. Associations between type and severity of hip pathology with pre-operative patient reported outcome measures. Braz J Phys Ther 2018; 23:402-411. [PMID: 30293956 DOI: 10.1016/j.bjpt.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/08/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The relationship between hip pathology and patient reported outcome responses following hip surgery has been previously investigated. No studies have investigated the relationship between pathology and patient reported outcome responses prior to surgery. OBJECTIVES (1) Determine the prevalence of chondral and labral pathology identified during hip arthroscopy. (2) Determine the association between intra-articular findings and patient reported outcome scores in a pre-arthroscopy hip pain population. METHODS Sixty-seven (22 female) participants scheduled for hip arthroscopy after clinical examination and radiographic assessment completed a series of patient reported outcomes (Hip Disability and Osteoarthritis Outcome Score; International Hip Outcome Tool; Pain on Activity; Visual Analogue Scale). Pathology discovered/addressed during arthroscopy was classified. Univariable and multivariable linear regression models were used to assess the relationship between demographics, pathology and patient reported outcome responses. RESULTS Ninety-one percent of participants had labral pathology; 76% had acetabular chondropathy and 31% had femoral head chondropathy. Across the ten patient reported outcome subscales, severe femoral head chondropathy and large labral tears had the greatest number of significant associations with patient reported outcome scores. The strongest association was with 'Hip Disability and Osteoarthritis Outcome Score symptoms and stiffness' subscale, where severe femoral head chondropathy explained 22% of variability in symptoms and stiffness, when adjusted for Body Mass Index and presence of pincer morphology (p=0.002). CONCLUSION Severe femoral head chondropathy and large labral tears along with a high prevalence of labral pathology and acetabular chondropathy were relatively common findings during hip arthroscopy. Severe femoral head chondropathy and large labral tears are most associated with patient reported outcome's, however, at best only explain 22% of the variability.
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Affiliation(s)
- Matthew D Freke
- Enoggera Health Centre, Gallipoli Barracks, Enoggera, Queensland, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Kay M Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Kevin J Sims
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; Cricket Australia, Albion, Queensland, Australia
| | - Adam Semciw
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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21
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Yu W, Xu P, Huang G, Liu L. Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Exp Ther Med 2018; 16:2119-2125. [PMID: 30186448 DOI: 10.3892/etm.2018.6412] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/23/2017] [Indexed: 12/18/2022] Open
Abstract
Knee osteoarthritis is the most common degenerative disease of the joints caused by articular cartilage injury, degradation of the joint edge and subchondral bone hyperplasia. Various treatments are used to alleviate the symptoms of patients with knee osteoarthritis, including analgesics and intra-articular injections. Platelet-rich plasma (PRP) is an autologous and multifunctional platelet concentrate of the blood, which stimulates the cartilage healing process and improves the damage caused by articular disease. Hyaluronic acid (HA) is an effective treatment for patients with knee osteoarthritis. In the current study, the effectiveness of PRP and HA combination therapy administered via intra-articular injections for patients with knee osteoarthritis was analyzed. A total of 360 patients with knee osteoarthritis were randomized into four different treatment groups as follows: Double-blind treatment with PRP (2-14 ml); double-blind treatment with HA (0.1-0.3 mg); combination therapy of PRP and HA; and placebo groups. Following treatment, all patients were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Common Toxicity Criteria. The most common treatment-emergent adverse events were hypertension and proteinuria. The current study demonstrated that PRP and HA treatment significantly improved arthralgia, and PRP treatment was determined to be significantly more effective than HA treatment using the WOMAC pain score (P<0.05). PRP and HA combination treatment significantly improved arthralgia, reduced humoral and cellular immune responses and promoted angiogenesis, which improved the patients' histological parameters compared with PRP or HA treatment alone. These results suggested that PRP and HA combination treatment may be a potential treatment option for patients with knee osteoarthritis in the future.
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Affiliation(s)
- Wenxing Yu
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiangtong University College of Medicine, Xi'an, Shaanxi 350021, P.R. China
| | - Peng Xu
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiangtong University College of Medicine, Xi'an, Shaanxi 350021, P.R. China
| | - Guiling Huang
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiangtong University College of Medicine, Xi'an, Shaanxi 350021, P.R. China
| | - Lin Liu
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiangtong University College of Medicine, Xi'an, Shaanxi 350021, P.R. China
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22
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Holden MA, Bennell KL, Whittle R, Chesterton L, Foster NE, Halliday NA, Spiers LN, Mason EM, Quicke JG, Mallen CD. How Do Physical Therapists in the United Kingdom Manage Patients With Hip Osteoarthritis? Results of a Cross-Sectional Survey. Phys Ther 2018. [PMID: 29514327 DOI: 10.1093/ptj/pzy013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hip osteoarthritis (OA) is common, painful, and disabling. Physical therapists have an important role in managing patients with hip OA; however, little is known about their current management approach and whether it aligns with clinical guideline recommendations. OBJECTIVE The objective of this study is to describe United Kingdom (UK) physical therapists' current management of patients with hip OA and to determine whether it aligns with clinical guidelines. DESIGN The design is a cross-section questionnaire. METHODS A questionnaire was mailed to 3126 physical therapists in the UK that explored physical therapists' self-reported management of a patient with hip OA using a case vignette and clinical management questions. RESULTS The response rate was 52.7% (n = 1646). In total, 1148 (69.7%) physical therapists had treated a patient with hip OA in the last 6 months and were included in the analyses. A treatment package was commonly provided incorporating advice, exercise (strength training 95.9%; general physical activity 85.4%), and other nonpharmacological modalities, predominantly manual therapy (69.6%), and gait retraining (66.4%). There were some differences in reported management between physical therapists based in the National Health Service (NHS) and non-NHS-based physical therapists, including fewer treatment sessions being provided by NHS-based therapists. LIMITATIONS Limitations include the potential for nonresponder bias and, in clinical practice, physical therapists may manage patients with hip OA differently. CONCLUSION UK-based physical therapists commonly provide a package of care for patients with hip OA that is broadly in line with current clinical guidelines, including advice, exercise, and other nonpharmacological treatments. There were some differences in clinical practice between NHS and non-NHS-based physical therapists, but whether these differences impact on clinical outcomes remains unknown.
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Affiliation(s)
- Melanie A Holden
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom, ST5 5BG
| | - Kim L Bennell
- BAppSci (physio), The University of Melbourne-Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia
| | | | | | | | | | - Libby N Spiers
- The University of Melbourne-Centre for Health, Exercise and Sports Medicine
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23
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Lozier CC, Nugent SM, Smith NX, Yarborough BJ, Dobscha SK, Deyo RA, Morasco BJ. Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy. J Gen Intern Med 2018; 33:46-53. [PMID: 29633138 PMCID: PMC5902344 DOI: 10.1007/s11606-018-4325-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). METHODS Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. RESULTS Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51-79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96-0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00-1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13-2.84), college graduate or more (OR = 2.02, 95% CI = 1.20-3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01-1.02). CONCLUSIONS NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.
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Affiliation(s)
- Crystal C Lozier
- VA Portland Health Care System, Portland, OR, USA.
- Oregon Health & Science University, Portland, OR, USA.
| | - Shannon M Nugent
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Ning X Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Steven K Dobscha
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Richard A Deyo
- Oregon Health & Science University, Portland, OR, USA
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Benjamin J Morasco
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
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Huang G, Hua S, Yang T, Ma J, Yu W, Chen X. Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med 2018; 15:3096-3102. [PMID: 29599843 DOI: 10.3892/etm.2018.5794] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/17/2017] [Indexed: 12/21/2022] Open
Abstract
Knee osteoarthritis is a degenerative disease that may develop due ageing, obesity, strain, congenital abnormal joints, joint deformity or trauma. It is caused by many factors, such as degradation of articular cartilage injury, joint edge and subchondral bone hyperplasia of reactivity. Platelet-rich plasma (PRP) is an autologous blood sample that contains highly concentrated platelets and multiple cell growth factors. PRP promotes synovial cell proliferation and differentiation and may recover cartilage morphology. In the present study, the clinical efficacy of PRP was investigated in patients with knee osteoarthritis aged between 18 and 30 years in a phase-III clinical study. Following an 8-week baseline, patients with knee osteoarthritis were randomized into once-weekly, double-blind treatment with PRP (2-14 ml) or placebo groups. The results indicated that patients with osteoarthritis treated with PRP had modulated plasma concentrations of inflammatory factors and pro-angiogenic factors compared with the placebo group. Treatment responses were assessed by median percent reduction in inflammatory and pro-angiogenic factors and these improved with PRP treatment compared with the placebo. Clinical data indicated that PRP alleviated knee osteoarthritis and reduced humoral and cellular immune responses that led to beneficial effects on histological parameters. Inflammation was significantly alleviated in patients receiving PRP compared with the placebo group. The most common treatment-emergent adverse events in the presence of PRP were hypertension and proteinuria. In conclusion, treatment with PRP for patients with knee osteoarthritis presented beneficial effects in alleviating joint inflammation, cartilage destruction and bone damage, and repairing joint tissue. These results suggested that PRP may be a potential therapeutic agent for knee osteoarthritis.
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Affiliation(s)
- Guilin Huang
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Sha Hua
- Department of Rheumatism, Immunity Branch, Xi'an No.5 Hospital, Xi'an, Shaanxi 710082, P.R. China
| | - Tuanmin Yang
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Jianbing Ma
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Wenxing Yu
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Xiujin Chen
- Department of Orthopedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, P.R. China
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25
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Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, Hagen KB. Exercise for Hand Osteoarthritis: A Cochrane Systematic Review. J Rheumatol 2017; 44:1850-1858. [PMID: 29032354 DOI: 10.3899/jrheum.170424] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA). METHODS Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. INCLUSION CRITERIA randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. MAIN OUTCOMES hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed. RESULTS Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.47 to -0.07], hand function (4 trials, SMD -0.28, 95% CI -0.58 to 0.02), and finger joint stiffness (4 trials, SMD -0.36, 95% CI -0.58 to -0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe. CONCLUSION Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.
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Affiliation(s)
- Nina Østerås
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway. .,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital.
| | - Ingvild Kjeken
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | - Geir Smedslund
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | - Rikke H Moe
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | - Barbara Slatkowsky-Christensen
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | - Till Uhlig
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | - Kåre Birger Hagen
- From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.,N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
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Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky‐Christensen B, Uhlig T, Hagen KB. Exercise for hand osteoarthritis. Cochrane Database Syst Rev 2017; 1:CD010388. [PMID: 28141914 PMCID: PMC6464796 DOI: 10.1002/14651858.cd010388.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hand osteoarthritis (OA) is a prevalent joint disease that may lead to pain, stiffness and problems in performing hand-related activities of daily living. Currently, no cure for OA is known, and non-pharmacological modalities are recommended as first-line care. A positive effect of exercise in hip and knee OA has been documented, but the effect of exercise on hand OA remains uncertain. OBJECTIVES To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand OA. Main outcomes are hand pain and hand function. SEARCH METHODS We searched six electronic databases up until September 2015. SELECTION CRITERIA All randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence using the GRADE approach. Outcomes consisted of both continuous (hand pain, physical function, finger joint stiffness and quality of life) and dichotomous outcomes (proportions of adverse events and withdrawals). MAIN RESULTS We included seven studies in the review. Most studies were free from selection and reporting bias, but one study was available only as a congress abstract. It was not possible to blind participants to treatment allocation, and although most studies reported blinded outcome assessors, some outcomes (pain, function, stiffness and quality of life) were self-reported. The results may be vulnerable to performance and detection bias owing to unblinded participants and self-reported outcomes. Two studies with high drop-out rates may be vulnerable to attrition bias. We downgraded the overall quality of the body of evidence to low owing to potential detection bias (lack of blinding of participants on self-reported outcomes) and imprecision (studies were few, the number of participants was limited and confidence intervals were wide for the outcomes pain, function and joint stiffness). For quality of life, adverse events and withdrawals due to adverse events, we further downgraded the overall quality of the body of evidence to very low because studies were very few and confidence intervals were very wide.Low-quality evidence from five trials (381 participants) indicated that exercise reduced hand pain (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.07) post intervention. The absolute reduction in pain for the exercise group, compared with the control group, was 5% (1% to 9%) on a 0 to 10 point scale. Pain was estimated to be 3.9 points on this scale (0 = no pain) in the control group, and exercise reduced pain by 0.5 points (95% CI 0.1 to 0.9; number needed to treat for an additional beneficial outcome (NNTB) 9).Four studies (369 participants) indicated that exercise improved hand function (SMD -0.28, 95% CI -0.58 to 0.02) post intervention. The absolute improvement in function noted in the exercise group, compared with the control group, was 6% (0.4% worsening to 13% improvement). Function was estimated at 14.5 points on a 0 to 36 point scale (0 = no physical disability) in the control group, and exercise improved function by 2.2 points (95% CI -0.2 to 4.6; NNTB 9).One study (113 participants) evaluated quality of life, and the effect of exercise on quality of life is currently uncertain (mean difference (MD) 0.30, 95% CI -3.72 to 4.32). The absolute improvement in quality of life for the exercise group, compared with the control group, was 0.3% (4% worsening to 4% improvement). Quality of life was 50.4 points on a 0 to 100 point scale (100 = maximum quality of life) in the control group, and the mean score in the exercise group was 0.3 points higher (3.5 points lower to 4.1 points higher).Four studies (369 participants) indicated that exercise reduced finger joint stiffness (SMD -0.36, 95% CI -0.58 to -0.15) post intervention. The absolute reduction in finger joint stiffness for the exercise group, compared with the control group, was 7% (3% to 10%). Finger joint stiffness was estimated at 4.5 points on a 0 to 10 point scale (0 = no stiffness) in the control group, and exercise improved stiffness by 0.7 points (95% CI 0.3 to 1.0; NNTB 7).Three studies reported intervention-related adverse events and withdrawals due to adverse events. The few reported adverse events consisted of increased finger joint inflammation and hand pain. Low-quality evidence from the three studies showed an increased likelihood of adverse events (risk ratio (RR) 4.55, 95% CI 0.53 to 39.31) and of withdrawals due to adverse events in the exercise group compared with the control group (RR 2.88, 95% CI 0.30 to 27.18), but the effect is uncertain and further research may change the estimates.Included studies did not measure radiographic joint structure changes. Two studies provided six-month follow-up data (220 participants), and one (102 participants) provided 12-month follow-up data. The positive effect of exercise on pain, function and joint stiffness was not sustained at medium- and long-term follow-up.The exercise intervention varied largely in terms of dosage, content and number of supervised sessions. Participants were instructed to exercise two to three times a week in four studies, daily in two studies and three to four times daily in another study. Exercise interventions in all seven studies aimed to improve muscle strength and joint stability or function, but the numbers and types of exercises varied largely across studies. Four studies reported adherence to the exercise programme; in three studies, this was self-reported. Self-reported adherence to the recommended frequency of exercise sessions ranged between 78% and 94%. In the fourth study, 67% fulfilled at least 16 of the 18 scheduled exercise sessions. AUTHORS' CONCLUSIONS When we pooled results from five studies, we found low-quality evidence showing small beneficial effects of exercise on hand pain, function and finger joint stiffness. Estimated effect sizes were small, and whether they represent a clinically important change may be debated. One study reported quality of life, and the effect is uncertain. Three studies reported on adverse events, which were very few and were not severe.
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Affiliation(s)
- Nina Østerås
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Ingvild Kjeken
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Geir Smedslund
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
- Norwegian Institute of Public HealthPO BOX 4404 NydalenOsloN‐0403Norway
| | - Rikke H Moe
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | | | - Till Uhlig
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Kåre Birger Hagen
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
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Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial. J Osteoporos 2017; 2017:3905492. [PMID: 28116214 PMCID: PMC5237464 DOI: 10.1155/2017/3905492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the older population. Although exercise is an effective treatment for knee OA, there is lack of evidence regarding hip OA. The aim of this trial was to test the safety and feasibility of a specifically designed exercise program in relieving hip pain and improving function in hip OA participants and to evaluate various methods to measure changes in their physical functioning. Materials and Methods. 13 women aged ≥ 65 years with hip OA were recruited in this 12-week pilot study. Results. Pain declined significantly over 30% from baseline, and joint function and health-related quality of life improved slightly. Objective assessment of physical functioning showed statistically significant improvement in the maximal isometric leg extensor strength by 20% and in the hip extension range of motion by 30%. Conclusions. The exercise program was found to be safe and feasible. The present evidence indicates that the exercise program is effective in the short term. However, adequate powered RCTs are needed to determine effects of long-term exercise therapy on pain and progression of hip OA.
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Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther 2016; 33:1921-1946. [PMID: 27671326 PMCID: PMC5083776 DOI: 10.1007/s12325-016-0409-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 01/05/2023]
Abstract
Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition’s etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.
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Affiliation(s)
- Nicholas J Murphy
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - Jillian P Eyles
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
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Murphy SL, Robinson-Lane SG, Niemiec SLS. Knee and Hip Osteoarthritis Management: A Review of Current and Emerging Non-Pharmacological Approaches. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0054-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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