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Al-Mhanna SB, Batrakoulis A, Mohamed M, Alkhamees NH, Sheeha BB, Ibrahim ZM, Aldayel A, Muhamad AS, Rahman SA, Afolabi HA, Zulkifli MM, Hafiz Bin Hanafi M, Abubakar BD, Rojas-Valverde D, Ghazali WSW. Home-based circuit training improves blood lipid profile, liver function, musculoskeletal fitness, and health-related quality of life in overweight/obese older adult patients with knee osteoarthritis and type 2 diabetes: a randomized controlled trial during the COVID-19 pandemic. BMC Sports Sci Med Rehabil 2024; 16:125. [PMID: 38831437 PMCID: PMC11145895 DOI: 10.1186/s13102-024-00915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND There is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown. METHODS This is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15-30 repetitions per exercise, 1 min passive rest between exercises; 2-4 rounds per session; 20-60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves. RESULTS HBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p < 0.05). Furthermore, HBCT induced meaningful increases in high-density lipoprotein (HDL-C), lower body muscular strength, endurance, function, mobility, and HRQoL in overweight/obese older adults with T2DM and KOA (p < 0.05). CONCLUSION The present outcomes recommend that an injury-free HBCT program may improve various indicators related to cardiometabolic health, musculoskeletal fitness, and HRQoL in elderly with overweight/obesity, T2DM and KOA. These findings offer valuable insights for clinicians and practitioners seeking evidence-based exercise interventions tailored for patients managing substantial metabolic and musculoskeletal health challenges in clinical practice.
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Affiliation(s)
- Sameer Badri Al-Mhanna
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 602105, India.
| | - Alexios Batrakoulis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Mahaneem Mohamed
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nouf H Alkhamees
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Bodor Bin Sheeha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Zizi M Ibrahim
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Abdulaziz Aldayel
- Department of Exercise Physiology, King Saud University, Riyadh, Saudi Arabia
| | - Ayu Suzailiana Muhamad
- Exercise and Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Shaifuzain Ab Rahman
- Department of Orthopaedic, Hospital University Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Maryam Mohd Zulkifli
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Muhammad Hafiz Bin Hanafi
- Rehabilitation Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Bishir Daku Abubakar
- Department of Human Physiology, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida Universidad Nacional de Costa Rica, Heredia, Costa Rica
| | - Wan Syaheedah Wan Ghazali
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
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de Luca K, Yanz M, Downie A, Kendall J, Skou ST, Hartvigsen J, French SD, Ferreira ML, Bierma-Zeinstra SMA. A mixed-methods feasibility study of a comorbidity-adapted exercise program for low back pain in older adults (COMEBACK): a protocol. Pilot Feasibility Stud 2022; 8:133. [PMID: 35780222 PMCID: PMC9250189 DOI: 10.1186/s40814-022-01097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of low back pain increases with age and has a profound impact on physical and psychosocial health. With increasing age comes increasing comorbidity, and this also has pronounced health consequences. Whilst exercise is beneficial for a range of health conditions, trials of exercise for low back pain management often exclude older adults. It is currently unknown whether an exercise program for older adults with low back pain, tailored for the presence of comorbidities, is acceptable for participants and primary healthcare providers (PHCPs). Therefore, this mixed-methods study will assess the feasibility of an 8-week comorbidity-adapted exercise program for older people with low back pain and comorbid conditions. METHODS The 3-phased feasibility study will be performed in a primary healthcare setting. PHCPs will be trained to deliver a comorbidity-adapted exercise program for older people with low back pain and comorbidities. Healthcare-seeking adults > 65 will be screened for eligibility over telephone, with a recruitment target of 24 participants. Eligible participants will attend an initial appointment (diagnostic phase). During this initial appointment, a research assistant will collect patient demographics, self-reported outcome measurement data, and perform a physical and functional examination to determine contraindications and restrictions to an exercise program. During the development phase, PHCPs will adapt the exercise program to the individual and provide patient education. During the intervention phase, there will be two supervised exercise sessions per week, over 8 weeks (total of 16 exercise sessions). Each exercise session will be approximately 60 min in duration. A qualitative evaluation after the last exercise program session will explore the feasibility of the exercise program for participants and PHCPs. Progression criteria will determine the suitability for a fully powered randomised controlled trial. DISCUSSION This mixed-methods feasibility study will assess an exercise program for older adults with low back pain and comorbidities. Once assessed for feasibility, the exercise program may be tested for effectiveness in a larger, fully powered randomised controlled trial. This information will add to the sparse evidence base on appropriate options for managing back pain in older adults. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry registration number: ACTRN12621000379819p (06/04/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000379819p ). TRIAL SPONSOR Macquarie University, Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. .,Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia.
| | - Megan Yanz
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Aron Downie
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Julie Kendall
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Sydney, Australia
| | - Sita M A Bierma-Zeinstra
- Department of General Practice and Department of Orthopaedics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
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Burgess LC, Taylor P, Wainwright TW, Bahadori S, Swain ID. Adherence to Neuromuscular Electrical Stimulation Interventions for Muscle Impairment in Hip and Knee Osteoarthritis: A Systematic Review. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:11795441211028746. [PMID: 34262384 PMCID: PMC8243113 DOI: 10.1177/11795441211028746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) provides a promising approach to counteract muscle impairment in hip and knee osteoarthritis, and to expedite recovery from joint replacement surgery. Nonetheless, application into clinical orthopaedic practice remains limited, partly due to concerns regarding patient tolerance. OBJECTIVES This systematic review aimed to quantify levels of adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis and identify strategies to increase compliance. DATA SOURCES Randomised controlled trials (RCTs) were identified in a web-based literature review, completed in December 2020. The databases sourced included the Cochrane Library, CINAHL Complete, Medline Complete and PubMed. ELIGIBILITY CRITERIA Studies were included if they were: (i) conducted in cohorts of adults with hip or knee osteoarthritis; (ii) a protocol of electrical muscle stimulation prescribed to treat muscle impairment; and (iii) reported intervention adherence or attrition rate. Data were extracted on adherence rate, reasons for non-adherence and potential strategies to increase adherence. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS The search yielded 120 articles, of which 15 studies were considered eligible and included in the analysis (n = 922). All NMES treatment was applied to the quadriceps, with 1 study targeting the quadriceps and calves. The mean PEDRO score of the included studies was 6.80 out of a possible 10 (range 6-8). Mean adherence did not differ between groups receiving treatment with NMES (85% ± 12%) and control groups receiving voluntary exercise or education (84% ± 9%) (P = .97). Reasons for non-adherence or attrition included a dislike of the device, dizziness, pain and discomfort. Strategies to increase adherence included NMES education, a familiarisation period, supervision, setting thresholds based upon patient tolerance, monitoring pain levels during stimulation and using built-in adherence trackers. CONCLUSIONS This systematic review indicates that adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis in clinical trials does not differ to control groups receiving education or voluntary exercise, and hence should not be a barrier to application in clinical practice.
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Affiliation(s)
- Louise C Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Paul Taylor
- Department of Clinical Science and Engineering, Salisbury District Hospital, Salisbury, Wiltshire, UK
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, Wiltshire, UK
- Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Ian D Swain
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
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Pihl K, Roos E, Taylor R, Grønne D, Skou S. Associations between comorbidities and immediate and one-year outcomes following supervised exercise therapy and patient education - A cohort study of 24,513 individuals with knee or hip osteoarthritis. Osteoarthritis Cartilage 2021; 29:39-49. [PMID: 33220446 PMCID: PMC7116561 DOI: 10.1016/j.joca.2020.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate if comorbidities are associated with change in health outcomes following an 8-week exercise and education program in knee and hip osteoarthritis (OA). METHODS We included 24,513 individuals with knee or hip OA from the Good Life with osteoArthritis in Denmark (GLA:D®). GLA:D® consists of two patient education sessions and 12 supervised exercise sessions. Before the program, individuals self-reported having one or more of 11 common comorbidities. Physical function was assessed using the 40-m Fast-Paced Walk Test (FPWT, m/sec) before and immediately after the program. Pain intensity and health-related quality of life was self-reported before, immediately after, and at 12 months post-intervention using a visual analogue scale (VAS, 0-100) and the EQ-5D-5L index (-0.624 to 1.000), respectively. Associations of comorbidity combinations with change in outcomes immediately and at 12 months was estimated using mixed linear regression. RESULTS Individuals with OA improved on average 0.12 m/s (95%CI 0.12 to 0.13) in 40-m FPWT, -12.7 mm (95%CI -13.2 to -12.2) in VAS, and 0.039 (95%CI 0.036 to 0.041) in EQ-5D-5L from before to immediately after the intervention with minor additional improvements at 12 months. Despite that individuals with comorbidities had worse baseline scores in all outcomes than individuals without comorbidities, they had similar levels of improvement immediately and 12 months after the intervention. CONCLUSION Comorbidities are not associated with worse nor better health outcomes following an 8-week exercise and education program in individuals with OA, suggesting exercise as a viable treatment option for individuals with OA, irrespective of comorbidities.
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Affiliation(s)
- K. Pihl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark,Address correspondence and reprint requests to: K. Pihl, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark. Tel.: 45-6550-1964.
| | - E.M. Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - R.S. Taylor
- Institute of Health and Well Being, University of Glasgow, UK,Institute of Health Services Research, University of Exeter Medical School, UK
| | - D.T. Grønne
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - S.T. Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
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5
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de Rooij M, van der Leeden M, van der Esch M, Lems WF, Meesters JJL, Peter WF, Roorda LD, Terbraak MS, Vredeveld T, Vliet Vlieland TPM, Dekker J. Evaluation of an educational course for primary care physiotherapists on comorbidity-adapted exercise therapy in knee osteoarthritis: an observational study. Musculoskeletal Care 2020; 18:122-133. [PMID: 31985164 PMCID: PMC7318645 DOI: 10.1002/msc.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Abstract
Objective The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage. Method The present research was an observational study with a pretest‐posttest design using mixed methods. PTs were offered a postgraduate course consisting of e‐learning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi‐structured interviews. Results Thirty‐four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6‐month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self‐) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians. Conclusion A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large‐scale implementation of exercise therapy can take place in these complex patients.
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Affiliation(s)
- Mariëtte de Rooij
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin van der Esch
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Willem F Lems
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jorit J L Meesters
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Wilfred F Peter
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Leo D Roorda
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Michel S Terbraak
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Tom Vredeveld
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Spitaels D, Mamouris P, Vaes B, Smeets M, Luyten F, Hermens R, Vankrunkelsven P. Epidemiology of knee osteoarthritis in general practice: a registry-based study. BMJ Open 2020; 10:e031734. [PMID: 31964664 PMCID: PMC7044813 DOI: 10.1136/bmjopen-2019-031734] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The present study investigated (1) trends in the prevalence and incidence of knee osteoarthritis over a 20-year period (1996-2015); (2) trends in multimorbidity and (3) trends in drug prescriptions. DESIGN Registry-based study. SETTING Primary healthcare, Flanders, Belgium. PARTICIPANTS Data were collected from Intego, a general practice-based morbidity registration network. In the study period between 1996 and 2015, data from 440 140 unique patients were available. OUTCOME MEASURES Trends in prevalence and incidence rate of knee osteoarthritis were computed using joinpoint regression analysis. The mean disease count was calculated to assess trends in multimorbidity. In addition, the number of drug prescriptions was identified by the Anatomical Therapeutic Chemical Classification code and trends were equally recorded with joinpoint regression. RESULTS The total age-standardised prevalence of knee osteoarthritis increased from 2.0% in 1996 to 3.6% in 2015. An upward trend was observed with an average annual percentage change (AAPC) of 2.5 (95% CI 2.2 to 2.9). In 2015, the prevalence rates in the 10 year age groups from the 45-54 years age group onwards were 3.1%, 5.6%, 9.0% and 13.9%, to reach 15.0% in people aged 85 years and older. The incidence remained stable with 3.75‰ in 2015 (AAPC=-0.5, 95% CI -1.4 to 0.5). The mean disease count significantly increased from 1.63 to 2.34 (p<0.001) for incident cases with knee osteoarthritis. Finally, we observed a significantly positive trend in the overall prescription of acetaminophen (AAPC=6.7, 95% CI 5.6 to 7.7), weak opioids (AAPC=4.0, 95% CI 0.9 to 7.3) and glucosamine (AAPC=8.6, 95% CI 2.4 to 15.1). Oral non-steroidal anti-inflammatory drugs were most prescribed, with a prevalence rate of 29.8% in 2015, but remained stable during the study period (AAPC=0.0, 95% CI -1.1 to 1.1). CONCLUSIONS Increased prevalence, multimorbidity, and number of drug prescriptions confirm an increased burden of knee osteoarthritis. In future, these trends can be used to prioritise initiatives for improvement in care.
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Affiliation(s)
- David Spitaels
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Pavlos Mamouris
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Louvain Drug Research Institute, Universite catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Miek Smeets
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frank Luyten
- Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rosella Hermens
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, Netherlands
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Cooper L, Ells L, Ryan C, Martin D. Perceptions of adults with overweight/obesity and chronic musculoskeletal pain: An interpretative phenomenological analysis. J Clin Nurs 2018; 27:e776-e786. [PMID: 29148620 DOI: 10.1111/jocn.14178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into the lived experience of adults with overweight/obesity and chronic musculoskeletal pain. Knowledge gained will inform healthcare professionals about the complexity of the weight-pain relationship and enable more effective engagement with this population. BACKGROUND Quantitative studies show links between weight and pain. Adults with overweight/obesity are more likely to experience comorbidity; however, qualitative research describing the complexities of the relationship is limited. METHODS A purposive sample of adults with overweight/obesity and chronic musculoskeletal pain participated in face-to-face interviews. Interviews were audio-recorded, transcribed verbatim and analysed using interpretive phenomenological analysis. RESULTS Eighteen adults (16 female) aged 29-71, body mass index ≥25-46, participated in this study. Three superordinate themes emerged: "pain as a motivator and barrier to weight loss"; "fear of weight causing more damage"; and "activity is positive." Pain motivates some individuals to lose weight while simultaneously inhibiting weight loss efforts. Participants' perception that extra pressure caused by their weight further damaged joints contributed to fear and catastrophising. Fear is often exacerbated by healthcare professionals' descriptions of musculoskeletal damage, or participants' perception of healthcare professionals' attitude towards people with overweight/obesity. Conversely, individuals acknowledged the benefits of increased activity. CONCLUSION Adults with overweight/obesity and chronic musculoskeletal pain in this study identified a bidirectional relationship between their weight and pain that challenged their weight loss efforts. Overweight/obesity contributed to fear and catastrophising, which resulted in avoidance of exercise that would have assisted their weight loss. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals need to understand the complex relationship between weight and pain, and their patients' understanding of that relationship. Healthcare professionals should use therapeutic communication to reduce the fear of weight causing damage, and thus promote physical activities that will contribute to weight loss. It is also important to ensure that the language used with this patient group does not stigmatise individuals, or cause or exacerbate fear of normal movement.
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Affiliation(s)
- Lesley Cooper
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Louisa Ells
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Cormac Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Denis Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
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8
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de Rooij M, van der Leeden M, Cheung J, van der Esch M, Häkkinen A, Haverkamp D, Roorda LD, Twisk J, Vollebregt J, Lems WF, Dekker J. Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 69:807-816. [DOI: 10.1002/acr.23013] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/10/2016] [Accepted: 08/09/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Mariëtte de Rooij
- Amsterdam Rehabilitation Research Center
- Reade; Amsterdam The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade, and VU University Medical Center; Amsterdam The Netherlands
| | - John Cheung
- Slotervaart Hospital; Amsterdam The Netherlands
| | | | - Arja Häkkinen
- University of Jyväskylä and Jyväskylä Central Hospital; Jyväskylä Finland
| | | | - Leo D. Roorda
- Amsterdam Rehabilitation Research Center
- Reade; Amsterdam The Netherlands
| | - Jos Twisk
- VU University Medical Center; Amsterdam The Netherlands
| | - Joke Vollebregt
- Amsterdam Rehabilitation Research Center
- Reade; Amsterdam The Netherlands
| | | | - Joost Dekker
- VU University Medical Center; Amsterdam The Netherlands
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van der Leeden M, Huijsmans RJ, Geleijn E, de Rooij M, Konings IR, Buffart LM, Dekker J, Stuiver MM. Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions. Disabil Rehabil 2017; 40:486-496. [PMID: 28054496 DOI: 10.1080/09638288.2016.1260647] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects. METHOD Tailored exercise prescriptions were developed in four steps, following the i3-S strategy. All steps were based on current best available evidence, complemented with expert opinions. First, common comorbidities and treatment-induced adverse effects were identified. In the subsequent steps, contra-indications and restrictions for exercise were described, along with possible exercise adaptations. In the final step, the obtained information was synthesized into a framework. RESULTS Prevalent comorbidities were hypertension, heart disease, diabetes mellitus, (osteo)arthritis, chronic obstructive pulmonary disease, and obesity. Adverse effects included conditions induced by pretreatment (e.g., lymphedema as a result of surgery) or by chemotherapy (e.g., reduced blood cell counts). Adaptations to the recommended exercise program were related to exercise tolerance, safety, and hygiene. A framework was proposed to guide clinical decisions during the exercise intervention. CONCLUSION Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy. Implications for Rehabilitation Exercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional. We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise. We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy.
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Affiliation(s)
- Marike van der Leeden
- a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands.,b Reade , Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands
| | - Rosalie J Huijsmans
- a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | - Edwin Geleijn
- a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | - Mariëtte de Rooij
- b Reade , Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands
| | - Inge R Konings
- c Department of Medical Oncology , VU University Medical Center-Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Laurien M Buffart
- c Department of Medical Oncology , VU University Medical Center-Cancer Center Amsterdam , Amsterdam , The Netherlands.,d Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands
| | - Joost Dekker
- a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | - Martijn M Stuiver
- e Department of Physiotherapy , Netherlands Cancer Institute , Amsterdam , The Netherlands
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Cooper L, Ryan C, Ells LJ, Hamilton S, Atkinson G, Cooper K, Johnson MI, Kirwan JP, Martin D. Weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain: a mixed methods systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:57-67. [PMID: 27532463 PMCID: PMC5206660 DOI: 10.11124/jbisrir-2016-002725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this mixed methods review is to develop an aggregated synthesis of qualitative and quantitative data on weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision making.The objective of the quantitative component of this review is to quantify the effectiveness of weight-loss interventions on weight, pain and physical and/or psychosocial function in overweight/obese adults with chronic musculoskeletal pain.The objectives of the qualitative component of this review are to explore the perceptions and experiences of overweight/obese adults with chronic musculoskeletal pain of the link between their weight and pain, and the effectiveness and appropriateness of weight-loss interventions and sustainability of weight-loss efforts.
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Affiliation(s)
- Lesley Cooper
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Cormac Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Louisa Jane Ells
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Sharon Hamilton
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Greg Atkinson
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
| | - Kay Cooper
- The Scottish Centre for Evidenced-Based, Multi-professional Practice: a Collaborating Centre of the Joanna Briggs Institute, Robert Gordon University, Aberdeen
| | | | - John P. Kirwan
- Lerner Research Institute, Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
- Teesside Centre for Evidence-Based Practice: an Affiliate Centre of the Joanna Briggs Institute, Adelaide, South Australia, Australia
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Dekker J, de Rooij M, van der Leeden M. Exercise and comorbidity: the i3-S strategy for developing comorbidity-related adaptations to exercise therapy. Disabil Rehabil 2015; 38:905-9. [DOI: 10.3109/09638288.2015.1066451] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Holla JFM, van der Leeden M, Knol DL, Roorda LD, Hilberdink WKHA, Lems WF, Steultjens MPM, Dekker J. Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study. Arthritis Care Res (Hoboken) 2015; 67:48-57. [PMID: 24905958 DOI: 10.1002/acr.22381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/03/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE It has been hypothesized that pain and low vitality lead to an increase in avoidance of activities in persons with early symptomatic knee osteoarthritis (OA), and that avoidance of activities leads to an increase in activity limitations. The present study aimed to evaluate these hypotheses. METHODS Baseline, 2-year, and 5-year followup data of 828 participants from the Cohort Hip and Cohort Knee Study with early symptomatic knee OA were used. Autoregressive generalized estimating equations and linear regression models were used to analyze the longitudinal and cross-sectional associations between self-reported knee pain, vitality, pain-related avoidance of activities, and activity limitations. The models were adjusted for the covariates age, sex, education level, body mass index, comorbidity, radiographic severity, and hip pain. RESULTS In longitudinal analyses, knee pain and vitality predicted a subsequent increase in avoidance of activities. Pain-related avoidance of activities predicted a subsequent increase in activity limitations; however, this relationship lost statistical significance (P = 0.089) after adjustment for covariates. Cross-sectional analyses showed strong relationships between knee pain, low vitality, pain-related avoidance of activities, and activity limitations at all time points. CONCLUSIONS In persons with early symptomatic knee OA, knee pain and low vitality lead to a subsequent increase in avoidance of activities. Pain-related avoidance of activities is related to activity limitations at inception of symptoms, but also years later. Therefore, it can be recommended to monitor and target avoidance of activities at various stages of the disease.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
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13
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Wainwright TW, Immins T, Middleton RG. Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education. BMJ Case Rep 2015; 2015:bcr-2014-208529. [PMID: 25678618 DOI: 10.1136/bcr-2014-208529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his general practitioner to CHAIN (Cycling against Hip PAIN), a 6 week programme developed to aid self-management of hip osteoarthritis through exercise, education and advice, as defined by the National Institute for Health and Care Excellence (NICE) guidelines. Significant improvements were seen in Oxford hip score, the Hip disability and Osteoarthritis Outcome Score (HOOS) - function score, sit-to-stand test, timed up and go test, pain scores and hip flexion. There was also a weight loss of 2.1 kg. The man reported 'an amazing difference' in his affected hip and leg, and improved fitness. Many clinicians would have questioned the man's suitability for the programme due to his coexisting medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise.
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Affiliation(s)
- Thomas William Wainwright
- Department of Orthopaedic, The Royal Bournemouth Hospital, Bournemouth, Dorset, UK CoPMRE, Bournemouth University, Bournemouth, Dorset, UK
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de Rooij M, van der Leeden M, Roorda LD, Lems WF, Dekker J. Response to commentary on: ‘Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity’. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bennell K, Hinman R. Exercise prescription for people with hip or knee osteoarthritis: accounting for co-morbidities. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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de Rooij M, van der Leeden M, Roorda LD, Lems WF, Dekker J. Response to commentary on: ‘Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity’. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Williams NH. Adapting exercise therapy to individual need in patients with osteoarthritis of the hip or knee. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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