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Miller KA, Baier Manwell LM, Bartels CM, Yu TY, Vundamati D, Foertsch M, Brown RL. Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100452. [PMID: 38495347 PMCID: PMC10940781 DOI: 10.1016/j.ocarto.2024.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center. Design This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability. Results Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p = 0.002). BMI did not significantly change (p = 0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 h weekly) and serving 953 patients over four years demonstrated OAMP sustainability. Conclusions OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.
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Affiliation(s)
- Kathryn A. Miller
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M. Baier Manwell
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christie M. Bartels
- Division of Rheumatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tommy Yue Yu
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Divya Vundamati
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marley Foertsch
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Roger L. Brown
- Research Design and Statistics Unit, Schools of Nursing, Medicine, and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Du X, Fan R, Kong J. What improvements do general exercise training and traditional Chinese exercises have on knee osteoarthritis? A narrative review based on biological mechanisms and clinical efficacy. Front Med (Lausanne) 2024; 11:1395375. [PMID: 38841568 PMCID: PMC11150680 DOI: 10.3389/fmed.2024.1395375] [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: 03/03/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Background Knee osteoarthritis (KOA) is a disease that significantly affects the quality of life of patients, with a complex pathophysiology that includes degeneration of cartilage and subchondral bone, synovitis, and associations with mechanical load, inflammation, metabolic factors, hormonal changes, and aging. Objective This article aims to comprehensively review the biological mechanisms and clinical effects of general exercise training and traditional Chinese exercises (such as Tai Chi and Qigong) on the treatment of KOA, providing references for the development of clinical exercise prescriptions. Methods A systematic search of databases including PubMed, Web of Science, Google Scholar, and China National Knowledge Infrastructure (CNKI) was conducted, reviewing studies including randomized controlled trials (RCTs), observational studies, systematic reviews, and meta-analyses. Keywords included "knee osteoarthritis," "exercise therapy," "physical activity," and "traditional Chinese exercise." Results and conclusion General exercise training positively affects KOA by mechanisms such as promoting blood circulation, improving the metabolism of inflammatory factors, enhancing the expression of anti-inflammatory cytokines, and reducing cartilage cell aging. Traditional Chinese exercises, like Tai Chi and Qigong, benefit the improvement of KOA symptoms and tissue repair by regulating immune function and alleviating joint inflammation. Clinical studies have shown that both types of exercise can improve physical function, quality of life, and pain relief in patients with KOA. Both general exercise training and traditional Chinese exercises are non-pharmacological treatment options for KOA that can effectively improve patients' physiological function and quality of life. Future research should further explore the long-term effects and biological mechanisms of these exercise interventions and develop personalized exercise programs based on the specific needs of patients.
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Affiliation(s)
- Xingbin Du
- Shandong Huayu University of Technology, Dezhou, China
- Faculty of Education, Qufu Normal University, Qufu, China
| | - Rao Fan
- College of Sports Science, Qufu Normal University, Qufu, China
| | - Jianda Kong
- College of Sports Science, Qufu Normal University, Qufu, China
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Amin R, Vaishali K, Maiya GA, Mohapatra AK, Sinha MK, Bhat A, Bommasamudram T, Acharya V, Gore S. Patient education for individuals with Interstitial Lung Disease: A scoping review. F1000Res 2024; 13:405. [PMID: 38895701 PMCID: PMC11184280 DOI: 10.12688/f1000research.147340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives Interstitial Lung Disease (ILD) is a severe and rapidly progressing disease with a high fatality rate. Patient education (PE) has been demonstrated to promote long-term adherence to exercise and lifestyle improvements by assisting patients in developing self-management techniques. Our scoping review's goal was to chart out the prevailing level of research about the content, processes, and effectiveness of PE for patients with ILD. Methods The relevant databases were searched using the rules provided by Arksey and O'Malley in 2005 and the Joanna Briggs Institute reviewers' manual 2015: an approach for JBI scoping reviews. Individuals with ILD, published in English between the years of inception and 2020, and describing PE administered by various healthcare practitioners were among the 355 studies found and reviewed. Thirteen studies met these criteria. Results PE delivery process, delivery techniques, quality of life assessments, common PE themes, and healthcare professional participation were all recognized and cataloged. Conclusion Despite the fact that healthcare professionals (physicians, nurses, and physiotherapists) provide PE to patients with ILD regularly, the PE provided varies greatly (contents of PE, process of delivery and delivery techniques). During the scoping review, a significant variation in the themes was addressed. They could not provide any evidence-based specific recommendations for all healthcare practitioners due to the studies' heterogeneity and lack of effectiveness measures.
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Affiliation(s)
- Revati Amin
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - K. Vaishali
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - G. Arun Maiya
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aswini Kumar Mohapatra
- Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mukesh Kumar Sinha
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Anup Bhat
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Tulasiram Bommasamudram
- Exercise and Sports Science, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vishak Acharya
- Pulmonary Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, 575001, India
| | - Shweta Gore
- MGH Institute of Health Professions, Boston, Massachusetts, 02129, USA
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Parniyan R, Pasyar N, Rambod M, Momennasab M, Nazarinia M. The effect of a self-management program on the quality of life of patients with scleroderma. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:440. [PMID: 38464627 PMCID: PMC10920719 DOI: 10.4103/jehp.jehp_1690_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/24/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Scleroderma is a rare disease with complex disorders. It affects the quality of life with severe impacts on the skin and extensive complications in the internal organs, and does not have a definitive treatment. This study aimed to investigate the effect of a self-management program on the quality of life of patients with scleroderma. MATERIALS AND METHODS This was a clinical trial in which 54 patients with scleroderma were randomly divided into two groups of 27 each (experimental and control groups). The data were collected using the Systemic Sclerosis Questionnaire. A self-management program was sent to the experimental group via a mobile phone application (WhatsApp) every day for three months. Statistical analysis was performed in Statistical Package for the Social Sciences V21. RESULTS The Wilcoxon signed-rank test showed that the average overall quality of life score of the experimental group showed a significant increase after the implementation of the program (P value: 0.00). The average overall quality of life score of the control group also significantly declined after the intervention (P value: 0.00). The Mann-Whitney U test revealed that there was no significant difference in the overall quality of life score of the two groups before the intervention (P value: 0.31); however, after the implementation of the self-management program, a significant difference was observed between the two groups (P value: 0.00). CONCLUSION According to the results, the self-management program can help improve the quality of life of patients with scleroderma.
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Affiliation(s)
- Razieh Parniyan
- Student Research Committee of Shiraz University of Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Momennasab
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadali Nazarinia
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Mei F, Li JJ, Lin J, Xing D, Dong S. Multidimensional characteristics of musculoskeletal pain and risk of hip fractures among elderly adults: the first longitudinal evidence from CHARLS. BMC Musculoskelet Disord 2024; 25:4. [PMID: 38166800 PMCID: PMC10759596 DOI: 10.1186/s12891-023-07132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hip fractures are a major public health concern among middle-aged and older adults. It is important to understand the associated risk factors to inform health policies and develop better prevention strategies. Musculoskeletal pain is a possible implicating factor, being associated with physical inactivity and risk of falls. However, the association between musculoskeletal pain and hip fractures has not been clearly investigated. METHODS A nationally representative sample of the Chinese population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The study collected patient information on their demographic characteristics, socioeconomic status, other health-related behavior, and history of musculoskeletal pain and hip fractures. Univariate and multivariate analyses were conducted to investigate the factors influencing the risk of hip fracture, including factors related to the individual and to musculoskeletal pain. P for trend test was performed to assess the trend of each continuous variable. The robustness and bias were assessed using the bootstrap method. Restricted cubic spline regression was utilized to identify linear or non-linear relationships. RESULTS Among the 18,813 respondents, a total of 215 individuals reported that they have experienced a hip fracture. An increased risk of hip fracture was associated with the presence of waist pain and leg pain (P < 0.05), as well as with an increased number of musculoskeletal pain sites (P < 0.05). For individuals aged 65 and above, a significant association was found between age and the risk of hip fracture (P < 0.05). Furthermore, respondents with lower education level had a higher risk of hip fracture compared to those with higher education levels (P < 0.05). CONCLUSION In the Chinese population, the risk of hip fracture was found to be associated with both the location and extent of musculoskeletal pain, as well as with other factors such as age and demographic characteristics. The findings of this study may be useful for informing policy development and treatment strategies, and provide evidence for comparison with data from other demographic populations.
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Affiliation(s)
- Fengyao Mei
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, 100044, P.R. China
- Thoracic surgery Department, Beijing Hospital, Beijing, 100044, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, 100044, P.R. China.
| | - Dan Xing
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, 100044, P.R. China.
| | - Shengjie Dong
- Department of the Joint and Bone Surgery, Yantaishan Hospital, Yantai, China.
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Zhou Y, Li C, Wang W, Ding L. Large-scale data reveal disparate associations between leisure time physical activity patterns and mental health. COMMUNICATIONS MEDICINE 2023; 3:175. [PMID: 38129660 PMCID: PMC10739930 DOI: 10.1038/s43856-023-00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Leisure time physical activity (LTPA) is known to be associated with a lower risk for mental health burden, while whether the underlying mechanisms vary across populations is unknown. We aimed to explore the disparate associations between LTPA and mental health based on large-scale data. METHODS In this study, we analyzed data including 711,759 individuals aged 15 years or above from the latest four rounds (2003, 2008, 2013, and 2018) of the National Health Service Survey (NHSS) in China. We used multiple logistic regression models adjusted for potential confounders to investigate associations between LTPA and mental health in the total population and subgroups by measuring a diverse set of activity frequencies, intensities, and types. To examine the dose-response associations between total activity volume and mental health, we conducted restricted cubic splines to investigate possible nonlinearity. RESULTS LTPA was associated with remarkably lower self-reported mental health burden (OR 0.56, 95% CI 0.54-0.58). The dose-response relationship between total activity volume and mental health was highly nonlinear (p < 0.001), presenting L-shaped with first 1200 metabolic equivalents of task (METs)-min/week for significant risk reduction (OR 0.58, 95% CI 0.56-0.60). Notably, merely exercising 3-5 times per week with moderate swimming was significantly associated with lower mental health burden among younger people, while the association was strongly large in older adults aged 60 years or above doing 55-min moderate apparatus exercise at least six times a week. CONCLUSIONS In a large Chinese sample, LTPA was meaningfully and disparately associated with mental health burden across different people. Policy targeted at prompting activity may be effective for reducing mental health burden, but importantly, tailored strategies are needed based on population contexts.
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Affiliation(s)
- Ying Zhou
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Chenshuang Li
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Wei Wang
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
- Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, 430030, Wuhan, Hubei, China.
| | - Lieyun Ding
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
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Sandberg A, Nordanstig J, Cider Å, Jivegård L, Hagströmer M, Bäck M. The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial. Phys Ther 2023; 103:pzad086. [PMID: 37459237 PMCID: PMC10630612 DOI: 10.1093/ptj/pzad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication. METHODS In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes. RESULTS At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (-3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs -0.23 [SD = 0.81]). CONCLUSION This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation. IMPACT At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
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Affiliation(s)
- Anna Sandberg
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jivegård
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pu A, Paul S, Luke B, Bhattacharyya T. Better Mobility Is Associated With Higher Incomes and Longer Working Years Among Older Adults. Clin Orthop Relat Res 2023; 482:00003086-990000000-01388. [PMID: 37878467 PMCID: PMC10723861 DOI: 10.1097/corr.0000000000002886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Robust physical mobility is the key to healthy independent aging. Although the association between socioeconomic status and health is well documented, it is unclear whether there is a relationship between mobility and income, because income data are not readily available. QUESTIONS/PURPOSES (1) Do individuals with better mobility have higher incomes? (2) Does maintaining mobility over time allow individuals to keep working? (3) Is exercise associated with higher mobility over time? METHODS We obtained longitudinal income and health data from the nationally representative Health and Retirement Study. Three cohorts were used. First, we studied the relationship between household income and mobility (on a 6-point index of walking impairment) in 19,430 adults who were assessed in 2016 (representing 93% of the 20,805-person total cohort). We measured the association of mobility and household income in a multivariate linear regression analysis of age, gender, health conditions, and education. We then identified a second group of 1094 individuals with unrestricted mobility in the year 2000 and compared differences in income and working rates between those who maintained mobility and those who lost mobility after 10 years. Finally, we identified a third group of 7063 individuals who were 60 to 80 years old in 2012, divided the group by how often they engaged in exercise, and observed differences in mobility after 4 years. RESULTS After adjusting for covariates, a drop of one level of mobility was associated with a USD 3410 reduction in annual household income (95% CI USD 2890 to USD 3920; p < 0.001). After 10 years, individuals who maintained their mobility had incomes that were USD 6500 higher than that of individuals who were not working (95% CI USD 2300 to USD 10,300; p < 0.001) and were more likely to be working (40% versus 34.5%; p < 0.001). Exercising at least once per week was associated with better mobility 4 years later (mobility score 4.46 ± 0.08 versus 3.66 ± 0.08; p < 0.001). CONCLUSION Better mobility was associated with more than USD 3000 in annual income. Regular exercise and other interventions that improve mobility may have meaningful returns on investment. CLINICAL RELEVANCE Because greater mobility is strongly associated with higher income, orthopaedic interventions may be undervalued.
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Affiliation(s)
- Alex Pu
- Clinical Trials and Outcomes Branch, National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Subrata Paul
- Integrated Data Sciences Section, Research Technologies Branch, NIADH/NIH, Bethesda, MD, USA
| | - Brian Luke
- Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Timothy Bhattacharyya
- Clinical Trials and Outcomes Branch, National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Al-Omari B, Farhat J, Khan M, Grancharov H, Zahr ZA, Hanna S, Alrahoomi A. Exploring patient treatment decision making for osteoarthritis in the UAE: a cross-sectional adaptive choice-based conjoint study. BMC Public Health 2023; 23:1542. [PMID: 37573337 PMCID: PMC10423421 DOI: 10.1186/s12889-023-16490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE To assess osteoarthritis (OA) patients' preferences for pharmaceutical treatment via Adaptive Choice-Based Conjoint (ACBC) method. METHODS A United Arab Emirates (UAE) based Patient and Public Involvement (PPI) group designed the ACBC questionnaire with 10 attributes and 34 levels. The questionnaire was developed using Sawtooth Software and analyzed through Hierarchical Bayesian (HB). Results were standardized using Z-score via SPSS. RESULTS Study participants were 1030 OA patients, 83.6% aged 50 or older and 83.4% female. The avoidance of medication's side effects accounted for 66% relative importance compared to 6% relative importance for the medication's benefits. The "way of taking the medicine" attribute had the highest coefficient of variation (70%) and the four side effect attributes "risk of gastric ulcer, addiction, kidney and liver impairment, and heart attacks and strokes" had a coefficient of variation from 18 to 21%. CONCLUSIONS Arab OA patients are similar to other ethnic groups in trading-off benefits and side effects and consistently prioritizing the avoidance of medications' side effects. Although the "Way of taking medicine" was the least important attribute it was associated with the highest variation amongst patients. OA patients also prefer prescribed medications to internet-purchased and over-the-counter options.
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Affiliation(s)
- Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Joviana Farhat
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Mumtaz Khan
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Rheumatology, Sheikh Shakhbout Medical City (SSMC), P.O. Box 11001, Abu Dhabi, United Arab Emirates
| | - Hristo Grancharov
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
| | - Zaki Abu Zahr
- Department of Rheumatology, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
| | - Sammy Hanna
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, E1 2AD, UK
| | - Abdulla Alrahoomi
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
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Rogers CJ, Ayuso J, Hackney ME, Penza C. Alzheimer Disease and Related Cognitive Impairment in Older Adults: A Narrative Review of Screening, Prevention, and Management for Manual Therapy Providers. J Chiropr Med 2023; 22:148-156. [PMID: 37346234 PMCID: PMC10280085 DOI: 10.1016/j.jcm.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The aim of this narrative review was to review literature relevant to manual therapists about cognitive impairment, together with screening, potential treatment, and prevention modalities. Methods A literature search of AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and MEDLINE was conducted with the search terms "cognitive decline," "cognitive impairment," "screening," and "prevention." We reviewed current screening practices, including functional exams, imaging, and laboratory testing. We reviewed current potential preventive measures and treatments being implemented in practice. Results We selected 49 resources for this narrative summary. The Montreal Cognitive Assessment and Mini-Mental State Exam are recommended screening tools. Imaging and laboratory testing are not recommended in screening for cognitive decline. Promotion of healthy, active living through physical and mental activities may assist with prevention of cognitive decline. Conclusion Cognitive decline affects a large proportion of the US population. Recognizing signs and symptoms of this condition starts with individuals, caretakers, family members, and health care providers. Health care providers should utilize the most appropriate screening tools to assess the presence of cognitive conditions.
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Affiliation(s)
- Casey J. Rogers
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
| | - Jaime Ayuso
- Northwestern Health Sciences University, Bloomington, Minnesota
| | - Madeleine E. Hackney
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Ahmad MA, Yusof A, Hamid MSA, Zulkifli Amin FH, Kamsan SS, Ag Daud DM, Ajit Singh DK. Effects of Self-management Program as Adjunctive to Usual Rehabilitation Exercise on Pain and Functional Outcomes in Knee Osteoarthritis: A Randomized Controlled Trial. J Res Health Sci 2023; 23:e00569. [PMID: 37571940 PMCID: PMC10422143 DOI: 10.34172/jrhs.2023.104] [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: 11/23/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Home-based exercise (HBE) and patient education (EDU) have been reported as beneficial additions to usual knee osteoarthritis (KOA) rehabilitation. However, previous trials mostly examined the effects of HBE and EDU separately. Thus, this study aimed to evaluate the effects of a structured combined HBE and EDU program in addition to usual KOA rehabilitation on pain score, functional mobility, and disability level. STUDY DESIGN A parallel-group, single-blinded randomized controlled trial. METHODS Eighty adults with KOA were randomly allocated to experimental (n=40) and control (n=40) groups. All participants underwent their usual physiotherapy care weekly for eight weeks. The experimental group received a structured HBE+EDU program to their usual care, while the control group performed home stretching exercises to equate treatment time. The Knee Injury and Osteoarthritis Outcome Score (KOOS) for the disability level, visual analogue scale (VAS) for pain, and timed up-and-go test (TUG) for mobility were measured pre-post intervention. RESULTS After eight weeks, the experimental group demonstrated significant improvements in the KOOS (all subscales), pain VAS, and TUG scores compared to baseline (P<0.001); meanwhile, only KOOS (activities of daily living and sports subscales) was significant in the control group. Relative to the control, the experimental group presented higher improvements (P<0.001) by 22.2%, 44.1%, and 15.7% for KOOS, pain VAS, and TUG, respectively. CONCLUSION Integrating the HBE+EDU program into usual KOA rehabilitation could reduce pain and disability, while it improved functional mobility. The finding of this study suggests a combination of a structured HBE and EDU program to be considered as part of mainstream KOA management.
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Affiliation(s)
- Mohd Azzuan Ahmad
- Physiotherapy Program, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ashril Yusof
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Shariff A Hamid
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Faizul Hafiz Zulkifli Amin
- Physiotherapy Program, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Salwana Kamsan
- Department of Physical Rehabilitation Sciences, Faculty of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - D Maryama Ag Daud
- HEAL Research Unit, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Jönsson T, Eek F, Hansson EE, Dahlberg LE, Dell’Isola A. Factors associated with clinically relevant pain reduction after a self-management program including education and exercise for people with knee and/or hip osteoarthritis: Data from the BOA register. PLoS One 2023; 18:e0282169. [PMID: 36827245 PMCID: PMC9955666 DOI: 10.1371/journal.pone.0282169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
AIM To examine the associations between individual- and disease-related factors and the odds of reaching a clinically relevant pain reduction in people with knee and/or hip osteoarthritis (OA) who underwent a first-line self-management program. MATERIALS AND METHODS An observational registry-based study including people with knee (n = 18,871) and hip (n = 7,767) OA who participated in a self-management program including education and exercise and had data recorded in the Better Management of patients with Osteoarthritis (BOA) register. We used multivariable logistic regression models to study the association between sex, age, body mass index (BMI), education, comorbidity, pain frequency, walking difficulties, willingness to undergo surgery and the odds of reaching a clinically relevant pain reduction (decrease of >33% on a 0-10 NRS scale) 3 and 12 months after the intervention. All analyses were stratified by joint (knee/hip). RESULTS Both in the short- and long-term follow-up, a younger age (18-65 years), a lower BMI (< 25), a higher level of education (university), the absence of comorbidities impacting the ability to walk, less frequent pain and not being willing to undergo surgery were associated with higher odds of reaching a clinically relevant pain reduction in people with knee OA. We found similar results for people with hip OA, but with larger uncertainty in the estimates (wider 95% CI). CONCLUSION Our study suggests that early fist line self-management interventions delivered when people have unilateral hip or knee OA with less frequent pain and are unwilling to undergo surgery, may be important for reaching a clinically relevant pain reduction after participation. Providing the most appropriate treatment to the right patient at the right time is a step in reducing the burden of OA for society and the patient.
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Affiliation(s)
- Thérése Jönsson
- Department of Health Sciences, Sport Sciences, Lund University, Lund, Sweden,* E-mail:
| | - Frida Eek
- Department of Health Sciences, Human Movement: Health and Rehabilitation, Lund University, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Human Movement: Health and Rehabilitation, Lund University, Lund, Sweden
| | - Leif E. Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Lund, Sweden
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13
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Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis. Pain Rep 2023; 8:e1052. [PMID: 36699992 PMCID: PMC9833456 DOI: 10.1097/pr9.0000000000001052] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023] Open
Abstract
Studies have identified demographic, clinical, psychosocial, and perioperative variables associated with persistent pain after a variety of surgeries. This study aimed to perform a systematic review and meta-analysis of factors associated with persistent pain after total knee replacement (TKR) and total hip replacement (THR) surgeries. To meet the inclusion criteria, studies were required to assess variables before or at the time of surgery, include a persistent postsurgical pain (PPSP) outcome measure at least 2 months after a TKR or THR surgery, and include a statistical analysis of the effect of the risk factor(s) on the outcome measure. Outcomes from studies implementing univariate and multivariable statistical models were analyzed separately. Where possible, data from univariate analyses on the same factors were combined in a meta-analysis. Eighty-one studies involving 171,354 patients were included in the review. Because of the heterogeneity of assessment methods, only 44% of the studies allowed meaningful meta-analysis. In meta-analyses, state anxiety (but not trait anxiety) scores and higher depression scores on the Beck Depression Inventory were associated with an increased risk of PPSP after TKR. In the qualitative summary of multivariable analyses, higher preoperative pain scores were associated with PPSP after TKR or THR. This review systematically assessed factors associated with an increased risk of PPSP after TKR and THR and highlights current knowledge gaps that can be addressed by future research.
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Jönsson T, Dell’Isola A, Lohmander LS, Wagner P, Cronström A. Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis. JAMA Netw Open 2022; 5:e2240126. [PMID: 36326763 PMCID: PMC9634502 DOI: 10.1001/jamanetworkopen.2022.40126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities. OBJECTIVE To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention. DESIGN, SETTING, AND PARTICIPANTS This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021. EXPOSURES Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application. MAIN OUTCOMES AND MEASURES Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior. RESULTS A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome. CONCLUSIONS AND RELEVANCE This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.
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Affiliation(s)
- Therese Jönsson
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - L. Stefan Lohmander
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anna Cronström
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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15
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Joseph KL, Dagfinrud H, Hagen KB, Nordén KR, Fongen C, Wold OM, Hinman RS, Nelligan RK, Bennell KL, Tveter AT. The AktiWeb study: feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis. Pilot Feasibility Stud 2022; 8:150. [PMID: 35859065 PMCID: PMC9296765 DOI: 10.1186/s40814-022-01110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient organisations may be an under-utilised resource in follow-up of patients requiring long-term exercise as part of their disease management. The purpose of this study was to explore the feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis (OA). Methods In this pre–post feasibility study, patients aged 40–80 years with hip and/or knee OA were recruited from Diakonhjemmet Hospital. The 12-week intervention was delivered through a patient organisation’s digital platform. Feasibility was evaluated by proportion of eligible patients enrolled, proportion of enrolled patients who provided valid accelerometer data at baseline, and proportion completing the cardiorespiratory exercise test according to protocol at baseline and completed follow-up assessments. Patient acceptability was evaluated for website usability, satisfaction with the initial exercise level and comprehensibility of the exercise program. Change in clinical outcomes were assessed for physical activity, cardiorespiratory fitness and patient-reported variables. Results In total, 49 eligible patients were identified and 35 were enrolled. Thirty (86%) of these attended baseline assessments and provided valid accelerometer data and 18 (51%) completed the maximal cardiorespiratory exercise test according to protocol. Twenty-two (63%) patients completed the follow-up questionnaire, and they rated the website usability as ‘acceptable’ [median 77.5 out of 100 (IQR 56.9, 85.6)], 19 (86%) reported that the initial exercise level was ‘just right’ and 18 (82%) that the exercise program was ‘very easy’ or ’quite easy’ to comprehend. Improvement in both moderate to vigorous physical activity (mean change 16.4 min/day; 95% CI 6.9 to 25.9) and cardiorespiratory fitness, VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29 to 3.36) were found in a subgroup of 8 patients completing these tests. Across all patient-reported outcomes 24–52% of the patients had a meaningful improvement (n = 22). Conclusion A web-based exercise program delivered by a patient organisation was found to be feasible and acceptable in patients with hip and/or knee OA. Trial registration ClinicalTrials.gov, NCT04084834 (registered 10 September 2019). The Regional Committee for Medical and Health Research Ethics south-east, 2018/2198. URL: Prosjekt #632074 - Aktiv med web-basert støtte. - Cristin (registered 7 June 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01110-3.
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Affiliation(s)
- Kenth Louis Joseph
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. .,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Hanne Dagfinrud
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- Division of Health Service, Norwegian Institute of Public health, Oslo, Norway
| | - Kristine Røren Nordén
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Rachel K Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Meng Y, Deng B, Liang X, Li J, Li L, Ou J, Yu S, Tan X, Chen Y, Zhang M. Effectiveness of self-efficacy-enhancing interventions on rehabilitation following total hip replacement: a randomized controlled trial with six-month follow-up. J Orthop Surg Res 2022; 17:225. [PMID: 35399102 PMCID: PMC8995056 DOI: 10.1186/s13018-022-03116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background As the world’s population ages, hip replacement, a routine treatment for arthritis, has become more common. However, after surgery, rehabilitation has some limited effectiveness with postoperative complications and persistent impairments. This study aimed to explore the effect of a self-efficacy-enhancing intervention program following hip replacement on patients’ rehabilitation outcomes (self-efficacy, functional exercise compliance, hip function, activity and social participation, anxiety and depression, and quality of life). Methods A prospective randomized controlled trial with a repeated-measures, two-group design was conducted in a grade A general hospital in Guangdong Province, China. A total of 150 participants with a unilateral total hip replacement were recruited via convenience sampling. Participants were randomly assigned to either the self-efficacy enhancing intervention group (n = 76) or the control group (n = 74). The intervention encompassed a face-to-face education before discharge and four telephone-based follow-ups in six months after surgery. Researchers collected baseline data on one to three days after surgery, and outcomes data were collected one, three, and six months after surgery. Results Average age (deviation) in intervention and control group were 58 (10.32) and 59 (10.82), respectively. After six months, intervention group scored 86.83 ± 5.89 in rehabilitation self-efficacy, significantly higher than control group (72.16 ± 6.52, t = -10.820, p < 0.001) and their hip function has turned to “excellent” (90.52 ± 4.03), while that of the latter was limited to a “middle” level (78.47 ± 7.57). Statistically significant differences were found in secondary outcomes (p < 0.001). The advantage of intervention in improving quality of life was seen in the long term rather than in the early postoperative period. Conclusions The self-efficacy-enhancing intervention performed by nurses induced better exercise compliance and physical, psychological, and social functions after hip replacement compared with routine care. We recommend such interventions to be combined with routine care soon after hip replacement. Further research should focus on the social participation of patients with hip replacement. Trial registration Retrospectively registered at Chinese Clinical Trial Registry (31/01/2020, No. ChiCTR2000029422, http://www.chictr.org.cn/index.aspx). Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03116-2.
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Vecchiato M, Quinto G, Palermi S, Foccardi G, Mazzucato B, Battista F, Duregon F, Michieletto F, Neunhaeuserer D, Ermolao A. Are Gyms a Feasible Setting for Exercise Training Interventions in Patients with Cardiovascular Risk Factors? An Italian 10-Years Cross-Sectional Survey Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042407. [PMID: 35206596 PMCID: PMC8872373 DOI: 10.3390/ijerph19042407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 01/28/2023]
Abstract
Background: Exercise training is a known important prevention and treatment modality in patients with cardiovascular (CV) diseases. However, the CV risk factors in gym users have been poorly studied. The aim of this study was to monitor CV risk factors of gym users over 10 years in order to investigate whether gyms are used settings for secondary disease prevention. Methods: In 2007 and 2017, a cross-sectional research survey was adopted to determine CV risk factors and habits in gym users (18–69 years) of the Veneto region. These data were analyzed and compared with those of PASSI, a national surveillance system of the Italian population. Results: During the last decade, there has been an increase in gym users over 50 years of age and in people with arterial hypertension and hypercholesterolemia. People attending the gym on medical referral are increasing, but they are still few (<10%). When comparing the collected data with PASSI surveillance, most of the CV risk factors are strongly underrepresented in gym users. Conclusion: The prevalence of gym users with CV risk factors is rather low, regardless of age. Physicians still need to encourage and prescribe physical exercise for secondary prevention and treatment of chronic diseases.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Giulia Foccardi
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Barbara Mazzucato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Federica Michieletto
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Veneto Region, 35123 Venice, Italy;
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
- Correspondence:
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (M.V.); (G.Q.); (G.F.); (B.M.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sport and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
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Effect of a Behavioural Intervention for Adoption and Maintenance of a Physically Active Lifestyle on Psychological Well-Being and Quality of Life in Patients with Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. Sports Med 2021; 52:643-654. [PMID: 34599476 PMCID: PMC8891112 DOI: 10.1007/s40279-021-01556-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/06/2022]
Abstract
Background Psychological well-being and quality of life (QoL) are important outcomes of lifestyle interventions, as a positive impact may favour long-term maintenance of behaviour change. Objective This study investigated the effect of a behavioural intervention for adopting and maintaining an active lifestyle on psychological well-being and health-related QoL in individuals with type 2 diabetes. Methods Three hundred physically inactive and sedentary patients were randomized 1:1 to receive 1 month’s theoretical and practical counselling once a year (intervention group, INT) or standard care (control group, CON) for 3 years. Psychological well-being and QoL, assessed using the World Health Organization (WHO)-5 and the 36-Item Short Form (SF-36) questionnaire, respectively, were pre-specified secondary endpoints. The primary endpoint was sustained behaviour change, as assessed by accelerometer-based measurement of physical activity (PA) and sedentary time. Results WHO-5 and SF-36 physical and mental component summary (PCS and MCS) scores increased progressively in the INT group and decreased in the CON group, resulting in significant between-group differences (WHO-5: mean difference 7.35 (95% confidence interval (CI) 3.15–11.55), P = 0.0007; PCS 4.20 (95% CI 2.25–6.15), P < 0.0001; MCS 3.04 (95% CI 1.09–4.99), P = 0.0025). Percentage of participants with likely depression decreased in the INT group and increased in the CON group. PA volume changes were independently associated with WHO-5 changes, which were significantly higher in participants who accumulated > 150 min·wk−1 of moderate-to-vigorous intensity PA versus those who did not (13.06 (95% CI 7.51–18.61), P < 0.0001), whereas no relationship was detected for QoL. Conclusion A counselling intervention that was effective in promoting a sustained change in PA and sedentary behaviour significantly improved psychological well-being and QoL. Trial Registration ClinicalTrials.gov; NCT01600937; 10 October 2012. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01556-0.
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Demircioğlu A, Özkal Ö, Dağ O. Multiple Factors Affecting Health-Related Quality of Life in Women With Chronic Multisite Musculoskeletal Pain: A Cross-Sectional Study in Ankara, Turkey. Eval Health Prof 2021; 45:115-125. [PMID: 34579589 DOI: 10.1177/01632787211049273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although chronic multi-site musculoskeletal pain is known to cause decreased physical function and impair work and social life, there is insufficient research about its impact on health-related quality of life (HRQoL) in women. The aim of this study was to investigate multiple factors affecting HRQoL in women with chronic multi-site musculoskeletal pain. This study included 227 women with two or more musculoskeletal areas which were painful during the last 3 months. The HRQoL and musculoskeletal system symptoms were evaluated with the Nottingham Health Profile (NHP) and the Nordic Musculoskeletal Questionnaire (NMQ), respectively. Physical activity level, social functionality and depressive symptoms were assessed with the International Physical Activity Questionnaire-Short Form (IPAQ- SF), Social Functioning Scale (SFS) and Beck Depression Inventory (BDI), respectively. Significant predictors for the total score on the NHP were found to be the number of children (p < 0.001), social engagement/withdrawal scale (p:0.094), the number of regions with musculoskeletal pain during the last year (p:0.002) and last 7 days (p:0.036), depressive symptoms (p < 0.001), current employment status (p:0.084), and the presence of chronic disease (p < 0.001). The results of this study demonstrated that both sociodemographic characteristics, and social and psychological factors may affect the HRQoL in women with chronic multi-site musculoskeletal pain.
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Affiliation(s)
- Arzu Demircioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özden Özkal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bursa Uludağ University, Bursa, Turkey
| | - Osman Dağ
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
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Cunningham J, M. Briggs A, Cottrell E, Doyle F, Dziedzic K, Finney A, Murphy P, Paskins Z, Sheridan E, Swaithes L, P. French H. Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol. HRB Open Res 2021; 4:102. [PMID: 34746643 PMCID: PMC8543168 DOI: 10.12688/hrbopenres.13377.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a 'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M. Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG, UK
| | - Eoin Sheridan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
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21
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Pedersini P, Savoldi M, Berjano P, Villafañe JH. A probiotic intervention on pain hypersensitivity and microbiota composition in patients with osteoarthritis pain: Study protocol for a randomized controlled trial. Arch Rheumatol 2021; 36:296-301. [PMID: 34527936 PMCID: PMC8418770 DOI: 10.46497/archrheumatol.2021.7719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/15/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES This study aims to examine the effects of probiotics on pain hypersensitivity at the end of a six-week intervention program in patients with osteoarthritis (OA)-related pain. PATIENTS AND METHODS This double-blind randomized controlled clinical trial with two parallel arms will be conducted between January 2021 and July 2022. At least 30 participants (age range, 50 to 90 years) of both sexes with a diagnosis of symptomatic hip or knee (Kellgren-Lawrence scale ≥3) will be recruited in each arm (total n=60) to achieve adequate statistical power in the analyses. The intervention will be administered for six weeks followed by a four-week follow-up period. The experimental group will receive a probiotic product plus the usual medical care. The control group will receive a probiotical sham plus the usual medical care. Assessment points will be measured at baseline, end of intervention, and one-month post-intervention. The outcomes of this intervention will be a change in visual analog scale pain and the gut microbiota composition. Group by time effects will be compared using mixed-model analysis of variance. CONCLUSION A reduction in pain hypersensitivity in patients with knee OA-related pain could suggest an involvement of microbiota, or part of it, in chronic pain state mechanisms.
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Affiliation(s)
- Paolo Pedersini
- Department of Clinical Research, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Marco Savoldi
- Department of School of Physiotherapy, University of Brescia, Brescia, Italy
| | - Pedro Berjano
- Department of Spinal Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Jorge Hugo Villafañe
- Department of Clinical Research, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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22
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Hawke LJ, Taylor NF, Dowsey MM, Choong PFM, Shields N. In the dark about physical activity - exploring patient perceptions of physical activity after elective total knee joint replacement: a qualitative study. Arthritis Care Res (Hoboken) 2021; 74:965-974. [PMID: 34057314 DOI: 10.1002/acr.24718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. METHODS Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semi-structured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12 months after total knee joint replacement. Interviews were audiotaped and transcribed verbatim. Themes were identified by an inductive and iterative process of data analysis. RESULTS The main theme to emerge was participants were in the dark about physical activity. Participants were typically not familiar with physical activity guidelines and had difficulty distinguishing between low and moderate-intensity physical activity. Three subthemes were identified: (1) people prioritise participation in meaningful life situations after total knee joint replacement; (2) rehabilitation was perceived to not explicitly address moderate-intensity physical activity levels; and (3) other health and social reasons replaced knee osteoarthritis as barriers to physical activity. CONCLUSION Limited understanding of physical activity recommendations, prioritisation of participation in meaningful life situations, rehabilitation that was impairment focused and other health and social reasons appeared to contribute to low levels of moderate-intensity physical activity for adults after knee joint replacement. Addressing being in the dark about physical activity may be an important first step to increase the effectiveness of behavioural interventions designed to promote physical activity after total knee joint replacement.
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Affiliation(s)
- Lyndon J Hawke
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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23
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Sato T, Shimizu K, Shiko Y, Kawasaki Y, Orita S, Inage K, Shiga Y, Suzuki M, Sato M, Enomoto K, Takaoka H, Mizuki N, Kim G, Hozumi T, Tsuchiya R, Otagiri T, Mukaihata T, Furuya T, Maki S, Nakamura J, Hagiwara S, Aoki Y, Koda M, Akazawa T, Takahashi H, Takahashi K, Ohtori S, Eguchi Y. Effects of Nintendo Ring Fit Adventure Exergame on Pain and Psychological Factors in Patients with Chronic Low Back Pain. Games Health J 2021; 10:158-164. [PMID: 33891508 DOI: 10.1089/g4h.2020.0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: In recent years, there has been an increase in research on the therapeutic effects of exergaming, but there have been few studies on these types of interventions for chronic low back pain. In this study, we hypothesized that the Nintendo Ring Fit Adventure (RFA) exergame would be effective for patients with chronic low back pain, and we conducted a randomized prospective longitudinal study. Materials and Methods: Patients with chronic low back pain were included in this study. Twenty randomly selected patients (9 males and 11 females, mean age 49.3 years) were included in the RFA group, and RFA exergaming was performed once a week for 40 minutes for 8 weeks. Twenty patients (12 males and 8 females, mean age 55.60 years) served as the control group and received oral treatment for 8 weeks. Pain and psychological scores (pain self-efficacy, pain catastrophizing, and kinesiophobia) were measured and analyzed before and after 8 weeks of treatment in both groups. Results: In the RFA group, low back pain, buttock pain, and pain self-efficacy were significantly improved after 8 weeks of RFA exergaming, but there was no significant improvement in lower limb numbness, pain catastrophizing, or kinesiophobia. In the control group, no significant improvement was observed after 8 weeks of oral treatment. Conclusion: RFA exergaming increased pain self-efficacy and reduced pain in patients with chronic low back pain. Future treatment protocols should be developed to improve pain self-efficacy. Approval code: 2894, School of Medicine, Chiba University.
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Affiliation(s)
- Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Shimizu
- Future Medicine Education and Research Organization at Chiba University, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryuto Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuma Otagiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohito Mukaihata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba-City, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba-City, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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24
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O'Brien MW, Bray NW, Kivell MJ, Fowles JR. A scoping review of exercise referral schemes involving qualified exercise professionals in primary health care. Appl Physiol Nutr Metab 2021; 46:1007-1018. [PMID: 33872547 DOI: 10.1139/apnm-2020-1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Qualified exercise professionals (QEPs) have the training, knowledge, and scope of practice to effectively provide physical activity counselling, prescribe exercise, and deliver exercise programming to patients with or without chronic diseases. Healthcare providers identify an interest in referring patients to QEPs; however, the impact of exercise referral schemes (ERS) involving QEPs on patients' physical health is unclear. A scoping review regarding the available evidence of ERS involving healthcare provider referrals to QEPs was performed. A literature search was conducted in 6 databases (initially: n = 6011 articles), yielding n = 23 articles examining QEP delivered physical activity counselling (n = 7), QEP supervised exercise training (n = 4), or some combination (n = 12). Although studies were heterogeneous in methods, procedures, and populations, ERSs increased patients' subjective physical activity levels. Few studies incorporated objective physical activity measures (n = 5/23), and almost half measured aerobic fitness (n = 11/23). ERS involving a QEP that includes activity counselling and/or exercise programming/training report favourable impacts on patients' subjectively measured physical activity and objectively measured aerobic fitness. Based on the existing literature on the topic, this scoping review provides recommendations for designing and evaluating ERS with QEPs that include: objective measures, long-term follow-up, QEP qualifications, and the cost-effectiveness of ERS. Novelty: ERS involving QEPs report increased patients' perceived physical activity level and may improve patients' cardiorespiratory fitness. Promoting the collaboration of QEPs with other healthcare providers can enhance patients' physical fitness and health. This scoping review provides recommendations for the design and evaluation of ERS involving QEPs.
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Affiliation(s)
| | - Nick W Bray
- School of Kinesiology, Western University, ON, Canada
| | | | - Jonathon R Fowles
- Nova Scotia Health, NS, Canada.,School of Kinesiology, Centre of Lifestyle Studies, Acadia University, NS, Canada
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25
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Klässbo M, Nordström K, Nyberg LA, Kristiansson P, Wadensjö HV. I exercise to postpone death - Interviews with persons with hip and/or knee osteoarthritis who are attending an osteoarthritis school. Physiother Theory Pract 2021; 38:1667-1682. [PMID: 33620013 DOI: 10.1080/09593985.2021.1882020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Physical activity (PA) and exercise constitute the first line of treatment for osteoarthritis (OA) of the hip and/or knee. Even though the symptoms may vary, OA should be considered a chronic disease and therefore PA and exercise should be performed lifelong. That needs knowledge and motivation.Purpose: The purpose of this study was to explore and create a deeper understanding of the motivational processes for PA and exercise for persons with hip and/or knee OA who have participated in a self-management program OA school that included long-term exercise supervised by physical therapists.Methods: Twenty-two in-depth interviews were conducted with 18 participants recruited from the OA school at a Physical Therapy Rehabilitation Clinic in Sweden. The interviews were analyzed with qualitative content analysis.Results: The analysis resulted in one main theme, Developing health literacy to encourage motivational processes for PA and exercise in OA and four themes: 1) meeting an established self-management program; 2) carrying my life history; 3) understanding the intelligence of the body; and 4) growing in existential motivationConclusion: Motivation for being physically active and to exercise, the life history in relation to PA and what creates existential motivation are important areas to ask questions about when people come to OA schools. Knowledge about the signals of the body connected to OA should be implemented in OA schools in order to motivate people to live an active life despite OA. Health literacy and the awareness of how PA can postpone death are likely to be important for existential motivation.
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Affiliation(s)
| | | | | | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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26
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Ettlin L, Rausch Osthoff AK, Nast I, Niedermann K. Applicability of Exercise and Education Programmes for Knee Osteoarthritis Management to Switzerland. FRONTIERS IN HEALTH SERVICES 2021; 1:760814. [PMID: 36926479 PMCID: PMC10012725 DOI: 10.3389/frhs.2021.760814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system. Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, "Reach, Effectiveness, Adoption, Implementation, and Maintenance," for rating the applicability of the programmes (on a scale of 1 = "least applicable" to 10 = "most applicable"). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating. Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction. Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.
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Affiliation(s)
- Lea Ettlin
- Schools of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Anne-Kathrin Rausch Osthoff
- Schools of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Irina Nast
- Schools of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Karin Niedermann
- Schools of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
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27
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Rabiei P, Sheikhi B, Letafatkar A. Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group-Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial. Pain Pract 2020; 21:333-342. [PMID: 33135286 DOI: 10.1111/papr.12963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. METHODS Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and self-efficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8 weeks post-intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. RESULTS Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [ηp2 ] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, ηp2 = 0.06) and disability (P = 0.021, ηp2 = 0.07) compared to the GE group. No significant difference was found in fear-avoidance beliefs during physical activity and work, and self-efficacy (P > 0.05) between the 2 groups. CONCLUSION PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted.
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Affiliation(s)
- Pouya Rabiei
- Department of Physical Education and Sports Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Bahram Sheikhi
- Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
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28
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Chen Z, Lan W, Yang G, Li Y, Ji X, Chen L, Zhou Y, Li S. Exercise Intervention in Treatment of Neuropsychological Diseases: A Review. Front Psychol 2020; 11:569206. [PMID: 33192853 PMCID: PMC7642996 DOI: 10.3389/fpsyg.2020.569206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/14/2020] [Indexed: 01/14/2023] Open
Abstract
Faced with a constant inundation of information and increasing pressures brought by the continuous development of modern civilization, people are increasingly faced with mental health challenges that are only now being actively researched. Mental illness is caused by brain dysfunction due to internal and external pathogenic factors that destroy the integrity of the human brain and alter its function. Regular participation in physical exercise can stimulate the cerebral cortex and simultaneously increase the supply of oxygen and nutrients, helping to preserve or restore normal functioning of the nervous system. In conjunction with other systems of the body, the nervous system constitutes the neuro-humoral regulation system responsible for maintaining the stable state of the human body. This paper is a systematic review of studies investigating the effects of exercise intervention on several common neuropsychological diseases, including depression, anxiety disorder, autism, and attention-deficit/hyperactivity disorder. Furthermore, we discuss possible physiological mechanisms underlying exercise-induced benefits and study limitations that must be addressed by future research. In many cases, drug therapy is ineffective and brings unwanted side effects. Based on the literature, we conclude that exercise intervention plays a positive role and that certain standards must be established in the field to make physical activity consistently effective.
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Affiliation(s)
- Zichao Chen
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Wencen Lan
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Guifen Yang
- College of Applied Technology, Sichuan Normal University, Chengdu, China
| | - Yan Li
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Xiang Ji
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Lan Chen
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Yan Zhou
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Shanshan Li
- Institute of Sport Science, Sichuan University, Chengdu, China
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29
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Rossettini G, Geri T, Palese A, Marzaro C, Mirandola M, Colloca L, Fiorio M, Turolla A, Manoni M, Testa M. What Physiotherapists Specialized in Orthopedic Manual Therapy Know About Nocebo-Related Effects and Contextual Factors: Findings From a National Survey. Front Psychol 2020; 11:582174. [PMID: 33192904 PMCID: PMC7606996 DOI: 10.3389/fpsyg.2020.582174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features. Design A cross-sectional online survey. Setting National. Main Outcome Measures A 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions). Participants 1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey. Results 791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient’s strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient’s anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a “medium” education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%). Conclusion OMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | - Tommaso Geri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Chiara Marzaro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mattia Mirandola
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Anesthesiology and Psychiatry, School of Medicine, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Turolla
- Department of Neurorehabilitation Technologies, San Camillo IRCCS srl, Venezia, Italy
| | - Mattia Manoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Poncela-Skupien C, Pinero-Pinto E, Martínez-Cepa C, Zuil-Escobar JC, Romero-Galisteo RP, Palomo-Carrión R. How does the Execution of the Pilates Method and Therapeutic Exercise Influence Back Pain and Postural Alignment in Children Who Play String Instruments? A Randomized Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7436. [PMID: 33066061 PMCID: PMC7650639 DOI: 10.3390/ijerph17207436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inappropriate posture in children while playing some string instruments can cause back pain and alterations of the spine. To date, there is no research on the effect of exercise on children who play a musical instrument, although it is known that transversus abdominis muscle control through the Pilates method has shown pain reduction and posture improvement in this population. OBJECTIVE To assess the effectiveness of the Pilates method combined with therapeutic exercise with respect to therapeutic exercise exclusively in reducing pain and improving postural alignment in children playing string instruments applying a protocol of low dose to increase children's adherence to training. METHODS A randomized controlled pilot study was designed with two parallel intervention groups. Twenty-five children (10-14 years old) were randomized in two intervention groups: Pilates method with therapeutic exercise (experimental) and therapeutic exercise (control) for 4 weeks (50 min per day, one day per week). Two assessments were performed (before and after treatment) to assess back pain and shoulders and hips alignment using a visual analog scale and the Kinovea program. RESULTS Statistically significant differences were obtained for pain reduction before (p = 0.04) and after (p = 0.01) playing the instrument in the experimental group. There were no significant changes in alignment improvement in any of the two groups. CONCLUSION The application of a low dose of the Pilates method combined with therapeutic exercise could be a beneficial intervention for pain reduction before and after musical practice in children who play string instruments.
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Affiliation(s)
| | - Elena Pinero-Pinto
- Department of Physical Therapy, Faculty of Nursery, Physiotherapy and Podiatry, University of Seville, 41004 Seville, Spain
| | - Carmen Martínez-Cepa
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28003 Madrid, Spain;
| | - Juan Carlos Zuil-Escobar
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28003 Madrid, Spain;
| | | | - Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
- GIFTO. Physiotherapy Research Group of Toledo, 45071 Toledo, Spain
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Holm I, Pripp AH, Risberg MA. The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up. J Clin Med 2020; 9:jcm9103112. [PMID: 32993103 PMCID: PMC7599935 DOI: 10.3390/jcm9103112] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent systematic reviews and international guidelines recommend patient education, exercises, and weight control (if overweight) as first-line treatment for patients with hip or knee osteoarthritis (OA). The Active with osteoArthritis (AktivA) program is a physiotherapy model for the implementation of these guidelines into clinical primary care practice. The purpose of the present study was to evaluate the long-term effects of and adherence to the AktivA program for patients with mild to moderate knee or hip OA. METHODS The AktivA program includes three modules: a physiotherapy certification course, a patient education and exercise program and an electronic quality register. An electronic questionnaire including questions about, pain, quality of life, physical activity, self-efficacy and satisfaction with the AktivA program are sent to the participants at inclusion and after 3, 12 and 24 months. A linear mixed model for repeated measurements was used to assess the difference between the follow-up times. RESULTS Until January 2020, 6245 patients were included in the register. The response rates were 98%, 86% and 63% at 3, 12 and 24 months, respectively. After participating in the AktivA program, the patients reported decreased pain and increased health-related and disease-specific quality of life at three months and the positive effect was maintained up to two years after inclusion. The proportion of patients reporting to be inactive or having a low physical activity level was reduced from 43% to 22%. After two years, more than 80% of the participants reported to use what they have learned from the AktivA program at least once a week. CONCLUSIONS Two years after inclusion in the AktivA physiotherapy program, the patients still report reduced pain, increased quality of life and higher activity levels.
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Affiliation(s)
- Inger Holm
- Department of Interdisciplinary Health Sciences, Oslo Norway/University of Oslo, Medical Faculty, 0318 Oslo, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, 0427 Oslo, Norway;
- Correspondence:
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0427 Oslo, Norway;
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital, 0427 Oslo, Norway;
- Department of Sports Medicine, Norwegian School of Sport Science, 0863 Oslo, Norway
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Sociodemographic Inequalities in Outcomes of a Swedish Nationwide Self-Management Program for Osteoarthritis: Results from 22,741 Patients between Years 2008-2017. J Clin Med 2020; 9:jcm9072294. [PMID: 32707725 PMCID: PMC7408785 DOI: 10.3390/jcm9072294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to investigate if there are educational level and birthplace related differences in joint-related pain, health-related quality of life (HRQoL), willingness to undergo joint surgery, walking difficulties, physical activity level, fear-avoidance behavior before, as well as three and 12 months after participation in a structured self-management program for hip and knee osteoarthritis. Differences in adherence to and use of knowledge from the program were also investigated. An observational national register-based study was performed with a prospective longitudinal design using patient and physiotherapist-reported data on 22,741 complete cases from the National Quality Register for better management of patients with osteoarthritis (BOA) during years 2008–2017. At baseline and after three and 12 months follow-up, higher educational level and being domestic-born was associated with less joint-related pain, better HRQoL, lower willingness to undergo joint surgery, fewer walking difficulties, higher physical activity level, and less fear-avoidance behavior. Foreign born individuals demonstrated higher adherence to exercise and reported better use of the self-management program. The BOA self-management program may require further pedagogical refinement to suit participants of different sociodemographic backgrounds and health literacy. A more patient-centered delivery, sensitive to educational, ethnic, and cultural differences may potentially reduce inequalities in future outcomes.
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Tsinaslanidis G, Tsinaslanidis P, Mahajan RH. Perioperative Pain Management in Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand? Cureus 2020; 12:e9049. [PMID: 32782868 PMCID: PMC7410504 DOI: 10.7759/cureus.9049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022] Open
Abstract
Total Hip replacement (THR) is a well-discussed topic, and it offers excellent results in patients suffering from end-stage osteoarthritis (OA). However, despite the fact that patients can fully bear weight immediately after the surgery, THR is often associated with a great amount of postoperative pain affecting recovery and rehabilitation. Therefore, the efficient management of pain is of paramount importance. The aim of this review is to examine all the currently available strategies of pain management such as preemptive analgesia (PA), patient-controlled analgesia (PCA), and the various types of anesthesia that are used during the operation. With that objective in mind, we conducted our research by searching through the PubMed database for articles published in 2015 and after. For purely clinical reasons, we have attempted to classify all the best available evidence into three major categories: prior to surgery, during the surgery, and after the surgery. Multimodal analgesia seems to play a major role in the perioperative care of patients undergoing total hip arthroplasty (THA). Therefore, a considerable number of studies have been conducted analyzing all the current strategies that aim to minimize perioperative pain and consequent complications.
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Affiliation(s)
- Georgios Tsinaslanidis
- Trauma and Orthopaedics, George Eliot Hospital National Health Service Trust, Nuneaton, GBR
| | - Prodromos Tsinaslanidis
- Trauma and Orthopaedics, St. George's University Hospitals National Health Service Foundation Trust, London, GBR
| | - Ravindra H Mahajan
- Trauma and Orthopaedics, George Eliot Hospital National Health Service Trust, Nuneaton, GBR
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Cronström A, Nero H, Lohmander L, Dahlberg L. On the waiting list for joint replacement for knee osteoarthritis: Are first-line treatment recommendations implemented? OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100056. [DOI: 10.1016/j.ocarto.2020.100056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
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Moseng T, Dagfinrud H, van Bodegom-Vos L, Dziedzic K, Hagen KB, Natvig B, Røtterud JH, Vlieland TV, Østerås N. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskelet Disord 2020; 21:236. [PMID: 32284049 PMCID: PMC7155273 DOI: 10.1186/s12891-020-03235-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/25/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To address the well-documented gap between hip and knee osteoarthritis (OA) treatment recommendations and current clinical practice, a structured model for integrated OA care was developed and evaluated in a stepped-wedge cluster-randomised controlled trial. The current study used secondary outcomes to evaluate clinically important response to treatment through the Outcome Measures in Rheumatology Clinical Trials clinical responder criteria (OMERACT-OARSI responder criteria) after 3 and 6 months between patients receiving the structured OA care model vs. usual care. Secondly, the study aimed to investigate if the proportion of responders in the intervention group was influenced by adherence to the exercise program inherent in the model. METHODS The study was conducted in primary healthcare in six Norwegian municipalities. General practitioners and physiotherapists received training in OA treatment recommendations and use of the structured model. The intervention group attended a physiotherapist-led OA education program and performed individually tailored exercises for 8-12 weeks. The control group received usual care. Patient-reported pain, function and global assessment of disease activity during the last week were evaluated using 11-point numeric rating scales (NRS 0-10). These scores were used to calculate the proportion of OMERACT-OARSI responders. Two-level mixed logistic regression models were fitted to investigate differences in responders between the intervention and control group. RESULTS Two hundred eighty-four intervention and 109 control group participants with hip and knee OA recruited from primary care in six Norwegian municipalities. In total 47% of the intervention and 35% of the control group participants were responders at 3 or 6 months combined; showing an uncertain between-group difference (ORadjusted 1.38 (95% CI 0.41, 4.67). In the intervention group, 184 participants completed the exercise programme (exercised ≥2 times/week for ≥8 weeks) and 55% of these were classified as responders. In contrast, 28% of the 86 non-completers were classified as responders. CONCLUSIONS The difference in proportion of OMERACT-OARSI responders at 3 and 6 months between the intervention and control group was uncertain. In the intervention group, a larger proportion of responders were seen among the exercise completers compared to the non-completers. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02333656. Registered 7. January 2015.
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Affiliation(s)
- Tuva Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Krysia Dziedzic
- School for Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
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Parker R, Madden VJ. State of the art: What have the pain sciences brought to physiotherapy? SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1390. [PMID: 32161828 PMCID: PMC7059532 DOI: 10.4102/sajp.v76i1.1390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. Objectives In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession. Method A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession. Results Scientific research on pain has largely converged in support of three ‘game-changing’ concepts that have shifted the physiotherapy profession’s understanding and treatment of pain: (1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous system itself is a viable target of treatment. These three concepts have influenced physiotherapy assessment and treatment approaches, and research design to consider pain mechanisms using patient-centred models. Conclusion The Pain Sciences have shifted physiotherapists’ assessment and treatment approaches and shifted the status of the physiotherapy profession. Ultimately the Pain Sciences have embedded interdisciplinary teams and expanded physiotherapy practice. Clinical implications We believe that the pain sciences should be embedded in undergraduate and postgraduate education and training of physiotherapists (including the three key concepts regarding pain) to benefit physiotherapists and their patients.
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Affiliation(s)
- Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Victoria J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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Gustafsson K, Kvist J, Eriksson M, Dahlberg LE, Rolfson O. Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population-a descriptive observational study. BMC Musculoskelet Disord 2020; 21:10. [PMID: 31906904 PMCID: PMC6945568 DOI: 10.1186/s12891-019-3016-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND First-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population. METHODS This is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed. RESULTS The BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with ≥10 years of education), and with knee OA (77% vs 72% with ≥10 years of education). Their average disposable income was higher (median [IQR] in Euro (€), for hip €17,442 [10,478] vs €15,998 [10,659], for knee €17,794 [10,574] vs €16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%). CONCLUSIONS The consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. .,Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marit Eriksson
- Department of Medical and Health Sciences, Linköping University and Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Iolascon G, Ruggiero C, Fiore P, Mauro GL, Moretti B, Tarantino U. Multidisciplinary integrated approach for older adults with symptomatic osteoarthritis: SIMFER and SI-GUIDA Joint Position Statement. Eur J Phys Rehabil Med 2019; 56:112-119. [PMID: 31742367 DOI: 10.23736/s1973-9087.19.05837-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multidisciplinary approach to osteoarthritis (OA) in older patients, whose functional decline is multifactorial and who present with multiple symptoms, has been long advocated, but it is still seldom implemented in daily practice. Therefore, further indications for the management of OA are eagerly awaited and should consider the specific clinical features of this population, including the presence of frailty and comorbidities. This clinical approach should be based both on well-grounded evidence and practical experience of experts in OA management. This manuscript comments the multidisciplinary integrated approach for OA management in the older population, according to the opinion of a multidisciplinary Panel of Experts. This project was developed by a Steering Committee, which consisted of three experts that were identified by the Italian Society of Physical and Rehabilitation Medicine (Società Italiana di Medicina Fisica e Riabilitativa, SIMFER) and the Italian Society for Unified and Interdisciplinary Management of Musculoskeletal Pain and Algodystrophy (Società Italiana per la Gestione Unificata e Interdisciplinare del Dolore muscolo-scheletrico e dell'Algodistrofia, SI-GUIDA). The Steering Committee identified key evidence on the management of OA in the older through systematic research in MEDLINE and EMBASE, selected the most relevant paper among those identified, and defined some questions concerning current unmet needs in the management of symptomatic OA in the older accordingly. The Panel discussed the identified evidence and questions during two meetings. The discussion was used to generate seven statements with relevance to clinical practice. In conclusion, older adults with symptomatic OA present multiple concomitant issues, including other diseases, marked pain, poly-pharmacy, and often poor psychological and/or socioeconomical status. According to the above-described evidence, it is crucial that the approach to those patients is multidisciplinary and based on the use of dedicated tools. A combination of exercise, mechanical support and properly selected analgesic treatment will greatly help the management of the OA patient, improving at the same time his/her quality of life.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Gerontology and Geriatrics Section, Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Pietro Fiore
- Physical and Rehabilitation Medicine-Unipolar Spinal Unit, Consorziale Polyclinic Hospital, Bari, Italy
| | - Giulia L Mauro
- Unit of Physiatry and Rehabilitation, Paolo Giaccone University Hospital, Palermo, Italy
| | - Biagio Moretti
- Clinic of Orthopedics and Traumathology, Policlinico University Hospital, Bari, Italy
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Jönsson T, Eek F, Dell'Isola A, Dahlberg LE, Ekvall Hansson E. The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden. PLoS One 2019; 14:e0222657. [PMID: 31536554 PMCID: PMC6752869 DOI: 10.1371/journal.pone.0222657] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023] Open
Abstract
We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish “Better Management of Patients with Osteoarthritis” registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear–avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara’s test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25–0.57 and hip OA of 0.15–0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear–avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of –0.04 to 0.43 and hip OA of –0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear–avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.
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Affiliation(s)
- Thérése Jönsson
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
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Ho CM, Thorstensson CA, Nordeman L. Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care-a randomised controlled pragmatic study. BMC Musculoskelet Disord 2019; 20:329. [PMID: 31301739 PMCID: PMC6626628 DOI: 10.1186/s12891-019-2690-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
Background In Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care. Methods An assessor-blinded randomised controlled pragmatic trial. Using a computer-generated list of random numbers, patients seeking primary care during 2013–2017 with suspected KOA were randomised to either a physiotherapist or physician for primary assessment and treatment. Data was collected before randomisation and at 3, 6, and 12-month follow-ups. Primary outcome was HrQoL using EuroQol 5 dimensions 3 levels questionnaire, index (EQ-5D-3L index) and a visual analogue scale (VAS) (EQ-5D-3L VAS); pain intensity was measured with VAS (0–100) and physical function measured with the 30-s chair stand test. Mixed effect model analyses compared repeated measures of HrQoL between groups. The significance level was p < 0.05 and data was applied with intention-to-treat. Results Patients were randomised to either a physiotherapist (n = 35) or physician (n = 34) for primary assessment. All 69 patients were included in the analyses. There were no significant differences in HrQoL for patients assessed by a physiotherapist or a physician as primary assessor (EQ-5D-3L index, p = 0.18; EQ-5D-3L VAS, p = 0.49). We found that HrQoL changed significantly 12 months after baseline assessment for all patients regardless of assessor (EQ-5D-3L index, p < 0.001; EQ-5D-3 L VAS, p = 0.0049). No adverse events or side effects were reported. Conclusions There were no differences in HrQoL, when adjusted for pain and physical function, for patients with KOA when the healthcare process was initiated with physiotherapist assessment compared to physician assessment in primary care. Both assessments resulted in significantly higher HrQoL at the 12-month follow-up. The results imply that physiotherapists and physicians in primary care are equally qualified as primary assessors. Trial registration Retrospectively registered at http://clinicaltrial.gov, ID: NCT03715764. Electronic supplementary material The online version of this article (10.1186/s12891-019-2690-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chan-Mei Ho
- Region Västra Götaland, Närhälsan Health Unit, Primary Health Care, Lidköping, Sweden. .,Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
| | - Carina A Thorstensson
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Department of Neurobiology, Care sciences and Society, Unit of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Lena Nordeman
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Borås, Sweden
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Niemitz M, Schrader M, Carlens J, Hengst M, Eismann C, Goldbeck L, Griese M, Schwerk N. Patient education for children with interstitial lung diseases and their caregivers: A pilot study. PATIENT EDUCATION AND COUNSELING 2019; 102:1131-1139. [PMID: 30709570 DOI: 10.1016/j.pec.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient education in children with rare chronic diseases like children's interstitial lung disease (chILD) remains a challenge. AIMS To develop and evaluate a component-based educational program for individual counselling and to improve patients' and caregivers' self-efficacy and treatment satisfaction. Furthermore, to create chILD-specific educational material and assess physicians' satisfaction with the intervention as well as patients' health-related quality of life (HrQoL). METHODS The study was conducted in two German centers for pediatric pulmonology, as a single-group intervention with pre-post-follow-up design. RESULTS Participants (N = 107, age: M = 7.67, SD = 5.90) showed significant improvement of self-efficacy (self-report: t = 2.89, p < 0.01; proxy-report: t = 3.03, p < 0.01), and satisfaction (patients: t = 3.56, p = 0.001; parents t = 6.38, p < 0.001) with the medical consultations. There were no pre-post differences in HrQoL. Participants were highly satisfied with the material and the physicians with the program. CONCLUSIONS The chILD education-program is a promising strategy to improve patients' and their parents' self-efficacy and treatment-satisfaction. Specific effects of the intervention need to be determined in a randomized controlled trial. PRACTICE IMPLICATION Healthcare providers managing pediatric patients with chILD, may choose to use a patient education-program specifically tailored to the needs of chILD patients and their families, such as the program described here, which is the first of its kind.
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Affiliation(s)
- Mandy Niemitz
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm Medical Centre, Ulm, Germany.
| | - Miriam Schrader
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Meike Hengst
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Claudia Eismann
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm Medical Centre, Ulm, Germany
| | - Matthias Griese
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Nicolaus Schwerk
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
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Cronström A, Dahlberg LE, Nero H, Ericson J, Hammarlund CS. 'I would never have done it if it hadn't been digital': a qualitative study on patients' experiences of a digital management programme for hip and knee osteoarthritis in Sweden. BMJ Open 2019; 9:e028388. [PMID: 31129601 PMCID: PMC6537991 DOI: 10.1136/bmjopen-2018-028388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support. SETTING This study was conducted at a regional hospital in the southern part of Sweden. METHODS Nineteen patients (10 women), median age of 66 (q1-q3, 57-71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation. RESULTS Three categories emerged during the interviews:(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care. CONCLUSIONS Digital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one's own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
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Affiliation(s)
- Anna Cronström
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Håkan Nero
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Catharina Sjödahl Hammarlund
- Department of Health Sciences, Lund University, Lund, Sweden
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord 2019; 20:159. [PMID: 30967128 PMCID: PMC6456984 DOI: 10.1186/s12891-019-2537-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps muscle strength and physical performance in individuals with knee OA. METHODS A three-arm single-blinded, randomized, controlled trial and intention-to-treat analysis was conducted in outpatient physiotherapy department, King Saud University, Saudi Arabia. Sixty-eight individuals (mean age, 55.6 years; 38 female) with knee OA participated. The participants in the retro or forward walking group completed 10 min of supervised retro or forward walking training in addition to usual care, 3 days/week for 6 weeks. The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score of quadriceps muscle strength and timed up and go test scores. All the outcomes were analyzed at baseline and week 6. RESULTS In total, 68 subjects participated in this 6-week randomized, controlled trial. The completion rates of the primary and secondary outcome measures at week 6 were 91, 87, and 82% in the retro walking, forward walking, and control groups, respectively. In the intention-to-treat analysis, the retro walking group had a greater reduction in pain intensity (mean changes, 1.8 versus 1; p = 0.01) and functional disability (mean changes, 4.8 versus 2.2; p = 0.008) than the control group. Similarly, the retro walking group had a greater improvement in the quadriceps muscle strength (mean changes, 1.7 kg versus 0.7 kg; p = 0.008) and the timed up and go test (mean changes, 0.6 s versus 0.1 s; p = 0.003) than the control group. CONCLUSIONS The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA. TRIAL REGISTRATION Controlled Trials ISRCTN12850845 , Registered 26 January 2015.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O. Box-10219, Riyadh, 11433, Saudi Arabia. .,Deparment of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China.
| | - Bibhuti Sarkar
- National Institute for the Locomotor Disabilities (Divyangjan), Kolkata, India
| | - Ashis K Paul
- Anand Vihar Hospital, Mahanadi Coalfields Limited, Sambalpur, Odisha, India
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Nero H, Ranstam J, Kiadaliri AA, Dahlberg LE. Evaluation of a digital platform for osteoarthritis treatment: study protocol for a randomised clinical study. BMJ Open 2018; 8:e022925. [PMID: 30413507 PMCID: PMC6231565 DOI: 10.1136/bmjopen-2018-022925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Despite favourable results from structured face-to-face treatment of osteoarthritis (OA) in Sweden through the Better management of patients with OsteoArthritis (BOA) initiative, only around 20% of people with knee or hip OA receive the primary treatment recommended by international guidelines (ie, information, exercise, weight management). In 2014, a digital treatment programme named Joint Academy was introduced in Sweden, based on the same concept as the face-to-face BOA programme. In line with BOA, Joint Academy follows national and international guidelines and best practice for OA treatment. Results from observational studies suggest that this digital treatment is a valuable alternative to the traditional treatment approach and can positively impact patients' function and pain. However, conclusions from such studies commonly suggest that more rigorous testing is necessary to ascertain the benefits of digital treatment delivery for people with OA. METHODS AND ANALYSIS A randomised clinical trial will be performed, comparing regular face-to-face care according to BOA with the digital version, Joint Academy. A total of 270 participants with clinically diagnosed knee OA will be recruited at primary care centres and randomised to either standard treatment (BOA) for 3 months, or the experimental group (digital intervention programme). Both groups will receive educational sessions and exercises yet with a difference in programme deliverance. The objective of the trial is to evaluate the effectiveness of the online treatment programme, in comparison with BOA. The two treatment groups will be compared with respect to the number of repetitions of the 30 s chair stand test at 3, 6 and 12 months, using a mixed model repeated measures analysis of variance. ETHICS AND DISSEMINATION Ethical approval has been attained from the Regional Board of Ethics in Lund, Sweden (Dnr 2017/719). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03328741.
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Affiliation(s)
- Håkan Nero
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Joint Academy, Malmö, Sweden
| | - Jonas Ranstam
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Leif E Dahlberg
- Joint Academy, Malmö, Sweden
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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