1
|
Kjeldsen T, Skou ST, Dalgas U, Tønning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, Mechlenburg I. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial. Ann Intern Med 2024; 177:573-582. [PMID: 38588540 DOI: 10.7326/m23-3225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). However, randomized controlled trials providing evidence for the optimal exercise type are lacking. OBJECTIVE To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance in patients with hip OA. DESIGN Multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT04714047). SETTING Hospitals and physiotherapy clinics. PARTICIPANTS 160 participants with clinically diagnosed hip OA were enrolled from 18 January 2021 to 28 April 2023 and randomly assigned to PRT (n = 82) or NEMEX (n = 78). INTERVENTION Twelve weeks of PRT or NEMEX with 2 supervised 60-minute group sessions each week. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability. MEASUREMENTS The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS). RESULTS The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, -0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX (difference, -0.7 [CI, -5.3 to 4.0] points). For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX (difference, 2.3 [CI, -3.0 to 7.6] points). LIMITATION Participants and physiotherapists were not blinded. CONCLUSION In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL. PRIMARY FUNDING SOURCE Independent Research Fund Denmark.
Collapse
Affiliation(s)
- Troels Kjeldsen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; and Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark (T.K.)
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark, and Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (S.T.S.)
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark (U.D.)
| | - Lisa U Tønning
- Department of Orthopedic Surgery, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (L.U.T.)
| | - Kim G Ingwersen
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, and Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark (K.G.I.)
| | - Sara Birch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Physiotherapy and Occupational Therapy, Gødstrup Regional Hospital, Herning, Denmark; and Department of Orthopedic Surgery, Gødstrup Regional Hospital, Herning, Denmark (S.B.)
| | - Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; and Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands (P.M.H.)
| | - Thomas Frydendal
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Odense, Denmark; and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (T.F.)
| | - Mette Garval
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark (M.G.)
| | - Claus Varnum
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark, and Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Odense, Denmark (C.V.)
| | - Bo M Bibby
- Department of Biostatistics, Institute of Public Health, Aarhus University, Aarhus, Denmark (B.M.B.)
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; and Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark (I.M.)
| |
Collapse
|
2
|
Foldager F, Jørgensen PB, Tønning LU, Petersen ET, Jakobsen SS, Vainorius D, Homilius M, Hansen TB, Stilling M, Mechlenburg I. The relationship between muscle power, functional performance, accelerometer-based measurement of physical activity and patient-reported outcomes in patients with hip osteoarthritis: A cross-sectional study. Musculoskelet Sci Pract 2022; 62:102678. [PMID: 36335851 DOI: 10.1016/j.msksp.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with unilateral hip osteoarthritis appear to have between-leg differences in leg extension power (LEP). The Nottingham Leg Extensor Power Rig provides reliable and valid results but requires sensitive equipment. It would be relevant to identify measures closely associated with this test. OBJECTIVE (i) To investigate if LEP is lower in the affected leg compared to the non-affected leg. Furthermore, to investigate the associations between LEP and the measures: (ii) Functional performance, (iii) accelerometer-based measurement of physical activity and (iv) patient-reported outcome measures (PROM). DESIGN Cross-sectional study including 60 patients (30 men, 30 women) with hip osteoarthritis scheduled for hip replacement. METHOD The counter movement jump and 10-m sprint tests were used to determine functional performance, accelerometer-sensors were used to determine physical activity and the Copenhagen Hip and Groin Outcome Score (HAGOS) was used to determine PROM. RESULTS (i) LEP in the affected leg corresponded to 79% [95% CI 74%; 85%] of the non-affected leg, (ii) LEP was positively associated with functional performance tests (β 0.63 to 0.78, p < 0.05), (iii) positively associated although non-significantly with physical activity (β 0.16 to 0.23, p > 0.05) and (iv) positively associated with the six HAGOS subscales (β 0.25 to 0.54, p < 0.05). CONCLUSION Functional performance tests may be used as feasible, inexpensive and fast ways to assess LEP in clinical settings. These results may suggest that interventions aimed at improving LEP can improve functional performance and PROM, but not physical activity. Future research is needed to confirm the causality of these cross-sectional findings. THE CLINICAL TRIAL REGISTRATION NUMBERS Danish Data Protection Agency (1-16-02-640-14), ClinicalTrials.gov (NTC02301182) and approved by the Danish Biomedical Research Ethics Committee (1-10-72- 343-14) prior to data collection.
Collapse
Affiliation(s)
- Frederik Foldager
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark.
| | - Peter Bo Jørgensen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Lisa Urup Tønning
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Emil Toft Petersen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark
| | - Dovydas Vainorius
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Morten Homilius
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Regional Hospital, Hospitalsparken 15, 7400, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 828200, Aarhus N, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| |
Collapse
|
3
|
The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip. J Clin Med 2021; 11:jcm11010017. [PMID: 35011758 PMCID: PMC8745579 DOI: 10.3390/jcm11010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.
Collapse
|
4
|
James KA, von Heideken J, Iversen MD. Reporting of Adverse Events in Randomized Controlled Trials of Therapeutic Exercise for Hip Osteoarthritis: A Systematic Review. Phys Ther 2021; 101:pzab195. [PMID: 34730830 PMCID: PMC8565302 DOI: 10.1093/ptj/pzab195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study was to describe adverse events (AEs) and dropouts (DOs) in randomized controlled trials of therapeutic exercise for hip osteoarthritis (HOA) and to identify whether Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed. METHODS The Cochrane Library, Embase, PubMed, and CINAHL databases were searched. Randomized controlled trials of therapeutic exercise for HOA published in English from January 1, 1980 to August 1, 2020 were included. Studies were excluded if other interventions were provided, if participants had previous hip arthroplasty, or if AEs and DOs for HOA participants were not reported separately. The internal validity of each study (Physiotherapy Evidence Database [PEDro] scoring) was assessed, participant and intervention characteristics were extracted, and the existence of a clear statement and reasons for AEs and DOs was reported. Descriptive statistics characterized results. Data heterogeneity prohibited the use of meta-analysis. RESULTS Fourteen studies (mean PEDro score = 7.4; range = 6-10) from 10 countries were included, with 707 participants exercising. Exercise intensity was unspecified in 72.2% of exercise arms. Six studies (42.9%) included a statement of AEs, and 32 AEs were reported. All studies had a DO statement, but 29.0% of DOs occurred for unknown reasons. Six studies (42.9%) gave reasons for DOs that could be classified as AEs in 9 participants; 41 participants (5.8%) experienced exercise-related AEs. CONCLUSION Reports of AEs were inconsistent, some DOs were potentially misclassified, and primary components of exercise interventions were frequently unreported. Despite these limitations, the overall low number of nonserious AEs suggests that the exercise-related risk of harm is minimal for individuals with HOA. IMPACT Understanding the risk of harm associated with exercise for HOA can better inform safe dosing of exercise, clinical implementation, and replicability. Informative, consistent reporting of AEs, DOs, and exercise is needed. Greater use of the CONSORT harms-reporting checklist is warranted.
Collapse
Affiliation(s)
- Khara A James
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Intitutet, Stockholm, Sweden
| | - Maura D Iversen
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Women’s and Children’s Health, Karolinska Intitutet, Stockholm, Sweden
- Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Brigham & Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- College of Health Professions, Sacred Heart University, Fairfield, Connecticut, USA
| |
Collapse
|