1
|
Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
Collapse
Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
2
|
Bobos P, MacDermid J, Ziebart C, Boutsikari E, Lalone E, Ferreira L, Grewal R. Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: a cross-sectional survey. BMJ Open 2021; 11:e041935. [PMID: 33483445 PMCID: PMC7831706 DOI: 10.1136/bmjopen-2020-041935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this survey was to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection (JP) programmes in people with hand arthritis. DESIGN Cross-sectional survey. SETTING Tertiary clinic. PARTICIPANTS Patients with hand arthritis: osteoarthritis, rheumatoid arthritis, psoriatic arthritis and other forms of arthritis. PRIMARY AND SECONDARY OUTCOME MEASURES This study used a survey among people with hand arthritis. Descriptive statistics and percentages were reported for all the data about the barriers, facilitators and preferences around JP. RESULTS A total of 192 patients consented to participate. Most of the patients (82%) were unaware of JP. Factors that may act as barriers to participation and were regarded as 'a very big concern' were: cost of the programme (44%), time of offering the programme (39%), work commitments (36%) and having a centre/clinic close to the house (28%). Factors that may act as facilitators and rated as 'extremely helpful' were: research that shows that JP works (26%) and having the centre/clinic close to the house (25%). An online format for JP was the most preferred option (54%). Half (46%) preferred a timeframe of 1 hour, three times per week and 44% preferred a 2-hour programme, for three times per week. CONCLUSIONS Awareness of the potential benefits of JP, and prior experience with JP programme were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: cost, work commitments, distance from home to clinic and times that the intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP programmes.
Collapse
Affiliation(s)
- Pavlos Bobos
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Christina Ziebart
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Eleni Boutsikari
- Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Emily Lalone
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Louis Ferreira
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| |
Collapse
|
3
|
Bobos P, MacDermid JC, Nazari G, Lalone EA, Ferreira L, Grewal R. Joint Protection Programmes for People with Osteoarthritis and Rheumatoid Arthritis of the Hand: An Overview of Systematic Reviews. Physiother Can 2021; 73:56-65. [PMID: 35110824 PMCID: PMC8774950 DOI: 10.3138/ptc-2019-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Purpose: Joint protection has been introduced as a self-management strategy for people with rheumatoid arthritis (RA) and osteoarthritis (OA) of the hand. The purpose of this study was to conduct an overview of systematic reviews (SRs) and critically appraise the evidence to establish the current effectiveness of joint protection for people with hand RA and OA. Method: A comprehensive search was conducted of six databases from January 2008 to May 2018. SRs that evaluated the effectiveness of joint protection for people with hand arthritis were eligible for inclusion. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 checklist was used to assess the methodological quality of each SR. Results: Nine SRs were included: two were rated as high quality, and seven were rated as low quality. Seven of the nine did not take into account risk of bias when interpreting or discussing their findings, six did not assess publication bias, and five did not register their protocol. The high-quality reviews found no clinically important benefit of joint protection for pain, hand function, and grip strength levels. The low-quality reviews reported improvements in function, pain, grip strength, fatigue, depression, self-efficacy, joint protection behaviours, and disease symptoms in people with RA. Conclusions: High-quality evidence from high-quality reviews found a lack of any clinically important benefit of joint protection programmes for pain, hand function, and grip strength outcomes, whereas low-quality evidence from low-quality reviews found improvements in these outcomes.
Collapse
Affiliation(s)
- Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Western’s Bone and Joint Institute
- Department of Clinical Epidemiology and Health Care Research, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Joy C. MacDermid
- School of Physical Therapy
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care, London
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
| | - Goris Nazari
- Department of Health and Rehabilitation Sciences, Western’s Bone and Joint Institute
| | - Emily A. Lalone
- Faculty of Engineering, Department of Mechanical and Materials Engineering, Western University
| | - Louis Ferreira
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care, London
| | - Ruby Grewal
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care, London
| |
Collapse
|