1
|
Wilfong JM, Badley EM, Perruccio AV. Old Before Their Time? The Impact of Osteoarthritis on Younger Adults. Arthritis Care Res (Hoboken) 2024; 76:1400-1408. [PMID: 38751094 DOI: 10.1002/acr.25374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults. METHODS Descriptive analysis of the Survey on Living with Chronic Diseases in Canada - Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749). RESULTS In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group. CONCLUSION OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.
Collapse
Affiliation(s)
- Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Castagno S, Birch M, van der Schaar M, McCaskie A. Predicting rapid progression in knee osteoarthritis: a novel and interpretable automated machine learning approach, with specific focus on young patients and early disease. Ann Rheum Dis 2024:ard-2024-225872. [PMID: 39237133 DOI: 10.1136/ard-2024-225872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES To facilitate the stratification of patients with osteoarthritis (OA) for new treatment development and clinical trial recruitment, we created an automated machine learning (autoML) tool predicting the rapid progression of knee OA over a 2-year period. METHODS We developed autoML models integrating clinical, biochemical, X-ray and MRI data. Using two data sets within the OA Initiative-the Foundation for the National Institutes of Health OA Biomarker Consortium for training and hold-out validation, and the Pivotal Osteoarthritis Initiative MRI Analyses study for external validation-we employed two distinct definitions of clinical outcomes: Multiclass (categorising OA progression into pain and/or radiographic) and binary. Key predictors of progression were identified through advanced interpretability techniques, and subgroup analyses were conducted by age, sex and ethnicity with a focus on early-stage disease. RESULTS Although the most reliable models incorporated all available features, simpler models including only clinical variables achieved robust external validation performance, with area under the precision-recall curve (AUC-PRC) 0.727 (95% CI: 0.726 to 0.728) for multiclass predictions; and AUC-PRC 0.764 (95% CI: 0.762 to 0.766) for binary predictions. Multiclass models performed best in patients with early-stage OA (AUC-PRC 0.724-0.806) whereas binary models were more reliable in patients younger than 60 (AUC-PRC 0.617-0.693). Patient-reported outcomes and MRI features emerged as key predictors of progression, though subgroup differences were noted. Finally, we developed web-based applications to visualise our personalised predictions. CONCLUSIONS Our novel tool's transparency and reliability in predicting rapid knee OA progression distinguish it from conventional 'black-box' methods and are more likely to facilitate its acceptance by clinicians and patients, enabling effective implementation in clinical practice.
Collapse
Affiliation(s)
- Simone Castagno
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Birch
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mihaela van der Schaar
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Andrew McCaskie
- Department of Surgery, University of Cambridge, Cambridge, UK
| |
Collapse
|
3
|
Widhalm K, Maul L, Durstberger S, Putz P, Leder-Berg S, Kainz H, Augat P. Efficacy of Real-Time Feedback Exercise Therapy in Patients Following Total Hip Arthroplasty: Protocol for a Pilot Cluster-Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e59755. [PMID: 39163589 PMCID: PMC11372329 DOI: 10.2196/59755] [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: 04/22/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Osteoarthritis of the hip joint is an increasing functional and health-related problem. The most common surgical treatment is hip replacement to reduce pain and improve function. Rehabilitation after total hip arthroplasty (THA) is not regulated in Austria and mostly depends on the patient's own initiative and possibilities. Functional deficits, such as valgus thrust of the leg, functional Trendelenburg gait, or Duchenne limp, are characteristic symptoms before and, due to the performance learning effect prior to surgery, also after the operation. Addressing these deficits is possible through neuromuscular-focused exercise therapy. The efficacy of such therapy relies significantly on the quality of performance, the frequency of exercise, and the duration of engagement. Enhancing sustainability is achievable through increased motivation and real-time feedback (RTF) on exercise execution facilitated by digital feedback systems. OBJECTIVE This study will be performed to quantify the medium-term effectiveness of digital home exercise feedback systems on functional performance following THA. METHODS A clinical trial with a cluster-randomized, 2-arm, parallel-group design with an 8-week intervention phase and subsequent follow-ups at 3 and 6 months postsurgery will be conducted. Feedback during exercising will be provided through a blended-care program, combining a supervised group exercise program with a self-developed digital feedback system for home exercise. In total, 70 patients will be recruited for baseline. The primary outcome parameters will be the frontal knee range of motion, pelvic obliquity, and lateral trunk lean. Secondary outcomes will be the sum scores of patient-reported outcomes and relevant kinematic, kinetic, and spatiotemporal parameters. RESULTS The trial started in January 2024, and the first results are anticipated to be published by June 2025. RTF-supported home exercise is expected to improve exercise execution quality and therapeutic adherence compared to using paper instructions for excise guidance. CONCLUSIONS The anticipated findings of this study aim to offer new insights into the effect of a blended-care program incorporating digital RTF on exercise therapy after unilateral THA, in addition to knowledge on the functional status 3 and 6 months postsurgery, for further improvement in the development of rehabilitation guidelines following THA. TRIAL REGISTRATION ClinicalTrials.gov: NCT06161194; https://clinicaltrials.gov/study/NCT06161194. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/59755.
Collapse
Affiliation(s)
- Klaus Widhalm
- Department of Health Sciences, FH Campus Wien University of Applied Sciences, Vienna, Austria
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Maul
- Department of Health Sciences, FH Campus Wien University of Applied Sciences, Vienna, Austria
| | - Sebastian Durstberger
- Department of Health Sciences, FH Campus Wien University of Applied Sciences, Vienna, Austria
| | - Peter Putz
- Department of Health Sciences, FH Campus Wien University of Applied Sciences, Vienna, Austria
| | | | - Hans Kainz
- Department of Biomechanics, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Peter Augat
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| |
Collapse
|
4
|
Weng Q, Chen Q, Jiang T, Zhang Y, Zhang W, Doherty M, Xie J, Liu K, Li J, Yang T, Wei J, Lei G, Zeng C. Global burden of early-onset osteoarthritis, 1990-2019: results from the Global Burden of Disease Study 2019. Ann Rheum Dis 2024; 83:915-925. [PMID: 38429104 DOI: 10.1136/ard-2023-225324] [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: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Early-onset osteoarthritis (OA) is an emerging health issue amidst the escalating prevalence of overweight and obesity. However, there are scant data on its disease, economic burden and attributable burden due to high body mass index (BMI). METHODS Using data from the Global Burden of Diseases Study 2019, we examined the numbers of incident cases, prevalent cases, years lived with disability (YLDs) and corresponding age-standardised rates for early-onset OA (diagnosis before age 55) from 1990 to 2019. The case definition was symptomatic and radiographically confirmed OA in any joint. The average annual percentage changes (AAPCs) of the age-standardised rates were calculated to quantify changes. We estimated the economic burden of early-onset OA and attributable burden to high BMI. RESULTS From 1990 to 2019, the global incident cases, prevalent cases and YLDs of early-onset OA were doubled. 52.31% of incident OA cases in 2019 were under 55 years. The age-standardised rates of incidence, prevalence and YLDs increased globally and for countries in all Sociodemographic Index (SDI) quintiles (all AAPCs>0, p<0.05), with the fastest increases in low-middle SDI countries. 98.04% of countries exhibited increasing trends in all age-standardised rates. Early-onset OA accounts for US$46.17 billion in healthcare expenditure and US$60.70 billion in productivity loss cost in 2019. The attributable proportion of high BMI for early-onset OA increased globally from 9.41% (1990) to 15.29% (2019). CONCLUSIONS Early-onset OA is a developing global health problem, causing substantial economic costs in most countries. Targeted implementation of cost-effective policies and preventive intervention is required to address the growing health challenge.
Collapse
Affiliation(s)
- Qianlin Weng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qiu Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Junqing Xie
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ke Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Yang
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Mocanu V, Timofte DV, Zară-Dănceanu CM, Labusca L. Obesity, Metabolic Syndrome, and Osteoarthritis Require Integrative Understanding and Management. Biomedicines 2024; 12:1262. [PMID: 38927469 PMCID: PMC11201254 DOI: 10.3390/biomedicines12061262] [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: 05/11/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Osteoarthritis (OA) is a progressive chronic disease affecting the articular joints, leading to pain and disability. Unlike traditional views that primarily link OA to aging, recent understanding portrays it as a multifactorial degenerative disease of the entire joint. Emerging research highlights metabolic and immune dysregulation in OA pathogenesis, emphasizing the roles of obesity, dyslipidemia, and insulin resistance in altering joint homeostasis. Recent studies have increasingly focused on the complex role of white adipose tissue (WAT) in OA. WAT not only serves metabolic functions but also plays a critical role in systemic inflammation through the release of various adipokines. These adipokines, including leptin and adiponectin, have been implicated in exacerbating cartilage erosion and promoting inflammatory pathways within joint tissues. The overlapping global crises of obesity and metabolic syndrome have significantly impacted joint health. Obesity, now understood to contribute to mechanical joint overload and metabolic dysregulation, heightens the risk of developing OA, particularly in the knee. Metabolic syndrome compounds these risks by inducing chronic inflammation and altering macrophage activity within the joints. The multifaceted effects of obesity and metabolic syndrome extend beyond simple joint loading. These conditions disrupt normal joint function by modifying tissue composition, promoting inflammatory macrophage polarization, and impairing chondrocyte metabolism. These changes contribute to OA progression, highlighting the need for targeted therapeutic strategies that address both the mechanical and biochemical aspects of the disease. Recent advances in understanding the molecular pathways involved in OA suggest potential therapeutic targets. Interventions that modulate macrophage polarization, improve chondrocyte function, or normalize adipokine levels could serve as preventative or disease-modifying therapies. Exploring the role of diet, exercise, and pharmacological interventions in modulating these pathways offers promising avenues for reducing the burden of OA. Furthermore, such methods could prove cost-effective, avoiding the increase in access to healthcare.
Collapse
Affiliation(s)
- Veronica Mocanu
- Center for Obesity BioBehavioral Experimental Research, Department of Morpho-Functional Sciences II (Pathophysiology), “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Daniel Vasile Timofte
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Camelia-Mihaela Zară-Dănceanu
- National Institute of Research and Development in Technical Physics Iasi, 700050 Iasi, Romania; (C.-M.Z.-D.); (L.L.)
| | - Luminita Labusca
- National Institute of Research and Development in Technical Physics Iasi, 700050 Iasi, Romania; (C.-M.Z.-D.); (L.L.)
- Department of Orthopedics, “Sf. Spiridon” Emergency Clinical Hospital, 700111 Iasi, Romania
| |
Collapse
|
6
|
Wang P, Duan F, Lv Y, Man S, Liu S, Liu Y. Long- and Intermediate-Term Ambient Particulate Pollution Is Associated with Increased Osteoarthritis Risk: A Population-Based Prospective Analysis. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:9536-9547. [PMID: 38771144 DOI: 10.1021/acs.est.3c10893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Recent studies found the intrusion and retention of exogenous fine particles into joints, but epidemiological data for long- and intermediate-term exposure associations are scare. Here, all urban working, retired employee, and rural residents (16.78 million) in Beijing from January 1, 2011 to December 31, 2019 were included to investigate the effects of long- and intermediate-term ambient particulate exposure on development of osteoarthritis. We identified 1,742,067 participants as first-visit patients with osteoarthritis. For each interquartile range increase in annual PM2.5 (23.32 μg/m3) and PM10 (23.92 μg/m3) exposure concentration, the pooled hazard ratios were respectively 1.238 (95% CI: 1.228, 1.249) and 1.178 (95% CI: 1.168, 1.189) for first osteoarthritis outpatient visits. Moreover, age at first osteoarthritis outpatient visits significantly decreased by 4.52 (95% CI: 3.45 to 5.40) days per μg/m3 for annual PM2.5 exposure at below 67.85 μg/m3. Finally, among the six constituents analyzed, black carbon appears to be the most important component associated with the association between PM2.5 exposure and the three osteoarthritis-related outcomes.
Collapse
Affiliation(s)
- Pingping Wang
- Department of Human Microbiome, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, China
| | - Fangfang Duan
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Yanwei Lv
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Siliang Man
- Department of Rheumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Yajun Liu
- Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing 100035, China
| |
Collapse
|
7
|
Boonsri P, Laohawiriyakamol T, Tanutit P. Editorial for "Comparing the Effect of Mechanical Loading on Deep and Superficial Cartilage Using Quantitative UTE MRI". J Magn Reson Imaging 2024; 59:2058-2059. [PMID: 37638760 DOI: 10.1002/jmri.28978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Pattira Boonsri
- Radiology department, Prince of Songkla University, Hat Yai, Thailand
| | | | - Pramot Tanutit
- Radiology department, Prince of Songkla University, Hat Yai, Thailand
| |
Collapse
|
8
|
Neculăeș M, Hernandez-Lucas P, Lucaci P. Implications of Stabilometric Assessment in Determining Functional Deficits in Patients with Severe Knee Osteoarthritis: Observational Study. J Clin Med 2024; 13:3181. [PMID: 38892890 PMCID: PMC11172977 DOI: 10.3390/jcm13113181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Osteoarthritis is one of the most frequent joint disorders in the world. The specialists in the field strongly support the role of physical exercise as a key component in the holistic management of arthrosis. The aim of the current study was to identify and assess the functional deficit of these patients and to identify means to alleviate it through pre-surgery physiotherapy programs. Methods: The study was conducted on two samples of patients: a witness sample, encompassing 126 subjects without pathologies at the level of their lower limbs, and a study sample, formed of 116 subjects diagnosed with severe gonarthrosis with total knee arthroplasty indication. The assessment protocol was accomplished with the GPS 400 stabilometric platform. Results: The barycenter differences within the support polygon, recorded for the two samples within sagittal deviation, emphasize that the barycenter shifting mainly towards the healthy lower limb will demand, from the individual, more intense rebalancing postural reactions that will place the center-of-gravity projection in the sagittal plane, closer to the central area of the support polygon. Conclusions: In the case of gonarthrosis and other joint disorders, the use of functional testing to assess body weight distribution and center-of-gravity imbalances represents a promising direction in the research on and management of these disorders, providing essential information for functional diagnosing and thus enabling the elaboration and monitoring of individualized functional rehabilitation plans.
Collapse
Affiliation(s)
- Marius Neculăeș
- Faculty of Physical Education and Sport, “Alexandru Ioan Cuza” University of Iași, 3 Toma Cozma Street, 700554 Iasi, Romania; (M.N.); (P.L.)
| | - Pablo Hernandez-Lucas
- Faculty of Physiotherapy, University of Vigo, Campus A Xunqueira, 36005 Pontevedra, Spain
| | - Paul Lucaci
- Faculty of Physical Education and Sport, “Alexandru Ioan Cuza” University of Iași, 3 Toma Cozma Street, 700554 Iasi, Romania; (M.N.); (P.L.)
| |
Collapse
|
9
|
Bell E, Mosler A, Barton C, Jones D, Heerey J, Johnston R, Coburn S, Kemp J. What are participant beliefs regarding physical therapy led treatment? A qualitative study of people living with femoroacetabular impingement syndrome. Braz J Phys Ther 2024; 28:101077. [PMID: 38838417 PMCID: PMC11215951 DOI: 10.1016/j.bjpt.2024.101077] [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: 07/12/2023] [Revised: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Physical therapist-led treatment programs are recommended for patients with femoroacetabular impingement (FAI) syndrome. Views of people with FAI syndrome regarding such interventions are currently unknown, including perceptions of potential barriers and facilitators to participation and adherence to exercise programs. OBJECTIVES To explore participant perceptions of physical therapist-led programs for FAI syndrome, including barriers and facilitators for accessing physical therapy, and adhering to a rehabilitation program. METHODS Our qualitative study used semi-structured interviews to explore the perceptions of patients with FAI syndrome undertaking physical therapy-led treatment, where treatment was ceased due to Coronavirus Disease 2019 (COVID-19). The interview topic guide was informed by the Theoretical Domain Framework. Interviews were transcribed verbatim and data categories were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was reached. RESULTS Fourteen participants (mean age: 30 years) with a range of physical activity backgrounds undertook interviews. We identified four key themes, 1) Patients believed their hip pain was caused by structural damage worsened through exercise; 2) Barriers and facilitators on the feasibility of physical therapist-led programs; 3) Participants held beliefs regarding the importance of adjunct treatments to exercise; and 4) Impact of FAI syndrome on physical activity participation. CONCLUSION People with FAI syndrome believe they have structural damage which leads to their hip pain and are often afraid to exercise due to fear of causing more damage to their hip. Our findings suggest that people with FAI syndrome want clear education about exercise, imaging, and expectations of cost and duration of treatment.
Collapse
Affiliation(s)
- Emily Bell
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea Mosler
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Christian Barton
- La Trobe Sport and Exercise Medicine Research Centre and Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Denise Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia
| | - Joshua Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Richard Johnston
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sally Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| |
Collapse
|
10
|
Huang Y, Li W, Shi X, Wang W, Xu C, Adams RD, Lyu J, Han J, He Y. Knee osteoarthritis patients assessed during walking for ankle inversion movement discrimination sensitivity. Front Bioeng Biotechnol 2024; 12:1372679. [PMID: 38699433 PMCID: PMC11063258 DOI: 10.3389/fbioe.2024.1372679] [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: 01/18/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background: Knee osteoarthritis (KOA) is a common musculoskeletal condition that affects dynamic balance control and increases the risk of falling during walking. However, the mechanisms underlying this are still unclear. Diminished ankle proprioception during walking has been found to be related to fear of falling in older adults, with a gender difference in incidence of falling. This study aimed to determine 1) whether ankle inversion proprioceptive acuity during walking is impaired in patients with KOA; and 2) whether there is any difference between genders. Methods: Thirty-two patients with KOA (F:M = 17:15, Median age = 52.5, BMI = 22.3 ± 3.0) and 34 healthy controls without KOA (HC) (F:M = 17:17; median age = 49.0, BMI = 22.5 ± 2.7) were recruited. In patients with KOA, ankle inversion proprioceptive acuity was measured on the affected side using the ankle inversion discrimination apparatus for walking (AIDAW), whilst HC were assessed on a randomly selected side. Two-way (2*2) analysis of variance (ANOVA) was performed to determine the main effects and interaction between gender and KOA condition. Results: Two-way ANOVA showed a significant KOA main effect (F = 26.6, p < 0.001, ƞp 2 = 0.3) whereby AIDAW scores during walking for individuals with KOA were significantly lower than those without KOA (KOA vs. HC: 0.746 ± 0.057 vs. 0.807 ± 0.035). There was neither a gender main effect nor interaction (both p > 0.05). Conclusion: Individuals with KOA demonstrated lower ankle proprioception scores during walking compared to their healthy counterparts, with a similar level of impairment in ankle proprioceptive acuity between male and female patients. A low score may contribute to an increased risk of falling in the KOA population. The current findings suggest the need for global concern about lower limb proprioception in the clinical management of KOA.
Collapse
Affiliation(s)
- Yanfeng Huang
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Wanjuan Li
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiaojian Shi
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Wenchao Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chengshuo Xu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Roger David Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jie Lyu
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jia Han
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Yaohua He
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Guo G, Wang Y, Xu X, Lu K, Zhu X, Gu Y, Yang G, Yao F, Fang M. Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol. BMJ Open 2024; 14:e074508. [PMID: 38453194 PMCID: PMC10921529 DOI: 10.1136/bmjopen-2023-074508] [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: 04/11/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA. METHODS AND ANALYSIS This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment. ETHICS AND DISSEMINATION This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78). TRIAL REGISTRATION NUMBER ChiCTR2200065178.
Collapse
Affiliation(s)
- Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yihang Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiruo Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaiqiu Lu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuanying Zhu
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yijia Gu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangpu Yang
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
12
|
Fan I, Govil D, King MG, Scholes MJ, Semciw AI. How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2024; 32:254-265. [PMID: 38030118 DOI: 10.1016/j.joca.2023.11.011] [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: 06/19/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). METHODS Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference -0.35, 95% confidence interval -0.59 to -0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. DISCUSSION The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups.
Collapse
Affiliation(s)
- Iryoung Fan
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Dhruv Govil
- Bass Coast Health, Wonthaggi, Victoria, Australia.
| | - Matthew G King
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Mark J Scholes
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Adam I Semciw
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| |
Collapse
|
13
|
Diamond LE, Grant T, Uhlrich SD. Osteoarthritis year in review 2023: Biomechanics. Osteoarthritis Cartilage 2024; 32:138-147. [PMID: 38043858 DOI: 10.1016/j.joca.2023.11.015] [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: 09/11/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Biomechanics plays a significant yet complex role in osteoarthritis (OA) onset and progression. Identifying alterations in biomechanical factors and their complex interactions is critical for gaining new insights into OA pathophysiology and identification of clearly defined and modifiable mechanical treatment targets. This review synthesized biomechanics studies from March 2022 to April 2023, from which three themes relating to human gait emerged: (1) new insights into the pathogenesis of OA using computational modeling and machine learning, (2) technology-enhanced biomechanical interventions for OA, and (3) out-of-lab biomechanical assessments of OA. We further highlighted future-focused areas which may continue to advance the field of biomechanics in OA, with a particular emphasis on exploiting technology to understand and treat biomechanical mechanisms of OA outside the laboratory. The breadth of studies included in this review highlights the complex role of biomechanics in OA and showcase numerous innovative and outstanding contributions to the field. Exciting cross-disciplinary efforts integrating computational modeling, mobile sensors, and machine learning methods show great promise for streamlining in vivo multi-scale biomechanics workflows and are expected to underpin future breakthroughs in the understanding and treatment of biomechanics in OA.
Collapse
Affiliation(s)
- Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Tamara Grant
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Scott D Uhlrich
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| |
Collapse
|
14
|
Niu H, Deng X, Zhang Q, Zhao Y, Wen J, Li W, Liu H, Guo X, Wu C. Identification and Verification of Hub Mitochondrial Dysfunction Genes in Osteoarthritis Based on Bioinformatics Analysis. J Immunol Res 2024; 2024:6822664. [PMID: 38292759 PMCID: PMC10827375 DOI: 10.1155/2024/6822664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024] Open
Abstract
Objective Age-related mitochondrial dysfunction and associated oxidative stress may contribute to the development of osteoarthritis. The aim of this study was to identify hub genes associated with mitochondrial dysfunction in osteoarthritis (OA) patients, helping predict the risk of OA, and revealing the mechanism of OA progression. Methods OA expression data and mitochondrial dysfunction genes were downloaded from GEO (GSE55235, GSE82107, and GSE114007) and GeneCard databases. The differentially expressed mitochondrial dysfunction genes (DEMDFGs) between OA and control samples were screened. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes pathways were analyzed for DEMDFGs. The hub genes were determined by WGCNA and LASSO regression analysis. ROC curves manifested the diagnostic efficacy of each hub gene. A nomogram model was constructed and validated to predict OA risk. The expression of hub genes in OA and normal chondrocytes was verified by external datasets, qRT-PCR and western blotting. Results A total of 31 DEMDFGs were identified, with 15 genes upregulated and 16 genes downregulated. GO functional enrichment analysis revealed that DEMDFGs were enriched in biological processes related to energy metabolism and cellular respiration. By employing weighted gene coexpression network analysis, we identified four distinct coexpression modules, among which the blue module exhibited the strongest correlation with OA. The intersection between DEMDFGs and this module yielded eight candidate genes. After LASSO analysis of the data, four hub genes (ACADL, CYBA, SLC19A2, and UCP2) were identified as potential biomarkers for OA. The expression levels of these four genes were externally validated in the GSE114007 dataset. And the biologically differential expression of these four genes has been verified in OA and normal chondrocytes. Moreover, the four hub genes had good sensitivity and specificity by ROC curve analysis, and the risk model constructed with these four genes showed promising performance. In conclusion, our study may provide novel mitochondrial dysfunction hub genes with potential clinical applications for understanding the pathology, diagnosis, and treatment of OA.
Collapse
Affiliation(s)
- Hui Niu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Xingxing Deng
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Qian Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Yijun Zhao
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Jinfeng Wen
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Wenyu Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Huan Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Xiong Guo
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Cuiyan Wu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| |
Collapse
|
15
|
Di J, Bai J, Zhang J, Chen J, Hao Y, Bai J, Xiang C. Regional disparities, age-related changes and sex-related differences in knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:66. [PMID: 38225636 PMCID: PMC10788997 DOI: 10.1186/s12891-024-07191-w] [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: 10/17/2022] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The objective of the study is to analyse the regions, age and sex differences in the incidence of knee osteoarthritis (KOA). METHODS Data were extracted from the global burden of diseases (GBD) 2019 study, including incidence, years lived with disability (YLD), disability-adjusted life-years (DALYs) and risk factors. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in age standardized rate (ASR) of KOA. Paired t-test, paired Wilcoxon signed-rank test and spearman correlation were performed to analyze the association of sex disparity in KOA and socio-demographic index (SDI). RESULTS There were significant regional differences in the incidence of knee osteoarthritis. In 2019, South Korea had the highest incidence of knee osteoarthritis (474.85,95%UI:413.34-539.64) and Thailand had the highest increase in incidence of knee osteoarthritis (EAPC = 0.56, 95%CI = 0.54-0.58). Notably, higher incidence, YLD and DALYs of knee osteoarthritis were associated with areas with a high socio-demographic index (r = 0.336, p < 0.001; r = 0.324, p < 0.001; r = 0.324, p < 0.001). In terms of age differences, the greatest increase in the incidence of knee osteoarthritis was between the 35-39 and 40-44 age groups. (EAPC = 0.52, 95%CI = 0.40-0.63; 0.47, 95%CI = 0.36-0.58). In addition, there were significant sex differences in the disease burden of knee osteoarthritis (P < 0.001). CONCLUSIONS The incidence of knee osteoarthritis is significantly different with regions, age and sex.
Collapse
Affiliation(s)
- Jingkai Di
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiang Bai
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Junrui Zhang
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaoyang Chen
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuxuan Hao
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaqi Bai
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chuan Xiang
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| |
Collapse
|
16
|
Kinsella R, Nasser A, Menz HB, Pizzari T, Collins NJ, Semciw AI. Effects of foot orthoses and footwear interventions on impairments and quality of life in people with hip pain: A systematic review. Musculoskeletal Care 2023; 21:1529-1550. [PMID: 37823790 DOI: 10.1002/msc.1826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Foot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip-related pain. METHODS MEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre-post studies reporting on footwear and foot orthoses interventions, in participants with hip-related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob-2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS Of the seven included studies (n = 266 participants), there was one RCT, one cohort and five single-group pre-post designs. Interventions included customised and non-customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non-specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta-analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low. CONCLUSION Single-group pre-post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non-invasive treatment approach, further rigorous studies are warranted.
Collapse
Affiliation(s)
- Rita Kinsella
- Department of Surgery, St Vincent's Hospital, Faculty Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Hylton B Menz
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
- Department of Allied Health, Northern Hospital, Melbourne, Australia
| |
Collapse
|
17
|
Ackerman IN, Buchbinder R, March L. Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia. Intern Med J 2023; 53:1875-1882. [PMID: 36114616 PMCID: PMC10946783 DOI: 10.1111/imj.15933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Understanding population-level trends in osteoarthritis (OA) is critical for planning health services and disease prevention initiatives. AIM To examine trends in the burden of hip, knee, hand and other OA related conditions in Australia from 1990 to 2019 and consider the OA burden in the context of other common conditions associated with older age. METHODS Global Burden of Disease Study 2019 data for Australia on OA prevalence, OA-related years lived with disability (YLDs) and OA-related YLDs attributable to high body mass index (BMI) were sourced for 1990-2019. Age-standardised YLD data for ischaemic heart disease, stroke, dementia, type 2 diabetes and chronic obstructive pulmonary disease were obtained for comparison. RESULTS Overall, 3.20 million Australians were estimated to have OA in 2019, with substantial growth in the prevalence of hip (+171%), knee (+126%), hand (+110%) and other types of OA (+130%) from 1990 to 2019. Age-standardised prevalence rates reflect the contribution of population ageing. Concomitant growth in OA-related YLDs was also evident; knee OA and hand OA demonstrated the highest disease burden in 2019 (59 684 and 41 893 YLDs respectively). The proportion of knee OA burden attributable to high BMI was 36% in 2019. In 2019, age-standardised YLD rates were higher for OA (313 per 100 000 population) than other common conditions (range: 47 per 100 000 (ischaemic heart disease) to 284 per 100 000 (type 2 diabetes)). CONCLUSIONS OA is an increasingly prevalent, impactful condition with a high non-fatal disease burden relative to other health conditions. Growth in OA populations and OA-related disability underscore the need for enhanced investment in prevention and management.
Collapse
Affiliation(s)
- Ilana N. Ackerman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash‐Cabrini Department of Musculoskeletal Health and Clinical EpidemiologyCabrini HealthMelbourneVictoriaAustralia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash‐Cabrini Department of Musculoskeletal Health and Clinical EpidemiologyCabrini HealthMelbourneVictoriaAustralia
| | - Lyn March
- Faculty of Medicine and HealthInstitute of Bone and Joint Research, Kolling Institute, University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
18
|
Evers BJ, Schers HJ, van den Ende CHM, Thurlings RM, Koëter S. Diagnosing knee osteoarthritis in patients, differences between general practitioners and orthopedic surgeons: a retrospective cohort study. BMC PRIMARY CARE 2023; 24:155. [PMID: 37528362 PMCID: PMC10391755 DOI: 10.1186/s12875-023-02107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND knee complaints are one of the most common reasons to consult the general practitioners in the Netherlands and contribute to the increasing burden on general practitioners. A proportion of patients that are referred to orthopedic outpatient clinics are potentially referred unnecessarily. We believe osteoarthritis is not always considered by general practitioners as the cause of atraumatic knee complaints. This may impede early recognition and timely care of osteoarthritis complaints and lead to unnecessary referrals. METHODS the aim of this study was to compare the frequency of (differential) diagnosis of osteoarthritis mentioned in referral letters of general practitioners with the frequency of osteoarthritis mentioned as orthopedic diagnosis at the outpatient clinic. Therefore we conducted a retrospective cohort study based on data collected from referral letters and the corresponding outpatient clinic reports of patients with atraumatic knee complaints of 45 years or older referred to a regional hospital in Nijmegen, The Netherlands in the period from 1-6-2019 until 1-01-2020. RESULTS a total of 292 referral letters were included. In the younger aged patients (45-54 years) osteoarthritis was mentioned less frequent and meniscal lesions were mentioned more frequent in referral letters when compared to diagnoses made at the outpatient clinic. Differences in differential diagnosis of osteoarthritis as well as meniscal lesions between orthopedic surgeon and general practitioners were found (both p < 0.001, McNemar). Matching diagnoses were present in 58.2% when all referral letters were analyzed (n = 292) and 75.2% when only referrals containing a differential diagnosis were analyzed (n = 226). Matching diagnoses were present in 31.6% in the younger age categories (45-54 years). A linear trend showing fewer matching diagnoses in younger patient categories was observed (p < 0.001). CONCLUSIONS Osteoarthritis was less frequently mentioned in general practitioner referral letters among the differential diagnosis then it was diagnosed at the outpatient clinic, especially in younger patients (45-54 years). Also matching diagnoses in younger patients were evidently lower than in older patients, partly explained by underdiagnosing of osteoarthritis in younger patients in this cohort. Better recognition of osteoarthritis in younger patients and changing the diagnostic approach of general practitioners might improve efficacy in knee care. Future research should focus on the effectiveness of musculoskeletal triage, the need for multidisciplinary educational programs for patients and promotion of conservative treatment modalities among general practitioners.
Collapse
Affiliation(s)
- Bob J Evers
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rogier M Thurlings
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander Koëter
- Department of Orthopedics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Thirumaran AJ, Deveza LA, Atukorala I, Hunter DJ. Assessment of Pain in Osteoarthritis of the Knee. J Pers Med 2023; 13:1139. [PMID: 37511752 PMCID: PMC10381750 DOI: 10.3390/jpm13071139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Knee osteoarthritis (KOA) pain is a subjective and personal experience, making it challenging to characterise patients' experiences and assess their pain. In addition, there is no global standard for the assessment of pain in KOA. Therefore, this article examines the possible methods of assessing and characterising pain in patients with KOA using clinical symptoms, pain assessment tools, and imaging. We examine the current methods of assessment of pain in KOA and their application in clinical practice and clinical trials. Furthermore, we explore the possibility of creating individualised pain management plans to focus on different pain characteristics. With better evaluation and standardisation of pain assessment in these patients, it is hoped that patients would benefit from improved quality of life. At the same time, improvement in pain assessment would enable better data collection regarding symptom response in clinical trials for the treatment of osteoarthritis.
Collapse
Affiliation(s)
- Aricia Jieqi Thirumaran
- Nepean Hospital, Kingswood, NSW 2747, Australia
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
| | - Leticia Alle Deveza
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Inoshi Atukorala
- Senior Lecturer in Clinical Medicine & Consultant Rheumatologist, University Medical Unit, National Hospital Sri Lanka, Colombo 00700, Sri Lanka
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| |
Collapse
|
20
|
Deveza LA, Zankl A, Hunter DJ. Investigation of a family affected by early-onset osteoarthritis - proposal of a clinical pathway and bioinformatics pipeline for the investigation of cases of familial OA. BMC Musculoskelet Disord 2023; 24:570. [PMID: 37443051 DOI: 10.1186/s12891-023-06691-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Familial cases of early-onset osteoarthritis (OA) are rare although the exact prevalence is unknown. Early recognition of underlying OA-associated disorders is vital for targeted treatment, when available, and genetic counselling, in case of skeletal dysplasias. Currently, there is no clear guidance on how best to investigate families affected by early-onset OA. METHODS We investigated a family with multiple members affected by early-onset OA (age at onset ≤ 40 years). Clinical and demographic characteristics were collected, followed by laboratory investigations screening for a range of potential OA-associated disorders, and whole genome sequencing in selected individuals. RESULTS Seventeen members of the family were included (7 affected and 10 non-affected). There was an even split between the two sexes and two participants were under 18 years old. No pattern of abnormality was seen in the laboratory investigation that could explain the OA phenotype in the family. Whole-genome sequencing was perfomed in one participant and analysed for likely pathogenic variants in genes known to be associated with skeletal dysplasias. A heterozygous variant in the COL2A1 gene was identified (p.Arg519Cys). Confirmatory tests were performed in five additional participants (four affected and one unaffected). CONCLUSION The methodology used in this study, including the clinical pathway and bioinformatics pipeline, could be applied to other families affected by early-onset OA.
Collapse
Affiliation(s)
- Leticia A Deveza
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine, University of Sydney, Camperdown, Australia.
- Rheumatology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
| | - Andreas Zankl
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine, University of Sydney, Camperdown, Australia
- Department of Clinical Genetics, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW, Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
- Bone Biology Division and Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine, University of Sydney, Camperdown, Australia
- Rheumatology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| |
Collapse
|
21
|
Dantas GAF, Sacco ICN, Ferrari AV, Matias AB, Watari R, Oliveira LVM, Marcon TR, Fatore JA, Pott-Junior H, Salvini TF. Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther 2023; 27:100531. [PMID: 37603935 PMCID: PMC10457687 DOI: 10.1016/j.bjpt.2023.100531] [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: 05/16/2022] [Revised: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Foot-ankle exercises could improve pain and function of individuals with KOA and need to be tested. OBJECTIVE To investigate whether an 8-week foot-ankle muscle strengthening program is effective for individuals with KOA to reduce pain and improve function. METHODS In this randomized controlled trial, individuals diagnosed with clinical and radiographic KOA were randomized into the intervention (supervised foot-ankle strengthening exercise program three times a week for 8 weeks) or control (usual care and recommendations of the healthcare team) group. Effectiveness was assessed by changes in clinical and functional outcomes between baseline and 8 weeks with pain as the primary outcome. ANCOVA tests using the intervention group as a reference and sex, body mass index, and baseline values as covariates assessed between-group differences. RESULTS The intervention group showed lower pain scores (-4.4 units; 95%CI = -7.5, -1.1), better function (-7.1 units; 95%CI = -12.7, -1.4), higher total functional score (-11.9 units; 95%CI = -20.7, -3.1), with confidence intervals indicating a potential for the differences to be clinically meaningful, and better scores for the 30-s chair stand test (2.7 repetitions; 95%CI = 1.1, 4.1), with a confidence interval indicating a moderate clinically meaningful difference, compared to the controls. CONCLUSION The 8-week foot-ankle exercise program showed positive, and potentially clinically meaningful, effects on knee pain and physical function among individuals with KOA, when compared to usual care. TRIAL REGISTRATION NCT04154059. https://clinicaltrials.gov/ct2/show/NCT04154059.
Collapse
Affiliation(s)
- Glauko A F Dantas
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Department of Physical Therapy, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil.
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Angélica V Ferrari
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Alessandra B Matias
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricky Watari
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Larissa V M Oliveira
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Thainá R Marcon
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - José A Fatore
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Tania F Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| |
Collapse
|
22
|
Jorge AES, Dantas LO, Aburquerque-Sendín F, Ferrari AV, Cunha JE, Dantas GADF, Barbosa GM, Serrão PRMDS, Salvini TDF. Photobiomodulation does not provide incremental benefits to patients with knee osteoarthritis who receive a strengthening exercises program: a randomized controlled trial. Braz J Phys Ther 2023; 27:100519. [PMID: 37572382 PMCID: PMC10440468 DOI: 10.1016/j.bjpt.2023.100519] [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: 09/30/2021] [Revised: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND There is lack of agreement in the literature about the effectiveness of photobiomodulation (PBM) for reducing pain-related symptoms in patients with knee osteoarthritis (OA). OBJECTIVE To evaluate whether PBM, when combined to exercises, provides incremental therapeutic benefits for pain, physical function, and quality of life (QoL) in patients with knee OA. METHODS A six-month double-blind placebo-controlled randomized trial was conducted. Patients with knee OA were randomly assigned to one of three treatment groups: Exercise, Exercise plus Active PBM, or Exercise plus Placebo PBM. Treatment was provided over an eight-week period, three times per week. The primary outcomes were pain at rest and upon movement, assessed by a visual analogue scale (VAS). WOMAC global score, QoL, and a core-set of performance-based tests were measured as secondary outcomes. All outcomes were collected at baseline, immediately after treatment, and after three- and six-month post-treatment. RESULTS 127 participants were allocated as follows: Exercise, N = 41; Exercise plus Active PBM, N = 44; and Exercise plus Placebo PBM, N = 42. There was no between-groups difference in improvement in pain, physical function, and QoL for all follow-up times. However, all groups presented significant, clinically relevant improvements in pain, physical function, and QoL immediately and three months after treatment compared with baseline measures. CONCLUSION Patients with knee OA who received a strengthening exercises program did not experience incremental benefits regarding pain, physical function, or QoL when adding PBM to their therapeutic exercises.
Collapse
Affiliation(s)
| | - Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Francisco Aburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Sociosanitary Sciences, Radiology and Physical Medicine, University of Córdoba, and Maimonides Biomedical Research Institute of Cordoba, Córdoba, Spain
| | | | | | | | - Germanna Medeiros Barbosa
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Faculty of Health Sciences of Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | | | | |
Collapse
|
23
|
Sahin E, Orhan C, Erten F, Saiyed Z, Azari EK, Durkee S, Sahin K. The effect of oral administration of undenatured type II collagen on monosodium iodoacetate-induced osteoarthritis in young and old rats. Sci Rep 2023; 13:6499. [PMID: 37081089 PMCID: PMC10119188 DOI: 10.1038/s41598-023-33763-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023] Open
Abstract
We investigated whether different doses of undenatured type II collagen (undenatured collagen, UC-II) help improve monosodium iodoacetate (MIA)-induced (osteoarthritis) OA in young and old rats. A total of 70 rats were divided into five groups: (1) control; (2) MIA (a single intra-articular injection of MIA); (3)-(5) MIA+ Undenatured Collagen with various oral doses (0.66, 1.33, and 2 mg/kg). The results showed that all doses of undenatured collagen in both age groups reduced knee diameter, while the two higher doses (1.33 mg/kg and 2 mg/kg) reduced the Mankin score and increased most gait measurements as early as day 14 compared to the MIA rats. However, the 2 mg/kg dose showed the best efficacy in improving Mankin score and gait measurements by 28 days post-OA induction. In young but not old rats, all doses of undenatured collagen reduced the Kellgren-Lawrence score compared to the MIA group. Undenatured collagen reduced the levels of most inflammatory and cartilage breakdown markers in serum and knee joint cartilage in both age groups. In conclusion, this data suggests that while all doses of undenatured collagen supplementation may ameliorate MIA-induced OA symptoms, the higher doses showed faster improvement in gait measurements and were more efficacious for overall joint health in rats.
Collapse
Affiliation(s)
- Emre Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Bingol University, Bingol, 12100, Turkey
| | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, 23119, Turkey
| | - Fusun Erten
- Department of Veterinary Science, Pertek Sakine Genc Vocational School, Munzur University, Tunceli, 62500, Turkey
| | | | | | | | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, 23119, Turkey.
| |
Collapse
|
24
|
Rosado SE. Osteoarthritis affects us too: an expert panel survey of factors important for younger adult wellbeing. SOCIAL WORK IN HEALTH CARE 2023; 62:73-92. [PMID: 36987586 DOI: 10.1080/00981389.2023.2191654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Research on quality of life (QOL) factors important for younger adults (ages 18-45 years old) with osteoarthritis (OA) is limited. This study utilizes an online survey method to conduct an expert panel review of QOL domains for this population. Health provider and young adult perspectives of living with OA were captured and compared. Results indicate that providers are underestimating the impact OA is having on a variety of QOL factors for younger adults. Overall, these results reveal critical QOL domains to consider during assessment and when considering intervention strategies aimed at improving the lives of younger adults with this chronic disease. Implications for social work are also discussed.
Collapse
|
25
|
Schindler M, Schmitz S, Reinhard J, Jansen P, Grifka J, Benditz A. Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study. J Clin Med 2022; 11:7204. [PMID: 36498779 PMCID: PMC9741301 DOI: 10.3390/jcm11237204] [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: 11/06/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. METHODS A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. RESULTS The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. CONCLUSIONS The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.
Collapse
Affiliation(s)
- Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Stephanie Schmitz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Petra Jansen
- Department of Sport Science, University of Regensburg, 93053 Regensburg, Bavaria, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
- Department of Orthopedics, Klinikum Fichtelgebirge, 95615 Marktredwitz, Bavaria, Germany
| |
Collapse
|
26
|
Li AK, Stavrakis AI, Photopoulos C. Platelet-rich plasma use for hip and knee osteoarthritis in the United States. Knee 2022; 39:239-246. [PMID: 36270110 DOI: 10.1016/j.knee.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) are rising in prevalence and increasingly affecting younger patients. There is a rising demand for therapeutics to address its growing disease burden. Platelet-rich plasma (PRP) therapy has been used to treat various musculoskeletal conditions, but its role in OA treatment is not well understood. Even still, there is significant interest in this biologic for treatment of OA. The purpose of this study was to determine the PRP utilization trends in the United States for hip and knee OA. METHODS This was a retrospective review from the PearlDiver Patient Record Database. International Classification of Diseases and Current Procedural Terminology codes were used to identify patients who had received PRP injections for hip and knee OA from 2010 to 2018. Injection incidence was evaluated on an annual basis and by patient demographics, geographic distribution, and medical specialty under which the treatment was administered. RESULTS A total of 3,884 PRP injections were administered over the study period, 15% for hip OA and 85% for knee OA. PRP injections per 100,000 patient cases increased by an average year-over-year percentage of 53% and 12% for hip and knee OA, respectively. The highest injection incidences were observed in patients younger than 44 years of age. 58% of both hip and knee PRP injections were administered in general orthopaedic practices. CONCLUSION These findings show that PRP is increasingly being used as a treatment modality for hip and knee OA. There is a need for further research on its long term outcomes.
Collapse
Affiliation(s)
- Alan K Li
- Departmentof Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, United States.
| | - Alexandra I Stavrakis
- Departmentof Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, United States.
| | | |
Collapse
|
27
|
Duvančić T, Škokić S, Erjavec I, Plečko M, Bohaček I, Gajović S, Delimar D. Novel micro-MRI approach for subchondral trabecular bone analysis in patients with hip osteoarthritis is comparable to micro-CT approach. Croat Med J 2022. [PMID: 36597563 PMCID: PMC9837720 DOI: 10.3325/cmj.2022.63.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM To test the agreement between a newly developed micro-magnetic resonance imaging (MRI) analysis of the subchondral bone and the micro-computed tomography (CT) approach. METHODS Samples obtained from 10 patients with osteoarthritis undergoing total hip arthroplasty were scanned with a 7.0 T micro-MRI. Proton density-weighted images and proton density-weighted images with fat suppression were obtained. The results were validated with a micro-CT device. Micro-MRI and micro-CT scans of the same sample were aligned, and regions of interest were delineated on equal areas of the sample. Bone volume fraction was calculated by using in-house plugins. The agreement between the methods was tested with Bland-Altman analysis. RESULTS The agreement between the methods was good, with average difference of 2.167%. The differences between the methods were not significant (P=0.272, t test). CONCLUSION The novel micro-MRI approach could be used for subchondral bone analysis. With further optimization for clinical MRI machines, the approach can be also used in the diagnostics of hip osteoarthritis.
Collapse
Affiliation(s)
- Tea Duvančić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Siniša Škokić
- Laboratory for Regenerative Neuroscience – GlowLab, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Igor Erjavec
- University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Ivan Bohaček
- Department of Orthopedic Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Srećko Gajović
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Domagoj Delimar
- Department of Orthopedic Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| |
Collapse
|
28
|
Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4115-4122. [PMID: 35348817 DOI: 10.1007/s00167-022-06947-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant. METHODS The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30 kg/m2) or nonobese (NO, BMI < 30 kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates. RESULTS A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5 years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group). CONCLUSIONS An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.
Collapse
|
29
|
Obesity increases the risk of conversion to total knee arthroplasty after unicompartimental knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3945-3957. [PMID: 34718836 DOI: 10.1007/s00167-021-06780-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this meta-analysis was to to determine the influence of obesity on patient outcome and implant survivorship after primary unicompartmental knee arthroplasty (UKA). METHODS A PRISMA systematic review was conducted by searching the Medline (PubMed), EMBASE, and Cochrane electronic databases to identify clinical studies investigating the effect of obesity on outcomes after UKA. Data were collected on aspecifically designed extraction form. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies score. Quantitative meta-analysis was carried out using RevMan 5.4 software. RESULTS A total of 17 studies were included; 43,845 primary UKA patients were classified by their BMI: on-obese (BMI 25 to < 30 kg/m2); obese (BMI 30 to < 35 kg/m2); severely obese (BMI > 35 kg/m2). Pooled analysis showed no statistically significant difference in Knee Society Score (KSS) pain in the obese (n.s.) and the severely obese (n.s.) group compared to the non-obese group, while the KSS function score was lower in the severely obese (P = 0.0002) compared to the obese (P = 0.06) and the non-obese group. Postoperative Oxford Knee Score (OKS) was lower in the obese group (P = 0.01) but not in the severely obese group (P = 0.16). Postoperative Range of Motion (ROM) was comparable in the obese and non-obese group (P = 0.16). Implant survival at 10 years follow-up was significantly lower in the obese (82.5-95.3%; P < 0.0001) and the severely obese group (87.5-93.8%; P < 0.0001) thanthe non-obese group (83.6-98.6%). CONCLUSION Obesity and severe obesity were associated with significantly higher revision and lower implant survival rates. Obesity did not influence clinical and most functional outcomes after UKA, whereas KSS function score was significantly lower only for the severely obese patient group. LEVEL OF EVIDENCE III, meta-analysis.
Collapse
|
30
|
Mesenchymal Stem Cell Secreted-Extracellular Vesicles are Involved in Chondrocyte Production and Reduce Adipogenesis during Stem Cell Differentiation. Tissue Eng Regen Med 2022; 19:1295-1310. [DOI: 10.1007/s13770-022-00490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background:
Extracellular vesicles (EVs) are derived from internal cellular compartments, and have potential as a diagnostic and therapeutic tool in degenerative disease associated with aging. Mesenchymal stem cells (MSCs) have become a promising tool for functional EVs production. This study investigated the efficacy of EVs and its effect on differentiation capacity.
Methods:
The characteristics of MSCs were evaluated by flow cytometry and stem cell differentiation analysis, and a production mode of functional EVs was scaled from MSCs. The concentration and size of EVs were quantitated by Nanoparticle Tracking Analysis (NTA). Western blot analysis was used to assess the protein expression of exosome-specific markers. The effects of MSC-derived EVs were assessed by chondrogenic and adipogenic differentiation analyses and histological observation.
Results:
The range of the particle size of adipose-derived stem cells (ADSCs)- and Wharton’s jelly -MSCs-derived EVs were from 130 to 150 nm as measured by NTA, which showed positive expression of exosomal markers. The chondrogenic induction ability was weakened in the absence of EVs in vitro. Interestingly, after EV administration, type II collagen, a major component in the cartilage extracellular matrix, was upregulated compared to the EV-free condition. Moreover, EVs decreased the lipid accumulation rate during adipogenic induction.
Conclusion:
The results indicated that the production model could facilitate production of effective EVs and further demonstrated the role of MSC-derived EVs in cell differentiation. MSC-derived EVs could be successfully used in cell-free therapy to guide chondrogenic differentiation of ADSC for future clinical applications in cartilage regeneration.
Collapse
|
31
|
Wang H, Shu J, Zhang C, Wang Y, Shi R, Yang F, Tang X. Extracellular Vesicle-Mediated miR-150-3p Delivery in Joint Homeostasis: A Potential Treatment for Osteoarthritis? Cells 2022; 11:cells11172766. [PMID: 36078172 PMCID: PMC9454967 DOI: 10.3390/cells11172766] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The disruption of joint homeostasis is a critical event during the process of joint injury in osteoarthritis (OA). As regulatory molecules, microRNAs (miRNAs) can be released from secretory cells and delivered to recipient cells through extracellular vesicles (EVs), thereby playing an important role in regulating joint homeostasis. We hypothesized that the fibroblast-like synoviocytes (FLSs) in healthy joints could release EVs enriched in miRNAs that can maintain joint homeostasis by regulating the signal transduction pathways in the joints, whereby the articular cartilage (AC) is protected from degeneration, and OA progression is delayed. Methods: Via high-throughput sequencing and qPCR, we found that miR-150-3p was enriched in the circulating EVs in healthy rats. Next, we established an in vitro cell model in which chondrocytes were cultured with (i) FLSs transfected with miR-150-3p mimics or (ii) EVs released by FLSs (FLS–EVs) inside the healthy synovial membrane (SM). The transportation mechanism from FLSs to chondrocytes was studied using the EV inhibitor GW4869, and the FLSs were transfected with a miR-150-3p mimic or inhibitor. To assess the therapeutic effect of miR-150-3p-carrying EVs (EVs-150) in vivo, healthy FLS-derived EVs (H-FLS–EVs) were injected into the tail vein of rats with OA at various stages of the pathogenesis and evaluated for the progression of OA. Results: The chondrocytes could uptake fluorescent-labeled miR-150-3p mimics and FLS–EVs, and GW4869 suppressed this uptake. The overexpression of miR-150-3p could significantly reduce the concentrations of pro-inflammatory cytokines in the cell culture medium and the expression of the miR-150-3p target T cell receptor-interacting molecule 14 (Trim14), as well as the innate immune-related factors, including nuclear factor kappa B (NF-κB) and interferon-β (IFN-β). Similarly to the in vitro findings, the miR-150-3p level in the serum EVs was significantly upregulated among the EV-treated rats. In the AC of the OA rat model injected with H-FLS–EVs, the joint degeneration was suppressed, and Type II collagen (COLII) and aggrecan (ACAN) were significantly upregulated, whereas the innate immune-related factors Trim14, NF-κB, and IFN-β were downregulated compared with the levels in the untreated OA rats. Notably, the suppression of joint degeneration was more significant when H-FLS–EVs were administered at the early stages of OA rather than the late stages. Conclusion: H-FLS–EVs protect chondrocyte function and maintain joint homeostasis by modulating the innate immune response by suppressing the Trim14/NF-κB/IFNβ axis. These effects are achieved through the EV-mediated transport of miR-150-3p from the FLSs to the chondrocytes. Our findings show that EV-mediated miR-150-3p can be used to suppress OA, thus providing a novel therapeutic strategy. Additionally, the EV-mediated miR-150-3p transport may also serve as a potential biomarker in the diagnosis, treatment, and prognosis of OA.
Collapse
Affiliation(s)
- Huan Wang
- Department of Traditional Chinese Medicine Massage, China-Japan Friendship Hospital, Beijing 100029, China
- Correspondence: (H.W.); (X.T.)
| | - Jun Shu
- Institute of Clinical Research, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chengfei Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yang Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Rongxing Shi
- Department of Traditional Chinese Medicine Acupuncture, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fan Yang
- Department of Traditional Chinese Medicine Massage, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xuezhang Tang
- Department of Traditional Chinese Medicine Massage, China-Japan Friendship Hospital, Beijing 100029, China
- Correspondence: (H.W.); (X.T.)
| |
Collapse
|
32
|
Berkovic D, Ayton D, Briggs AM, Ademi Z, Ackerman IN. Personal healthcare costs borne by younger people living with arthritis in Australia: An exploratory observational study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2540-e2548. [PMID: 34957623 DOI: 10.1111/hsc.13697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Arthritis is a long-term musculoskeletal disease, requiring ongoing management. However, the financial burden of managing arthritis is under-explored and is yet to be quantified from the perspective of individuals with the condition. Using an exploratory observational design, this study aimed to quantify arthritis-related costs borne by a sample of working-age adults aged 18-50 years who responded to the study advertisement. Participants completed a weekly cost diary for 6 weeks, detailing their personal non-reimbursed (out-of-pocket) arthritis-related costs. Financial distress was measured using the InCharge Financial Distress/Financial Well-Being Scale. Costs data were analysed descriptively. Mann-Whitney U tests were used to examine relationships between residential location or employment status and out-of-pocket costs. Linear regression and Spearman's rho were used to estimate relationships between age or years since diagnosis and out-of-pocket costs, and between out-of-pocket costs and financial distress respectively. Sixteen adults (median age 40 years, 100% female) with a range of arthritis conditions (median (IQR): 8 (7.5) years since diagnosis) including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and ankylosing spondylitis completed the six-week cost diary. All participants reported out-of-pocket expenditure related to arthritis. The median per-person expenditure across the 6 weeks was AUD 1635. The highest reported costs per participant across the 6 weeks were for medical expenses (median AUD 197) and allied health appointments (median AUD 190). In total, the cohort spent AUD 15,272 across the study period. Perceived financial distress was high: median (IQR) financial distress 7 (2.25) on a 1 (lowest) to 10 (highest) scale. Positive relationships between age and costs, and between costs and financial distress were identified. These findings help us understand fiscal expenditure and related distress relevant to younger individuals with arthritis, and can be used to raise awareness of their financial concerns.
Collapse
Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
33
|
Biological Targets of Multimolecular Therapies in Middle-Age Osteoarthritis. Sports Med Arthrosc Rev 2022; 30:141-146. [PMID: 35921596 DOI: 10.1097/jsa.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knee osteoarthritis (OA) is a common condition, prevalent in middle-agedness, associated with chronic pain and impaired quality of life. Two interrelated biological processes fuel early OA progression: inflammation and structural tissues catabolism. Procatabolic and proinflammatory mediators are interconnected and form part of a self-perpetuating loop. They leverage OA research complexity because of the impossibility to discern certain spatiotemporal tissues' changes from others. Both are shared targets of versatile regenerative multimolecular therapies. In particular, platelet-rich plasma can interfere with inflammation and inflammatory pain. The therapeutic approach is to alter the vicious inflammatory loop by modifying the molecular composition of the synovial fluid, thereby paracrine cellular cross talk. Intra-articular injections of platelet-rich plasma can provide key factors balancing proinflammatory and anti-inflammatory factors, targeting macrophage dysfunction and modulating immune mechanisms within the knee.
Collapse
|
34
|
Abstract
PURPOSE Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
Collapse
|
35
|
Bertoncelli CM, Altamura P, Bagui S, Bagui S, Vieira ER, Costantini S, Monticone M, Solla F, Bertoncelli D. Predicting osteoarthritis in adults using statistical data mining and machine learning. Ther Adv Musculoskelet Dis 2022; 14:1759720X221104935. [PMID: 35859927 PMCID: PMC9290106 DOI: 10.1177/1759720x221104935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Osteoarthritis (OA) has traditionally been considered a disease of older adults (⩾65 years old), but it may appear in younger adults. However, the risk factors for OA in younger adults need to be further evaluated. Objectives: To develop a prediction model for identifying risk factors of OA in subjects aged 20–50 years and compare the performance of different machine learning models. Methods: We included data from 52,512 participants of the National Health and Nutrition Examination Survey; of those, we analyzed only subjects aged 20–50 years (n = 19,133), with or without OA. The supervised machine learning model ‘Deep PredictMed’ based on logistic regression, deep neural network (DNN), and support vector machine was used for identifying demographic and personal characteristics that are associated with OA. Finally, we compared the performance of the different models. Results: Being a female (p < 0.001), older age (p < 0.001), a smoker (p < 0.001), higher body mass index (p < 0.001), high blood pressure (p < 0.001), race/ethnicity (lowest risk among Mexican Americans, p = 0.01), and physical and mental limitations (p < 0.001) were associated with having OA. Best predictive performance yielded a 75% area under the receiver operating characteristic curve. Conclusion: Sex (female), age (older), smoking (yes), body mass index (higher), blood pressure (high), race/ethnicity, and physical and mental limitations are risk factors for having OA in adults aged 20–50 years. The best predictive performance was achieved using DNN algorithms.
Collapse
Affiliation(s)
- Carlo M Bertoncelli
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology, University of Chieti, Chieti, Italy
| | - Sikha Bagui
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Subhash Bagui
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Stefania Costantini
- Department of Information Engineering Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health and Department of Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
| | - Federico Solla
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice, France
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| |
Collapse
|
36
|
Porter A, Wang L, Han L, Lu XL. Bio-orthogonal Click Chemistry Methods to Evaluate the Metabolism of Inflammatory Challenged Cartilage after Traumatic Overloading. ACS Biomater Sci Eng 2022; 8:2564-2573. [PMID: 35561285 PMCID: PMC10461521 DOI: 10.1021/acsbiomaterials.2c00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
During traumatic joint injuries, impact overloading can cause mechanical damage to the cartilage. In the following inflammation phase, excessive inflammatory cytokines (e.g., interleukin-1β (IL-1β)) can act on chondrocytes, causing over-proliferation, apoptosis, and extracellular matrix (ECM) degradation that can lead to osteoarthritis. This study investigated the combined effects of traumatic overloading and IL-1β challenge on the metabolic activities of chondrocytes. Bovine cartilage explants underwent impact overloading followed by IL-1β exposure at a physiologically relevant dosage (1 ng/mL). New click chemistry-based methods were developed to visualize and quantify the proliferation of in situ chondrocytes in a nondestructive manner without the involvement of histological sectioning or antibodies. Click chemistry-based methods were also employed to measure the ECM synthesis and degradation in cartilage explants. As the click reactions are copper-free and bio-orthogonal, i.e., with negligible cellular toxicity, cartilage ECM was cultured and studied for 6 weeks. Traumatic overloading induced significant cell death, mainly in the superficial zone. The high number of dead cells reduced the overall proliferation of chondrocytes as well as the synthesis of glycosaminoglycan (GAG) and collagen contents, but overloading alone had no effects on ECM degradation. IL-1β challenge had little effect on cell viability, proliferation, or protein synthesis but induced over 40% GAG loss in 10 days and 61% collagen loss in 6 weeks. For the overloaded samples, IL-1β induced greater degrees of degradation, with 68% GAG loss in 10 days and 80% collagen loss in 6 weeks. The results imply a necessary immediate ease of inflammation after joint injuries when trauma damage on cartilage is present. The new click chemistry methods could benefit many cellular and tissue engineering studies, providing convenient and sensitive assays of metabolic activities of cells in native three-dimensional (3D) environments.
Collapse
Affiliation(s)
- Annie Porter
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Liyun Wang
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Lin Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - X Lucas Lu
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| |
Collapse
|
37
|
Salucci S, Falcieri E, Battistelli M. Chondrocyte death involvement in osteoarthritis. Cell Tissue Res 2022; 389:159-170. [PMID: 35614364 PMCID: PMC9287242 DOI: 10.1007/s00441-022-03639-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/09/2022] [Indexed: 12/22/2022]
Abstract
Chondrocyte apoptosis is known to contribute to articular cartilage damage in osteoarthritis and is correlated to a number of cartilage disorders. Micromass cultures represent a convenient means for studying chondrocyte biology, and, in particular, their death. In this review, we focused the different kinds of chondrocyte death through a comparison between data reported in the literature. Chondrocytes show necrotic features and, occasionally, also apoptotic features, but usually undergo a new form of cell death called Chondroptosis, which occurs in a non-classical manner. Chondroptosis has some features in common with classical apoptosis, such as cell shrinkage, chromatin condensation, and involvement, not always, of caspases. The most crucial peculiarity of chondroptosis relates to the ultimate elimination of cellular remnants. Independent of phagocytosis, chondroptosis may serve to eliminate cells without inflammation in situations in which phagocytosis would be difficult. This particular death mechanism is probably due to the unusual condition chondrocytes both in vivo and in micromass culture. This review highlights on the morpho-fuctional alterations of articular cartilage and focus attention on various types of chondrocyte death involved in this degeneration. The death features have been detailed and discussed through in vitro studies based on tridimensional chondrocyte culture (micromasses culture). The study of this particular mechanism of cartilage death and the characterization of different biological and biochemical underlying mechanisms can lead to the identification of new potentially therapeutic targets in various joint diseases.
Collapse
Affiliation(s)
- S Salucci
- Department of Biomolecular Sciences (DiSB), Urbino University Carlo Bo, Via Cà le Suore, 2, Campus Scientifico Enrico Mattei, 61029, Urbino (PU), Italy.,Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126, Bologna, Italy
| | - E Falcieri
- Department of Biomolecular Sciences (DiSB), Urbino University Carlo Bo, Via Cà le Suore, 2, Campus Scientifico Enrico Mattei, 61029, Urbino (PU), Italy
| | - M Battistelli
- Department of Biomolecular Sciences (DiSB), Urbino University Carlo Bo, Via Cà le Suore, 2, Campus Scientifico Enrico Mattei, 61029, Urbino (PU), Italy.
| |
Collapse
|
38
|
Govil G, Tomar L, Dhawan P. Knee-Spine Syndrome: Management Dilemma When Knee Osteoarthritis Coexists With Spine Degeneration. Cureus 2022; 14:e24939. [DOI: 10.7759/cureus.24939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
|
39
|
Bowden JL, Callahan LF, Eyles JP, Kent JL, Briggs AM. Realizing Health and Well-being Outcomes for People with Osteoarthritis Beyond Health Service Delivery. Clin Geriatr Med 2022; 38:433-448. [DOI: 10.1016/j.cger.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
40
|
Tkacz R, Larysz D, Przybylski R, Tkacz M, Safranow K, Tarnowski M. Short-Term Functional Outcomes of Short Femoral Neck Stems Are the Same as Those of Conventional Stems in Primary Total Hip Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084670. [PMID: 35457538 PMCID: PMC9031126 DOI: 10.3390/ijerph19084670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: In this study, two types of implants were compared-a conventional hip stem and a femoral neck prosthesis. (2) Methods: The femoral neck prosthesis study group included 21 patients, while the conventional hip stem control group was 40 patients. The first examination was the pre-op check, while the next ones were performed 6 weeks, 1 year, and 3 years after surgery. The Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), University of California at Los Angeles Activity Score (UCLA), and Visual Analog Scale EQ (VAS EQ) forms were completed at each clinical study visit. (3) Results: The HHS in the femoral neck prosthesis group and the conventional hip stem group 6 weeks after surgery was 68.8 ± 16.47 and 67.6 ± 8.92, respectively, and 1 year after surgery, this was 93 ± 5.58 vs. 90.6 ± 5.17, respectively. The OHS of the femoral neck prosthesis group was 34.8 points after 6 weeks, 45.5 points after 1 year, and 43.9 points after 3 years. The respective values in the conventional hip stem group were 35.5, 41.55, and 42.13 points. The WOMAC values for the femoral neck prosthesis group were 70.6, 92.7, and 86 points, respectively, while for the conventional hip stem group, they were 74, 88.1, and 86.1 points. The UCLA scores recorded in the conventional hip stem group ranged from 3.15 to 5.05 points, but a higher mean value of 5.33 points was obtained in the femoral neck prosthesis group. VAS EQ was equal to 84 points three years after the operation. (4) Conclusions: The study showed no significant differences in the functional scores of both groups, and the new type of cervical femoral stem could be the first choice in younger patients.
Collapse
Affiliation(s)
- Rafał Tkacz
- Department of Trauma and Orthopaedic Surgery, 109 Military Hospital, 71-442 Szczecin, Poland;
- Correspondence:
| | - Dariusz Larysz
- Department of Trauma and Orthopaedic Surgery, 109 Military Hospital, 71-442 Szczecin, Poland;
| | - Rafał Przybylski
- Department of Orthopaedic Surgery, Independent Public Health Care Ministry of Internal Affairs and Administration, 70-382 Szczecin, Poland;
| | - Marta Tkacz
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.T.); (M.T.)
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Maciej Tarnowski
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.T.); (M.T.)
| |
Collapse
|
41
|
Kokkotis C, Ntakolia C, Moustakidis S, Giakas G, Tsaopoulos D. Explainable machine learning for knee osteoarthritis diagnosis based on a novel fuzzy feature selection methodology. Phys Eng Sci Med 2022; 45:219-229. [PMID: 35099771 PMCID: PMC8802106 DOI: 10.1007/s13246-022-01106-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/19/2022] [Indexed: 01/30/2023]
Abstract
Knee Osteoarthritis (ΚΟΑ) is a degenerative joint disease of the knee that results from the progressive loss of cartilage. Due to KOA's multifactorial nature and the poor understanding of its pathophysiology, there is a need for reliable tools that will reduce diagnostic errors made by clinicians. The existence of public databases has facilitated the advent of advanced analytics in KOA research however the heterogeneity of the available data along with the observed high feature dimensionality make this diagnosis task difficult. The objective of the present study is to provide a robust Feature Selection (FS) methodology that could: (i) handle the multidimensional nature of the available datasets and (ii) alleviate the defectiveness of existing feature selection techniques towards the identification of important risk factors which contribute to KOA diagnosis. For this aim, we used multidimensional data obtained from the Osteoarthritis Initiative database for individuals without or with KOA. The proposed fuzzy ensemble feature selection methodology aggregates the results of several FS algorithms (filter, wrapper and embedded ones) based on fuzzy logic. The effectiveness of the proposed methodology was evaluated using an extensive experimental setup that involved multiple competing FS algorithms and several well-known ML models. A 73.55% classification accuracy was achieved by the best performing model (Random Forest classifier) on a group of twenty-one selected risk factors. Explainability analysis was finally performed to quantify the impact of the selected features on the model's output thus enhancing our understanding of the rationale behind the decision-making mechanism of the best model.
Collapse
Affiliation(s)
- Christos Kokkotis
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 38333, Volos, Greece.
- TEFAA, Department of Physical Education & Sport Science, University of Thessaly, 42100, Trikala, Greece.
| | - Charis Ntakolia
- University Mental Health Research Institute, 11527, Athens, Greece
- School of Naval Architecture and Marine Engineering, National Technical University of Athens, 15772, Athens, Greece
| | | | - Giannis Giakas
- TEFAA, Department of Physical Education & Sport Science, University of Thessaly, 42100, Trikala, Greece
| | - Dimitrios Tsaopoulos
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 38333, Volos, Greece
| |
Collapse
|
42
|
Teunissen M, Miranda Bedate A, Coeleveld K, Riemers FM, Meij BP, Lafeber FPJG, Tryfonidou MA, Mastbergen SC. Enhanced Extracellular Matrix Breakdown Characterizes the Early Distraction Phase of Canine Knee Joint Distraction. Cartilage 2021; 13:1654S-1664S. [PMID: 34014119 PMCID: PMC8721609 DOI: 10.1177/19476035211014595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Joint distraction triggers intrinsic cartilage repair in animal models of osteoarthritis (OA), corroborating observations in human OA patients treated with joint distraction. The present study explores the still largely elusive mechanism initiating this repair process. DESIGN Unilateral OA was induced in the knee joint of 8 dogs using the groove model; the contralateral joint served as a control. After 10 weeks, 4 animals received joint distraction, the other 4 serving as OA controls. Halfway the distraction period (after 4 weeks of a standard 8-week distraction treatment), all animals were euthanized, and joint tissues were collected. A targeted quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis was performed of commonly involved processes including matrix catabolism/anabolism, inflammation, and known signaling pathways in OA. In addition, cartilage changes were determined on tissue sections using the canine OARSI (Osteoarthritis Research Society International) histopathology score and collagen type II (COL2A1) immunostaining. RESULTS Midway distraction, the distracted OA joint showed an upregulation of proteolytic genes, for example, ADAMTS5, MMP9, MMP13, compared to OA alone and the healthy joints, which correlated with an increased OARSI score. Additionally, genes of the transforming growth factor (TGF)-β and Notch pathway, and markers associated with progenitor cells were increased. CONCLUSIONS Joint distraction initiates both catabolic and anabolic transcriptional responses. The enhanced turnover, and thereby renewal of the matrix, could be the key to the cartilage repair observed in the months after joint distraction.
Collapse
Affiliation(s)
- Michelle Teunissen
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Alberto Miranda Bedate
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Katja Coeleveld
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank M. Riemers
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Björn P. Meij
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Floris P. J. G. Lafeber
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands,Simon C. Mastbergen, Rheumatology &
Clinical Immunology, UMC Utrecht, Utrecht University, G02.228, PO Box 85500, GA,
Utrecht 3508, The Netherlands.
| |
Collapse
|
43
|
Hah JM, Lee E, Shrestha R, Pirrotta L, Huddleston J, Goodman S, Amanatullah DF, Dirbas FM, Carroll IR, Schofield D. Return to work and productivity loss after surgery: A health economic evaluation. Int J Surg 2021; 95:106100. [PMID: 34600123 PMCID: PMC8604782 DOI: 10.1016/j.ijsu.2021.106100] [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] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to identify preoperative psychosocial factors associated with return-to-work (RTW) and the associated cost of productivity loss due to work absenteeism following surgery. Research demonstrates a high economic burden from productivity loss after surgery, but the comparative cost of productivity loss relative to income across different operations has not been examined. MATERIALS AND METHODS A mixed surgical cohort recruited for a randomized controlled trial were prospectively followed for up to two years following surgery with daily phone assessments to three months, weekly assessments thereafter to six months, then monthly assessments thereafter to determine RTW status, opioid use and pain. RESULTS 183 of 207 (88.3%) patients in paid employment prior to surgery, who provided at least one day of follow-up, were included in this analysis. The average cost of productivity loss due to work absenteeism was $13 761 (median $9064). Patients who underwent total knee replacement incurred the highest income loss. Medical claims filed before surgery were significantly associated with relative income loss (AOR 5.09; 95% CI 1.73-14.96; p < 0.01) and delayed postoperative RTW. Elevated preoperative PTSD symptoms were associated with delayed RTW (HR 0.78; 95%CI 0.63-0.96; p-value = 0.02) while male gender (HR 1.63; 95%CI 1.11-2.38; p-value = 0.01) was associated with faster postoperative RTW. CONCLUSION Surgery places a high economic burden on individuals due to postoperative productivity loss. Multidisciplinary approaches, such as pathways, that facilitate the operation and recovery may mitigate the economic consequences for patients, employers, and the healthcare system.
Collapse
Affiliation(s)
- Jennifer M Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, NSW, Australia Stanford Systems Neuroscience and Pain Lab, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Stanford University, Stanford, CA, USA Department of General Surgery, Stanford University, Stanford, CA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
De Rosis S, Pennucci F, Lungu DA, Manca M, Nuti S. A continuous PREMs and PROMs Observatory for elective hip and knee arthroplasty: study protocol. BMJ Open 2021; 11:e049826. [PMID: 34548358 PMCID: PMC8458328 DOI: 10.1136/bmjopen-2021-049826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Scholars, healthcare practitioners and policymakers have increasingly focused their attention on patient-centredness. Patient-reported metrics support patient-driven improvement actions in healthcare systems. Despite the great interest, patient-reported outcome measures (PROMs) are still not extensively collected in many countries and not integrated with the collection of patient-reported experience measures (PREMs). This protocol describes the methodology behind an innovative observatory implemented in Tuscany, Italy, aiming at continuously and longitudinally collecting PROMs and PREMs for elective hip and knee total replacement. METHODS AND ANALYSIS The Observatory is digital. Enrolled patients are invited via SMS or email to online questionnaires, which include the Oxford Hip Score or the Oxford Knee Score. Data are real-time reported to healthcare professionals and managers in a raw format, anonymised and aggregated on a web platform. The data will be used to investigate the relationship between the PROMs trend and patients' characteristics, surgical procedure, hospital characteristics, and PREMs. Indicators using patient data will be computed, and they will integrate the healthcare performance evaluation system adopted in Tuscany. ETHICS AND DISSEMINATION The data protection officers of local healthcare organisations and the regional privacy office framed the initiative referring to the national and regional guidelines that regulate patient surveys. The findings will be reported both in real time and for publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mario Manca
- Department of Orthopaedic Surgery, Versilia Hospital, Lido di Camaiore, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| |
Collapse
|
45
|
Drummer D, McAdam J, Seay R, Ferrando A, Bridges SL, Singh JA, Bamman M. Osteoarthritis Progression: Mitigation and Rehabilitation Strategies. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:724052. [PMID: 36188773 PMCID: PMC9397730 DOI: 10.3389/fresc.2021.724052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
Osteoarthritis is the most common form of arthritis and is a substantial burden for patients with the disease. Currently, there is no cure for osteoarthritis, but many emerging therapies have been developed to aid in the mitigation of disease progression. When osteoarthritis reaches the end-stage of disease many patients undergo total joint arthroplasty to improve quality of life, yet some experience persistent pain and mobility limitations for extended periods following surgery. This review highlights recent therapeutic advancements in osteoarthritis treatment consisting of pharmacologics, nutraceuticals, biologics, and exercise while emphasizing the current state of post-arthroplasty rehabilitation.
Collapse
Affiliation(s)
- Devin Drummer
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeremy McAdam
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Regina Seay
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Arny Ferrando
- Department of Geriatrics and Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - S Louis Bridges
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States.,Division of Rheumatology, Weill Cornell Medical Center, New York, NY, United States
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States.,Veterans Affairs Medical Center, Birmingham, AL, United States
| | - Marcas Bamman
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States.,Florida Institute for Human and Machine Cognition, Pensacola, FL, United States
| |
Collapse
|
46
|
Ettlin L, Nast I, Huber EO, Niedermann K. Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:658831. [PMID: 36188839 PMCID: PMC9397950 DOI: 10.3389/fresc.2021.658831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 01/05/2023]
Abstract
Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations. Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators. Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%). Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.
Collapse
Affiliation(s)
- Lea Ettlin
- School 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
- *Correspondence: Lea Ettlin
| | - Irina Nast
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Erika O. Huber
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Karin Niedermann
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| |
Collapse
|
47
|
Saini D, Chand T, Chouhan DK, Prakash M. A comparative analysis of automatic classification and grading methods for knee osteoarthritis focussing on X-ray images. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
48
|
Wirth W, Eckstein F, Culvenor AG, Hudelmaier MI, Stefan Lohmander L, Frobell RB. Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness: secondary analysis of a randomized clinical trial. Osteoarthritis Cartilage 2021; 29:518-526. [PMID: 33549723 DOI: 10.1016/j.joca.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. DESIGN 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally. RESULTS Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: -5 μm, 95% CI: [-118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone. CONCLUSIONS In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness. TRIAL REGISTRATION ISRCTN84752559.
Collapse
Affiliation(s)
- W Wirth
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - F Eckstein
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - A G Culvenor
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - M I Hudelmaier
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| | - R B Frobell
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| |
Collapse
|
49
|
Kokkotis C, Moustakidis S, Baltzopoulos V, Giakas G, Tsaopoulos D. Identifying Robust Risk Factors for Knee Osteoarthritis Progression: An Evolutionary Machine Learning Approach. Healthcare (Basel) 2021; 9:260. [PMID: 33804560 PMCID: PMC8000487 DOI: 10.3390/healthcare9030260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
Knee osteoarthritis (KOA) is a multifactorial disease which is responsible for more than 80% of the osteoarthritis disease's total burden. KOA is heterogeneous in terms of rates of progression with several different phenotypes and a large number of risk factors, which often interact with each other. A number of modifiable and non-modifiable systemic and mechanical parameters along with comorbidities as well as pain-related factors contribute to the development of KOA. Although models exist to predict the onset of the disease or discriminate between asymptotic and OA patients, there are just a few studies in the recent literature that focused on the identification of risk factors associated with KOA progression. This paper contributes to the identification of risk factors for KOA progression via a robust feature selection (FS) methodology that overcomes two crucial challenges: (i) the observed high dimensionality and heterogeneity of the available data that are obtained from the Osteoarthritis Initiative (OAI) database and (ii) a severe class imbalance problem posed by the fact that the KOA progressors class is significantly smaller than the non-progressors' class. The proposed feature selection methodology relies on a combination of evolutionary algorithms and machine learning (ML) models, leading to the selection of a relatively small feature subset of 35 risk factors that generalizes well on the whole dataset (mean accuracy of 71.25%). We investigated the effectiveness of the proposed approach in a comparative analysis with well-known FS techniques with respect to metrics related to both prediction accuracy and generalization capability. The impact of the selected risk factors on the prediction output was further investigated using SHapley Additive exPlanations (SHAP). The proposed FS methodology may contribute to the development of new, efficient risk stratification strategies and identification of risk phenotypes of each KOA patient to enable appropriate interventions.
Collapse
Affiliation(s)
- Christos Kokkotis
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 60361 Volos, Greece;
- Department of Physical Education & Sport Science, University of Thessaly, 38221 Trikala, Greece;
| | | | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercises Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - Giannis Giakas
- Department of Physical Education & Sport Science, University of Thessaly, 38221 Trikala, Greece;
| | - Dimitrios Tsaopoulos
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 60361 Volos, Greece;
| |
Collapse
|
50
|
Macri EM, Callaghan M, van Middelkoop M, Hattle M, Bierma-Zeinstra SMA. Effects of mechanical interventions in the management of knee osteoarthritis: protocol for an OA Trial Bank systematic review and individual participant data meta-analysis. BMJ Open 2021; 11:e043026. [PMID: 33550258 PMCID: PMC7925922 DOI: 10.1136/bmjopen-2020-043026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is a prevalent and disabling musculoskeletal condition. Biomechanical factors may play a key role in the aetiology of knee OA, therefore, a broad class of interventions involves the application or wear of devices designed to mechanically support knees with OA. These include gait aids, bracing, taping, orthotics and footwear. The literature regarding efficacy of mechanical interventions has been conflicting or inconclusive, and this may be because certain subgroups with knee OA respond better to mechanical interventions. Our primary aim is to identify subgroups with knee OA who respond favourably to mechanical interventions. METHODS AND ANALYSIS We will conduct a systematic review to identify randomised clinical trials of any mechanical intervention for the treatment of knee OA. We will invite lead authors of eligible studies to share individual participant data (IPD). We will perform an IPD meta-analysis for each type of mechanical intervention to evaluate efficacy, with our main outcome being pain. Where IPD are not available, this will be achieved using aggregate data. We will then evaluate five potential treatment effect modifiers using a two-stage approach. If data permit, we will also evaluate whether biomechanics mediate the effects of mechanical interventions on pain in knee OA. ETHICS AND DISSEMINATION No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publication in peer-reviewed journals and summaries posted on websites serving the public and clinicians. PROSPERO REGISTRATION NUMBER CRD42020155466.
Collapse
Affiliation(s)
- Erin M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michael Callaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miriam Hattle
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|