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Østerås N, Aas E, Moseng T, van Bodegom-Vos L, Dziedzic K, Natvig B, Røtterud JH, Vlieland TV, Furnes O, Fenstad AM, Hagen KB. Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial. Osteoarthritis Cartilage 2024; 32:108-119. [PMID: 37839506 DOI: 10.1016/j.joca.2023.10.003] [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: 05/31/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. DESIGN In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). RESULTS Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. CONCLUSIONS This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02333656.
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Affiliation(s)
- Nina Østerås
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Tuva Moseng
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Krysia Dziedzic
- Impact Accelerator Unit, Primary Care Centre Versus Arthritis, Keele University, United Kingdom.
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.
| | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Kåre Birger Hagen
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
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Pacheco-Brousseau L, Dobransky J, Jane A, Beaulé PE, Poitras S. Feasibility of a preoperative strengthening exercise program on postoperative function in patients undergoing hip or knee arthroplasty: a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:162. [PMID: 35908037 PMCID: PMC9338629 DOI: 10.1186/s40814-022-01126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are conflicting results on the effect of preoperative exercise programs on long-term function and little evidence on short-term function. The aim is to assess the feasibility of a preoperative strengthening exercise program in patients undergoing hip or knee joint arthroplasty in terms of trial design, recruitment, and follow-up rates. METHODS A randomized controlled feasibility study with patients undergoing hip or knee joint arthroplasty. Patients were randomized to a preoperative strengthening exercise program or standard of care. Feasibility outcome measures were recruitment rate (≥ 50%) and loss to follow-up (≤ 15%). RESULTS Of the 129 eligible participants, 63 participants consented to participate in the study (49%), and 27 were successfully randomized prior to surgery (43%). All 27 participants completed the baseline assessment. Of these, 6 (22%) had surgery during the exercise period. Of the remaining 21 participants, 20 (95%) completed the pre-surgery assessment. The study was terminated before five participants could be eligible for the 6-month assessment. Sixteen (76%) participants completed the 6-week post-surgery assessment. Twelve participants completed the 6-month assessment (75%). CONCLUSION Given the recruitment rate, randomization barriers, and study participant loss to follow-up, the study was discontinued since it was not considered feasible in this current form at our clinical site despite modifications made to the protocol. Future investigations into a modified intervention via telerehabilitation should be explored. TRIAL REGISTRATION ClinicalTrials.gov, NCT03483519 . Retrospectively registered in March 2018.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Johanna Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alanna Jane
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Faculty of Medicine, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
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Silva JMND, Dantas DAC, da Silva LB, Melo IESD, Correia LMADM. Assessment of the influence of psychosocial factors on musculoskeletal disorder symptom intensity. Work 2021; 71:187-200. [PMID: 34924412 DOI: 10.3233/wor-205113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous studies have observed that psychosocial factors are associated with an increase in work-related musculoskeletal disorders (WMSDs) in European countries. However, the influence of psychosocial factors on the WMSD symptoms has not been studied in detail. Additionally, working conditions differ between developing and developed countries. OBJECTIVE In this study, the influence of psychosocial factors on WMSD symptoms among men and women in the footwear industry in northeastern Brazil is investigated. METHODS A questionnaire survey was conducted to evaluate workers' perceptions of psychosocial factors and WMSD symptoms. The influence of psychosocial factors on WMSD symptom trends was observed through ordinal logistic regression models. RESULTS It was found that different psychosocial factors are related to WMSD symptom intensification. Factors such as "job insecurity" and "low social support," which are not associated with the worsening of WMSD symptoms in developed countries, showed a noticeable influence in the sample analyzed. CONCLUSION These findings may be associated with differences in working conditions and economic problems in developing countries, suggesting that some psychosocial factors have a different effect on workers' perceptions in developing countries.
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Affiliation(s)
| | | | - Luiz Bueno da Silva
- Federal University of Paraíba, ProductionEngineering Department, University City, João Pessoa, Paraíba, Brazil
| | - Igor Eduardo Santos de Melo
- Federal University ofPernambuco, Postgraduate Program in Production Engineering, University City, Refice, Pernambuco, Brazil
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Cranmer M, Walston Z. Heavy resistance training in the management of hip pain in older adults: A case series. Physiother Theory Pract 2021; 38:2241-2249. [PMID: 33896330 DOI: 10.1080/09593985.2021.1917022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and Purpose: Resistance training has been shown to improve strength, endurance, and function in healthy older adults. The purpose of this case series was to describe the outcomes of a rehabilitation program consisting of heavy resistance training in older adults for management of hip pain. Case Description: Two male patients, aged 69 and 71, with chronic hip pain, participated in a six-week progressive resistance training rehabilitation program at loads equivalent to 76-81% of their one repetition maximum. Outcomes were assessed at evaluation, three, and six weeks. Outcomes included the Lower Extremity Functional Scale, hip and lumbar mobility, and the Five Times Sit to Stand test. Outcomes: By six weeks, each patient reported 0/10 pain and demonstrated clinically important improvements on the LEFS. Both patients' final scores on the Five Times Sit to Stand test fell below the 15 second value for being at risk for falls. Patient One increased his lifting capacity for the deadlift by 92%, and Patient Two by 56%. Both patients were able to deadlift >70% of their one repetition maximum by the conclusion of this report. Discussion: To our knowledge, this is the first report of the outcomes of utilizing heavy resistance training in elderly adults with hip pain in a rehabilitative setting. Both patients demonstrated clinically important improvements in pain, disability, global lower extremity strength, and function by the conclusion of six weeks duration. Further research is needed regarding the effectiveness of heavy resistance training for the treatment of elderly adults with musculoskeletal pain.
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Zacharias A, Pizzari T, Semciw AI, English DJ, Kapakoulakis T, Green RA. Gluteus medius and minimus activity during stepping tasks: Comparisons between people with hip osteoarthritis and matched control participants. Gait Posture 2020; 80:339-346. [PMID: 32603886 DOI: 10.1016/j.gaitpost.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks. RESEARCH QUESTION Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults? METHODS Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks. RESULTS Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task. SIGNIFICANCE For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation.
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Affiliation(s)
- Anita Zacharias
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia.
| | - Tania Pizzari
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia; La Trobe University Sports and Exercise Medicine Research Centre, Victoria, Australia
| | - Adam I Semciw
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia; La Trobe University Sports and Exercise Medicine Research Centre, Victoria, Australia
| | - Daniel J English
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Fusion Physiotherapy, Bendigo, Victoria, Australia
| | | | - Rodney A Green
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia
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Moseng T, Dagfinrud H, van Bodegom-Vos L, Dziedzic K, Hagen KB, Natvig B, Røtterud JH, Vlieland TV, Østerås N. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskelet Disord 2020; 21:236. [PMID: 32284049 PMCID: PMC7155273 DOI: 10.1186/s12891-020-03235-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/25/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To address the well-documented gap between hip and knee osteoarthritis (OA) treatment recommendations and current clinical practice, a structured model for integrated OA care was developed and evaluated in a stepped-wedge cluster-randomised controlled trial. The current study used secondary outcomes to evaluate clinically important response to treatment through the Outcome Measures in Rheumatology Clinical Trials clinical responder criteria (OMERACT-OARSI responder criteria) after 3 and 6 months between patients receiving the structured OA care model vs. usual care. Secondly, the study aimed to investigate if the proportion of responders in the intervention group was influenced by adherence to the exercise program inherent in the model. METHODS The study was conducted in primary healthcare in six Norwegian municipalities. General practitioners and physiotherapists received training in OA treatment recommendations and use of the structured model. The intervention group attended a physiotherapist-led OA education program and performed individually tailored exercises for 8-12 weeks. The control group received usual care. Patient-reported pain, function and global assessment of disease activity during the last week were evaluated using 11-point numeric rating scales (NRS 0-10). These scores were used to calculate the proportion of OMERACT-OARSI responders. Two-level mixed logistic regression models were fitted to investigate differences in responders between the intervention and control group. RESULTS Two hundred eighty-four intervention and 109 control group participants with hip and knee OA recruited from primary care in six Norwegian municipalities. In total 47% of the intervention and 35% of the control group participants were responders at 3 or 6 months combined; showing an uncertain between-group difference (ORadjusted 1.38 (95% CI 0.41, 4.67). In the intervention group, 184 participants completed the exercise programme (exercised ≥2 times/week for ≥8 weeks) and 55% of these were classified as responders. In contrast, 28% of the 86 non-completers were classified as responders. CONCLUSIONS The difference in proportion of OMERACT-OARSI responders at 3 and 6 months between the intervention and control group was uncertain. In the intervention group, a larger proportion of responders were seen among the exercise completers compared to the non-completers. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02333656. Registered 7. January 2015.
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Affiliation(s)
- Tuva Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Krysia Dziedzic
- School for Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
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Østerås N, Moseng T, van Bodegom-Vos L, Dziedzic K, Mdala I, Natvig B, Røtterud JH, Schjervheim UB, Vlieland TV, Andreassen Ø, Hansen JN, Hagen KB. Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Med 2019; 16:e1002949. [PMID: 31613885 PMCID: PMC6793845 DOI: 10.1371/journal.pmed.1002949] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care. METHODS AND FINDINGS We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities (clusters) between January 2015 and October 2017. The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase. The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8-12 weeks. The primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0-100, 100 = optimal quality) at 6 months. Secondary outcomes included patient-reported referrals to physiotherapy, magnetic resonance imaging (MRI), and orthopaedic surgeon consultation; patients' satisfaction with care; physical activity level; and proportion of patients who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 of 80 general practitioners (mean age [SD] 50 [12] years, 42% females) and 37 of 64 physiotherapists (mean age [SD] 42 [8] years, 65% females) participated. They identified 531 patients, of which 393 patients (mean age [SD] 64 [10] years, 71% females) with symptomatic hip or knee OA were included. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The patients in the intervention group reported significantly higher quality of care (score of 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) and higher satisfaction with OA care (odds ratio [OR] 12.1; 95% CI 6.44, 22.72; p < 0.001) compared to patients in the control group. The increase in quality of care was close to, but below, the pre-specified minimal important change. In the intervention group, a higher proportion was referred to physiotherapy (OR 2.5; 95% CI 1.08, 5.73; p = 0.03), a higher proportion fulfilled physical activity recommendations (OR 9.3; 95% CI 2.87, 30.37; p < 0.001), and a lower proportion was referred to an orthopaedic surgeon (OR 0.3; 95% CI 0.08, 0.80; p = 0.02), as compared to the control group. There were no significant group differences regarding referral to MRI (OR 0.6; 95% CI 0.13, 2.38; p = 0.42) and proportion of patients who were overweight or obese (OR 1.3; 95% CI 0.70, 2.51; p = 0.34). Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals. CONCLUSIONS In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale. TRIAL REGISTRATION ClinicalTrials.gov NCT02333656.
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Affiliation(s)
- Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- * E-mail:
| | - Tuva Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Krysia Dziedzic
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Ibrahim Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | | | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Øyvor Andreassen
- Patient Research Panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jorun Nystuen Hansen
- Patient Research Panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Moseng T, Dagfinrud H, Østerås N. Implementing international osteoarthritis guidelines in primary care: uptake and fidelity among health professionals and patients. Osteoarthritis Cartilage 2019; 27:1138-1147. [PMID: 31075423 DOI: 10.1016/j.joca.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This paper evaluates the implementation fidelity of a strategy and intervention used to implement osteoarthritis (OA) treatment recommendations in primary care. We also evaluate uptake of core treatment (patient information, exercise and referral to weight management) among OA patients. DESIGN A stepped-wedge cluster-randomised controlled study (RCT) in primary care. The study involved general practitioners (GPs), physiotherapists (PTs) and patients with hip and/or knee OA in six Norwegian municipalities (clusters). Workshops for general practitioners (GPs) and PTs represented the main implementation activity. Uptake of core treatment (patient education, exercise and weight management) was evaluated using self-reported data from the patient intervention and control group, analysed with logistic regression models. Fidelity was evaluated using six components representing adherence to the content and dose instructions in the implementation strategy and assessed against a-priori criteria for high adherence. RESULTS Data were collected from 40 GPs, 37 PTs and 393 OA patients. The patient-reported data showed statistically significant higher uptake for exercise, patient education and referral to support for weight reduction, among the intervention group compared to the control group (P < 0.05). Evaluation of fidelity showed high adherence to GP and PT workshop attendance and physiotherapy use, partly adherence to PT knowledge after workshops, and low adherence to exercise attendance, dose and progression instructions. CONCLUSIONS The implementation strategy and intervention successfully improved OA patients' access to physiotherapy and uptake of recommended core treatment. However, the strategy was less effective in providing exercise programs with sufficient dose and progression and in supporting patients' adherence to the exercise program. TRIAL REGISTRATION ClinicalTrials.gov NCT02333656.
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Affiliation(s)
- T Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
| | - H Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
| | - N Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
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Unnanuntana A, Ruangsomboon P, Keesukpunt W. Validity and Responsiveness of the Two-Minute Walk Test for Measuring Functional Recovery After Total Knee Arthroplasty. J Arthroplasty 2018; 33:1737-1744. [PMID: 29454556 DOI: 10.1016/j.arth.2018.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The 2-minute walk test (2mwt) is a performance-based test that evaluates functional recovery after total knee arthroplasty (TKA). This study evaluated its validity compared with the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), modified Knee Score, Numerical Pain Rating Scale, and Timed Up and Go test, and its responsiveness in assessing functional recovery in TKA patients. METHODS This prospective cohort study included 162 patients undergoing primary TKA between 2013 and 2015. We used patient-reported outcome measures (modified WOMAC, OKS, modified Knee Score, Numerical Pain Rating Scale) and performance-based tests (2mwt and Timed Up and Go test) at baseline and 3, 6, and 12 months postoperatively. The construct validity of 2mwt was determined between the 2mwt distances walked and other outcome measurements. To assess responsiveness, effect size and standardized response mean were analyzed. Minimal clinically important difference of 2mwt at 12 months after TKA was also calculated. RESULTS All outcome measurements improved significantly from baseline to 3, 6, and 12 months postoperatively. Bivariate analysis revealed mild to moderate associations between the 2mwt and modified WOMAC function subscales, and moderate to strong associations with OKS. Mild to moderate correlations were found for pain and stiffness between 2mwt and other outcome measurements. The effect size and standardized response mean at 12 months were large, with a minimal clinically important difference of 12.7 m. CONCLUSION 2mwt is a validated performance-based test with responsiveness properties. Being simple and easy to perform, it can be used routinely in clinical practice to evaluate functional recovery after TKA.
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Affiliation(s)
- Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Ruangsomboon
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Coppack RJ, Bilzon JL, Wills AK, McCurdie IM, Partridge L, Nicol AM, Bennett AN. A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel - a protocol for a randomised controlled trial. BMC Musculoskelet Disord 2016; 17:459. [PMID: 27821103 PMCID: PMC5100075 DOI: 10.1186/s12891-016-1309-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/26/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Non-arthritic hip disorders are defined as abnormalities of the articulating surfaces of the acetabulum and femur before the onset of osteoarthritis, including intra-articular structures such as the acetabular labrum and chondral surfaces. Abnormal femoroacetabular morphology is commonly seen in young men who constitute much of the UK military population. Residential multidisciplinary team (MDT) rehabilitation for patients with musculoskeletal injuries has a long tradition in the UK military, however, there are no studies presenting empirical data on the efficacy of a residential MDT approach compared with individualised conventional outpatient treatment. With no available data, the sustainability of this care pathway has been questioned. The purpose of this randomised controlled trial is to compare the effects of a residential multidisciplinary intervention, to usual outpatient care, on the clinical outcomes of young active adults undergoing treatment for non-arthritic intra-articular hip pain. METHODS/DESIGN The trial will be conducted at the Defence Medical Rehabilitation Centre, Headley Court, UK. One hundred military male participants with clinical indicators of non-arthritic intra-articular hip pain will be randomly allocated to either: (1) 7-day residential multidisciplinary team intervention, n = 50; (2) 6-week physiotherapist-led outpatient intervention (conventional care), n = 50. Measurements will be taken at baseline, post-treatment (1-week MDT group; 6-weeks physiotherapy group), and 12-weeks. The primary outcome measures are the function in daily living sub-scale of the Copenhagen Hip and Groin Outcome Score (HAGOS), the physical function subscale of the Non-arthritic Hip Score (NAHS), and VAS pain scale. Secondary outcomes include objective measures of physical capacity and general health. An intention-to-treat analysis will be performed using linear and mixed models. DISCUSSION This study will be the first to assess the efficacy of intensive MDT rehabilitation, versus conventional outpatient care, for the management of non-arthritic hip pain. The results from this study will add to the evidence-base and inform clinical practice for the management of intra-articular non-arthritic hip pain and femoroacetabular impingement in young active adults. TRIAL REGISTRATION ISRCTN Reference: ISRCTN 59255714 dated 11-Nov-2015.
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Affiliation(s)
- Russell J. Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Andrew K. Wills
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ian M. McCurdie
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Laura Partridge
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Alastair M. Nicol
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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11
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Steinhilber B, Haupt G, Miller R, Janssen P, Krauss I. Exercise therapy in patients with hip osteoarthritis: Effect on hip muscle strength and safety aspects of exercise—results of a randomized controlled trial. Mod Rheumatol 2016; 27:493-502. [DOI: 10.1080/14397595.2016.1213940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Benjamin Steinhilber
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Georg Haupt
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Regina Miller
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Pia Janssen
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Inga Krauss
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
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12
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Brosseau L, Wells GA, Pugh AG, Smith CAM, Rahman P, Àlvarez Gallardo IC, Toupin-April K, Loew L, De Angelis G, Cavallo S, Taki J, Marcotte R, Fransen M, Hernandez-Molina G, Kenny GP, Regnaux JP, Lefevre-Colau MM, Brooks S, Laferriere L, McLean L, Longchamp G. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis. Clin Rehabil 2016; 30:935-946. [DOI: 10.1177/0269215515606198] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/22/2015] [Indexed: 12/13/2022]
Abstract
Objectives: The primary objective is to identify effective land-based therapeutic exercise interventions and provide evidence-based recommendations for managing hip osteoarthritis. A secondary objective is to develop an Ottawa Panel evidence-based clinical practice guideline for hip osteoarthritis. Methods: The search strategy and modified selection criteria from a Cochrane review were used. Studies included hip osteoarthritis patients in comparative controlled trials with therapeutic exercise interventions. An Expert Panel arrived at a Delphi survey consensus to endorse the recommendations. The Ottawa Panel hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) considered the study design (level I: randomized controlled trial and level II: controlled clinical trial), statistical significance ( p < 0.5), and clinical importance (⩾15% improvement). Results: Four high-quality studies were included, which demonstrated that variations of strength training, stretching, and flexibility exercises are generally effective for improving the management of hip osteoarthritis. Strength training exercises displayed the greatest improvements for pain (Grade A), disability (Grades A and C+), physical function (Grade A), stiffness (Grade A), and range of motion (Grade A) within a short time period (8–24 weeks). Stretching also greatly improved physical function (Grade A), and flexibility exercises improved pain (Grade A), range of motion (Grade A), physical function (Grade A), and stiffness (Grade C+). Conclusion: The Ottawa Panel recommends land-based therapeutic exercise, notably strength training, for management of hip osteoarthritis in reducing pain, stiffness and self-reported disability, and improving physical function and range of motion.
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Affiliation(s)
- Lucie Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arlanna G Pugh
- Department of Public Health Sciences, Queens University, Canada
| | - Christine AM Smith
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Prinon Rahman
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Karine Toupin-April
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Laurianne Loew
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gino De Angelis
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabrina Cavallo
- School of Public Health, Option Epidemiology, University of Montreal, Montreal, Quebec, Canada
| | - Jade Taki
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rachel Marcotte
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Marlene Fransen
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Philippe Regnaux
- Centre de recherche Epidémiologie et Biostatistique, Hôpital Hôtel-Dieu, Paris, France
| | | | - Sydney Brooks
- The Arthritis Society, Ontario Division, Ontario, Canada
| | - Lucie Laferriere
- Canadian Forces Health Services Group Headquarters, National Defense, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Coudeyre E, Jegu A, Giustanini M, Marrel J, Edouard P, Pereira B. Isokinetic muscle strengthening for knee osteoarthritis: A systematic review of randomized controlled trials with meta-analysis. Ann Phys Rehabil Med 2016; 59:207-215. [DOI: 10.1016/j.rehab.2016.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/11/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
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Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial. Phys Ther 2016; 96:818-27. [PMID: 26678445 DOI: 10.2522/ptj.20140520] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 12/06/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis (OA) is limited. OBJECTIVE The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion (ROM), muscle strength, physical fitness, walking capacity, and pain during walking in people with hip OA. DESIGN This was a secondary outcome analysis of a randomized clinical trial. SETTING The setting was a university hospital. PARTICIPANTS One hundred nine people with clinically and radiographically evident hip OA were randomly allocated to receive both exercise therapy and patient education (exercise group) or patient education only (control group). INTERVENTION All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists. Two other physical therapists were responsible for providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening, functional, and stretching exercises over 12 weeks. Both interventions were conducted at a sports medicine clinic. MEASUREMENTS Outcome measures included ROM, isokinetic muscle strength, predicted maximal oxygen consumption determined with the Astrand bicycle ergometer test, and distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware of group allocations. RESULTS No significant group differences were found for ROM, muscle strength, predicted maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but the exercise group had less pain during the 6MWT than the control group at 10 months (mean difference=-8.5 mm; 95% confidence interval=-16.1, -0.9) and 29 months (mean difference=-9.3 mm; 95% confidence interval=-18.1, -0.6). LIMITATIONS Limitations of the study were reduced statistical power and 53% rate of adherence to the exercise therapy program. CONCLUSIONS The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking capacity, but exercise in addition to patient education resulted in less pain during walking in the long term.
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Nguyen C, Lefèvre-Colau MM, Poiraudeau S, Rannou F. Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review. Ann Phys Rehabil Med 2016; 59:190-195. [PMID: 27155923 DOI: 10.1016/j.rehab.2016.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/21/2016] [Accepted: 02/28/2016] [Indexed: 10/21/2022]
Abstract
Rehabilitation is widely recommended in national and international guidelines for managing osteoarthritis (OA) in primary care settings. According to the 2014 OA Research Society International (OARSI) recommendations, rehabilitation is even considered the core treatment of OA and is recommended for all patients. Rehabilitation for OA widely includes land- and water-based exercise, strength training, weight management, self-management and education, biomechanical interventions, and physically active lifestyle. We performed a critical narrative review of the efficacy and safety of rehabilitation for managing OA and discuss evidence-based international recommendations. The process of article selection was unsystematic. Articles were selected based on authors' expertise, self-knowledge, and reflective practice. For the purpose of the review, we focused on land- and water-based exercise and strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere in this special issue. Exercise therapy is widely recommended for managing knee, hip and hand OA. However, the level of evidence varies according to OA location. Overall, consistent evidence suggests that exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore, because of the lack of specific studies, recommendations for hip and hand OA are mainly derived from studies of knee OA. In addition, no recommendations have been established regarding the exercise regimen. The efficacy and safety of exercise therapy and strength training need to be further evaluated in randomized controlled trials of patients with hip and hand OA. The optimal delivery of exercise programs also has to be more clearly defined.
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Affiliation(s)
- Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
| | - Marie-Martine Lefèvre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Serge Poiraudeau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
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16
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Krauss I, Mueller G, Haupt G, Steinhilber B, Janssen P, Jentner N, Martus P. Effectiveness and efficiency of an 11-week exercise intervention for patients with hip or knee osteoarthritis: a protocol for a controlled study in the context of health services research. BMC Public Health 2016; 16:367. [PMID: 27129849 PMCID: PMC4851810 DOI: 10.1186/s12889-016-3030-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/21/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Osteoarthritis is the most common reason for pain in older adults, and the individual and economic burden of this disease is immense. The chronic character of osteoarthritis requires a long-term therapeutic treatment. In this regard life-style interventions such as physical exercises that can be carried out by the patient himself are recommended as first line treatment. There is evidence for the short-term benefit of exercise therapy in terms of pain reduction and physical functioning. Nonetheless research agendas highlight the need for multifaceted interventions that incorporate exercise strategies into patient care. Studies should be conducted with appropriate sample sizes and should allow statements on long-term effects as well as cost-utility and safety. These open questions are under the scope of this study. METHODS/DESIGN This is a controlled study in the context of health services research. The study population consists of n = 1400 subjects with hip or knee osteoarthritis. The intervention group will be recruited from participants of a country-wide health insurance offer for people with hip or knee osteoarthritis. Potential participants for the control group (ratio 10:1 (control vs. intervention) will be filtered out from the insurance data base according to pre-defined matching criteria and asked by letter for their participation. The final statistical twins from the responders (1:1) will be determined via propensity score matching. The progressive training intervention comprises 8 supervised group sessions, supplemented by home exercises (2/week over 11 weeks). Exercises include mobilization, strengthening and training of postural control. Primary outcomes are pain and function measured with the WOMAC Index immediately after the intervention period. Among other things, health related quality of life, self-efficacy, cost utility and safety will be evaluated as secondary outcomes. Participants will be followed up 6, 12 and 24 month after baseline. DISCUSSION Results of this trial will document the effects of clinical as well as economic outcomes in a regular health care setting on the basis of a large sample size. As such, results of this trial might have great impact on future implementations of group- and home-based exercises in hip or knee osteoarthritis. TRAIL REGISTRATION German Clinical Trial Register DRKS00009251 . Registered 10 September 2015.
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Affiliation(s)
- Inga Krauss
- Medical Clinic, Department of Sports Medicine, University Hospital, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany.
| | - Gerhard Mueller
- Allgemeine Ortskrankenkasse AOK, Baden-Wuerttemberg, Germany
| | - Georg Haupt
- Medical Clinic, Department of Sports Medicine, University Hospital, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
| | - Benjamin Steinhilber
- Medical Clinic, Department of Sports Medicine, University Hospital, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Pia Janssen
- Medical Clinic, Department of Sports Medicine, University Hospital, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
| | - Nicola Jentner
- Medical Clinic, Department of Sports Medicine, University Hospital, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital, Tuebingen, Germany
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Strand LI, Liland Olsen A, Nygard H, Furnes O, Heide Magnussen L, Lygren H, Sundal MA, Helvik Skjaerven L. Basic Body Awareness Therapy and patient education in hip osteoarthritis: a multiple case study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.3109/21679169.2015.1135982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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No effects of a 12-week supervised exercise therapy program on gait in patients with mild to moderate osteoarthritis: a secondary analysis of a randomized trial. J Negat Results Biomed 2015; 14:5. [PMID: 25886499 PMCID: PMC4355150 DOI: 10.1186/s12952-015-0023-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/12/2015] [Indexed: 12/16/2022] Open
Abstract
Background It is unknown whether gait biomechanics in hip osteoarthritis patients with mild to moderate symptoms change following exercise therapy interventions. The aim of the present study was to compare stance phase gait characteristics in hip osteoarthritis patients with mild to moderate symptoms participating in a randomized trial with two different interventions; patient education only or patient education followed by a 12-week supervised exercise therapy program. Results The study was conducted as a secondary analysis of a single-blinded randomized controlled trial. Patients aged 40 to 80 years, with hip osteoarthritis verified from self-reported pain and radiographic changes, were included. The final material comprised 23 patients (10 males/13 females, mean (SD) age 58.2 (10.02) years) in the patient education only group, and 22 patients (9 males/13 females, mean (SD) age 60.2 (9.49) years) in the patient education + exercise therapy group. Three-dimensional gait analysis was conducted at baseline and at four month follow-up. Sagittal and frontal plane joint angle displacement and external joint moments of the hip, knee and ankle were compared from a one-way analysis of covariance between the groups at follow-up, with baseline values as covariates (p < 0.05). No group differences were observed at the four-month follow-up in gait velocity, joint angle displacement, or moments. As the compliance in the exercise therapy group was inadequate, we calculated possible associations between the number of completed exercise sessions and change in each of the kinematic or kinetic variables. Associations were weak to neglible. Thus, the negative findings in this study cannot be explained from inadequate compliance alone, but most likely also suggest the exercise therapy program itself to be insufficient to engender gait alterations. Conclusions Adding a 12-week supervised exercise therapy program to patient education did not induce changes in our selected biomechanical variables during the stance phase of gait, even when adjusting for poor compliance. Thus, we did not find evidence to support our exercise therapy program to be an efficacious intervention to induce gait alterations in this population of hip osteoarthritis patients. Trial registration NCT00319423 at ClinicalTrials.gov (registration date 2006-04-26).
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Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol 2013; 1:1943-2008. [PMID: 23733694 DOI: 10.1002/cphy.c100057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.
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Affiliation(s)
- Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis 2013; 74:164-9. [PMID: 24255546 PMCID: PMC4283660 DOI: 10.1136/annrheumdis-2013-203628] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown. Methods We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA. Results regarding the primary outcome measure of the trial, self-reported pain at 16 months follow-up, have been reported previously. Results There were no group differences at baseline. The response rate at follow-up was 94%. 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period, giving a 6-year cumulative survival of the native hip of 41% and 25%, respectively (p=0.034). The HR for survival of the native hip was 0.56 (CI 0.32 to 0.96) for the exercise therapy group compared with the control group. Median time to THR was 5.4 and 3.5 years, respectively. The exercise therapy group had better self-reported hip function prior to THR or end of study, but no significant differences were found for pain and stiffness. Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip OA. ClinicalTrials.gov number NCT00319423 (original project protocol) and NCT01338532 (additional protocol for long-term follow-up).
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Affiliation(s)
- Ida Svege
- Department of Orthopaedics, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Oslo, Norway
| | - Lars Nordsletten
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Linda Fernandes
- Department of Orthopaedics, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Oslo, Norway Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense C, Denmark
| | - May Arna Risberg
- Department of Orthopaedics, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Oslo, Norway
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Abstract
With the aging of the work force, occupational health nurses must prepare for encounters with clients who are challenged by osteoarthritis or osteoporosis. Clients should be encouraged to exercise safely to promote functioning at home and work. This article reviews recent literature on the benefits of exercise for workers with osteoarthritis, osteoporosis, or both.
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Garrison D. Osteoarthritis, Osteoporosis, and Exercise. Workplace Health Saf 2012. [DOI: 10.3928/21650799-20120828-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Performance-based tests and self-reported questionnaires provide distinct information for the preoperative evaluation of total hip arthroplasty patients. J Arthroplasty 2012; 27:770-5.e1. [PMID: 21958935 DOI: 10.1016/j.arth.2011.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 08/04/2011] [Indexed: 02/01/2023] Open
Abstract
Our objectives were to assess relationships between self-reported questionnaires and 2-minute walk test (2MWT) and timed get-up-and-go test (TUG) in preoperative total hip arthroplasty patients. A total of 162 patients completed the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 36 and performed 2MWT and TUG. Correlations between self-reported questionnaires and 2MWT and TUG were mild to moderate, indicating that the 2MWT and TUG capture additional dimensions of preoperative total hip arthroplasty function not measured by the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 36. Use of walking aids, female sex, and presence of other painful joints were significantly associated with 2MWT, whereas older age and additional painful joints were significantly associated with TUG. These 2 tests are easy to perform in clinical practice and contribute to a comprehensive assessment of preoperative status.
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Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J. The intensity and effects of strength training in the elderly. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:359-64. [PMID: 21691559 PMCID: PMC3117172 DOI: 10.3238/arztebl.2011.0359] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 03/14/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The elderly need strength training more and more as they grow older to stay mobile for their everyday activities. The goal of training is to reduce the loss of muscle mass and the resulting loss of motor function. The dose-response relationship of training intensity to training effect has not yet been fully elucidated. METHODS PubMed was selectively searched for articles that appeared in the past 5 years about the effects and dose-response relationship of strength training in the elderly. RESULTS Strength training in the elderly (>60 years) increases muscle strength by increasing muscle mass, and by improving the recruitment of motor units, and increasing their firing rate. Muscle mass can be increased through training at an intensity corresponding to 60% to 85% of the individual maximum voluntary strength. Improving the rate of force development requires training at a higher intensity (above 85%), in the elderly just as in younger persons. It is now recommended that healthy old people should train 3 or 4 times weekly for the best results; persons with poor performance at the outset can achieve improvement even with less frequent training. Side effects are rare. CONCLUSION Progressive strength training in the elderly is efficient, even with higher intensities, to reduce sarcopenia, and to retain motor function.
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Affiliation(s)
- Frank Mayer
- Hochschulambulanz der Universität Potsdam, Zentrum für Freizeit-, Gesundheits- und Leistungssport, Germany.
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Juhakoski R, Tenhonen S, Malmivaara A, Kiviniemi V, Anttonen T, Arokoski JPA. A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis. Clin Rehabil 2010; 25:370-83. [PMID: 21078702 DOI: 10.1177/0269215510388313] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the short- and long-term effectiveness of exercise training in relation to pain, function and direct costs to health care systems attributable to hip osteoarthritis. DESIGN Prospective, two-year randomized controlled trial. SETTING An outpatient primary health care setting. SUBJECTS One hundred and twenty men and women aged from 55 to 80, with radiologically diagnosed hip osteoarthritis with associated clinical symptoms. INTERVENTIONS The combined exercise and general practitioner (GP) care group received 12 supervised (once per week) exercise sessions at the baseline and four additional booster sessions one year later. Both groups received standard GP care. MAIN MEASURES The WOMAC Osteoarthritis Index, physical functioning score of RAND-36 (SF-36), the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis, number of total hip replacements, the use of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs), performance-based outcome scores and body mass index (BMI). RESULTS There were no differences between the groups with respect to WOMAC hip pain, physical functioning score of RAND-36, performance-based outcome scores or BMI. The effect of the exercise intervention on WOMAC function was statistically significant at 6 months (mean = -7.5; 95% confidence interval (CI) -13.9 to -1.0; P = 0.02) and 18 months (mean = -7.9; 95% CI -15.3 to -0.4; P = 0.04). There were no statistically significant differences in the total health care system costs between the groups. CONCLUSION The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period.
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Affiliation(s)
- Riikka Juhakoski
- Department of Physical and Rehabilitation Medicine, Mikkeli Central Hospital, Mikkeli
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Fernandes L, Storheim K, Sandvik L, Nordsletten L, Risberg MA. Efficacy of patient education and supervised exercise vs patient education alone in patients with hip osteoarthritis: a single blind randomized clinical trial. Osteoarthritis Cartilage 2010; 18:1237-43. [PMID: 20633669 DOI: 10.1016/j.joca.2010.05.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/21/2010] [Accepted: 05/29/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of patient education and supervised exercise with that of patient education alone for the management of pain in patients with hip osteoarthritis (OA). DESIGN Single blind randomized clinical trial. SETTING Recruitment of patients from hospitals, primary health care and advertisement, Oslo, Norway. PARTICIPANTS 109 patients with radiographic and symptomatic hip OA with mild to moderate symptoms. INTERVENTIONS Patient education (PE). Patient education and supervised exercise (PE+SE). PRIMARY OUTCOME MEASURE The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC pain). RESULTS No significant between group differences were found for WOMAC pain over the 16-month follow-up. Significant improvements were found for the secondary outcome WOMAC physical function (P=0.011) in the group receiving PE+SE compared to the group receiving PE only. No significant differences were found for WOMAC stiffness, the SF-36 subscales or the activity scale. The effect sizes (95% confidence interval) for WOMAC pain were -0.26 (0.11, -0.64), -0.35 (0.07, -0.77), and -0.30 (0.15, -0.75), and for WOMAC physical function -0.29 (0.09, -0.67), -0.48 (-0.06, -0.91), and -0.47 (-0.02, -0.93) at 4, 10 and 16 months, respectively, in favor of the group receiving both PE and SE. All patients attended the three-session PE program, and 75% performed ≥16 sessions of the 12-week SE program. CONCLUSION The study could not demonstrate a significant difference in pain reduction over time between PE+SE vs PE alone. Adding SE to PE may improve physical function, but the magnitude of possible benefit is unknown as the 95% confidence intervals around the mean difference were wide. TRIAL REGISTRATION Clinical Trials NCT00319423.
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Affiliation(s)
- L Fernandes
- Norwegian Research Center for Active Rehabilitation (NAR), Department of Orthopedics, Oslo University Hospital, Oslo, Norway.
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