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Isaji Y, Kurasawa Y, Sasaki D, Hayashi M, Kitagawa T. Psychological intervention for knee osteoarthritis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2025; 30:636-662. [PMID: 39873210 DOI: 10.1080/13548506.2025.2454039] [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] [Academic Contribution Register] [Received: 09/17/2024] [Accepted: 01/09/2025] [Indexed: 01/30/2025]
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions compared to standard rehabilitation in patients with knee osteoarthritis (OA). Given the recognized influence of psychological factors in OA management, the review assessed their impact on pain, functional disability, and self-efficacy. A comprehensive search was performed across multiple databases, including PubMed, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, Web of Science, OpenGrey, and ClinicalTrials.gov, covering records from inception to September 2023. Eligible studies were randomized controlled trials that examined psychological interventions such as cognitive-behavioral therapy and biofeedback in adults with knee OA diagnosed based on established clinical or radiological criteria. Studies with mixed populations were included only if at least 75% of participants had OA. Exclusion criteria included studies focused on surgical patients or individuals with systemic conditions (e.g. rheumatoid arthritis). No restrictions were placed on intervention duration, allowing for a broad range of studies to be considered. From the 3,649 records identified, 70 studies met the inclusion criteria, and 20 studies involving 3,138 participants were included in the meta-analysis. The results demonstrated that psychological interventions led to significant improvements in pain (mean difference [MD]: -1.04; 95% confidence interval [CI]: -1.61 to -0.46), disability and function (standardized mean difference [SMD]: -0.26; 95% CI: -0.38 to -0.15), and self-efficacy (SMD: 0.49; 95% CI: 0.28 to 0.70). The strongest effects were observed in self-efficacy. However, concerns regarding methodological limitations, variability in intervention approaches, and high heterogeneity led to the evidence quality being rated as low to very low. This review underscores the potential benefits of psychological interventions in knee OA management, particularly for enhancing self-efficacy. Nonetheless, further high-quality research employing standardized protocols is needed to validate these findings and facilitate their clinical application.
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Affiliation(s)
- Yuichi Isaji
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Yasuyuki Kurasawa
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Daisuke Sasaki
- Department of Rehabilitation, Iwami Medical Clinic, Masuda, Japan
| | - Masateru Hayashi
- Department of Rehabilitation, Matsuoka Orthopedic Surgery and Internal Medicine Rehabilitation, Gifu, Japan
| | - Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
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March MK, Roberts KE. Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context. BMC Musculoskelet Disord 2024; 25:998. [PMID: 39639261 PMCID: PMC11619146 DOI: 10.1186/s12891-024-08107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/29/2023] [Accepted: 11/22/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care. ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery. IMPLEMENTATION OF PSYCHOSOCIAL CARE Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities. CONCLUSION This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Marcel Cres, Blacktown, NSW, 2148, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Katharine E Roberts
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
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Tan BY, Yang SY, Pereira MJ, Tan CY, Lim CJ, Ng JP, Lee KT, Pua YH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, Car J. Collaborative model of care between orthopaedics and allied healthcare professionals (CONNACT) in knee osteoarthritis: Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention. Osteoarthritis Cartilage 2024; 32:972-981. [PMID: 38710437 DOI: 10.1016/j.joca.2024.04.018] [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] [Academic Contribution Register] [Received: 08/30/2023] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA). METHODS Pragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS4) ≤75) were enrolled. Primary outcome was KOOS4 at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modeling were conducted. Economic evaluation through a societal approach was embedded. RESULTS 110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: -1.86 [-9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group. CONCLUSION CONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03809975. Registered January 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03809975.
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Affiliation(s)
- Bryan Y Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore; Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, Singapore
| | | | - Chun Yue Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Julia P Ng
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Andrew M Briggs
- Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Soren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Pires DPDC, Monte FAD, Monteiro LF, Soares FRDC, Faria JLRD. Updates in the Treatment of Knee Osteoarthritis. Rev Bras Ortop 2024; 59:e337-e348. [PMID: 38911892 PMCID: PMC11193585 DOI: 10.1055/s-0044-1786351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/22/2022] [Accepted: 07/21/2023] [Indexed: 06/25/2024] Open
Abstract
Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings.
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Affiliation(s)
| | - Felipe Alves do Monte
- Departamento de Ortopedia e Traumatologia, Hospital da Restauração Governador Paulo Guerra, Recife, PE, Brasil
| | | | - Francisco Rafael do Couto Soares
- Serviço de Traumatologia e Ortopedia, Hospital Metropolitano Norte Miguel Arraes (HMA), Recife, PE, Brasil
- Serviço de Traumatologia e Ortopedia, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brasil
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Chen Q, Liu Q, Wang W. Application effect of behavioral cognition combined with psychological intervention on orthodontic patients: A prospective, randomized, controlled trial. Medicine (Baltimore) 2024; 103:e37131. [PMID: 38306509 PMCID: PMC10843585 DOI: 10.1097/md.0000000000037131] [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] [Academic Contribution Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024] Open
Abstract
To explore the application effect of behavioral cognition combined with psychological intervention in orthodontic patients, so as to provide new ideas for clinical nursing of orthodontic patients. The 70 patients with orthodontic treatment were divided into 2 groups: the control group and the nursing group. Control group received routine clinical intervention, was treated with the normal clinical intervention, while nursing group was treated with behavior cognition and psychology intervention. The orthodontic effects of the 2 groups were evaluated, and the mental state, health behavior, gum swelling and pain were compared between the 2 groups before and after care. The cure rate of orthodontic treatment in the nursing group was significantly higher than that in the control group (P < .05). At 12 months after intervention, the nursing group scored lower than the control group on the Hamilton Anxiety Scale and the Hamilton Depression Scale (P < .05), and the score of Health Promotion Lifestyle Profile-II was higher than that in the control group (P < .05). After intervention, the degree of gum swelling and pain in 2 group were notably relieved, and the alleviation degree of nursing group was better than that of control group (P < .05). Compared with normal clinical intervention, the behavioral cognition combined with psychological intervention have obvious improvement in mental state and health behavior of orthodontic patients, and can reduce the symptoms of gum swelling and pain, promote the recovery of gum, showing high clinical application value in improving the gingival health of patients.
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Affiliation(s)
- Qing Chen
- Department of Stomatology, The Affiliated Hospital of Jinggangshan University, Ji'an Clinical Medical Research Center of Oral Diseases, Ji'an, Jiangxi, China
| | - Qingwen Liu
- Department of Stomatology, The Affiliated Hospital of Jinggangshan University, Ji'an Clinical Medical Research Center of Oral Diseases, Ji'an, Jiangxi, China
| | - Wei Wang
- Department of Stomatology, The Affiliated Hospital of Jinggangshan University, Ji'an Clinical Medical Research Center of Oral Diseases, Ji'an, Jiangxi, China
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Rękas-Dudziak A, Brzeziński K, Kotlińska-Hasiec E, Dąbrowski W, Matuła P, Płotek W. A retrospective assessment of the effectiveness of pulsed radiofrequency ablation in the treatment of chronic pain caused by advanced knee osteoarthritis. Anaesthesiol Intensive Ther 2024; 56:151-159. [PMID: 39166507 PMCID: PMC11284582 DOI: 10.5114/ait.2024.139860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION Patients suffering from severe chronic pain often have problems finding an appropriate combination of painkillers. We retrospectively evaluated the effectiveness and safety of pulsed radiofrequency ablation (pRFA) of the genicular nerves in 96 patients with knee osteoarthritis (KO). We hypothesized that age, sex, and body mass index (BMI) may influence the quality of the pRFA treatment. MATERIAL AND METHODS A diagnostic blockade with total volume of 9 ml of 1% lidocaine (WZF, Poland) combined with 4 mg of dexamethasone with subsequent pRFA with a radio frequency of 300-500 kHz under ultrasound guidance was used during the procedure. The study participants were assessed during regular monthly visits until 12 months. RESULTS The nerves' ultrasound identification was successful in 90.62% of the cases. According to the numeric rating scale (NRS), pain was reduced by 50% or more in 64.06% of the cases. The average pain relief period lasted just over 7 and a half months. There were no pRFA-related complications or side effects of the drugs used. CONCLUSIONS pRFA seems to be safe and effective for the treatment of chronic pain in KO. The outcome of the treatment may be related to the patient's age (block duration increased with patient age) and sex (in women, the therapeutic effect was more effectively prolonged) in our study group. There was also higher effectiveness of pRFA in high-BMI patients, which was close to statistical significance ( P = 0.053).
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Affiliation(s)
- Anna Rękas-Dudziak
- Department of Anaesthesiology and Intensive Therapy, Ludwik Bierkowski Independent Healthcare Centre of the Ministry of the Interior, Poznań, Poland
| | | | - Edyta Kotlińska-Hasiec
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Wojciech Dąbrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Przemysław Matuła
- Institute of Mathematics, University of Maria Curie-Skłodowska, Lublin, Poland
| | - Włodzimierz Płotek
- Clinic of Anaesthesiology and Intensive Therapy; Clinical Hospital nr 4, Lublin, Poland
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Bowden JL, Hunter DJ, Mills K, Allen K, Bennell K, Briggs AM, Dziedzic K, Hinman RS, Kim JS, Martinez N, Quicke JG, Tan Yijia B, van der Esch M, Verges J, Eyles J. The OARSI Joint Effort Initiative: Priorities for osteoarthritis management program implementation and research 2024-2028. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100408. [PMID: 37771392 PMCID: PMC10522998 DOI: 10.1016/j.ocarto.2023.100408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Objective The Joint Effort Initiative (JEI) is an international collaboration of clinicians, researchers, and consumer organisations with a shared vision of improving the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify JEI's future priorities and guide direction. Design A two-part international survey to prioritise topics of importance to our membership and research stakeholders. Survey one presented a list of 40 topics under 5 themes. Consenting participants were asked to choose their top three topics in each theme. A short list of 25 topics was presented in survey two. Participants were asked to rank the importance (100-point NRS scale, 100 = highest priority). Response frequency (median, IQR) was used to rank the top priorities by theme. Results Ninety-five participants completed survey one (61% female, 48% clinicians) and 57 completed survey two. The top ranked topic/s were:i. Promotion and advocacy: support training for health professionals (median 85, IQR 24).ii. Education and training: incorporating behaviour change into OAMPs (80, 16), advanced OA skills (80, 30), and integration of OA education into clinical training (80, 36).iii. Improving OAMPs delivery: regular updates on changes to best-evidence OA care (84, 24).iv. Future research: improve uptake of exercise, physical activity, and weight-loss (89, 16).v. Enhancing relationships, alliances, and shared knowledge: promote research collaborations (81, 30), share challenges and opportunities for OAMP implementation (80, 23). Conclusions These topics will set the JEI's research and collaboration agenda for the next 5 years and stimulate ideas for others working in the field.
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Affiliation(s)
- Jocelyn L. Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Kathryn Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Kelli Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Durham Department of Veterans Affairs Health Care System, USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - K. Dziedzic
- Impact Accelerator Unit, School of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nina Martinez
- Department of Research and Development, Osteoarthritis Foundation International, Barcelona, Spain
| | - Jonathan G. Quicke
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Bryan Tan Yijia
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - Josep Verges
- President of the Osteoarthritis Foundation International, Barcelona, Spain
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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Opava CH, Kindblom K, Rao K, Thorstensson CA, Swärdh E. Challenges of transforming evidence-based management of osteoarthritis into clinical practice in rural central Western India. Perceptions of an educational program. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2014. [PMID: 37170720 DOI: 10.1002/pri.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/22/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT). Our study aimed to describe Indian PTs' knowledge, attitudes and confidence on evidence-based management of OA, and their perceptions of a course on this subject. METHODS The 2-day course included didactic parts and practical skills training. Thirty-five PTs participated and answered a questionnaire. Fourteen of them participated in focus group interviews. Questionnaire data are presented as medians and full ranges. Manifest content analysis was used to analyze interview data that are presented as catagories illustrated by interview quotes. The formal ethics permission was granted. RESULTS 74% of PTs agreed that radiography determines the type of treatment required, and 69% agreed that a prescription for exercise is enough to ensure adherence. PTs agreed (mean 5 on 6-point scale) that exercises increasing pain should be advised against. Confidence in guiding the physical activity was generally high (≥5 on 6-point scales). Five categories reflected participants' perceptions of the course content: Shift in management focus, Need for cultural adaptation, Importance of social support, Development of organization and collaboration, and Feelings of hesitation. DISCUSSION Our results indicate that in order to facilitate the implementation of CPGs, PT curricula may consider the inclusion of knowledge on CPGs, focus more on students' own reflections on transforming theory into practice, and incorporate training of basic skills required for implementation of self-management, body awareness, and neuromuscular fitness. If given access and mandates, PTs may play a major role in the early diagnosis and treatment of OA and thus contribute to the prevention of an epidemic of OA in India.
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Affiliation(s)
- Christina H Opava
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Kristina Kindblom
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Keerthi Rao
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Carina A Thorstensson
- Institute of Neuroscience and Physiology, Gothenburg University, Goteborg, Sweden
- Department of Research and Development, Halland County Council, Varberg, Sweden
| | - Emma Swärdh
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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King LK, Ivers NM, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, Wong S, Weisman A, Bardai Z, Ross S, Brady S, Shloush M, Stier T, Gakhal N, Agarwal P, Parsons J, Lipscombe L, Hawker GA. Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention. Implement Sci Commun 2023; 4:20. [PMID: 36855209 PMCID: PMC9972628 DOI: 10.1186/s43058-023-00398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/16/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Symptomatic knee osteoarthritis (OA) commonly co-occurs in people with type 2 diabetes (T2DM) and increases the risk for diabetes complications, yet uptake of evidence-based treatment is low. We combined theory, stakeholder involvement and existing evidence to develop a multifaceted intervention to improve OA care in persons with T2DM. This was done in partnership with Arthritis Society Canada to leverage the existing infrastructure and provincial funding for community arthritis care. METHODS Each step was informed by a User Advisory Panel of stakeholder representatives, including persons with lived experience. First, we identified the target groups and behaviours through consulting stakeholders and current literature. Second, we interviewed persons living with T2DM and knee OA (n = 18), health professionals (HPs) who treat people with T2DM (n = 18) and arthritis therapists (ATs, n = 18) to identify the determinants of seeking and engaging in OA care (patients), assessing and treating OA (HPs) and considering T2DM in OA treatment (ATs), using the Theoretical Domains Framework (TDF). We mapped the content to behavioural change techniques (BCTs) to identify the potential intervention components. Third, we conducted stakeholder meetings to ascertain the acceptability and feasibility of intervention components, including content and modes of delivery. Fourth, we selected intervention components informed by prior steps and constructed a programme theory to inform the implementation of the intervention and its evaluation. RESULTS We identified the barriers and enablers to target behaviours across a number of TDF domains. All stakeholders identified insufficient access to resources to support OA care in people with T2DM. Core intervention components, incorporating a range of BCTs at the patient, HP and AT level, sought to identify persons with knee OA within T2DM care and refer to Arthritis Society Canada for delivery of evidence-based longitudinal OA management. Diverse stakeholder input throughout development allowed the co-creation of an intervention that appears feasible and acceptable to target users. CONCLUSIONS We integrated theory, evidence and stakeholder involvement to develop a multifaceted intervention to increase the identification of knee OA in persons with T2DM within diabetes care and improve the uptake and engagement in evidence-based OA management. Our partnership with Arthritis Society Canada supports future spread, scalability and sustainability. We will formally assess the intervention feasibility in a randomized pilot trial.
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Affiliation(s)
- Lauren K. King
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Noah M. Ivers
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Esther J. Waugh
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Crystal MacKay
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Ian Stanaitis
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Owen Krystia
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Sim Wong
- Patient Research Partner, Toronto, ON Canada
| | - Alanna Weisman
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Zahra Bardai
- grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Susan Ross
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Shawn Brady
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Marlee Shloush
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Tara Stier
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Natasha Gakhal
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Payal Agarwal
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Janet Parsons
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada ,grid.415502.7Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Lorraine Lipscombe
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Gillian A. Hawker
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
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Ekediegwu EC, Akpaenyi CE, Nwosu IB, Onyeso OK. Demographic and disease characteristics associated with pain intensity, kinesiophobia, balance, and fall self-efficacy among people with osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:544. [PMID: 35668383 PMCID: PMC9172058 DOI: 10.1186/s12891-022-05486-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/14/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a common degenerative joint disease leading to significant pain, mobility limitation, economic burden, reduced quality of life, and disability among adults globally. Psychological factors related to pain intensity (PI), kinesiophobia, fall self-efficacy (FSE), and balance may lead to a poor OA prognosis. This study was designed to explore the association between PI, kinesiophobia, FSE, balance, and age, gender, marital status, site of OA, duration, symmetry, comorbidity, and adaptive behaviours among patients with knee or hip OA. METHODS This cross-sectional study involved 70 purposively selected participants aged 59.91 ± 11.12 years. Numeric pain rating scale, Tampa scale for kinesiophobia, fall-efficacy scale, and timed up and go test were used to measure PI, kinesiophobia, FSE, and balance, respectively. Statistical analyses were completed with the Pearson correlation test, independent samples t-test, and multiple linear regression. RESULTS The participants were mainly women (n = 59, 84.3%). However, there was no gender difference in the reported PI, kinesiophobia, FSE, and balance. There was a significant correlation between FSE and balance (r = 0.422, p<0.001). Kinesiophobia was significantly associated with the presence of comorbidity (β = 0.240, p = 0.001) and knee OA (β = 0.208, p<0.042). There was an association between FSE and the use of a walking aid (β = -0.442, p<0.042), stop-for-rest during walking (β = -0.292, p = 0.002), presence of comorbidity (β = 0.209, p = 0.014), and bilateral lower limb OA (β = 0.167, p = 0.057). Balance was associated with the use of a walking aid (β = -0.421, p<0.001) and stop-for-rest during walking (β = - 0.294, p = 0.006). CONCLUSION Osteoarthritis-related psychological distress affects both men and women. This study support integration of psychological outcomes in the assessment, management, and follow-up of people with lower limb osteoarthritis. Moreover, comorbidity worsened psychological distress among people with osteoarthritis. Therefore, the traditional biomedical management of osteoarthritis can be optimised by timely diagnosis and treatment of comorbidities, and the inclusion of psychotherapy.
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Affiliation(s)
- Ezinne Chika Ekediegwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria
| | - Chigbogu Earnest Akpaenyi
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria
| | - Ifeoma Blessing Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria
| | - Ogochukwu Kelechi Onyeso
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria.
- Prentice Institute for Global Population and Economy, University of Lethbridge, Lethbridge, Alberta, Canada.
- Population Studies in Health, Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada.
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11
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Liu H, Hu J, Zheng Q, Feng X, Zhan F, Wang X, Xu G, Hua F. Piezo1 Channels as Force Sensors in Mechanical Force-Related Chronic Inflammation. Front Immunol 2022; 13:816149. [PMID: 35154133 PMCID: PMC8826255 DOI: 10.3389/fimmu.2022.816149] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/16/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022] Open
Abstract
Mechanical damage is one of the predisposing factors of inflammation, and it runs through the entire inflammatory pathological process. Repeated or persistent damaging mechanical irritation leads to chronic inflammatory diseases. The mechanism of how mechanical forces induce inflammation is not fully understood. Piezo1 is a newly discovered mechanically sensitive ion channel. The Piezo1 channel opens in response to mechanical stimuli, transducing mechanical signals into an inflammatory cascade in the cell leading to tissue inflammation. A large amount of evidence shows that Piezo1 plays a vital role in the occurrence and progression of chronic inflammatory diseases. This mini-review briefly presents new evidence that Piezo1 responds to different mechanical stresses to trigger inflammation in various tissues. The discovery of Piezo1 provides new insights for the treatment of chronic inflammatory diseases related to mechanical stress. Inhibiting the transduction of damaging mechanical signals into inflammatory signals can inhibit inflammation and improve the outcome of inflammation at an early stage. The pharmacology of Piezo1 has shown bright prospects. The development of tissue-specific Piezo1 drugs for clinical use may be a new target for treating chronic inflammation.
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Affiliation(s)
- Hailin Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialing Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qingcui Zheng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaojin Feng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fenfang Zhan
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xifeng Wang
- Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guohai Xu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fuzhou Hua
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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