Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials

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

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.

Updates in the Treatment of Knee Osteoarthritis

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.

Application effect of behavioral cognition combined with psychological intervention on orthodontic patients: A prospective, randomized, controlled trial

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.

The OARSI Joint Effort Initiative: Priorities for osteoarthritis management program implementation and research 2024-2028

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.

Challenges of transforming evidence-based management of osteoarthritis into clinical practice in rural central Western India. Perceptions of an educational program

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.

Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

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.

Demographic and disease characteristics associated with pain intensity, kinesiophobia, balance, and fall self-efficacy among people with osteoarthritis: a cross-sectional study

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.

Piezo1 Channels as Force Sensors in Mechanical Force-Related Chronic Inflammation

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.