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Ghazni Khan MA, Sulaiman MA, Zahid M, Kumar S, Ahmad T. Role of tourniquet release timing on blood loss and functional outcomes in total knee arthroplasty: Insights from a low- and middle-income country. J Exp Orthop 2024; 11:e12075. [PMID: 39050594 PMCID: PMC11267165 DOI: 10.1002/jeo2.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose To identify the effect of releasing a tourniquet before versus after wound closure in total knee arthroplasty (TKA) on blood loss, functional outcome and postoperative complications. Methodology A prospective cohort study was conducted including 53 patients from May 2023 to September 2023. All patients underwent unilateral TKA and were divided into two groups based on surgeon preference of deflating tourniquet, Group A consisted of patients in whom the tourniquet was deflated before wound closure for haemostasis and Group B consisted of patients in which tourniquet was deflated after wound closure and compressive dressing. Blood loss was evaluated via intraoperative blood loss (the number of soaked sponges/gauzes, blood in a suction bottle, total output in a suction bottle-irrigation used) and on-field blood loss and calculated blood loss (Using Gross and Meunier's formula). The Functional outcome was evaluated using Knee injury and osteoarthritis score-42 questions. Early postoperative complications and differences in the requirement of blood transfusions were also assessed. Results There was a significant difference in intraoperative blood loss between the two groups. The median intraoperative blood loss was 135 mL (interquartile range [IQR]: 90-149) in Group A and 56.2 mL (IQR: 45-68) in Group B (p value: 0.001). However, no difference was found between the groups in calculated blood loss using Gross and Meunier's formula. The median calculated blood loss was 439 mL (IQR: 450-813) in Group A and 508 mL (IQR: 226-671) in group B (p value: 0.981). There was no significant difference between the groups in blood transfusion requirements or functional outcomes. Conclusion Based on our results, we conclude that the intraoperative blood loss in TKA is significantly different between the groups but only represents a fraction of true blood loss (23%). The timing of releasing the tourniquet does not affect functional outcomes, blood transfusion and postoperative morbidity; hence, any time can be opted as per surgeon preference. Level of Evidence Level II, prospective comparative study.
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Affiliation(s)
| | | | - Marij Zahid
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Suresh Kumar
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Tashfeen Ahmad
- Department of SurgeryAga Khan University HospitalKarachiPakistan
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Longo UG, Corradini A, Marchetti A, Di Sarno C, D’Angelo C, Arias C, De Marinis MG, de Sire A, Denaro V. I Am Afraid I Will Not Be Able to Walk, That Is What Worries Me-The Experience of Patients with Knee Osteoarthritis before Total Knee Arthroplasty: A Qualitative Study. J Clin Med 2024; 13:2878. [PMID: 38792420 PMCID: PMC11122229 DOI: 10.3390/jcm13102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Knee osteoarthritis is the most prevalent type of osteoarthritis. Patients frequently encounter pain triggered by movement that evolves into impaired joint function. Needing persistent rest or having night-time pain signifies advanced disease. Qualitative research is considered the most effective method for comprehending patients' needs and contexts. Methods: This study employed a qualitative research design, allowing the researchers to acquire insights into the patients' beliefs and values, and the contextual factors influencing the formation and expression of these beliefs and values. Results: A cohort of nine patients awaiting total knee replacement (TKR) surgery was included and they were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: "The existence of pain impedes the capacity to participate in daily life activities"; "TKR induced fears and uncertainties regarding the progression of the disease"; "Severe nighttime pain compromising sleep quality". Conclusions: This study analyzes the experiences of people awaiting TKR surgery, emphasizing the importance of addressing their unique needs to improve preoperative education and rehabilitation. In this way, patients' recovery during the postoperative phase can be improved.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Alessandra Corradini
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico University, 00128 Rome, Italy; (A.M.); (M.G.D.M.)
| | - Chiara Di Sarno
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Carlotta D’Angelo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Claudia Arias
- Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru;
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico University, 00128 Rome, Italy; (A.M.); (M.G.D.M.)
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
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Khatri C, Dhaif F, Ellard D, Rodrigues JN, Underwood M, Mitchell P, Metcalfe A. What recovery domains are important following a total knee replacement? A qualitative, interview-based study. BMJ Open 2024; 14:e080795. [PMID: 38724049 PMCID: PMC11086519 DOI: 10.1136/bmjopen-2023-080795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To explore people's views of recovery from total knee replacement (TKR) and which recovery domains they felt were important. DESIGN Semi-structured interviews exploring the views of individuals about to undergo or who have undergone TKR. A constant-comparative approach with thematic analysis was used to identify themes. The process of sampling, collecting data and analysis were continuous and iterative throughout the study, with interviews ceasing once thematic saturation was achieved. SETTING Tertiary care centre. PARTICIPANTS A purposive sample was used to account for variables including pre, early or late postoperative status. RESULTS 12 participants were interviewed, 4 who were preoperative, 4 early postoperative and 4 late postoperative. Themes of pain, function, fear of complications, awareness of the artificial knee joint and return to work were identified. Subthemes of balancing acute and chronic pain were identified. CONCLUSIONS The results of this interview-based study identify pain and function, in particular mobility, that were universally important to those undergoing TKR. Surgeons should consider exploring these domains when taking informed consent to enhance shared decision-making. Researchers should consider these recovery domains when designing interventional studies.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Fatema Dhaif
- Clinical Trials Unit, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - David Ellard
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | - Paul Mitchell
- Health Economics Bristol, University of Bristol, Bristol, UK
| | - Andrew Metcalfe
- Clinical Trials Unit, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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MacIntyre E, Braithwaite FA, Stanton TR. Painful distortions: people with painful knee osteoarthritis have biased visuospatial perception of the environment. Pain 2024:00006396-990000000-00577. [PMID: 38635468 DOI: 10.1097/j.pain.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Visuospatial perception is thought to be adaptive-ie, hills are perceived as steeper when capacity is low, or threat is high-guiding appropriate interaction with the environment. Pain (bodily threat) may similarly modulate visuospatial perception, with the extent of modulation influenced by threat magnitude (pain intensity, fear) and associated with behaviour (physical activity). We compared visuospatial perception of the environment between 50 people with painful knee osteoarthritis and 50 age-/sex-matched pain-free control participants using 3 virtual reality tasks (uphill steepness estimation, downhill steepness estimation, and a distance-on-hill measure), exploring associations between visuospatial perception, clinical characteristics (pain intensity, state and trait fear), and behaviour (wrist-worn accelerometry) within a larger knee osteoarthritis group (n = 85). People with knee osteoarthritis overestimated uphill (F1,485 = 19.4, P < 0.001) and downhill (F1,480 = 32.3, P < 0.001) steepness more so than pain-free controls, but the groups did not differ for distance-on-hill measures (U = 1273, P = 0.61). There was also a significant group x steepness interaction for the downhill steepness task (F4,480 = 3.11, P = 0.02). Heightened overestimation in people with knee osteoarthritis relative to pain-free controls increased as downhill slopes became steeper. Results were unchanged in a replication analysis using all knee osteoarthritis participants (n = 85), except the downhill steepness interaction was no longer significant. In people with knee osteoarthritis, higher state fear was associated with greater over-estimation of downhill slope steepness (rho = 0.69, P < 0.001), and greater visuospatial overestimation (distance-on-hill) was associated with lower physical activity levels (rho = -0.22, P = 0.045). These findings suggest that chronic pain may shift perception of the environment in line with protection, with overestimation heightened when threat is greater (steeper hills, more fearful), although impact on real-world behaviour is uncertain.
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Affiliation(s)
- Erin MacIntyre
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Unal N, Bektaş Akpinar N, Bek D, Yurtsever S. The Effect of Reiki on Pain, Functional Status, and Holistic Well-Being in Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Orthop Nurs 2024; 43:109-118. [PMID: 38546686 DOI: 10.1097/nor.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
Knee osteoarthritis (OA) is a chronic degenerative joint disease that causes pain and adversely affects functional status and holistic well-being. This randomized controlled trial investigated the effect of Reiki on pain, functional status, and holistic well-being in patients with knee OA. The sample consisted of 42 patients. The control group received standardized treatment only, whereas the intervention group received face-to-face Reiki (nine positions; 39 minutes) and distance Reiki on two consecutive days in addition to standardized treatment. The Reiki group had lower pain scores than the control group as measured by the Visual Analog Scale (p < .001) and the Western Ontario and McMaster Universities Arthritis Index pain score (p < .001). Those participating in the Reiki group had improved holistic well-being scores specifically for the subscales of Sadness, Perception of Sadness, Spiritual Disruption, Cognitive Awareness, and General mood. Reiki is a safe, noninvasive, and cost-effective alternative treatment technique that has the potential to reduce symptoms of pain and improve holistic well-being in patients with knee OA.
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Affiliation(s)
- Nursemin Unal
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Nilay Bektaş Akpinar
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Doğan Bek
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Sabire Yurtsever
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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Smith A, Olson RE, da Costa NC, Cuerton M, Hardy J, Good P. Quality of life beyond measure: Advanced cancer patients, wellbeing and medicinal cannabis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1709-1729. [PMID: 37283094 PMCID: PMC10946949 DOI: 10.1111/1467-9566.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
Experiences of advanced cancer are assembled and (re)positioned with reference to illness, symptoms and maintaining 'wellbeing'. Medical cannabis is situated at a borderline in this and the broader social domain: between stigmatised and normalised; recreational and pharmaceutical; between perception, experience, discourse and scientific proof of benefit. Yet, in the hyper-medicalised context of randomised clinical trials (RCTs), cancer, wellbeing and medical cannabis are narrowly assessed using individualistic numerical scores. This article attends to patients' perceptions and experiences at this borderline, presenting novel findings from a sociological sub-study embedded within RCTs focused on the use of medical cannabis for symptom relief in advanced cancer. Through a Deleuzo-Guattarian-informed framework, we highlight the fragmentation and reassembling of bodies and propose body-situated experiences of wellbeing in the realm of advanced cancer. Problematising 'biopsychosocial' approaches that centre an individualised disconnected patient body in understandings of wellbeing, experiences of cancer and potential treatments, our findings foreground relational affect and embodied experience, and the role of desire in understanding what wellbeing is and can be. This also underpins and enables exploration of the affective reassembling ascribed to medical cannabis, with particular focus on how it is positioned within RCTs.
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Affiliation(s)
- Alexandra Smith
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Rebecca E. Olson
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nathalia Cordeiro da Costa
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Maddison Cuerton
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Philip Good
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
- Department of Palliative CareSt. Vincent's Private Hospital BrisbaneBrisbaneQueenslandAustralia
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Burger M, Watson F, van Wyk A. A diarized journey: an interpretative phenomenological analysis of the older person's lived experience of a hip or knee replacement within a fast-track programme. BMC Geriatr 2023; 23:592. [PMID: 37743501 PMCID: PMC10518952 DOI: 10.1186/s12877-023-04276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND For the older person living with end-stage hip or knee osteoarthritis, a hip or knee replacement can be a traumatic event, influencing the physical, physiological, psychological, social and economic facets of daily living. This interpretative phenomenological study aimed to reveal and interpret the daily lived experiences of the older person before, during and after a primary total hip or knee replacement surgery in a fast-track programme in South Africa. METHODS A qualitative interpretive phenomenological study, collecting data through solicited diaries and reflexive member validation interviews from seven participants aged 65-75 years, who underwent a primary elective hip or knee replacement surgery. The surgical fast-track process and data collection process happened simultaneously. Data collection from the solicited diary started before surgery, continued during the surgery process and finished six weeks after surgery and this was followed with reflexive member validation interviews. Interpretative phenomenological analysis was used throughout the three phases of the fast-track programme. RESULTS Three superordinate themes developed during the three phases of surgery: "The holistic impact of pain on daily quality of life", "Finding ways to cope", and "Transition between independence and dependence and back". Although former research confirms the physical impact of osteoarthritis on the older person and the success of fast-track programmes for subsequent hip and knee replacements, this study contributes to the holistic impact of the surgery on participants' daily lives. The diarized journey of individuals through the psychological, psychosocial, physical, professional, and spiritual experience are described and interpreted in this study. CONCLUSIONS Across the solicited diaries, it was clear that pain as catalyst impacted the daily activities of the individual physically, psychologically, and psychosocially. Pain was subjectively present at different intensities during all the phases of the replacement surgery, impairing mobilization and triggering roller-coaster emotions. In order to cope with physical and emotional difficulties while preparing and adjusting to the environment, participants reflected on social support, physical and professional support, and spirituality. Throughout the preparation, hospitalization and the recovery process, the transition between independence, dependence, and back to independence was significant, reinforcing the individual's determination to recover.
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Affiliation(s)
- Marisa Burger
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa
| | - Francois Watson
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa.
| | - Annemarie van Wyk
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa
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Zacher S, Lauberger J, Thiel C, Lühnen J, Steckelberg A. Informed consent for total knee arthroplasty: exploration of patient`s information acquisition and decision-making processes-a qualitative study. BMC Health Serv Res 2023; 23:978. [PMID: 37697293 PMCID: PMC10494361 DOI: 10.1186/s12913-023-09993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an option for the treatment of knee osteoarthritis (OA). Patients have high expectations regarding the benefits of the actual operation. Patients can seek a second opinion on the indication for TKA. In a study, less than half of recommended TKAs were confirmed by the second opinion and conservative treatments are not fully utilized. Informed consent forms that are used in Germany usually do not meet the requirements to support informed decision-making. Our aim was to describe the process from the diagnosis of knee OA through the decision-making process to the informed consent process for TKA, and to understand when, how, and by whom decisions are made. Moreover, we wanted to describe patients' information needs and preferences about knee OA and its treatment, including TKA, and find out what information is provided. We also wanted to find out what information was important for decision-making and identify barriers and facilitators for the optimal use of evidence-based informed consent forms in practice. METHODS We chose a qualitative approach and conducted semi-structured interviews with patients who were going to receive, have received, or have declined TKA, and with general practitioners (GP), office-based as well as orthopaedists and anaesthesiologists in clinics who obtain informed consent. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. RESULTS We conducted interviews with 13 patients, three GPs, four office-based orthopaedists and seven doctors in clinics who had obtained informed consent. Information needs were modelled on subjective disease theory and information conveyed by the doctors. Patients in this sample predominantly made their decisions without having received sufficient information. Trust in doctors and experiences seemed to be more relevant in this sample than fact-based information. Office-based (GPs, orthopaedists) and orthopaedists in clinics had different understandings of their roles and expectations in terms of providing information. CONCLUSIONS We were able to identify structural barriers and assumptions that hinder the implementation of evidence-based informed consent forms.
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Affiliation(s)
- Sandro Zacher
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Julia Lauberger
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Carolin Thiel
- Medical Faculty, Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Julia Lühnen
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Anke Steckelberg
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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Vo NX, Che UTT, Ngo TTT, Bui TT. Economic Evaluation of Glucosamine in Knee Osteoarthritis Treatments in Vietnam. Healthcare (Basel) 2023; 11:2502. [PMID: 37761699 PMCID: PMC10531128 DOI: 10.3390/healthcare11182502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Osteoarthritis (OA) is the degeneration of cartilage in joints that results in bones rubbing against each other; it causes uncomfortable symptoms such as pain, swelling, and stiffness and can lead to disability. It usually occurs in the elderly and causes a large medical burden. The aim of this study is to evaluate the cost-effectiveness between the standard treatment for osteoarthritis and standard treatment with added crystalline glucosamine sulfate at various stages. Markov analysis modeling was applied to evaluate the effect of both adding glucosamine compared to standard treatment from a societal perspective during whole patients' lifetimes. Data input was collected from reviews in previous studies. The outcome was measured in quality-adjusted life years (QALYs), and the Incremental Cost-Effectiveness Ratio (ICER) from a societal perspective was applied with 3% and discounted for all costs and outcomes. One-way analysis via the Tornado diagram was performed to investigate the change in factors in the model. In general, adding glucosamine into the standard treatment proved to be more cost-effective compared to the standard treatment. Particularly, the early-stage addition of glucosamine in the treatment was cost-effective compared to the post-stage addition of glucosamine. The addition of supplementing crystalline glucosamine sulfate to the whole regimen at any stage was cost-effective at the willingness-to-pay (WTP) threshold.
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Affiliation(s)
- Nam Xuan Vo
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam; (U.T.T.C.); (T.T.T.N.)
| | - Uyen Thi Thuc Che
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam; (U.T.T.C.); (T.T.T.N.)
| | - Thanh Thi Thanh Ngo
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam; (U.T.T.C.); (T.T.T.N.)
| | - Tien Thuy Bui
- Faculty of Pharmacy, Le Van Thinh Hospital, Ho Chi Minh City 700000, Vietnam;
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Alanazi SA, Vicenzino B, Maclachlan LR, Smith MD. "It's like a nail being driven in the ankle": A qualitative study of individuals' lived experiences to inform a core domain set for ankle osteoarthritis. Musculoskelet Sci Pract 2023; 66:102813. [PMID: 37421757 DOI: 10.1016/j.msksp.2023.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Explore individuals' lived experience with ankle osteoarthritis and to identify health-related domains for ankle osteoarthritis based on the perspectives of people living with the condition, as an initial step to address the International Foot and Ankle Osteoarthritis Consortium's recommendation to develop a core domain set for ankle osteoarthritis. METHODS A qualitative study using semi-structured interviews was conducted. Interviews were undertaken with individuals with symptomatic ankle osteoarthritis who were aged ≥35 years. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-three individuals (16 females; mean (range) age 62 (42-80) years) were interviewed. Five themes were identified: pain, often severe, is a central feature of living with ankle osteoarthritis; stiffness and swelling are key symptoms; ankle osteoarthritis induced mobility impairments compromise enjoyment in life; ankle osteoarthritis instability and balance impairments lead to concerns about falling; there are financial implications of living with ankle osteoarthritis. We propose 17 domains based on individuals' experiences. CONCLUSION Study findings indicate that individuals with ankle osteoarthritis live with chronic ankle pain, stiffness and swelling which affect their ability to participate in physical, and social activities, maintain an active lifestyle, and work in physical occupations. From the data, we propose 17 domains that are important to people with ankle osteoarthritis. These domains require further evaluation to ascertain their inclusion in a core domain set for ankle osteoarthritis.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi Arabia. https://twitter.com/PTsultan_
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/Bill_Vicenzino
| | - Liam R Maclachlan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/LiamRobMac
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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Ferreira RM, Martins PN, Pimenta N, Gonçalves RS. Physical Therapists' Choices, Views and Agreements Regarding Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis Patients: A Mixed-Methods Study. Mediterr J Rheumatol 2023; 34:188-219. [PMID: 37654628 PMCID: PMC10466349 DOI: 10.31138/mjr.34.2.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 09/01/2023] Open
Abstract
Objective/Aims The aims of this study are to collect the most common non-pharmacological and non-surgical interventions used by the Portuguese physical therapists in their knee osteoarthritis patients, and to deeper understand the factors associated to their intervention choices. Methods This study incorporated a mixed-methods design. For the quantitative data it was choose an e-survey (with 25 close-end questions, plus general information of the study and a clinical vignette), retrieving sociodemographic and self-reported practice on knee osteoarthritis information. It was analysed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was chosen to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors and survey responses regarding the physical therapists' interventions chosen. After the interviews, the audios were collected, anonymised, transcribed verbatim, and the texts explored by the thematic approach. Results From the 277 PTs that shown interest in participating in the study, 120 fully completed the questionnaire and, from those, 10 participated in the interviews. The most chosen interventions included Resistance Exercise, Manual Therapy, Nutrition/Weight Loss, Self-care/Education, Stretching and Aquatic Exercise. Furthermore, it seems that PTs' individual characteristics (age, experience, and clinical reasoning), patient's characteristics (clinical findings and preferences), and work-related factors (facility type, work environment and available resources) are the main actors responsible for an intervention chosen. Conclusions In the Portuguese PTs context the most important interventions are Exercise, Manual Therapy, Nutrition/Weight Loss, and Self-care/Education; these interventions chosen may be influenced by PT, patient and work-related factors.
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Affiliation(s)
- Ricardo M. Ferreira
- Physical Exercise and Sports Department, Polytechnic Institute of Maia, N2i, Maia, Portugal
- Physical Therapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, São Martinho do Bispo, Coimbra, Portugal
| | - Pedro N Martins
- Physical Exercise and Sports Department, Polytechnic Institute of Maia, N2i, Maia, Portugal
- Physical Exercise and Sports Department, Polytechnic Institute of Bragança, Bragança, Portugal
| | - Nuno Pimenta
- Physical Exercise and Sports Department, Polytechnic Institute of Maia, N2i, Maia, Portugal
| | - Rui S. Gonçalves
- Physical Therapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, São Martinho do Bispo, Coimbra, Portugal
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A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100355. [PMID: 37020788 PMCID: PMC10068262 DOI: 10.1016/j.ocarto.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.
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14
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Khan SA, Parasher P, Ansari MA, Parvez S, Fatima N, Alam I. Effect of an Integrated Physiotherapy Protocol on Knee Osteoarthritis Patients: A Preliminary Study. Healthcare (Basel) 2023; 11:healthcare11040564. [PMID: 36833098 PMCID: PMC9956031 DOI: 10.3390/healthcare11040564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Exercise therapy can potentially relieve symptoms and improve functional status of the knee osteoarthritis population. Despite the proved practical benefits, there is no standard, comprehensive physiotherapeutic protocol available targeting the physical and physiological impairment cluster associated with disease. Osteoarthritis is a whole joint disease, affecting joint cartilage, ligaments, menisci and joint associated muscles, from variable pathophysiological processes. Hence, there is a need to develop a physiotherapy protocol to address the multi-structural physical, physiological and functional impairments associated with the disease. OBJECTIVE The objective of the present study is to evaluate the efficacy of designed, therapist supervised, patient education, progressive resistance exercises, passive stretching exercises, soft tissue manipulation, muscle energy technique, Maitland mobilization, aerobic exercise, and neuromuscular training physiotherapy protocol on pain, disability, balance, and physical functional performance in knee osteoarthritis patients. METHODOLOGY The preliminary study was conducted on a (n = 60) sample of convenience. The samples were randomly allocated into two study groups, intervention, and control group. The control group was advised on a basic home program. On the other hand, the treatment of the intervention group was designed with a therapist supervised Physiotherapy Protocol. The outcome variables studied were the Visual Analogue Scale, Modified WOMAC Scale, Timed Up and Go Test, Functional Reach Test, 40 m Fast Paced Walk Test, Stair Climb Test, 30 s Chair Stand Test. RESULTS The results of the study revealed a significant improvement among most of the studied outcome measures in the intervention group, hence the designed supervised physiotherapy protocol was found effective in relieving multiple physiological impairments associated with this whole joint disease.
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Affiliation(s)
| | - Prithvi Parasher
- Department of Physiotherapy, Jamia Hamdard, New Delhi 110062, India
| | | | - Suhel Parvez
- Department of Toxicology, SCLS, Jamia Hamdard, New Delhi 110062, India
| | - Noor Fatima
- Department of Biotechnology, SCLS, Jamia Hamdard, New Delhi 110062, India
- Department of Molecular Medicine, SIST, Jamia Hamdard, New Delhi 110062, India
| | - Iqbal Alam
- Department of Physiology, Hamdard Institute of Medical Sciences and Research, New Delhi 110062, India
- Correspondence:
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15
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O'Brien P, Prehn R, Green C, Lin I, Flanagan W, Conley B, Bessarab D, Coffin J, Choong PFM, Dowsey MM, Bunzli S. Understanding the Impact and Tackling the Burden of Osteoarthritis for Aboriginal and Torres Strait Islander People. Arthritis Care Res (Hoboken) 2023; 75:125-135. [PMID: 36214055 PMCID: PMC10952431 DOI: 10.1002/acr.25004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to understand and describe the lived experience of Aboriginal and Torres Strait Islander people with osteoarthritis. METHODS Qualitative study guided by cultural security, which ensures that research is conducted in a way that will not compromise the cultural values, beliefs, and expectations of Aboriginal and Torres Strait Islander people. Participants were purposively sampled through the networks of project staff. Research yarns (a cultural form of conversation used as a data gathering tool) were conducted with 25 Aboriginal and Torres Strait Islander adults with self-reported osteoarthritis in Western Australia and Victoria, Australia. Data were analyzed using a framework approach and presented through composite storytelling (hypothetical stories representing an amalgam of participants' experiences). RESULTS Two composite stories were constructed to reflect themes relating to beliefs and knowledge, impact, coping, and health care experiences. Common beliefs held by participants were that osteoarthritis is caused by previous physically active lifestyles. Many participants feared for their future, increasing disability and needing a wheelchair. Pain associated with osteoarthritis impacted daily activities, sleep, work, family, and social life and cultural activities. Multidimensional impacts were often experienced within complex health or life circumstances and associated with increased anxiety and depression. Most participants reported negative health care experiences, characterized by poor patient-provider communication. CONCLUSION Our findings highlight that osteoarthritis is a multidimensional issue for Aboriginal and Torres Strait Islander people that permeates all aspects of life and highlights the need for integrated, multidisciplinary care that is culturally informed and individualized to patient need.
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Affiliation(s)
- Penny O'Brien
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Ryan Prehn
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Charmaine Green
- The University of Western Australia, Western Australian Centre for Rural HealthGeraldtonWestern AustraliaAustralia
| | - Ivan Lin
- The University of Western Australia, Western Australian Centre for Rural HealthGeraldtonWestern AustraliaAustralia
| | - Wanda Flanagan
- The University of Western Australia, Western Australian Centre for Rural HealthGeraldtonWestern AustraliaAustralia
| | - Brooke Conley
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Dawn Bessarab
- The University of Western Australia, Centre for Aboriginal Medical and Dental HealthPerthWestern AustraliaAustralia
| | - Juli Coffin
- Ngangk Yira Institute for Change, Murdoch UniversityMurdochWestern AustraliaAustralia
| | - Peter F. M. Choong
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Michelle M. Dowsey
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Samantha Bunzli
- The University of Melbourne, St Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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16
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Hanson HM, Friesen J, Beaupre L, Jasper L, Millington J, Jones CA. Supporting Rehabilitation of Rural Patients Receiving Total Knee Arthroplasty Through Physical Activity: Perceptions of Stakeholder Groups. ACR Open Rheumatol 2022; 4:863-871. [PMID: 35862257 PMCID: PMC9555196 DOI: 10.1002/acr2.11489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To identify how patients with osteoarthritis waiting for and recovering from total knee arthroplasty (TKA) conceptualized and participated in physical activity behaviors in their rural setting and to gather perceptions of health care professionals and rehabilitation decision‐makers on the feasibility of a remotely led physical activity coaching intervention. Methods Using a qualitative descriptive study, we collected data from three stakeholder groups: patients waiting for or recovering from TKA (interviews), health professionals delivering a physical activity intervention to patients in the recovering cohort (focus group), and rehabilitation leaders involved in decision‐making at the local or provincial level (interviews). Results A total of 38 individuals provided their perspectives (25 patients, five health professionals, eight decision‐makers). Patients waiting for and recovering from surgery described the attributes of their rural environment that supported and restricted their ability to participate in physical activities. Patients recovering from TKA appreciated support for goal‐setting and problem‐solving during their rehabilitation. Health care professionals and decision‐makers commented on the benefits of the program's innovative use of relatively simple technology to support remotely delivered, personalized rehabilitation in rural settings. Conclusion This study adds to the limited voice of and about patients living with osteoarthritis who reside in rural settings and identifies facilitators and barriers to TKA rehabilitation in this population. Our findings highlight that it is important to consider the local context and the resources available to patients as they navigate living well with osteoarthritis.
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Affiliation(s)
- Heather M. Hanson
- Alberta Health Services, Edmonton, Alberta, Canada, and University of Calgary Calgary Alberta Canada
| | | | | | - Lisa Jasper
- University of Alberta Edmonton Alberta Canada
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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18
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Kaya Ç, Bilik Ö. A Qualitative Study: What Did Say the Patients with Total Knee Arthroplasty About Their Lived Experiences. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2020.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Identification of the Resveratrol Potential Targets in the Treatment of Osteoarthritis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9911286. [PMID: 34917160 PMCID: PMC8670923 DOI: 10.1155/2021/9911286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/13/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Objectives Osteoarthritis (OA) is a chronic joint degenerative disease and has become an important health problem for the elderly. However, there is still a lack of effective drugs for the treatment of OA. Our research combines bioinformatics and experimental strategies to determine the target of resveratrol for OA treatment. Methods First, the differentially expressed genes (DEGs) of OA joint tissues were obtained from the related microarray gene expression data. Second, resveratrol, a natural polyphenol compound, was used to screen the drug treatment target genes. Third, the drug-disease network was established, and the resveratrol target genes for OA treatment were obtained and verified through experimental verification. Results A total of 300 differentially expressed genes with 246 upregulated and 54 downregulated were found in OA joint tissues, and 310 resveratrol potential target genes were obtained. Finally, six genes, namely, CXCL1, HIF1A, IL-6, MMP3, NOX4, and PTGS2, were selected to validate the treatment effects of the resveratrol. The results showed that all six genes in human OA chondrocytes were significantly increased. In addition, in these chondrocytes, CXCL1, HIF1A, IL-6, MMP3, NOX4, and PTGS2 were reduced considerably, but HIF1A was significantly increased after resveratrol treatment. Conclusions Our data indicates that CXCL1, HIF1A, IL-6, MMP3, NOX4, and PTGS2 are all targets of resveratrol therapy. Our findings may provide valuable information for the mechanism and therapeutic of OA.
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20
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Rodríguez-Borlado Díaz B, Sanz-Rosa D, Sanz Pozo B, Llisterri Caro JL, Herrero Barbero M. [Pain, quality of life and mental health in patients with gonalgia due to gonarthrosis: Cases and controls study]. Semergen 2021; 48:45-53. [PMID: 34429262 DOI: 10.1016/j.semerg.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate pain, quality of life and psychological state in patients with gonalgia due to gonarthrosis. MATERIAL AND METHODS Epidemiological, multicenter, case-control study. 1.152 patients were included (576 with arthrosis and 576 without arthrosis) matched by age and sex, from 63 health centers in Spain. The Huskisson Pain Scale (VAS), the EuroQol and Goldberg questionnaires were administered. A descriptive and comparative analysis of the data was carried out in both groups. Factors influencing the quality of life and mental health of arthritic patientes were studied with logistic regression models. RESULTS 576 case patients and 576 controls were included. 70.3% were women in both groups. The mean score in the VAS score of the arthritic patients was 65±4.9mm corresponding to a moderate intensity. The EQ-5D questionnaire indicated a worse state of health (P<.05) in patients with osteoarthritis in each of its dimensions. In the GHQ-12 questionnaire, the presence of psychopathology was detected in 36.5% (n=209) of patients with osteoarthritis compared to 14.0% (n=80) in controls (P<.001). Pain was the variable that affected quality of life in all dimensions (P<.001). CONCLUSIONS Patients with arthrosis manifest moderate pain due to this disease. They present a limitation of mobility, personal care and daily activities that negatively affects their quality of life and psychologically they are more affected. It is a priority to develop self-care and treatment strategies in this group of subjects to globally improve their quality of life.
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Affiliation(s)
| | - D Sanz-Rosa
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, España
| | - B Sanz Pozo
- Centro de Salud Las Américas, Servicio Madrileño de Salud, Parla, Profesora titular Atención Primaria de la Universidad Europea de Madrid, Madrid, España
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Bakaa N, Chen LH, Carlesso L, Richardson J, Shanthanna H, Macedo L. Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty. Disabil Rehabil 2021; 44:6348-6355. [PMID: 34397309 DOI: 10.1080/09638288.2021.1965232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA. MATERIAL AND METHODS We used an interpretive description approach. Data was gathered using semi-structured qualitative interviews. Participants were interviewed at 8 weeks post-operatively to capture physical, psychological, social and contextual changes and information. Topics that were explored included participants' experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, factors that limit their ability to engage in exercise, and the importance of self-regulation in exercise adherence. RESULTS This study identified 4 themes within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that influence exercise adherence. CONCLUSION Exercise adherence is a multidimensional, interconnected construct and future research should focus on understanding the factors, particularly health care system, that impact adherence.IMPLICATIONS FOR REHABILITATIONRehabilitation therapists should aim to foster competence and confidence in post-operative rehabilitation by implementing strategies such as positive-reinforcement, goal setting, and increased education regarding the benefits of exercise.Clinical strategies to improve exercise adherence should be implemented both pre-and-post-operatively.Health care providers should clearly discuss post-operative outcomes and expectations (e.g., complications, etc.) with patients prior to surgery.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Harsha Shanthanna
- Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
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22
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Stern BZ, Njelesani J, Howe TH. Transitioning from hurting to healing: self-management after distal radius fracture. Disabil Rehabil 2021; 44:6277-6286. [PMID: 34388959 DOI: 10.1080/09638288.2021.1962990] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Chronic pain and disability after musculoskeletal trauma support the need for non-biomedical perspectives to frame experiences of recovery. Self-management is a specific holistic lens with implications for improving health outcomes. This qualitative study explored how adults made meaning of self-management after distal radius fracture (DRF). METHODS Thirty-one individuals aged 45-72 with a unilateral DRF participated in a semi-structured interview 2-4 weeks after discontinuing full-time wrist immobilization. Interviews were audio-recorded and transcribed, and constructivist grounded theory techniques were used to analyze the data. RESULTS Participants made meaning of self-management as a process of "transitioning from hurting to healing," which occurred via three underlying processes. "Learning because of my injury" included gaining information for empowerment and understanding by physically living through the experience. "Working and hoping toward healing" involved taking active steps to recovery in the face of uncertainty. "Getting back to my normal self" comprised reconnecting to one's body and identity after injury. CONCLUSIONS Participants' lived experiences overlapped with those of self-managing chronic conditions, highlighting the need to consider how individuals actively engage in their recovery after DRF. Findings suggest using supportive interventions to facilitate patients' understanding, activation, and engagement in meaningful activity after DRF.Implication for rehabilitationTo maximize health outcomes after distal radius fracture, clinicians should move beyond impairment remediation to supporting multiple dimensions of recovery, including emotional distress and functional limitations.Clinicians should routinely provide early and ongoing information, such as expected symptoms and recovery time frames, to minimize loss of control related to uncertainty.Clinicians should emphasize active interventions, such as collaborative goal setting and functional tasks, that engage patients in their own healing.Clinicians should support patients' early return to meaningful activity to maintain or restore connection to the body and identity.
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Affiliation(s)
- Brocha Z Stern
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA.,Kessler Rehabilitation Center, Howell, NJ, USA
| | - Janet Njelesani
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Tsu-Hsin Howe
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
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Bunzli S, Taylor N, O'Brien P, Dowsey M, Wallis J, Choong P, Shields N. How Do People Communicate About Knee Osteoarthritis? A Discourse Analysis. PAIN MEDICINE 2021; 22:1127-1148. [PMID: 33502513 DOI: 10.1093/pm/pnab012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. DESIGN A qualitative synthesis using discourse analysis methods. METHODS Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers, and/or clinicians. Methodological quality was evaluated through the use of the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analyzed with inductive discourse analysis. RESULTS A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1,673 direct quotes) from people with knee osteoarthritis, carers, and clinicians in 16 countries. Two overarching discourses were identified-impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore down over time and required a doctor to repair. The overarching participatory discourse almost always coexisted alongside an impairment discourse. According to this discourse, a "busy body" was perceived as "healthy," and people could remain active despite knee osteoarthritis. CONCLUSION The prevailing impairment discourse may potentially discourage people from using knees that have passed their "use-by date" and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating that may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.
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Affiliation(s)
- Samantha Bunzli
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nicholas Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Michelle Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Jason Wallis
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nora Shields
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Australia
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Teo PL, Bennell KL, Lawford B, Egerton T, Dziedzic K, Hinman RS. Patient experiences with physiotherapy for knee osteoarthritis in Australia-a qualitative study. BMJ Open 2021; 11:e043689. [PMID: 34006028 PMCID: PMC7942256 DOI: 10.1136/bmjopen-2020-043689] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Physiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA. DESIGN Qualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard. SETTING Participants were recruited from around Australia via Facebook and our research volunteer database. PARTICIPANTS Interviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee. RESULTS Six themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery. CONCLUSION Patients' experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.
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Affiliation(s)
- Pek Ling Teo
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Lawford
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - T Egerton
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Rana S Hinman
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
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Dantas LO, Salvini TDF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther 2021; 25:135-146. [PMID: 33262080 PMCID: PMC7990728 DOI: 10.1016/j.bjpt.2020.08.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation. OBJECTIVE To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA. CONCLUSION There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | | | - Timothy E McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA.
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Swärdh E, Jethliya G, Khatri S, Kindblom K, Opava CH. Approaches to osteoarthritis - A qualitative study among patients in a rural setting in Central Western India. Physiother Theory Pract 2021; 38:1683-1692. [PMID: 33435793 DOI: 10.1080/09593985.2021.1872126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world. OBJECTIVE The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India. DESIGN AND METHOD Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India. RESULTS Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients' approaches to OA. The categories were further elaborated on in seven subcategories. CONCLUSION Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists' implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients.
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Affiliation(s)
- Emma Swärdh
- Division of Physiotherapy, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.,Karolinska University Hospital, Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals' Function, Huddinge, Sweden
| | - Gitanjali Jethliya
- Pravara Institute of Medical Sciences - DU, Dr. APJ Abdul Kalam College of Physiotherapy, Loni, Maharashtra, India
| | - Subhash Khatri
- Pravara Institute of Medical Sciences - DU, Dr. APJ Abdul Kalam College of Physiotherapy, Loni, Maharashtra, India
| | - Kristina Kindblom
- Division of Physiotherapy, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.,Pravara Institute of Medical Sciences - DU, Dr. APJ Abdul Kalam College of Physiotherapy, Loni, Maharashtra, India
| | - Christina H Opava
- Division of Physiotherapy, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.,Pravara Institute of Medical Sciences - DU, Dr. APJ Abdul Kalam College of Physiotherapy, Loni, Maharashtra, India.,Karolinska University Hospital, Theme Inflammation and Infection, Rheumatology, Solna, Sweden
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Abstract
AIMS The purpose of our study was to determine whether mesenchymal stem cells (MSCs) are an effective and safe therapeutic agent for the treatment of knee osteoarthritis (OA), owing to their cartilage regeneration potential. METHODS We searched PubMed, Embase, and the Cochrane Library, with keywords including "knee osteoarthritis" and "mesenchymal stem cells", up to June 2019. We selected randomized controlled trials (RCTs) that explored the use of MSCs to treat knee OA. The visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), adverse events, and the whole-organ MRI score (WORMS) were used as the primary evaluation tools in the studies. Our meta-analysis included a subgroup analysis of cell dose and cell source. RESULTS Seven trials evaluating 256 patients were included in the meta-analysis. MSC treatment significantly improved the VAS (mean difference (MD), -13.24; 95% confidence intervals (CIs) -23.28 to -3.20, p = 0.010) and WOMAC (MD, -7.22; 95% CI -12.97 to -1.47, p = 0.010). The low-dose group with less than 30 million cells showed lower p-values for both the VAS and WOMAC. Adipose and umbilical cord-derived stem cells also had lower p-values for pain scores than those derived from bone marrow. CONCLUSION Overall, MSC-based cell therapy is a relatively safe treatment that holds great potential for OA, evidenced by a positive effect on pain and knee function. Using low-dose (25 million) and adipose-derived stem cells is likely to achieve better results, but further research is needed. Cite this article: Bone Joint Res 2020;9(10):719-728.
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Affiliation(s)
- Jiaqian Wang
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liang Zhou
- Orthopedics Department, Lianshui County People's Hospital, Huai'an, China
| | - Yong Zhang
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lixin Huang
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qin Shi
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
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Ferreira de ACA, Genov IR, Pereira SRN, Barreto JM, Ramos MRF, da Silva ECF, de Oliveira LP. Viscossuplementation for the treatment of osteoarthritis of the knee: A protocol for an umbrella review of systematic reviews with meta-analyses of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21813. [PMID: 32925717 PMCID: PMC7489737 DOI: 10.1097/md.0000000000021813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common chronic disease with worldwide prevalence of 10% to 79%, with costs ranging from $560 to $635 billion for year in United States of America. The main guidelines recommend interventions with undesirable adverse events (AE) or highly dependent on the patient's persistence. Thus, intra-articular (IA) therapies appear to be attractive in patients with KOA, as well as a valid therapy by maximizing effects locally in the joint and limiting systemic AE. Presently, the main available IA therapies are corticosteroids and hyaluronic acid.As several meta-analyses about the efficacy of intra-articular hyaluronic acid (IAHA) for treatment of KOA with discordant results were published, we decided to conduct an umbrella review to summarize this efficacy METHODS:: We will search MEDLINE/PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) from inception to February 2020 for systematic reviews with meta-analyses of randomized clinical trials that investigate IAHA for therapy of KOA. Grey literature will be searched in Opengray platform, Research Gate, and Google Scholar. The reference lists of eligible studies will be screened. The search will be performed without language restriction.We will include any type of IAHA as experimental intervention and different types of oral or intra-articular placebo or medications as controls. The primary outcome will be measures of efficacy as the Western Ontario and McMaster Universities Osteoarthritis Index.A synthesis of the evidence will be conducted and data will be presented in tables.Two reviewers will independently appraise the quality of included meta-analyses using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and will classify the included systematic reviews into high, moderate, low, or critically low levels of confidence. RESULTS The results of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION No ethical approval is required since this study data is based on published literature. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42019120269 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).
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Affiliation(s)
- Andrade Carlos Augusto Ferreira de
- Unimed-Rio Institute - Rio de Janeiro
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca (ENSP)/Oswaldo Cruz Foundation (Fiocruz)
- Faculty of Medicine - Vassouras University
| | | | - Sara Regina Neto Pereira
- Unimed-Rio Institute - Rio de Janeiro
- Faculty of Medical Sciences, State University of Rio de Janeiro
| | | | - Max Rogério Freitas Ramos
- Unimed-Rio Institute - Rio de Janeiro
- Orthopaedic Department, Federal University of Rio de Janeiro - Rio de Janeiro
| | | | - Liszt Palmeira de Oliveira
- Unimed-Rio Institute - Rio de Janeiro
- Department of Surgical Specialties, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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An exploration of the experiences of people living with painful ankle osteoarthritis and the non-surgical management of this condition. Physiotherapy 2020; 110:70-76. [PMID: 32713738 DOI: 10.1016/j.physio.2020.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) of the ankle joint is associated with life-long joint pain and disability if not appropriately managed. There is a dearth of research concerning ankle OA and the impact on those living with the condition. AIM To explore the experiences of people living with painful OA ankle and their views about the non-surgical management of this condition. DESIGN Qualitative design, using semi-structured interviews. PARTICIPANTS Nine participants, recruited from an orthopaedic clinic at a UK hospital and the general population. All had a clinical and radiographic diagnosis of OA ankle. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken to identify emerging themes. Ethical approval was obtained. RESULTS Nine semi-structured interviews were undertaken. Eight participants were male, median age=55 years (IQR=42.5-64.5). Mechanism of onset was due to trauma (falls, repeated inversion injuries or road traffic collisions) (n=7), or the effects of haemophilia (n=2). The median duration of symptoms was 2 years (IQR=1.5-10). Data saturation was achieved. Four themes were identified: CONCLUSIONS: This is the first study to explore the experiences of people with symptomatic OA ankle. Our findings suggest that those with OA ankle suffer with severe pain, which has a substantial negative impact on a person's physical and mental wellbeing. The findings of this study may be used to inform future research.
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Kamsan SS, Singh DKA, Tan MP, Kumar S. The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study. PLoS One 2020; 15:e0230318. [PMID: 32226047 PMCID: PMC7105111 DOI: 10.1371/journal.pone.0230318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults’ understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults’ knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants’ knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.
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Affiliation(s)
- Siti Salwana Kamsan
- Physiotherapy Program & Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physical Rehabilitation Sciences, Faculty of Allied Health Sciences, International Islamic University Malaysia, Selayang, Pahang, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Program & Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Saravana Kumar
- School of Health Sciences, City East Campus, University of South Australia, Adelaide, South Australia
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Exploring the burden of X-linked hypophosphatemia: a European multi-country qualitative study. Qual Life Res 2020; 29:1883-1893. [PMID: 32162120 PMCID: PMC7295835 DOI: 10.1007/s11136-020-02465-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 01/28/2023]
Abstract
Introduction X-linked hypophosphatemia (XLH) is a rare, lifelong, progressive disease characterised by renal phosphate wasting and abnormal bone mineralisation. Symptoms begin in early childhood, with the development of rickets and related skeletal deformities and reduced growth, progressing to long-term complications, including pseudofractures and fractures, as well as pain, stiffness and fatigue. The present study was designed to explore the patient experience of pain, stiffness and fatigue and the psychosocial impact of XLH in detail. Methods A cross-sectional qualitative study was conducted in the United Kingdom (18), Finland (6), France (4), Germany (1) and Luxembourg (1) with XLH patients aged 26 and over. Interview discussion guides were developed in consultation with clinical experts and patient associations. Data were analysed thematically. Results Participants (N = 30) described pain, stiffness and fatigue as frequently experienced symptoms with a significant impact on physical functioning and activities of daily living (ADLs). Some also described the symptoms as impacting their mood/mental health, relationships, social life and leisure activities. Participants described how common symptoms could interact or aggravate other symptoms. Symptoms had often worsened over time, and for many, were associated with concern about the future. Most participants were worried or felt guilty about having children with XLH. The findings confirmed and extended the existing model of the burden of XLH. Conclusion The present study is the first to provide an in-depth analysis of pain, stiffness and fatigue, their impact and the interrelatedness of these symptoms among adults with XLH. The study also described the psychosocial impact of XLH as a hereditary, lifelong progressive disease. Electronic supplementary material The online version of this article (10.1007/s11136-020-02465-x) contains supplementary material, which is available to authorized users.
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Lape EC, Hudak P, Davis AM, Katz JN. Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework. ACR Open Rheumatol 2019; 1:90-96. [PMID: 31777785 PMCID: PMC6857960 DOI: 10.1002/acr2.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital Boston Massachusetts
| | - Pamela Hudak
- Alternative Dispute Resolution Practice, Inc. Toronto Canada
| | - Aileen M Davis
- Krembil Research Institute University Health Network and University of Toronto Toronto Canada
| | - Jeffrey N Katz
- Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts
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van der Horst AY, Trompetter HR, Pakvis DF, Kelders SM, Schreurs KM, Bohlmeijer ET. Between hope and fear: A qualitative study on perioperative experiences and coping of patients after lumbar fusion surgery. Int J Orthop Trauma Nurs 2019; 35:100707. [DOI: 10.1016/j.ijotn.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 01/10/2023]
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Choojaturo S, Sindhu S, Utriyaprasit K, Viwatwongkasem C. Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study. BMC Health Serv Res 2019; 19:688. [PMID: 31604433 PMCID: PMC6788102 DOI: 10.1186/s12913-019-4441-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients. METHODS A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL. RESULTS The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (β = .10, p = .01) and patient factors (β = .29, p = .00 for self-management and β = -.49, p = .00 for disease factors). Access to health services was determined by self-management (β = .10, p = .01), but it was not significantly associated with QoL (β = .00, p = 1.0). CONCLUSIONS This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.
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Affiliation(s)
- Siriwan Choojaturo
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, 10700 Thailand
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Siriorn Sindhu
- Mahidol University, Faculty of Nursing, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700 Thailand
| | - Ketsarin Utriyaprasit
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, 10700 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
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Are priorities of younger patients with knee pain addressed by PROMs? A qualitative study. Phys Ther Sport 2019; 40:160-168. [PMID: 31569057 DOI: 10.1016/j.ptsp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the impact of knee pain and dysfunction in young adults and determine whether current patient reported outcome measures (PROMs) address their recovery priorities. DESIGN Qualitative. SETTING Outpatient rehabilitation center. PARTICIPANTS Young adults, 23-30 years. MAIN OUTCOME MEASURES 1:1 semi-structured interviews were held and analyzed with NVivo version 11. The Lower Extremity Functional Scale (LEFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) were compared to participant identified functional limitations. RESULTS 9 themes were identified in 7 interviews: Incomplete Recovery as Acceptable, Motivation for Adequate Long Term Function, Guidance Needed to Facilitate Recovery, Sports: To Play or Not to Play, Pain, Therapy Participation and Interventions, Impact on Life, Decreased Knowledge and Condition Management, and A Wide Range of Functional Limitations. The LEFS captured 23/26 identified functional activities, the KOOS 22/26, the IKDC 16/26, and the WOMAC 13/26. CONCLUSIONS Incomplete recovery as an acceptable outcome was the most unique theme found in this study. LEFS captured the most relevant functional activities reported by this group. Physical Therapists should consider these findings in PROM selection to better inform meaningful outcome measurement.
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Abstract
OBJECTIVES Systematically review the qualitative literature on living with knee osteoarthritis from patient and carer perspectives. DESIGN Systematic review of qualitative studies. Five electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, SPORTDiscus) were searched from inception until October 2018. Data were synthesised using thematic and content analysis. PARTICIPANTS Studies exploring the experiences of people living with knee osteoarthritis, and their carers were included. Studies exploring experiences of patients having participated in specific interventions, including surgery, or their attitudes about the decision to proceed to knee replacement were excluded. RESULTS Twenty-six articles reporting data from 21 studies about the patient (n=665) and carer (n=28) experience of living with knee osteoarthritis were included. Seven themes emerged: (i) Perceived causes of knee osteoarthritis are multifactorial and lead to structural damage to the knee and deterioration over time (n=13 studies), (ii) Pain and how to manage it predominates the lived experience (n=19 studies), (iii) Knee osteoarthritis impacts activity and participation (n=16 studies), (iv) Knee osteoarthritis has a social impact (n=10 studies), (v) Knee osteoarthritis has an emotional impact (n=13 studies), (vi) Interactions with health professionals can be positive or negative (n=11 studies), (vii) Knee osteoarthritis leads to life adjustments (n=14 studies). A single study reporting the perspectives of carers reported similar themes. Psychosocial impact of knee osteoarthritis emerged as a key factor in the lived experience of people with knee osteoarthritis. CONCLUSIONS This review highlights the value of considering patient attitudes and experiences including psychosocial factors when planning and implementing management options for people with knee osteoarthritis. Trial registrationnumber CRD42018108962.
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Affiliation(s)
- Jason A Wallis
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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O'Brien P, Bunzli S, Ayton D, Dowsey MM, Gunn J, Manski-Nankervis JA. What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis. BMJ Open 2019; 9:e031310. [PMID: 31551388 PMCID: PMC6773346 DOI: 10.1136/bmjopen-2019-031310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) are often the first health professionals to assess patients with osteoarthritis (OA). Despite clinical guideline recommendations for non-surgical intervention as first-line therapies, the most frequent referral from a GP for a person with knee OA is to an orthopaedic surgeon. The aim of our study was to explore patient factors that impact on the decision to progress to total knee replacement (TKR), including the experience of patients in general practice, their perceptions of their condition, and their access and use of community-based allied health interventions. DESIGN Qualitative investigation using semi-structured interviews. The Candidacy framework was selected as a lens to examine the factors driving healthcare access. Data were analysed using a thematic analysis approach. Codes identified in the data were mapped to the seven Candidacy domains. Themes corresponding to each domain were described. SETTING A public hospital in Melbourne, Australia. PARTICIPANTS 27 patients with knee OA who were on a waiting list to undergo TKR. RESULTS Ten themes described factors influencing access and use of non-surgical interventions and decision-making for undergoing TKR: (1) History of knee problems, change in symptoms; (2) Physical and psychosocial functioning (Identification of Candidacy); (3) GP and social networks as information sources, access to care (Navigation); (4) Referral pathways (Permeability of services); (5) Communication of impact (Appearances at health services); (6) GP-Surgeon as the predominant referral pathway (Adjudications); (7) Physical activity as painful; (8) Beliefs about effectiveness of non-surgical interventions (Offers and resistance); (9) Familiarity with local system; and (10) Availability (Operating conditions and local production of Candidacy). CONCLUSIONS Using the Candidacy framework to analyse patients' experiences when deciding to progress to TKR highlighted missed opportunities in general practice to orient patients to first try non-surgical interventions. Patients with knee OA also require improved support to navigate allied health services.
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Affiliation(s)
- Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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Pain perception and coping strategies influence early outcomes following knee surgery in athletes. J Sci Med Sport 2019; 23:100-104. [PMID: 31563440 DOI: 10.1016/j.jsams.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 07/23/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia. DESIGN Prospective cohort study. METHODS 101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure. RESULTS Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02). CONCLUSIONS Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.
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Benkel I, Ljungqvist E, Arnby M, Molander U. "Not Thinking that This Means the End When You Are Seriously Ill but Doing Something Positive about It"-A Qualitative Study of Living with a Life-Changing Disease. Diseases 2019; 7:diseases7030053. [PMID: 31514413 PMCID: PMC6787749 DOI: 10.3390/diseases7030053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Chronic diseases have an impact on and can change the lives of the persons affected by them. This study examines how a disease can influence patients’ daily lives, the strategies they adopt to cope, and their experiences of support. The study focuses on four chronic diseases: asthma-allergy, cancer, diabetes mellitus, and inflammatory rheumatic arthritis. Methods: The study has a qualitative design and includes 41 transcribed in-depth interviews and a content analysis. Results: The participants’ new life situation was changed for a very long time or forever, and this was not a voluntary choice. The new life situation comprised the following themes: life-changing—the disease could be a turning point in a negative or positive way, strategies—designed to create ways of coping with daily tasks to find a good quality of life, and support—that could be obtained from the participants’ private network or the healthcare professionals. Conclusions: The patients had to make changes in their daily life, and these could bring about different feelings and restrict activity. Healthcare professionals need more knowledge of the process of coping with such life-changing matters and what could strengthen patients and give a sense of empowerment in their lives.
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Affiliation(s)
- Inger Benkel
- Sahlgrenska Academy, Institute of Medicine, Geriatric Medicine and Clinical Osteoporosis Research School, University of Gothenburg, Gothenburg 4405 30, Sweden.
- Sahlgrenska University Hospital Palliative Care Unit, Gothenburg 400 43, Sweden.
| | - Elin Ljungqvist
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.
| | - Maria Arnby
- Sahlgrenska University Hospital Palliative Care Unit, Gothenburg 400 43, Sweden.
| | - Ulla Molander
- Sahlgrenska Academy, Institute of Medicine, Geriatric Medicine and Clinical Osteoporosis Research School, University of Gothenburg, Gothenburg 4405 30, Sweden.
- Sahlgrenska University Hospital Palliative Care Unit, Gothenburg 400 43, Sweden.
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Skogö Nyvang J, Hedström M, Iversen MD, Andreassen Gleissman S. Striving for a silent knee: a qualitative study of patients' experiences with knee replacement surgery and their perceptions of fulfilled expectations. Int J Qual Stud Health Well-being 2019; 14:1620551. [PMID: 31116100 PMCID: PMC6542175 DOI: 10.1080/17482631.2019.1620551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Purpose: Fifteen to twenty percent of patients with a knee arthroplasty are dissatisfied with their replaced joint. This study aimed to describe patients' experiences of undergoing knee replacement surgery, both total- and unicompartmental knee replacement, and post-operative recovery, and to determine whether expectations of surgery were fulfilled. Methods: Using semi-structured interviews, this study describes twelve patients' experiences of undergoing knee replacement surgery in the prior year, their post-operative recovery, and whether their expectations of surgery were fulfilled. Qualitative thematic analysis was used. Results: A theme "striving for a silent knee", and two categories "the bumpy road to recovery" and "the presence of the future" were created. Some participants were not fully restored one year after surgery. Those still in pain had thoughts about the future, from hoping to improve, to accepting living with an aching knee. Those with no pain, did not think about their knee-the knee had become silent. Conclusions: Surgeons often inform patients that the recovery time after a knee arthroplasty is one year, which in light of this study, might be too short. We suggest that a follow-up after one year might identify those who need enhanced physical and psychological support to get the best possible outcome, whether it is to help patients accepting persistent symptoms or to continue striving towards a silent knee.
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Affiliation(s)
- Josefina Skogö Nyvang
- a Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology , Karolinska Institutet , Huddinge , Sweden
| | - Margareta Hedström
- a Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology , Karolinska Institutet , Huddinge , Sweden.,b Department of Orthopaedics , Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Maura D Iversen
- c Department of Women and Children's Health , Karolinska Institutet, Elevhemmet H2:00, Karolinska University Hospital Solna , Stockholm , Sweden.,d Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Brigham & Women's Hospital, Division of Rheumatology, Immunology & Allergy, Section of Clinical Sciences, and Department of Medicine , Harvard Medical School , Boston , MA , USA
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Buus AAØ, Hejlsen OK, Dorisdatter Bjørnes C, Laugesen B. Experiences of pre- and postoperative information among patients undergoing knee arthroplasty: a systematic review and narrative synthesis. Disabil Rehabil 2019; 43:150-162. [PMID: 31106616 DOI: 10.1080/09638288.2019.1615997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The aim of this review was to identify and synthesize knowledge of how patients undergoing knee arthroplasty experience pre- and postoperative information provided by healthcare professionals.Materials and methods: A systematic review and narrative synthesis was conducted in accordance with Popay et al.'s guidelines which involve 1) developing a preliminary synthesis; 2) exploring relationships; and 3) assessing the robustness of the synthesis. Qualitative and quantitative studies were considered for inclusion, and a systematic, extensive search was conducted in scientific databases.Results: A total of 31 studies were included in this review. The analysis resulted in five synthesized themes: 1) Support in the decision to undergo surgery; 2) Confidence versus uncertainty in the preparation for surgery; 3) Prerequisites for feeling secure before discharge; 4) Struggling through rehabilitation at home; and 5) Unmet expectations and endeavoring to accept realities.Conclusions: The findings illustrate the complexities of patients' experiences of information from healthcare professionals and its significance for how they manage challenges throughout the surgical care pathway. Information from healthcare professionals influences patients' knowledge, skills and confidence in the journey through knee arthroplasty. Therefore, it is important that healthcare professionals recognize patients' support requirements and adapt information to their individual needs.Implications for rehabilitationHealthcare professionals should encourage more dialog with patients and adapt information to their individual circumstances and needs throughout the surgical care pathway.It is important that healthcare professionals provide ongoing information and repeat information throughout the entire surgical care pathway in order to facilitate predictability and improve patients' ability to comprehend and assimilate information.Improved access to information and advice from healthcare professionals following knee arthroplasty will offer patients reassurance and increase their confidence in managing postoperatively at home.Patients who require enhanced information and guidance from healthcare professionals need to be identified in order to support their progress and achieve the best possible postoperative outcomes.
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Affiliation(s)
| | - Ole Kristian Hejlsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Tollefsrud I, Mengshoel AM. A fragile normality - illness experiences of working-age individuals with osteoarthritis in knees or hips. Disabil Rehabil 2019; 42:2593-2599. [PMID: 30829074 DOI: 10.1080/09638288.2019.1573930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Examine how individuals manage to live a life with osteoarthritis in the knee or hip.Methods: Focus group interviews were held with ten female and two male patients aged 45-65 years, who had participated in a vocational rehabilitation programme one to five years' earlier. The interviews were analysed using thematic analysis.Results: Participants' experiences are described in three themes: (1) Having "a changed and unreliable body" refers to a persistent presence of symptoms and an occasional, unpredictable flare up of symptoms involving sudden loss of movement control; (2) patients living with "(un) manageable life situations" downscale their daily activities to maintain a normal life; however, their flare-ups are unmanageable and cause significant life disruption; and (3) patients "strive to maintain an independent self" by doing their best to continue living as before without receiving any help. For the patients, continuing to participate in working life signifies an independent life that is on equal terms with others.Conclusions: The participants of this study adjusted and managed their daily activities to continue to live a normal life in accord with cultural norms. However, unpredictable flare ups and loss of control made their otherwise normal life somewhat fragile.Implications for rehabilitation•Osteoarthritis is a common disease which is often considered relatively stable, controllable and manageable.•This sample study highlights the participants uncertainty related to unpredictable variability in symptoms.•Appropriate management strategies for bad days need to be developed especially for those struggling at work.
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Affiliation(s)
| | - Anne Marit Mengshoel
- Department of Health Sciences, Medical Faculty, Institute of Health and Society, University of Oslo, Oslo, Norway
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Lundgren-Nilsson Å, Dencker A, Palstam A, Person G, Horton MC, Escorpizo R, Küçükdeveci AA, Kutlay S, Elhan AH, Stucki G, Tennant A, Conaghan PG. Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties. RMD Open 2018; 4:e000715. [PMID: 30622735 PMCID: PMC6307597 DOI: 10.1136/rmdopen-2018-000715] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. Methods The study included a systematic search for PROMs that have been in use over 17 years (period 2000–2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. Results 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. Conclusion A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.
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Affiliation(s)
- Åsa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annie Palstam
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mike C Horton
- Psychometric Laboratory for Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Ayse A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Alan Tennant
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Quantifying walking ability in Japanese patients with knee osteoarthritis: Standard values derived from a multicenter study. J Orthop Sci 2018; 23:1027-1031. [PMID: 30122337 DOI: 10.1016/j.jos.2018.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/22/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to determine useful parameters for quantifying walking ability in patients with knee osteoarthritis. METHODS This study included 621 Japanese patients with knee osteoarthritis scheduled to undergo total knee arthroplasty at any of 14 participating hospitals. Sex, age, body mass index, osteoarthritis severity (Kellgren-Lawrence grade), laterality, prior contralateral surgery, and pain were analyzed for their influence on walking ability, which was evaluated in terms of the 5-m walk test and the Timed Up and Go test outcomes during preoperative hospitalization. Patients were stratified based on dichotomized values of the independent influencing factors of walking ability, and the standard values for parameters describing walking ability were obtained. RESULTS Multiple regression analysis revealed that sex, age, and Kellgren-Lawrence grade were factors influencing walking ability (5-m walk test and Timed Up and Go test outcomes). Therefore, the patients were stratified by sex, age, and Kellgren-Lawrence grade. The standard values (median values) for walking time on the 5-m walk test among patients aged 60-74/75-89 years were: 3.90/4.64 vs. 4.27/5.12 s for men vs. women with Kellgren-Lawrence grade III; 4.26/5.60 vs. 4.80/6.05 s for men vs. women with Kellgren-Lawrence grade IV. Regarding walking speed on the 5-m test, the standard values were: 1.28/1.08 vs. 1.17/0.98 m/s for men vs. women with Kellgren-Lawrence grade III; 1.17/0.89 vs. 1.04/0.83 m/s for men vs. women with Kellgren-Lawrence grade IV. Finally, the standard values for time on the Timed Up and Go test were: 8.52/10.30 vs. 9.30/11.74 s for men vs. women with Kellgren-Lawrence grade III; 9.40/12.90 vs. 10.05/13.20 s for men vs. women with Kellgren-Lawrence grade IV. CONCLUSIONS The standard values reported in this study can be used to quantify walking ability decline in patients with knee osteoarthritis and to aid in the decision to consider total knee arthroplasty.
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Smith TO, Dainty JR, Williamson E, Martin KR. Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing. Br J Pain 2018; 13:82-90. [PMID: 31019689 DOI: 10.1177/2049463718802868] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Musculoskeletal pain is a prevalent health challenge for all age groups worldwide, but most notably in older adults. Social isolation is the consequence of a decrease in social network size with a reduction in the number of social contacts. Loneliness is the psychological embodiment of social isolation and represents an individual's perception of dissatisfaction in the quality or quantity of their social contacts. This study aims to determine whether a relationship exists between musculoskeletal pain and social isolation and loneliness. Methods A cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA) cohort was undertaken. ELSA is a nationally representative sample of the non-institutionalised population of individuals aged 50 years and over based in England. Data were gathered on social isolation through the ELSA Social Isolation Index, loneliness through the University of California, Los Angeles (UCLA) Loneliness Scale and musculoskeletal pain. Data for covariates included physical activity, depression score, socioeconomic status, access to transport and demographic characteristics. Logistic regression analyses were undertaken to determine the relationship between social isolation and loneliness with pain and the additional covariates. Results A total of 9299 participants were included in the analysis. This included 4125 (44.4%) males, with a mean age of 65.8 years. There was a significant association where social isolation was lower for those in pain (odd ratio (OR): 0.87; 95% confidence intervals (CI): 0.75 to 0.99), whereas the converse occurred for loneliness where this was higher for those in pain (OR: 1.15; 95% CI: 1.01 to 1.31). Age, occupation, physical activity and depression were all associated with increased social isolation and loneliness. Conclusion People who experience chronic musculoskeletal pain are at greater risk of being lonely, but at less risk of being socially isolated. Health professionals should consider the wider implications of musculoskeletal pain on individuals, to reduce the risk of negative health implications associated with loneliness from impacting on individual's health and well-being.
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Affiliation(s)
- Toby O Smith
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Jack R Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Esther Williamson
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Kathryn R Martin
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Bright P, Hambly K. Patients Using an Online Forum for Reporting Progress When Engaging With a Six-Week Exercise Program for Knee Conditioning: Feasibility Study. JMIR Rehabil Assist Technol 2018; 5:e9. [PMID: 29699967 PMCID: PMC5945989 DOI: 10.2196/rehab.8567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/26/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual “sticky notes.” OBJECTIVE The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression. METHODS Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically. RESULTS Nineteen participants were recruited (47%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63%) opted to engage with the forum (range 4-40 entries), with five (42%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95% CI 0.06-6.93). No significant difference manifested between body mass index and engagement P=.46); age and entry frequency did not correlate (R2=.054, 95% CI –0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single participants. Themes of pain, mitigation, and response were inducted from the experiences posted. CONCLUSIONS Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee pain populations need further consideration.
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Affiliation(s)
- Philip Bright
- School of Sport and Exercise Sciences, Medway Campus, University of Kent, Chatham, United Kingdom.,Research Department, European School of Osteopathy, Maidstone, United Kingdom
| | - Karen Hambly
- School of Sport and Exercise Sciences, Medway Campus, University of Kent, Maidstone, United Kingdom
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Wride JM, Bannigan K. 'If you can't help me, so help me God I will cut it off myself…' The experience of living with knee pain: a qualitative meta-synthesis. Physiotherapy 2018; 104:299-310. [PMID: 30017098 DOI: 10.1016/j.physio.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/12/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and explore the feelings and experiences of people living with knee pain as a precursor to exploring how this might contribute to improved care in the future. DESIGN The qualitative meta-synthesis was undertaken in three parts (1) a systematic search of the literature, (2) a critical appraisal of the relevant studies and (3) meta-aggregation of the findings from the selected studies. A qualitative meta-synthesis is a process that enables researchers to answer a specific research question by combining and summarising a variety of qualitative sources. This was undertaken using a contextualist approach which acknowledges different realities exist but tries to determine an underlying 'truth'. SETTING The participants from the selected studies were from a range of settings and ethnic groups, and cultural backgrounds. PARTICIPANTS There were nine articles included in the meta-synthesis. Articles focused on the experiences of surgery, return to sport, or other aspects of care were excluded. RESULTS No articles were excluded following critical appraisal. Eleven categories were identified from 55 findings which resulted in two synthesised findings being identified: knee pain affects every aspect of life and Searching for the best way forward. LIMITATIONS Articles were largely limited to older adults living with osteoarthritis. Many of the findings did not report demographic data. Only English language studies were included. CONCLUSION Many people living with knee pain struggle to adapt to living with knee pain and this is often exacerbated by a lack of knowledge and available information to help them plan for the future. PROSPERO NO CRD42017070227.
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Affiliation(s)
- James M Wride
- School of Health Professions, University of Plymouth, Peninsula Allied Health Centre, Derriford Road, Derriford, Plymouth, Devon, PL6 8BH, UK; Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - Katrina Bannigan
- School of Health Professions, University of Plymouth, Peninsula Allied Health Centre, Derriford Road, Derriford, Plymouth, Devon, PL6 8BH, UK
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Traumer L, Sørensen EE, Kusk KH, Skou ST. Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study. Musculoskeletal Care 2018; 16:380-387. [PMID: 29656439 DOI: 10.1002/msc.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Line Traumer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Søren Thorgaard Skou
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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See MTA, Kowitlawakul Y, Tan AJQ, Liaw SY. Expectations and experiences of patients with osteoarthritis undergoing total joint arthroplasty: An integrative review. Int J Nurs Pract 2018; 24:e12621. [PMID: 29336515 DOI: 10.1111/ijn.12621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effectiveness of educational interventions for osteoarthritic patients undergoing total joint arthroplasty remains inconclusive. It is essential to understand the educational needs of these patients from their perspectives. AIM The aim of this study was to systematically summarize and synthesize osteoarthritic patients' expectations and experiences in undergoing total joint arthroplasty to identify their educational needs. DESIGN An integrative review was conducted. METHODS Twenty studies (13 qualitative and 7 quantitative), published between 2006 and 2016, were independently appraised by 2 reviewers using the Critical Appraisal Skills Programme checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Tools for quantitative studies. Data were analysed using thematic analysis, and the findings were synthesized in a narrative summary. RESULTS Six themes describing patients' preoperative and post-operative educational needs were identified: (1) preoperative anxiety, (2) unrealistic expectations of recovery, (3) post-operative pain, (4) regaining functional abilities, (5) physical and psychological sense of loss, and (6) lack of continuity of care. CONCLUSION This review is the first to capture the osteoarthritic patients' educational needs from their perspectives. The biopsychosocial model can address the multidimensionality (biological, psychological, and social) of patients' educational needs. A robust infrastructure supporting interprofessional collaborative practice and continuity of care should be adopted to enhance current educational efforts.
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Affiliation(s)
- Min Ting Alicia See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yanika Kowitlawakul
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Xing D, Wang Q, Yang Z, Hou Y, Zhang W, Chen Y, Lin J. Mesenchymal stem cells injections for knee osteoarthritis: a systematic overview. Rheumatol Int 2017; 38:1399-1411. [DOI: 10.1007/s00296-017-3906-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
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