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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Turner AS. Reply. Arthritis Care Res (Hoboken) 2024; 76:438-439. [PMID: 37818722 DOI: 10.1002/acr.25255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Constien D, Chan KK, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips L“R, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:1299-1311. [PMID: 37227071 PMCID: PMC10947582 DOI: 10.1002/art.42507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R. England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | | | - Jennifer L. Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | - Carole V. Dodge
- University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY
| | | | | | | | | | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Chris Y. Lane
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, TN
| | | | | | | | | | - Louise Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Chan KK, Constien D, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips LR, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023. [PMID: 37227116 DOI: 10.1002/acr.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | | | | | | | - Carole V Dodge
- University of Michigan Hospital and Health System, Ann Arbor
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | | | | | | | - Janet Lewis
- University of Virginia, Charlottesville, Virginia
| | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, California
| | | | - Neha Shah
- Stanford Health Care, Palo Alto, California
| | | | | | - Rawan AlHeresh
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Linda C Li
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, Tennesee
| | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Oatis CA, Konnyu KJ, Franklin PD. Generating consistent longitudinal real‐world data to support research: lessons from physical therapists. ACR Open Rheumatol 2022; 4:771-774. [PMID: 35712813 PMCID: PMC9469481 DOI: 10.1002/acr2.11465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
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Franklin PD, Oatis CA, Zheng H, Westby MD, Peter W, Laraque-Two Elk J, Rizk J, Benbow E, Li W. Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint). JMIR Rehabil Assist Technol 2022; 9:e37714. [PMID: 36301608 PMCID: PMC9650563 DOI: 10.2196/37714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Electronic health records (EHRs) have the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform health care system and its data to a "learning health care system" generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. Objective The purpose of this paper was to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case was ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods To identify the PT intervention type and intensity (or dose) used to treat patients with knee arthritis following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing physical therapists and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical structured system for intervention and intensity documentation was designed and deployed. Results The PT documentation system was implemented by 114 physical therapists agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 physical therapists. No technical problems with data entry were reported, and data entry required less than 2 minutes per visit. A total of 42 (2%) interventions could not be categorized and were recorded using free text. Conclusions The use of user-centered design principles provides a road map for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and disseminate knowledge to practice.
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Affiliation(s)
- Patricia D Franklin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, United States
| | - Marie D Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Wilfred Peter
- Department of Orthopedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | | | - Joseph Rizk
- Cascade Rehabilitation Associates, Everett, WA, United States
| | - Ellen Benbow
- Magee Rehabilitation Hospital, Philadelphia, PA, United States
| | - Wenjun Li
- Department of Public Health, University of Massachusetts-Lowell, Lowell, MA, United States
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Oatis CA, Johnson JK, DeWan T, Donahue K, Li W, Franklin PD. Characteristics of Usual Physical Therapy Post-Total Knee Replacement and Their Associations With Functional Outcomes. Arthritis Care Res (Hoboken) 2018; 71:1171-1177. [PMID: 30281207 DOI: 10.1002/acr.23761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although total knee replacement (TKR) surgery is highly prevalent and generally successful, functional outcomes post-TKR vary widely. Most patients receive some physical therapy (PT) following TKR, but PT practice is variable and associations between specific content and dose of PT interventions and functional outcomes are unknown. Research has identified exercise interventions associated with better outcomes but studies have not assessed whether such evidence has been translated into clinical practice. We characterized the content, dose, and progression of usual post-acute PT services following TKR, and examined associations of specific details of post-acute PT with patients' 6-month functional outcomes. METHODS Post-acute PT data were collected from patients who were undergoing primary unilateral TKR and participating in a clinical trial of a phone-based coaching intervention. PT records from the terminal episode of care were reviewed and utilization and exercise content data were extracted. Descriptive statistics and linear regression models characterized PT treatment factors and identified associations with 6-month outcomes. RESULTS We analyzed 112 records from 30 PT sites. Content and dose of specific exercises and incidence of progression varied widely. Open chain exercises were utilized more frequently than closed chain (median 21 [interquartile range (IQR) 4-49] versus median 13 [IQR 4-28.5]). Median (IQR) occurrence of progression of closed and open chain exercise was 0 (0-2) and 1 (0-3), respectively. Shorter timed stair climb was associated with greater total number of PT interventions and use and progression of closed chain exercises. DISCUSSION Data suggest that evidence-based interventions are underutilized and dose may be insufficient to obtain optimal outcomes.
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Affiliation(s)
| | | | | | - Kelly Donahue
- MossRehab, Einstein Healthcare Network, Elkins Park, Pennsylvania
| | - Wenjun Li
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Hannan MT, Oatis CA, McLean RR. A Cinderella Tale: Can New Shoes Change the Life of a Person With Knee Osteoarthritis? Ann Intern Med 2016; 165:443-4. [PMID: 27399880 DOI: 10.7326/m16-1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marian T Hannan
- From Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, and Arcadia University, Glenside, Pennsylvania
| | - Carol A Oatis
- From Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, and Arcadia University, Glenside, Pennsylvania
| | - Robert R McLean
- From Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, and Arcadia University, Glenside, Pennsylvania
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Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in Delivery and Exercise Content of Physical Therapy Rehabilitation Following Total Knee Replacement Surgery: A Cross-Sectional Observation Study. ACTA ACUST UNITED AC 2014; Suppl 5. [PMID: 26594649 PMCID: PMC4651458 DOI: 10.4172/2329-9096.s5-002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Prevalence of total knee replacement (TKR) is large and growing but functional outcomes are variable. Physical therapy (PT) is integral to functional recovery following TKR but little is known about the quantity or content of PT delivered. Purposes of this study were to describe the amount and exercise content of PT provided in the terminal episode of PT care following TKR and to examine factors associated with utilization and content. Methods Subjects included participants in a clinical trial of behavioral interventions for patients undergoing primary unilateral TKR who had completed the 6-month study evaluation. PT records were requested from 142 consecutive participants who had completed their post-TKR rehabilitation, 102 in/out patient care, and 40 in homecare. Information on utilization and exercises was extracted from a retrospective review of the PT records. Results We received 90 (88%) outpatient and 27 (68%) homecare PT records. Records showed variability in timing, amount and content of PT. Patients receiving outpatient PT had more visits and remained in PT longer (p<0.001). Exercises known in the TKR literature were utilized more frequently in the outpatient setting (p=0.001) than in home care. Records from both settings had limited documentation of strengthening progression. Conclusions The study reveals considerable variability in timing, utilization and exercise content of PT following TKR and suggests sub-optimal exercise for strengthening. While methods we employed document variability, improved systematic PT documentation and in-depth research are needed to identify optimal timing, utilization and content of PT following TKR.
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Affiliation(s)
- Carol A Oatis
- Department of Physical Therapy, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA
| | - Wenjun Li
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA ; Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jessica M DiRusso
- The Queens Medical Center, 1301 Punchbowl St, Honolulu, HI 96813, USA
| | - Mindy J Hoover
- The Physical Therapy Associates of Myerstown, 11 E Lincoln Ave, Myerstown, PA 17067, USA
| | - Katherine K Johnston
- Sports and More Physical Therapy, Inc., 8300 Health Park, Suite 127, Raleigh, NC 27615, USA
| | - Monika K Butz
- Drayer PT Institute, 998 Hospitality Way, Aberdeen, MD 21001, USA
| | - Amy L Phillips
- UPMC Shadyside, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Kimberly M Nanovic
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Elizabeth C Cummings
- HealthEast Optimum Rehabilitation, Midway Clinic, 1390 University Avenue West Saint Paul, Minnesota 55104, USA
| | - Milagros C Rosal
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Patricia D Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Zheng H, Rosal MC, Oatis CA, Li W, Franklin PD. Tailored system to deliver behavioral intervention and manage data in randomized trials. J Med Internet Res 2013; 15:e58. [PMID: 23579207 PMCID: PMC3636316 DOI: 10.2196/jmir.2375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/06/2013] [Accepted: 02/09/2013] [Indexed: 12/25/2022] Open
Abstract
Background The integrity of behavioral intervention trials depends on consistent intervention delivery, and uniform, comprehensive process data collection. It can be challenging in practice due to complex human interactions involved. Objective We sought to design a system to support the fidelity of intervention delivery and efficient capture of qualitative and quantitative process data for a telephone-delivered behavioral counseling intervention to increase physical activity and function after total knee replacement surgery. Methods A tailored system was designed to prompt the intervention coach in the delivery of a 5 step counseling protocol to support intervention fidelity across patients. System features included structured data components, automated data exchange functions, user-friendly data capture screens, and real-time surveillance reporting. The system structured the capture of patient goals and open-ended conversation. Results The system recorded intervention process data from each of 12 sessions held with the 92 intervention patients. During the trial, 992 telephone sessions were conducted, and more than 97% (4816/4960) of intervention process data fields were completed in the system. The coach spent 5-10 minutes preparing for each counseling call using system-generated summaries of historical data and 10-15 minutes entering intervention process data following each telephone session. Conclusions This intervention delivery system successfully supported the delivery of a structured behavioral counseling intervention and collection of intervention process data. It addressed the unique needs of clinical behavioral intervention trials, and had promising potential to facilitate high-fidelity translation of the intervention to broad clinical practice and Web-based multicenter clinical trials in the future.
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Affiliation(s)
- Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA 01655, United States
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Stanislavova O, Robbins SJ, Oatis CA. Nonconscious priming of elderly or youthful stereotypes influences walking velocity in healthy undergraduates. Gait Posture 2013; 37:470-1. [PMID: 23021253 DOI: 10.1016/j.gaitpost.2012.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 06/01/2012] [Accepted: 08/30/2012] [Indexed: 02/02/2023]
Abstract
Psychological studies of "priming" effects document that covertly presented stimuli can influence behavior without participant awareness. We examined whether nonconscious priming can influence walking velocity on an instrumented walkway. Fifty-nine healthy participants were randomly assigned to unscramble sentences and answer self-concept questions containing words related to either the concepts elderly/passive or youthful/active. Walking velocity was measured before and after this priming manipulation. An ANOVA revealed a significant Group×Time interaction; the elderly/passive group showed a decrease in walking velocity over time while the youthful/active group showed an increase. None of the participants expressed any awareness of the study purpose and the experimenter was blind to group assignment. These results suggest that spoken or written material received by patients prior to gait assessments (such as casual conversations or written health inventories) might influence walking performance outside of client or clinician awareness.
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Affiliation(s)
- Olga Stanislavova
- Department of Psychology, Arcadia University, 450 South Easton Road, Glenside, PA 19038, United States
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Oatis CA, Wolff EF, Lockard MA, Michener LA, Robbins SJ. Correlations among measures of knee stiffness, gait performance and complaints in individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2013; 28:306-11. [PMID: 23410554 DOI: 10.1016/j.clinbiomech.2013.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/20/2012] [Accepted: 01/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stiffness is a common complaint in individuals with knee osteoarthritis and is a component of the osteoarthritis diagnosis. Yet the relationship between stiffness and function is poorly understood and methods to quantify stiffness are limited. METHODS Using a cross-sectional observational design with 66 subjects with knee osteoarthritis, stiffness and damping coefficients were calculated from a relaxed knee oscillation procedure. Gait parameters were measured using an electronic walkway. Self-reported pain, stiffness, and function were measured with the Western Ontario and McMaster Osteoarthritis Index. Correlation and Alexander's normalized-t approximation analyses were used to assess associations among the variables. Subset analysis was performed on subjects with and without tibiofemoral joint crepitus. FINDINGS Slight to moderate correlations existed between stiffness and damping coefficients and most gait parameters ((| r |=0.30-0.56; P<.05) and between Western Ontario and McMaster Osteoarthritis Index scores and all gait parameters (| r |=0.35-0.62; P<.05). The damping coefficient was only slightly associated with patient-rated Western Ontario and McMaster Osteoarthritis Index stiffness subscale scores. Subset analysis revealed significant correlations that differed between those with and without crepitus. INTERPRETATION These findings suggest that laboratory measured stiffness and damping coefficients, Western Ontario and McMaster Osteoarthritis Index scores and gait-related measurements assess different aspects related to movement in individuals with knee osteoarthritis. Stiffness and damping coefficients may offer the ability to explain gait changes in the knee that are independent of a person's perceptions particularly in the early stages of the disease.
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Affiliation(s)
- Carol A Oatis
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States.
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Abstract
STUDY DESIGN Descriptive, case-matched comparison. OBJECTIVES To compare the knee joint stiffness and damping coefficients of individuals with knee osteoarthritis (KOA) to those of age- and gender-matched individuals without KOA. A secondary purpose was to investigate relationships between these coefficients and complaints of stiffness in individuals with KOA. BACKGROUND KOA is a leading cause of disability, and stiffness is a common complaint in individuals with KOA. Yet the most common method of assessing knee joint stiffness is through a self-report questionnaire. METHODS AND MEASURES Stiffness and damping coefficients at the knee were calculated in 10 volunteers (mean age +/- SD, 64.1+/-15.5 years) with KOA and compared to coefficients from age-and gender-matched individuals without KOA, collected in a previous study (mean age +/- SD, 62.1+/-13.9 years). Stiffness and damping coefficients were calculated from the angular motion of the knee during a relaxed oscillation. Spearman correlation coefficients were calculated between stiffness and damping coefficients and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores for subjects with KOA. RESULTS Independent 2-tailed t tests revealed significantly larger damping coefficients (P = .035) among those with KOA (95% CI, 0.10-2.32 Nm s/rad). Spearman rank correlations revealed a significant positive relationship (r = .85, P = .003) between the damping coefficient and the stiffness subscore of the WOMAC. CONCLUSION This study offers preliminary data demonstrating the feasibility of measuring stiffness and damping coefficients in individuals with KOA. Additionally, the damping coefficient is increased in people with KOA when compared to age- and gender-matched individuals without KOA. The damping coefficient appears to be associated with the complaints of stiffness reported by the WOMAC.
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Affiliation(s)
- Carol A Oatis
- Department of Physical Therapy, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA.
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Goldman RJ, Reinbold KA, Iglarsh ZA, Neustadter LM, Oatis CA, Schumacher HR. Phase I design and evaluation of an isometric muscle reeducation device for knee osteoarthritis rehabilitation03/40/2/PDF/goldman.pdf. ACTA ACUST UNITED AC 2003; 40:95-107. [PMID: 15077636 DOI: 10.1682/jrrd.2003.03.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation of knee osteoarthritis (OA) using a force-biofeedback device (Isopad). Our goal for Phase I was to design and evaluate an Isopad-based program in a supervised clinical setting. Our subjects were five patients with knee OA of Kellgren stage II or greater. A capacitive force sensor was tested for accuracy, repeatability, and durability. An Arthritis Foundation home-based isometric program inspired the Isopad design. The Isopad provided visual and auditory feedback instantaneously and continuously about force generated between the ankles. The five subjects completed a supervised 8-week progressive isometric program using the Isopad. Absolute isolated quadriceps and hamstring torques were quantified with a dynamometer, and patients completed a self-assessment of symptoms (Western Ontario and McMaster Universities Osteoarthritis Index). The capacitive sensor accuracy error averaged 10% and repeatability 4%. Cognitively intact subjects used the Isopad successfully for isometric progressive resistance training. Quadriceps and hamstrings absolute torques increased an average of 30%. Patients reported decreased functional complaints (Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index). All changes were trends. The Isopad helped subjects with knee OA adhere to a supervised isometric program and meet progressive strength targets. The next-generation Isopad will be employed in a home-based program.
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Abstract
BACKGROUND AND PURPOSE Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of this study was to determine the reliability of a relaxed oscillation test that yields stiffness and damping coefficients of the knee. These coefficients describe the knee joint's resistance to bending and the time-dependent nature of that resistance. SUBJECTS AND METHODS Effects of age, gender, and knee position on these coefficients were assessed in 96 healthy volunteers aged 20 to 79 years. Measures were based on the premise that the knee joint can be modeled as a damped spring. Oscillations of the knee were recorded using an electrogoniometer with the knee oscillating through about 45 and 75 degrees of knee flexion. RESULTS Intraclass correlation coefficients revealed moderate to high reliability in the measurements taken three times in the same test session and on three separate days. Analysis of variance showed significant increases in stiffness and damping coefficients in the male subjects as compared with the female subjects. Analysis of variance also suggested an age effect on stiffness coefficients at the 75-degree test position, with decreasing stiffness with age. Both stiffness and damping coefficients were significantly smaller when measured at the 75-degree test position compared with the 45-degree position (Student's t test). CONCLUSION AND DISCUSSION These results demonstrate a reliable method of measuring knee joint stiffness, and they correlate well with known morphological differences related to age and gender. This measure may prove to be more useful in evaluating the function of the knee than more commonly used assessments. It may also lead to a better understanding of how the knee functions in such activities as locomotion.
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Affiliation(s)
- C A Oatis
- Department of Physical Therapy, Beaver College, Glenside, PA 19038
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15
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Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther 1992; 72:425-31. [PMID: 1589462 DOI: 10.1093/ptj/72.6.425] [Citation(s) in RCA: 310] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purposes of this study were to identify the incidence of postural abnormalities of the thoracic, cervical, and shoulder regions in two age groups of healthy subjects and to explore whether these abnormalities were associated with pain. Eighty-eight healthy subjects, aged 20 to 50 years, were asked to answer a pain questionnaire and to stand by a plumb line for postural assessment of forward head, rounded shoulders, and kyphosis. Subjects were divided into two age groups: a 20- to 35-year-old group (mean = 25, SD = 63) and a 36- to 50-year-old group (mean = 47, SD = 2.6). Interrater and intrarater reliability (Cohen's Kappa coefficients) for postural assessment were established at .611 and .825, respectively. Frequency counts revealed postural abnormalities were prevalent (forward head = 66%, kyphosis = 38%, right rounded shoulder = 73%, left rounded shoulder = 66%). No relationship was found between the severity of postural abnormality and the severity and frequency of pain. Subjects with more severe postural abnormalities, however, had a significantly increased incidence of pain, as determined by chi-square analysis (critical chi 2 = 6, df = 2, P less than .05). Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.
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16
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McCully KK, Forciea MA, Hack LM, Donlon E, Wheatley RW, Oatis CA, Goldberg T, Chance B. Muscle metabolism in older subjects using 31P magnetic resonance spectroscopy. Can J Physiol Pharmacol 1991; 69:576-80. [PMID: 1650649 DOI: 10.1139/y91-084] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We used phosphorus magnetic resonance spectroscopy to study the calf muscles of elderly normal (mean +/- SD) (80.0 +/- 5.12 years), elderly impaired (80.7 +/- 0.58 years), old normal (66.8 +/- 1.92 years), and young normal people (24.6 +/- 4.72 years). Relative levels of inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate were measured with a 1.9-tesla, 30-cm bore magnet at rest and following plantra flexon exercise. No differences were found at rest or during recovery from exercise in the elderly normal subjects with respect to gender or the presence of stable medical problems treated with medication. At rest there was an age-related decrease in the ratio of PCr/Pi. After exercise, the time constant of PCr recovery increased with age. A mild 7-week exercise regimen consisting of plantar flexion had no effect on time constant of PCr recovery in the elderly subjects. Four elderly impaired subjects had lower PCr/Pi ratios at rest and slower time constant of PCr recovery after exercise than normal elderly subjects. We conclude that gender and the presence of stable medical problems had no effect on muscle metabolism in the elderly and that the elderly recovered slower than young controls. This slower recovery was not corrected with a mild exercise program.
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Affiliation(s)
- K K McCully
- Department of Biochemistry and Biophysics, Philadelphia Institute of Physical Therapy, University of Pennsylvania 19104
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17
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Abstract
The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the motions of the ankle and foot available during nonambulatory activities are described by reviewing the literature discussing the axes of motion for the ankle and joints of the foot. Conflicting terminology is presented and clarified, and a scheme for a reasonable terminology is presented. The role of the ankle-foot complex in closed and open kinetic chains is also discussed. Terminology describing structural and functional positions of the foot is presented, including definitions of the subtalar neutral position. A systematic format of terminology is offered to reduce the current inconsistencies. Finally, the weight-bearing area of the foot and muscle activity in quiet standing are reviewed.
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Affiliation(s)
- C A Oatis
- Philadelphia Institute for Physical Therapy, PA 19104
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