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King LK, Ivers NM, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, Wong S, Weisman A, Bardai Z, Ross S, Brady S, Shloush M, Stier T, Gakhal N, Agarwal P, Parsons J, Lipscombe L, Hawker GA. Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention. Implement Sci Commun 2023; 4:20. [PMID: 36855209 PMCID: PMC9972628 DOI: 10.1186/s43058-023-00398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Symptomatic knee osteoarthritis (OA) commonly co-occurs in people with type 2 diabetes (T2DM) and increases the risk for diabetes complications, yet uptake of evidence-based treatment is low. We combined theory, stakeholder involvement and existing evidence to develop a multifaceted intervention to improve OA care in persons with T2DM. This was done in partnership with Arthritis Society Canada to leverage the existing infrastructure and provincial funding for community arthritis care. METHODS Each step was informed by a User Advisory Panel of stakeholder representatives, including persons with lived experience. First, we identified the target groups and behaviours through consulting stakeholders and current literature. Second, we interviewed persons living with T2DM and knee OA (n = 18), health professionals (HPs) who treat people with T2DM (n = 18) and arthritis therapists (ATs, n = 18) to identify the determinants of seeking and engaging in OA care (patients), assessing and treating OA (HPs) and considering T2DM in OA treatment (ATs), using the Theoretical Domains Framework (TDF). We mapped the content to behavioural change techniques (BCTs) to identify the potential intervention components. Third, we conducted stakeholder meetings to ascertain the acceptability and feasibility of intervention components, including content and modes of delivery. Fourth, we selected intervention components informed by prior steps and constructed a programme theory to inform the implementation of the intervention and its evaluation. RESULTS We identified the barriers and enablers to target behaviours across a number of TDF domains. All stakeholders identified insufficient access to resources to support OA care in people with T2DM. Core intervention components, incorporating a range of BCTs at the patient, HP and AT level, sought to identify persons with knee OA within T2DM care and refer to Arthritis Society Canada for delivery of evidence-based longitudinal OA management. Diverse stakeholder input throughout development allowed the co-creation of an intervention that appears feasible and acceptable to target users. CONCLUSIONS We integrated theory, evidence and stakeholder involvement to develop a multifaceted intervention to increase the identification of knee OA in persons with T2DM within diabetes care and improve the uptake and engagement in evidence-based OA management. Our partnership with Arthritis Society Canada supports future spread, scalability and sustainability. We will formally assess the intervention feasibility in a randomized pilot trial.
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Affiliation(s)
- Lauren K. King
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Noah M. Ivers
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Esther J. Waugh
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Crystal MacKay
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Ian Stanaitis
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Owen Krystia
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Sim Wong
- Patient Research Partner, Toronto, ON Canada
| | - Alanna Weisman
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Zahra Bardai
- grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Susan Ross
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Shawn Brady
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Marlee Shloush
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Tara Stier
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Natasha Gakhal
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Payal Agarwal
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Janet Parsons
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada ,grid.415502.7Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Lorraine Lipscombe
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Gillian A. Hawker
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
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King LK, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, Ross S, Brady S, Weisman A, Lipscombe L, Hawker GA. Formulating Knee Osteoarthritis Management Plans Taking Type 2 Diabetes Into Account: Qualitative Study of Arthritis Therapists Using Theoretical Domains Framework. J Rheumatol Suppl 2022; 49:1365-1371. [PMID: 36109079 DOI: 10.3899/jrheum.220535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Delivering person-centered care in individuals with knee osteoarthritis (OA) necessitates consideration of other chronic conditions that frequently co-occur. We sought to understand the extent to which arthritis therapists consider type 2 diabetes mellitus (T2DM) when treating persons with knee OA and concomitant T2DM, and barriers to doing so. METHODS We conducted 18 semistructured telephone interviews with arthritis therapists working within a provincially funded arthritis care program (Arthritis Society Canada) in Ontario, Canada. We first analyzed interviews deductively using the Theoretical Domains Framework (TDF) to comprehensively identify barriers and enablers to health behaviors. Then, within TDF domains, we inductively developed themes. RESULTS We identified 5 TDF domains as prominently influencing the behavior of arthritis therapists considering concomitant T2DM when developing a knee OA management plan. These were as follows: therapists' perceived lack of specific knowledge around comorbidities including diabetes; the lack of breadth in skills in behavioral change techniques to help patients set and reach their goals, particularly when it came to physical activity; variable intention to factor a patient's comorbidity profile to influence their treatment recommendations; the perception of their professional role and identity as joint focused; and the environmental context with lack of formalized follow-up structure of the current Arthritis Society Canada program that limited sufficient patient monitoring and follow-up. CONCLUSION Within the context of a Canadian arthritis program, we identified several barriers to arthritis therapists considering T2DM in their management plan for persons with knee OA and T2DM. These results can help inform strategies to improve person-centered OA care and overall health outcomes.
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Affiliation(s)
- Lauren K King
- L.K. King, MD, MSc, G.A. Hawker, MD, MSc, Department of Medicine, University of Toronto, and Women's College Research Institute, Women's College Hospital
| | - Esther J Waugh
- E.J. Waugh, PhD, BScPT, Department of Physical Therapy, University of Toronto
| | - Crystal MacKay
- C. MacKay, PhD, BScPT, Department of Physical Therapy, University of Toronto, and West Park Healthcare Centre
| | - Ian Stanaitis
- I. Stanaitis, BMSc, Women's College Research Institute, Women's College Hospital
| | | | - Jane Stretton
- J. Stretton, MSW, Women's College Research Institute, Women's College Hospital
| | - Susan Ross
- S. Ross, MSc, Arthritis Rehabilitation and Education Program, Arthritis Society Canada
| | - Shawn Brady
- S. Brady, MSc, BScPT, Arthritis Rehabilitation and Education Program & Innovation, Arthritis Society Canada
| | - Alanna Weisman
- A. Weisman, MD, PhD, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital
| | - Lorraine Lipscombe
- L. Lipscombe, MD, MSc, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Gillian A Hawker
- L.K. King, MD, MSc, G.A. Hawker, MD, MSc, Department of Medicine, University of Toronto, and Women's College Research Institute, Women's College Hospital
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King LK, Krystia O, Waugh EJ, MacKay C, Stanaitis I, Stretton J, Weisman A, Ivers NM, Parsons JA, Lipscombe L, Hawker GA. Understanding the behavioural determinants of seeking and engaging in care for knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the theoretical domains framework. Osteoarthr Cartil Open 2022; 4:100305. [PMID: 36474800 PMCID: PMC9718122 DOI: 10.1016/j.ocarto.2022.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Symptomatic knee osteoarthritis (OA) frequently co-occurs in individuals with type 2 diabetes mellitus (T2DM). In the context of T2DM, OA is often underdiagnosed and undertreated. To elucidate strategies to improve OA care in persons with T2DM, we assessed their perceptions of the barriers and enablers to seeking and engaging in OA care. Design We conducted semi-structured interviews with 18 individuals with T2DM and symptomatic knee OA in Ontario, Canada. Transcripts were deductively coded using the Theoretical Domains Framework (TDF), an implementation science framework that incorporates theoretical domains of behaviour determinants, which can be linked to behaviour change techniques. Within each of the relevant domains, data were thematically analyzed to generate belief statements. Results Seven of the TDF domains prominently influenced the behaviour to seek and engage in OA care. Participants described insufficient receipt of OA knowledge to fully engage in care (knowledge), feeling incapable of participating in physical activity due to joint pain (beliefs about capabilities), uncertainty about effectiveness of therapies (optimism) and lack of guidance from health care providers and insufficient access to community programs/supports (environmental context and resources). Key enablers were strong social support (social influences), sources of accountability (behavioural regulation) and experiencing benefit from treatment (reinforcement). Participants did not see concomitant T2DM as limiting the desire to seek OA care. Conclusions Among individuals with symptomatic knee OA and T2DM, we identified behavioural determinants of seeking and engaging in OA care. These will be mapped to behavioural change techniques to inform development of a complex intervention.
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Affiliation(s)
- Lauren K. King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Owen Krystia
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Esther J. Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Noah M. Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet A. Parsons
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital – Unity Health Toronto, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Gillian A. Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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King LK, Krystia O, Waugh EJ, MacKay C, Stanaitis I, Stretton J, Weisman A, Ivers NM, Parsons JA, Lipscombe L, Hawker GA. Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework. Osteoarthr Cartil Open 2022; 4:100299. [PMID: 36474789 PMCID: PMC9718241 DOI: 10.1016/j.ocarto.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs') perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM. Design We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines. Results Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences). Conclusions We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.
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Affiliation(s)
- Lauren K. King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Owen Krystia
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Esther J. Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Noah M. Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet A. Parsons
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital – Unity Health Toronto, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Gillian A. Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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King LK, Hawker GA, Stanaitis I, Woodhouse L, Jones CA, Waugh EJ. Minimal clinically important difference for improvement in six-minute walk test in persons with knee osteoarthritis after total knee arthroplasty. BMC Musculoskelet Disord 2022; 23:307. [PMID: 35361173 PMCID: PMC8969367 DOI: 10.1186/s12891-022-05262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interpretability of the six-minute walk test (6MWT) in individuals with knee osteoarthritis (OA) is unclear. We aimed to determine the minimal clinically important difference (MCID) for improvement in 6MWT in persons with knee OA at 12 months after total knee arthroplasty (TKA), and if it differed by baseline walking ability. METHODS Participants with knee OA were assessed 1 month pre- and 12 months post-TKA, including completion of 6MWT. At 12 months, participant-perceived change in walking ability was assessed on an 8-point Likert scale ranging from "extremely worse" to "extremely better". Using logistic regression, ROC curves examined the ability of change in 6MWT distance to discriminate those who perceived walking was improved. MCID was selected overall and then by quartile of baseline 6MWT distance using the Youden method. RESULTS Two hundred seventy-eight participants were included: mean age 67 years (SD 8.5), 65.5% female, mean pre-TKA 6MWT distance 323.1 (SD 104.7) m, and mean 12-mo 6MWT distance 396.0 (SD 111.9) m. The overall MCID was 74.3 m (AUC 0.65). Acceptable model discrimination (AUC > 0.70) was achieved for individuals in the lowest quartiles of baseline 6MWT distance: Quartile 1: MCID 88.63 m (AUC 0.73); Quartile 2: MCID 84.47 m (AUC 0.72). CONCLUSIONS In persons with knee OA 12 months post-TKA, 6MWT MCID is dependent on baseline walking ability. Poor model discrimination for those in the highest (best) quartiles of baseline walking ability raise questions about 6MWT use across the full spectrum of walking ability. Further research is needed to better understand use of 6MWT as a performance-based measure of physical function for persons with knee OA.
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Affiliation(s)
- Lauren K King
- Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada. .,Women's College Research Institute, Women's College Hospital, 6307 - 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada.
| | - Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada.,Women's College Research Institute, Women's College Hospital, 6307 - 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, 6307 - 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada
| | - Linda Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Esther J Waugh
- Women's College Research Institute, Women's College Hospital, 6307 - 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, M5G 1V7, Canada
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King LK, Waugh EJ, Jones CA, Bohm E, Dunbar M, Woodhouse L, Noseworthy T, Marshall DA, Hawker GA. Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study. BMJ Open 2021; 11:e047061. [PMID: 34145017 PMCID: PMC8215258 DOI: 10.1136/bmjopen-2020-047061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA). DESIGN Prospective cohort study. SETTING Two provincial central intake hip and knee centres in Alberta, Canada. PARTICIPANTS 1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA. PRIMARY AND SECONDARY OUTCOME MEASURES Pre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA. RESULTS Mean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least one comorbidity. Individuals with a higher number of comorbidities had worse pre-TKA and post-TKA scores for pain, physical function and 6MWT distance. At 12-month follow-up, mean changes in pain, function and 6MWT distance, and proportion reporting a PASS, were similar for those with and without comorbidities. In multivariable regression analysis, adjusted for potential confounders and clustering by surgeon, no specific comorbidities nor total number of comorbidities were associated with less improvement in pain, physical function or 6MWT distance at 12 months after TKA. Patients with diabetes (OR 0.64, 95% CI 0.44 to 0.94) and a higher number of lower extremity troublesome joints (OR 0.85, 95% CI 0.76 to 0.96) had lower odds of reporting a PASS. CONCLUSION For individuals with knee OA, comorbid conditions do not limit improvement in pain, physical function or walking ability after TKA, and most conditions do not impact achieving an acceptable symptom state.
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Affiliation(s)
- Lauren K King
- Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Esther J Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - C Allyson Jones
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Bohm
- Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Dunbar
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Woodhouse
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Thomas Noseworthy
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gillian A Hawker
- Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Jakiela JT, Waugh EJ, White DK. Walk At Least 10 Minutes a Day for Adults With Knee Osteoarthritis: Recommendation for Minimal Activity During the COVID-19 Pandemic. J Rheumatol 2020; 48:157-159. [PMID: 32801138 DOI: 10.3899/jrheum.200914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jason T Jakiela
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Esther J Waugh
- E.J. Waugh, BScPT, MSc, PhD, University of Toronto, Department of Physical Therapy, Toronto, Ontario, Canada
| | - Daniel K White
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA;
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King LK, Kendzerska T, Waugh EJ, Hawker GA. Impact of Osteoarthritis on Difficulty Walking: A Population-Based Study. Arthritis Care Res (Hoboken) 2017; 70:71-79. [PMID: 28513082 DOI: 10.1002/acr.23250] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/28/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the relationship of hip and knee osteoarthritis (OA) to walking difficulty. METHODS A population cohort ages ≤55 years recruited from 1996 to 1998 (n = 28,451) completed a standardized questionnaire assessing demographics, health conditions, joint symptoms, and functional limitations, including difficulty walking in the past 3 months. Survey data were linked to health administrative databases; self-report and administrative data were used to identify health conditions. Hip/knee OA was defined as self-reported swelling, pain, or stiffness in a hip or knee lasting ≥6 weeks in the past 3 months without an inflammatory arthritis diagnosis. Using multivariable logistic regression, we examined the determinants of walking difficulty and constructed a clinical nomogram. RESULTS A total of 18,490 cohort participants were eligible (mean age 68 years, 60% women), and 25% reported difficulty walking. Difficulty walking was significantly and independently associated with older age, female sex, body mass index, and several health conditions. Of the conditions examined, the likelihood of walking difficulty was greatest with hip and knee OA and increased with the number of hip/knee joints affected. The predicted probability of difficulty walking for a 60-year-old middle-income, normal-weight woman was 5-10% with no health conditions, 10-20% with diabetes mellitus and cardiovascular (CV) disease, 40% with OA in 2 hips/knees, 60-70% with diabetes mellitus, CV disease, and OA in 2 hips/knees, and 80% with diabetes mellitus, CV disease, and OA in all hips/knees. CONCLUSION In a population cohort, symptomatic hip/knee OA was the strongest contributor to walking difficulty. Given the importance of walking to engagement in physical activity for chronic disease management, greater attention to OA is warranted.
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Affiliation(s)
| | - Tetyana Kendzerska
- University of Toronto, Women's College Research Institute, Women's College Hospital, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Esther J Waugh
- Women's College Research Institute, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Gillian A Hawker
- University of Toronto, Women's College Research Institute, Women's College Hospital, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Carlesso LC, Hawker GA, Waugh EJ, Davis AM. Disease-specific pain and function predict future pain impact in hip and knee osteoarthritis. Clin Rheumatol 2016; 35:2999-3005. [DOI: 10.1007/s10067-016-3401-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
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Waugh EJ, Badley EM, Borkhoff CM, Croxford R, Davis AM, Dunn S, Gignac MA, Jaglal SB, Sale J, Hawker GA. Primary care physicians' perceptions about and confidence in deciding which patients to refer for total joint arthroplasty of the hip and knee. Osteoarthritis Cartilage 2016; 24:451-7. [PMID: 26432986 DOI: 10.1016/j.joca.2015.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to examine the perceptions of primary care physicians (PCPs) regarding indications, contraindications, risks and benefits of total joint arthroplasty (TJA) and their confidence in selecting patients for referral for TJA. DESIGN PCPs recruited from among those providing care to participants in an established community cohort with hip or knee osteoarthritis (OA). Self-completed questionnaires were used to collect demographic and practice characteristics and perceptions about TJA. Confidence in referring appropriate patients for TJA was measured on a scale from 1 to 10; respondents scoring in the lowest tertile were considered to have 'low confidence'. Descriptive analyses were conducted and multiple logistic regression was used to determine key predictors of low confidence. RESULTS 212 PCPs participated (58% response rate) (65% aged 50+ years, 45% female, 77% >15 years of practice). Perceptions about TJA were highly variable but on average, PCPs perceived that a typical surgical candidate would have moderate pain and disability, identified few absolute contraindications to TJA, and overestimated both the effectiveness and risks of TJA. On average, PCPs indicated moderate confidence in deciding who to refer. Independent predictors of low confidence were female physicians (OR = 2.18, 95% confidence interval (CI): 1.06-4.46) and reporting a 'lack of clarity about surgical indications' (OR = 3.54, 95% CI: 1.87-6.66). CONCLUSIONS Variability in perceptions and lack of clarity about surgical indications underscore the need for decision support tools to inform PCP - patient decision making regarding referral for TJA.
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Affiliation(s)
- E J Waugh
- Women's College Hospital, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
| | - E M Badley
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - C M Borkhoff
- Women's College Hospital, Toronto, Ontario, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A M Davis
- Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - S Dunn
- Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M A Gignac
- Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - S B Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - J Sale
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - G A Hawker
- Women's College Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE The response of bone to exercise in women with anorexia nervosa (AN) is unclear. We investigated the associations between bone mineral density (BMD) and exercise performed while ill and while recovered in women with a history of AN. METHODS A cross-sectional study was conducted with 141 women with AN (85 ill; 56 recovered), aged 17-40 yr. BMD at the lumbar spine (LS), femoral neck (FN), and total body (TB) was measured by dual-energy x-ray absorptiometry. Life History Calendar and Minnesota Leisure Time Physical Activity interviews were used to collect lifetime illness and exercise histories (amount and bone loading type). Average hours per week of each of moderate (MOD) and high (HI) bone loading exercise were determined for three illness phases: "before ill," "while ill," and "while recovered." Participants were categorized into four exercise groups for each phase: MOD-ONLY, HI-ONLY, BOTH, and NEITHER (reference group). Weight-adjusted BMD z-scores were compared in the exercise groups by multivariable linear regression, adjusting for illness duration and severity, and exercise during the other illness phases. RESULTS In ill participants, MOD-ONLY "while ill" had lower BMD at LS (β = -0.69, 95% confidence interval (CI) = -1.02 to -0.05) and TB (β = -0.73, 95% CI = -1.31 to -0.15) than the NEITHER group. In recovered participants, HI-ONLY "while recovered" had higher BMD at FN (β = 0.95, 95% CI = 0.15-1.75) and TB (β = 0.79, 95% CI = 0.07-1.51) than the NEITHER group. CONCLUSIONS The effect of exercise on bone in AN patients is dependent on both the type of mechanical loading and the phase of illness during which it was performed. Excessive moderate loading exercise while ill may put patients at higher risk of low bone mass, but high bone loading activities may provoke bone accrual during recovery.
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Affiliation(s)
- Esther J Waugh
- Osteoporosis Research Program, Women’s College Hospital, 76 Grenville St., 8th Floor E, Room 812B, Toronto, Ontario, Canada M5S 2B2.
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12
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Hawker GA, French MR, Waugh EJ, Gignac MAM, Cheung C, Murray BJ. The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Osteoarthritis Cartilage 2010; 18:1365-71. [PMID: 20708004 DOI: 10.1016/j.joca.2010.08.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [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: 02/24/2010] [Revised: 06/04/2010] [Accepted: 08/02/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate subjective sleep quality and its relationship to fatigue in older adults with osteoarthritis (OA). METHOD In a community cohort with hip/knee OA, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and fatigue was measured by the Profile of Mood States - Fatigue subscale (POMS-F). Correlates of sleep quality and fatigue were determined by standardized interviews including socio-demographics, OA severity (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) summary score), comorbidity, depression (Center for Epidemiologic Studies Depression Scale, CES-D), stressful life events, daytime napping, symptoms of restless legs syndrome (RLS) and prior sleep disorder diagnoses. Logistic regression examined correlates of poor sleep (PSQI score>5). Linear regression evaluated the relationship between poor sleep and fatigue, and the effect of napping on this relationship. RESULTS In 613 respondents, mean age was 78 years, 78% were female, 11% had concomitant fibromyalgia, and 26% had 3+ comorbid conditions. Responses indicated moderate OA severity. Seventy percent reported poor sleep; 25% met criteria for RLS and 6.5% reported a diagnosed sleep disorder. Independent correlates of poor sleep were: greater arthritis severity (adjusted odds ratio (OR) per unit increase in WOMAC score=1.03, P<0.0001), 3+ comorbid conditions (adjusted OR=1.88; P=0.03), depressed mood (adjusted OR per unit increase in CES-D score=1.09, P<0.0001), and RLS (adjusted OR=1.87; P=0.02). Controlling for previously reported fatigue correlates, poor sleep was significantly associated with greater fatigue (parameter estimate=1.63, P=0.0003) and napping did not moderate this relationship (P=0.55 for the interaction between napping and poor sleep). CONCLUSIONS Among older people with OA, poor sleep is highly prevalent and significantly linked with fatigue. Identifying the nature of sleep disturbances in OA is important as treatment of sleep disturbances may reduce OA-related fatigue.
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Affiliation(s)
- G A Hawker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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13
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Waugh EJ, Lam MA, Hawker GA, McGowan J, Papaioannou A, Cheung AM, Hodsman AB, Leslie WD, Siminoski K, Jamal SA. Risk factors for low bone mass in healthy 40-60 year old women: a systematic review of the literature. Osteoporos Int 2009; 20:1-21. [PMID: 18523710 PMCID: PMC5110317 DOI: 10.1007/s00198-008-0643-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 04/07/2008] [Indexed: 11/24/2022]
Abstract
UNLABELLED Based on a systematic review of the literature, only low body weight and menopausal status can be considered with confidence, as important risk factors for low BMD in healthy 40-60 year old women. The use of body weight to identify high risk women may reduce unnecessary BMD testing in this age group. INTRODUCTION BMD testing of perimenopausal women is increasing but may be unnecessary as fracture risk is low. Appropriate assessment among younger women requires identification of risk factors for low BMD specific to this population. METHODS We conducted a systematic literature review of risk factors for low BMD in healthy women aged 40-60 years. Articles were retrieved from six databases and reviewed for eligibility and methodological quality. A grade for overall strength of evidence for each risk factor was assigned. RESULTS There was good evidence that low body weight and post-menopausal status are risk factors for low BMD. There was good or fair evidence that alcohol and caffeine intake, and reproductive history are not risk factors. There was inconsistent or insufficient evidence for the effect of calcium intake, physical activity, smoking, age at menarche, history of amenorrhea, family history of OP, race and current age on BMD. CONCLUSIONS Based on current evidence in Caucasians, we suggest that, in healthy women aged 40-60 years, only those with a low body weight (< 70 kg) be selected for BMD testing. Further research is necessary to determine optimal race-specific discriminatory weight cut-offs and to evaluate the risk factors for which there was inconclusive evidence.
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Affiliation(s)
- E J Waugh
- Osteoporosis Research Program, Women's College Hospital, Toronto, ON, Canada.
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Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am J Clin Nutr 2007. [DOI: 10.1093/ajcn/86.6.1791] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Esther J Waugh
- From the Osteoporosis Research Program, Women's College Hospital, Toronto, Canada (EJW and GAH), and the Departments of Health Policy, Management and Evaluation (EJW and GAH), Psychology (JP), and Medicine (RR and GAH), University of Toronto, Toronto, Canada
| | - Janet Polivy
- From the Osteoporosis Research Program, Women's College Hospital, Toronto, Canada (EJW and GAH), and the Departments of Health Policy, Management and Evaluation (EJW and GAH), Psychology (JP), and Medicine (RR and GAH), University of Toronto, Toronto, Canada
| | - Rowena Ridout
- From the Osteoporosis Research Program, Women's College Hospital, Toronto, Canada (EJW and GAH), and the Departments of Health Policy, Management and Evaluation (EJW and GAH), Psychology (JP), and Medicine (RR and GAH), University of Toronto, Toronto, Canada
| | - Gillian A Hawker
- From the Osteoporosis Research Program, Women's College Hospital, Toronto, Canada (EJW and GAH), and the Departments of Health Policy, Management and Evaluation (EJW and GAH), Psychology (JP), and Medicine (RR and GAH), University of Toronto, Toronto, Canada
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15
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Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am J Clin Nutr 2007; 86:1791-801. [PMID: 18065600 DOI: 10.1093/ajcn/86.5.1791] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive dietary restraint (CDR) may mediate subclinical ovulatory disturbances, which may result in loss of bone mineral density (BMD). CDR is associated with greater physical activity, which may modify the effect of CDR and ovulatory disturbances on bone mass. OBJECTIVE We aimed to investigate the relations among CDR, ovulatory disturbances, and physical activity and their effect on BMD in healthy premenopausal women over a 2-y period. DESIGN In this prospective cohort study, key explanatory factors, important covariates, and BMD were measured at baseline and at 12 and 24 mo; 225 women completed the baseline assessment, and 189 completed the study. CDR was measured with the Three-Factor Eating Questionnaire, and physical activity was measured with the Baecke scale. An average of 9.8 menstrual cycles in 2 y were monitored by using salivary progesterone measurements and urinary ovulation detection kits. Ovulatory disturbances included anovulatory cycles or short luteal phase lengths of <10 d. BMD at the lumbar spine, femoral neck, and total body was measured by using dual-energy X-ray absorptiometry. General linear mixed modeling was used to determine predictors of change in BMD over time. RESULTS CDR was not associated with ovulatory disturbances or changes in BMD. The average annual rate of change in lumbar spine BMD was decreased by 0.01 g/cm(2) in women who had experienced > or =3 monitored cycles with ovulatory disturbances (P = 0.02). CONCLUSIONS CDR did not predict bone loss, and there was no relation between CDR and ovulatory disturbances. Ovulatory disturbances had a negative effect on the rate of change at the lumbar spine. The cause of these disturbances is unknown.
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Affiliation(s)
- Esther J Waugh
- Osteoporosis Research Program, Women's College Hospital, Toronto, ON, Canada.
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17
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Abstract
STUDY DESIGN Multicenter prospective design with a cohort of patients with lateral epicondylalgia commencing physical therapy. OBJECTIVE To identify key factors associated with long-term prognosis of conservatively managed lateral epicondylalgia. BACKGROUND The response to conservative management of lateral epicondylalgia is inconsistent and the rate of recovery varies widely among individuals. The reasons for these discrepancies are not understood. The identification of factors associated with prognosis will aid in the prediction of patient outcomes. METHODS AND MEASURES Sixty patients with lateral epicondylalgia, recruited from 9 sports medicine clinics and 2 hospital outpatient physical therapy departments in Ontario, Canada, were followed for 6 months. A baseline clinical assessment was conducted on each participant using standard physical therapy techniques. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a 100-mm pain visual analog scale (VAS) were completed at baseline and 6 months later. RESULTS The key factor associated with both 6-month DASH and pain VAS scores was repetitive-work tasks (DASH, 9.8 [P < .011; pain VAS, 13.1 mm [P = .0105]). A subanalysis indicated that women were more likely than men to have cervical joint signs and, among women, positive cervical articular signs were also associated with higher final DASH and pain VAS scores. CONCLUSIONS Although many of the participants identified sports activities as the cause of their injury, these findings emphasize the importance that a patient's work tasks can have on recovery of lateral epicondylalgia. This would suggest that management should perhaps focus on work stations, postures, and behaviors.
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Affiliation(s)
- Esther J Waugh
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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18
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Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil 2004; 85:308-18. [PMID: 14966719 DOI: 10.1016/s0003-9993(03)00480-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify key factors associated with outcomes of patients who underwent 8 weeks of physical therapy (PT) for lateral epicondylitis. DESIGN Multicenter prospective design with inception cohort of lateral epicondylitis patients commencing PT. Baseline clinical examinations were conducted by 1 physical therapist; self-report outcome measures were completed at baseline and 8 weeks later. SETTING Nine private sports medicine clinics and 2 hospital outpatient departments in Ontario, Canada. PARTICIPANTS Eighty-three patients with unilateral lateral epicondylitis identified by the treating physical therapists. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The final scores of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and a vertical pain visual analog scale (VAS) were used as the dependent variables. RESULTS The final prognostic model for the 8-week DASH scores included the baseline score (95% confidence interval [CI], 0.34-0.66), sex (female) (95% CI, 3.3-14.5), and self-reported nerve symptoms (95% CI, 0.8-13.8). The model for the 8-week VAS scores included the baseline score (95% CI, 0.01-0.37), sex (female) (95% CI, 0.4-18.2), and self-reported nerve symptoms (95% CI, 4.7-25.5). A subanalysis indicated that women were more likely than men to have work-related onsets, repetitive keyboarding jobs, and cervical joint signs. Among women, these factors were associated with higher final DASH and VAS scores. CONCLUSIONS Women and patients who report nerve symptoms are more likely to experience a poorer short-term outcome after PT management of lateral epicondylitis. Work-related onsets, repetitive keyboarding jobs, and cervical joint signs have a prognostic influence on women.
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Affiliation(s)
- Esther J Waugh
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
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Sundstrom JM, Hall FS, Stellar JR, Waugh EJ. Effects of isolation-rearing on intracranial self-stimulation reward of the lateral hypothalamus: baseline assessment and drug challenges. Life Sci 2002; 70:2799-810. [PMID: 12269384 DOI: 10.1016/s0024-3205(02)01509-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is evidence that isolation rearing produces down-regulation of the dopamine D2 receptor. Therefore, isolation rearing should also modify the effects of D2 antagonists on intracranial self-stimulation (ICSS) reward. This study investigated the effect of isolation rearing on ICSS reward, and modulation of that reward by SCH23390, Raclopride and MK-801. Sprague-Dawley rats were reared alone (isolates) or in pairs from day 21 postnatal to day 75 postnatal. At this time, all rats were implanted with monopolar stimulating electrodes in the lateral hypothalamus. The ICSS rate-frequency curve-shift method was used to assess reward and operant motor function at baseline and after administration of SCH-23390 (D1 antagonist: 0.02, 0.06, 0.2 mg/kg), Raclopride (D2 antagonist: 0.01, 0.025, 0.06 mg/kg), and MK-801 (non-competitive NMDA receptor antagonist: 0.1, 0.2 mk/kg). Isolation-reared rats displayed similar measures of both basal reward and motor function when compared to socially reared controls. Isolation-reared rats were subsensitive to the reward decreasing effects of Raclopride. Socially reared rats were observed to have more variant baseline reward measures, and could be divided into distinctly different groups with different basal reward function. Isolation-rearing down-regulates D2 function but does not affect basal reward function, but some unknown factor in the social rearing environment did have a substantial effect on basal reward function.
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Affiliation(s)
- J M Sundstrom
- Department of Psychology, Northeastern University, Boston, MA 02115, USA
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