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Voinier D, Neogi T, Master H, Thoma LM, Brunette M, Jakiela J, Stefanik JJ, White DK. Sitting may increase risk for radiographic incidence and progression of knee osteoarthritis over 2 years: Data from a large cohort study. Musculoskeletal Care 2023; 21:1075-1084. [PMID: 37253682 PMCID: PMC10687316 DOI: 10.1002/msc.1786] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To examine the association of leisure-time sitting with radiographic incidence and progression of knee osteoarthritis (OA) over 2 years, and to determine whether worktime sitting modifies this association. METHODS We included adults with or at high risk for knee OA who enroled in the Osteoarthritis Initiative (OAI). Participants reported leisure-time sitting (≤4 vs. >4 h/day) and worktime sitting (frequent vs. infrequent) at enrolment, and had bilateral knee radiographs at enrolment and 2 years later. Our outcome, radiographic knee OA incidence/progression (yes/no), was defined as any increase in Kellgren-Lawrence grade over 2 years. We examined the association of leisure-time sitting (≤4 vs. >4 h/day) with risk of radiographic knee OA incidence/progression using binary linear regression, adjusting for potential confounders. We stratified by worktime sitting (frequent vs. infrequent) and repeated our analysis. RESULTS We included 4254 adults (mean age 61 years; 58% women; mean body mass index 29 kg/m2 ) who contributed a total of 8127 knees. Adults with >4 h/day of leisure-time sitting had 25% higher risk (adjusted risk ratio [RR] 1.25, 95% confidence interval [95% CI] 1.08-1.50) for radiographic knee OA incidence/progression compared with adults with ≤4 h/day of leisure-time sitting (referent group). Importantly, this association was intensified (RR 1.60, 95% CI 1.19-2.33) among adults with frequent worktime sitting, but was attenuated (RR 1.11, 95% CI 0.89-1.39) among adults with infrequent worktime sitting. CONCLUSIONS Higher leisure-time sitting (>4 h/day) may be associated with greater risk for radiographic knee OA incidence/progression over 2 years. Furthermore, this association was intensified among adults who also reported frequent worktime sitting.
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Affiliation(s)
- Dana Voinier
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise M. Thoma
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jason Jakiela
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Voinier D, Neogi T, Arbeeva L, Voinier S, Master H, Thoma LM, Brunette M, Jakiela JT, White DK. Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2023; 31:1091-1100. [PMID: 36822497 PMCID: PMC10523474 DOI: 10.1016/j.joca.2022.12.012] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. METHODS We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2 years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2 years, adjusting for potential confounders. RESULTS We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8 kg/m2). Mean PA composition was: MVPA 9.1 min/day, LPA 278 min/day, SED 690 min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β = -0.0005, P = 0.97), nor was LPA (β = 0.06, P = 0.27) or SED (β = -0.06, P = 0.21). CONCLUSION Using CoDA, PA composition was not associated with medial JSW loss over 2 years.
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Affiliation(s)
- D Voinier
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Arbeeva
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - S Voinier
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - H Master
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA.
| | - L M Thoma
- University of North Carolina at Chapel Hill, Division of Physical Therapy, Chapel Hill, NC, USA.
| | - M Brunette
- Evidation Health Inc, San Mateo, CA, USA.
| | - J T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - D K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Mulligan EP, Brunette M, Shirley Z, Khazzam M. Sleep quality and nocturnal pain in patients with shoulder disorders. J Shoulder Elbow Surg 2015; 24:1452-7. [PMID: 25842028 DOI: 10.1016/j.jse.2015.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 11/24/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nocturnal shoulder pain resulting in poor sleep quality is a common finding in patients with shoulder disease. The purpose of this paper was to describe and to compare the sleep quality, pain, and function in adult subjects who have been diagnosed with rotator cuff disorders, osteoarthritis, or adhesive capsulitis (AC). METHODS Patients completed a clinical assessment and comprehensive questionnaire regarding their current medical health history, shoulder symptoms, and impact of their symptoms on activities of daily living and quality of sleep. RESULTS The study analyzed 343 patients with an average age of 57.4 years. The mean Single Assessment Numeric Evaluation score for AC was 34%, which was significantly lower than the score for the subacromial impingement syndrome group of 53% (P = .007). The mean American Shoulder and Elbow Surgeons scale score for AC was 38, which was also significantly lower than the score for the subacromial impingement syndrome group of 51 (P = .007). There were no significant differences in pain, with mean scores ranging from 4.90 to 5.82 for diagnostic subgroups on a visual analog scale (P = .28). Sleep quality was significantly poorer in the AC group (P = .008), with a mean Pittsburgh Sleep Quality Index score of 12.07. Specific subcomponents of the Pittsburgh Sleep Quality Index that had a significant impact on sleep interruption included sleep quality, sleep duration, and habitual sleep efficiency in the AC group (P < .05). CONCLUSION This study shows that whereas many patients with shoulder disease may have sleep-related issues, patients with adhesive capsulitis are particularly vulnerable to reduced sleep quality.
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Affiliation(s)
- Edward P Mulligan
- Department of Physical Therapy, UT Southwestern School of Health Professions, Dallas, TX USA
| | - Meredith Brunette
- Department of Physical Therapy, UT Southwestern School of Health Professions, Dallas, TX USA
| | - Zachary Shirley
- School of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michael Khazzam
- UT Southwestern Medical Center, Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Dallas, TX, USA.
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Mulligan EP, Middleton EF, Brunette M. Evaluation and management of greater trochanter pain syndrome. Phys Ther Sport 2014; 16:205-14. [PMID: 25497431 DOI: 10.1016/j.ptsp.2014.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 06/28/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 01/27/2023]
Abstract
Greater trochanteric pain syndrome is an enigmatic but common cause of lateral hip symptoms in middle-aged active women. The most common manifestation of this syndrome is a degenerative tendinopathy of the hip abductors similar to the intrinsic changes seen with rotator cuff pathology in the shoulder. There are no definitive tests to isolate the underlying pathology and palpation is a non-specific means by which to differentiate the source of the pain generator. The physical examination must comprehensively evaluate for a cluster of potential impairments and contributing factors that will need to be addressed to effectively manage the likely functional limitations and activity challenges the syndrome presents to the patient. Compressive forces through increased tension in the iliotibial band should be avoided. Intervention strategies should include education regarding postural avoidance, activity modifications, improvement of lumbopelvic control, and a patient approach to resolving hip joint restrictions and restoring the tensile capabilities of the deep rotators and abductors of the hip. A number of reliable and validated hip-specific self-report outcome tools are available to baseline a patient's status and monitor their progress. Further investigations to identify the epidemiological risk factors, establish effective treatment strategies, and predict prognosis are warranted.
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Affiliation(s)
- Edward P Mulligan
- UT Southwestern Medical Center School of Health Professions, Department of Physical Therapy, 5323 Harry Hines Blvd, Dallas, TX 75390-8876, USA.
| | - Emily F Middleton
- UT Southwestern Medical Center School of Health Professions, Department of Physical Therapy, 5323 Harry Hines Blvd, Dallas, TX 75390-8876, USA
| | - Meredith Brunette
- UT Southwestern Medical Center School of Health Professions, Department of Physical Therapy, 5323 Harry Hines Blvd, Dallas, TX 75390-8876, USA
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Brumitt J, Meira EP, En Gilpin H, Brunette M. Comprehensive strength training program for a recreational senior golfer 11-months after a rotator cuff repair. Int J Sports Phys Ther 2011; 6:343-356. [PMID: 22163096 PMCID: PMC3230162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. CASE DESCRIPTION The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. OUTCOMES The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program. DISCUSSION The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery.
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Brumitt J, En Gilpin H, Brunette M, Meira EP. Incorporating kettlebells into a lower extremity sports rehabilitation program. N Am J Sports Phys Ther 2010; 5:257-265. [PMID: 21655384 PMCID: PMC3096147] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.
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Affiliation(s)
- Jason Brumitt
- Pacific University (Oregon), School of Physical Therapy, 222 SE 8 Avenue, Hillsboro, Oregon, USA, 97123
| | - Hui En Gilpin
- Pacific University (Oregon), School of Physical Therapy, 222 SE 8 Avenue, Hillsboro, Oregon, USA, 97123
| | - Meredith Brunette
- Pacific University (Oregon), School of Physical Therapy, 222 SE 8 Avenue, Hillsboro, Oregon, USA, 97123
| | - Erik P. Meira
- Clinic Director, Black Diamond Physical Therapy, 335 NE 18 Avenue, Portland, Oregon, USA , 97232
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Noordsy DL, Torrey WC, Mead S, Brunette M, Potenza D, Copeland ME. Recovery-oriented psychopharmacology: redefining the goals of antipsychotic treatment. J Clin Psychiatry 2000; 61 Suppl 3:22-9. [PMID: 10724130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The traditional goals of psychopharmacology stem from the medical model. Rehabilitation interventions attempt to improve aspects of functioning in patients with chronic illnesses that are not responsive to biological intervention. Recovery is a concept emanating from the consumer self-help movement. It describes a move away from the patient role defined by a diagnostic label toward community membership defined by relationships and responsibilities in the community. Comprehensive care for people with psychotic disorders can include attention to each realm. This article provides an overview of the 3 models of care and describes a role for the psychopharmacologist in each as well as his or her unique potential to incorporate all 3. We outline potential synergistic benefits of integrating recovery-, rehabilitation-, and medical-model thinking into the practice of psychopharmacology and explore implications for the goals and outcomes of treatment for people with psychotic disorders.
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Affiliation(s)
- D L Noordsy
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA.
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Abstract
A cohort of 72 persons who had entered a rural Oregon county's involuntary treatment system in 1979 through 1982 was followed for six years. While schizophrenia was the most frequent diagnosis, several other conditions were represented including adjustment disorders, organic mental disorders, and substance abuse. The majority (55%) of persons with organic mental disorders died as did 12% of the individuals with schizophrenia. The overall mortality rate was three times the expected figure (p = .002). During the follow-up period, only 39% of the initial cohort received treatment from a community mental health program whereas 28% were newly admitted (involuntarily) to a state mental hospital. Hospital recividism was most likely among individuals who had had prior involuntary treatment. At least in rural areas, the civil commitment system seems to serve both "infrequent" and "persistent" users. Infrequent users mainly have diagnoses of adjustment disorders and/or substance abuse. Persistent users chiefly have diagnoses of organic mental disorders, mood disorders, or schizophrenia. Modifying the involuntary treatment system to take account of this heterogeneous population's diverse needs is discussed.
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Affiliation(s)
- B H McFarland
- Western Mental Health Research Center, Oregon Health Sciences University, Portland 97201
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Abstract
The purpose of this study was to test the generalizability of previous research on gender differences between men and women with co-occurring schizophrenia and substance abuse. One hundred eight patients with schizophrenia or schizo-affective disorder involved in a study of treatment for homeless persons were interviewed for information regarding substance use, social functioning and support, comorbid disorders, victimization, medical illness, and legal troubles. We found that women had more children and were more socially connected than men. Women also had higher rates of sexual and physical victimization, comorbid anxiety and depression, and medical illness than men. We conclude that homeless women with dual disorders, like women with substance use disorders in the general population, have distinct characteristics, vulnerabilities, and treatment needs compared with men. In addition to comprehensive treatment of psychiatric and substance use disorders, gender-specific services should be developed, including prevention and treatment of victimization and related problems as well as help with accessing medical services.
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Affiliation(s)
- M Brunette
- New Hampshire-Dartmouth Psychiatric Research Center, Lebanon, New Hampshire 03766, USA
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Berteloot A, Malo C, Breton S, Brunette M. Fast sampling, rapid filtration apparatus: principal characteristics and validation from studies of D-glucose transport in human jejunal brush-border membrane vesicles. J Membr Biol 1991; 122:111-25. [PMID: 1895337 DOI: 10.1007/bf01872635] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [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: 12/29/2022]
Abstract
Kinetic data in (brush-border) membrane vesicles which rely on the validity of the initial rate assumption for their interpretation and depend on tracer flux studies using the rapid filtration technique for their experimental measurement have been limited to some extent by the absence of techniques that would allow for real-time data analysis. In this paper, we report on our successful design of a fast sampling, rapid filtration apparatus (FSRFA) which seems to fill up this technical gap since showing the following characteristics: (i) rapid injection (5 msec) and mixing (less than 100 msec) of small amounts of vesicles (10-40 microliters) with an incubation medium (0.2-1.0 ml); (ii) fast (20 to 80 msec depending on the sample volume) and multiple (up to 18 samples at a maximal rate of 4 sec) sampling of the uptake mixture followed by rapid quenching in the stop solution (approximately 5 msec) according to a predetermined time schedule (any time combination from 0.25 to 9999 sec); and (iii) fast, automated, and sampling-synchronized filtration and washings of the quenched uptake medium (only 15-20 sec are necessary for the first filtration followed by two washings and extra filtrations). As demonstrated using adult human jejunal brush-border membrane vesicles and Na(+)-D-glucose cotransport as models, the FSRFA accurately reproduces the manual aspects of the rapid filtration technique while allowing for very precise initial rate determinations. Moreover, the FSRFA has also been designed to provide as much versatility as possible and, in its present version, allows for a very precise control of the incubation temperature and also permits a few efflux protocols to be performed. Finally, its modular design, which separates the fast sampling unit from the rapid filtration device, should help in extending its use to fields other than transport measurement.
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Affiliation(s)
- A Berteloot
- Department of Physiology, Faculty of Medicine, University of Montréal, Canada
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