The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study

Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study

BACKGROUND

Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and healthcare utilization in patients with knee OA. Secondary aims are to explore the mediation and directional relationships and the role it plays in predicting the discordance between self-reported measures (SRM), physical-performance measures (PPMs) and objective clinical parameters.

METHODS

A multi-centre prospective cohort study of community ambulant knee OA patients seeking treatment in the tertiary healthcare institutions in Singapore will be conducted. Patients with secondary arthritis, significant cognitive impairment, severe medical comorbidities or previous knee arthroplasty will be excluded. Primary clinical outcome measure is the Knee injury and OA Outcome Score-12 (KOOS-12). Baseline characteristics include sociodemographic status, arthritis status including symptom duration and radiographic severity, comorbidities and functional status through Charlson Comorbidities Index (CCI), Barthel Index (BI) and Parker Mobility Score (PMS). Psychosocial variables include social support, kinesiophobia, negative affect, self-efficacy, injustice, chronic illness shame and the built environment. Clinical outcomes include quality of life, physical performance, global assessment, satisfaction and physical activity levels. Productivity and healthcare utilization will be assessed by a modified OA Cost and Consequences Questionnaire (OCC-Q) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Variables will be collected at baseline, 4, 12 months and yearly thereafter. Regression, mediation and structural equation modelling will be used for analysis.

DISCUSSION

Results will allow contextualization, identification, and phenotyping of the critical (and potentially modifiable) psychosocial parameters that predict positive clinical outcomes in the OA population to guide optimization and refinement of healthcare and community. This will facilitate: 1. identification of high-risk knee OA subpopulations that will likely experience poor outcomes and 2. formulation of targeted multidisciplinary comprehensive approaches to address these psychosocial factors to optimize non-surgical treatment care, maximize functional outcomes and create more value-based care model for knee OA.

ETHICS AND DISSEMINATION

The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).

Bone Marrow-Derived Mesenchymal Stem Cell Implants for the Treatment of Focal Chondral Defects of the Knee in Animal Models: A Systematic Review and Meta-Analysis

Osteoarthritis remains an unfortunate long-term consequence of focal cartilage defects of the knee. Associated with functional loss and pain, it has necessitated the exploration of new therapies to regenerate cartilage before significant deterioration and subsequent joint replacement take place. Recent studies have investigated a multitude of mesenchymal stem cell (MSC) sources and polymer scaffold compositions. It is uncertain how different combinations affect the extent of integration of native and implant cartilage and the quality of new cartilage formed. Implants seeded with bone marrow-derived MSCs (BMSCs) have demonstrated promising results in restoring these defects, largely through in vitro and animal studies. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL) to identify studies using BMSC-seeded implants in animal models of focal cartilage defects of the knee. Quantitative results from the histological assessment of integration quality were extracted. Repair cartilage morphology and staining characteristics were also recorded. Meta-analysis demonstrated that high-quality integration was achieved, exceeding that of cell-free comparators and control groups. This was associated with repair tissue morphology and staining properties which resembled those of native cartilage. Subgroup analysis showed better integration outcomes for studies using poly-glycolic acid-based scaffolds. In conclusion, BMSC-seeded implants represent promising strategies for the advancement of focal cartilage defect repair. While a greater number of studies treating human patients is necessary to realize the full clinical potential of BMSC therapy, high-quality integration scores suggest that these implants could generate repair cartilage of substantial longevity.

The Burden of Rheumatoid Arthritis: Findings from the 2019 Global Burden of Diseases Study and Forecasts for 2030 by Bayesian Age-Period-Cohort Analysis

BACKGROUND

Rheumatoid arthritis (RA) is a key health issue worldwide. Due to early identification and effective treatment strategies, the disease pattern of RA has also changed. However, the most comprehensive and up-to-date information about the burden of RA and its trends in subsequent years is lacking.

OBJECTIVE

this study aimed to report the global burden of RA by sex, age, region, and forecast for 2030.

METHOD

Publicly available data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used in this study. The trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of RA from 1990 to 2019 were reported. The global burden of RA in 2019 was reported by a sex, age, and sociodemographic index (SDI). Finally, the trends in the following years were predicted by Bayesian age-period-cohort (BAPC) models.

RESULTS

Globally, the age-standardized prevalence rate increased from 207.46 (95% UI:189.99 to 226.95) in 1990 to 224.25 (95% UI: 204.94 to 245.99) in 2019, with an estimated annual percent change (EAPC) of 0.37% (95% CI: 0.32 to 0.42). Regarding the incidence, the age-standardized incidence rate (ASR) increased from 12.21 (95% UI: 11.13 to 13.38) to 13 (95% UI: 11.83 to 14.27) per 100,000 people from 1990 to 2019, with an EAPC of 0.3% (95% CI: 11.83 to 14.27). The age-standardized DALY rate also increased from 39.12 (95% UI: 30.13 to 48.56) per 100,000 people in 1990 to 39.57 (95% UI: 30.51 to 49.53) in 2019, with an EAPC of 0.12% (95% CI: 0.08% to 0.17%). There was no significant association between the SDI and ASR when the SDI was lower than 0.7, while there was a positive association between the SDI and ASR when the SDI was higher than 0.7 The BAPC analysis showed that the ASR was estimated to be up to 18.23 in females and approximately 8.34 per 100,000 people in males by 2030.

CONCLUSION

RA is still a key public health issue worldwide. The global burden of RA has increased over the past decades and will continue to increase in the coming years, and much more attention should be given to early diagnosis and treatment to reduce the burden of RA.

Tissue Integration of Calcium Phosphate Compound after Subchondroplasty: 4-Year Follow-Up in a 76-Year-Old Female Patient

Subchondroplasty is a new minimally invasive surgical technique developed to treat bone marrow lesions (BML) and early osteoarthritis (OA). During the procedure, engineered calcium phosphate compound (CPC) is injected. It is claimed by the manufacturer that during the healing process, the CPC is replaced with new bone. The purpose of this study was to verify the replacement of CPC with new bone after subchondroplasty for the first time in humans. A 76-year old woman was referred for resistant medial knee pain. Standing radiographs showed varus knee OA and magnetic resonance imaging (MRI) revealed BML. She was treated with subchondroplasty of medial femoral condyle. Excellent relief of pain was achieved after procedure. Afterwards, the pain worsened, the radiographs confirmed the OA progression and the patient was treated with a total knee arthroplasty (TKA) 4 years after primary procedure. The resected bone was examined histologically and with micro-computed tomography (CT). Histologically, bone trabeculae of subcortical bone were embedded in the amorphous mass. However, no signs of CPC resorption and/or bone replacement have been found with micro-CT. In short term, excellent pain relief could be expected after the subchondroplasty procedure. However, there was no replacement of CPC with bone and the technique probably did not influence the natural process of knee OA.

Osteoarthritis: pathogenic signaling pathways and therapeutic targets

Osteoarthritis (OA) is a chronic degenerative joint disorder that leads to disability and affects more than 500 million population worldwide. OA was believed to be caused by the wearing and tearing of articular cartilage, but it is now more commonly referred to as a chronic whole-joint disorder that is initiated with biochemical and cellular alterations in the synovial joint tissues, which leads to the histological and structural changes of the joint and ends up with the whole tissue dysfunction. Currently, there is no cure for OA, partly due to a lack of comprehensive understanding of the pathological mechanism of the initiation and progression of the disease. Therefore, a better understanding of pathological signaling pathways and key molecules involved in OA pathogenesis is crucial for therapeutic target design and drug development. In this review, we first summarize the epidemiology of OA, including its prevalence, incidence and burdens, and OA risk factors. We then focus on the roles and regulation of the pathological signaling pathways, such as Wnt/β-catenin, NF-κB, focal adhesion, HIFs, TGFβ/ΒΜP and FGF signaling pathways, and key regulators AMPK, mTOR, and RUNX2 in the onset and development of OA. In addition, the roles of factors associated with OA, including MMPs, ADAMTS/ADAMs, and PRG4, are discussed in detail. Finally, we provide updates on the current clinical therapies and clinical trials of biological treatments and drugs for OA. Research advances in basic knowledge of articular cartilage biology and OA pathogenesis will have a significant impact and translational value in developing OA therapeutic strategies.

Do Individualized Patient-Specific Situations Predict the Progression Rate and Fate of Knee Osteoarthritis? Prediction of Knee Osteoarthritis

Factors affecting the progression rate and fate of osteoarthritis need to be analyzed when considering patient-specific situation. This study aimed to identify the rate of remarkable progression and fate of primary knee osteoarthritis based on patient-specific situations. Between May 2003 and May 2019, 83,280 patients with knee pain were recruited for this study from the clinical data warehouse. Finally, 2492 knees with pain that were followed up for more than one year were analyzed. For analyzing affecting factors, patient-specific information was categorized and classified as demographic, radiologic, social, comorbidity disorders, and surgical intervention data. The degree of contribution of factors to the progression rate and the fate of osteoarthritis was analyzed. Bone mineral density (BMD), Kellgren-Lawrence (K-L) grade, and physical occupational demands were major contributors to the progression rate of osteoarthritis. Hypertension, initial K-L grade, and physical occupational demands were major contributors to the outcome of osteoarthritis. The progression rate and fate of osteoarthritis were mostly affected by the initial K-L grade and physical occupational demands. Patients who underwent surgical intervention for less than five years had the highest proportion of initial K-L grade 2 (49.0%) and occupations with high physical demand (41.3%). In identifying several contributing factors, the initial K-L grade and physical occupational demands were the most important factors. BMD and hypertension were also major contributors to the progression and fate of osteoarthritis, and the degree of contribution was lower compared to the two major factors.

Mapping of disease-specific Oxford Knee Score onto EQ-5D-5L utility index in knee osteoarthritis

BACKGROUND

EQ5D is a generic measure of health. It provides a single index value for health status that can be used in the clinical and economic evaluation of healthcare. Oxford Knee Score (OKS) is a joint-specific outcome measure tool designed to assess symptoms and function in osteoarthritis patients after joint replacement surgery. Though widely used, it has the disadvantage of lacking health index value. To fill the gap between functional and generic questionnaires with economic value, we linked generic EQ-5D-5L to the specific OKS to give a single index value for health status in KOA patients.

QUESTIONS/PURPOSES

Developing and evaluating an algorithm to estimate EuroQoL generic health utility scores (EQ-5D-5L) from the disease-specific OKS using data from patients with knee osteoarthritis (KO).

PATIENTS AND METHODS

This is a cross-sectional study of 571 patients with KO. We used four distinct mapping algorithms: Cumulative Probability for Ordinal Data, Penalized Ordinal Regression, CART (Classification and Regression Trees), and Ordinal random forest. We compared the resultant models' degrees of accuracy.

RESULTS

Mobility was best predicted by penalized regression with pre-processed predictors, usual activities by random forest, pain/discomfort by cumulative probability with pre-processed predictors, self-care by random forest with RFE (recursive feature elimination) predictors, and anxiety/depression by CART with RFE predictors. Model accuracy was lowest with anxiety/depression and highest with mobility and usual activities. Using available country value sets, the average MAE was 0.098 ± 0.022, ranging from 0.063 to 0.142; and the average MSE was 0.020 ± 0.008 ranging from 0.008 to 0.042.

CONCLUSIONS

The current study derived accurate mapping techniques from OKS to the domains of EQ-5D-5L, allowing for the computation of QALYs in economic evaluations. A machine learning-based strategy offers a viable mapping alternative that merits further exploration.

The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses

INTRODUCTION

Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology.

METHODS

The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations).

RESULTS

Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field.

DISCUSSION

While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.

Knee osteoarthritis and adverse health outcomes: an umbrella review of meta-analyses of observational studies

BACKGROUND

Knee osteoarthritis (OA) is a common condition, associated with a high rate of disability and poor quality of life. Despite the importance of such evidence in public health, no umbrella review (i.e., a review of other systematic reviews and meta-analyses) has systematically assessed evidence on association between knee OA and adverse health outcomes.

AIMS

To map and grade all health outcomes associated with knee OA using an umbrella review approach.

METHODS

The search was made across several databases up to 22 April 2022. We used an umbrella review of systematic reviews with meta-analyses of observational studies assessing the effect sizes, based on random effect summary, 95% prediction intervals, heterogeneity, small study effects, and excess significance bias. The evidence was then graded from convincing (class I) to weak (class IV).

RESULTS

Among 3,847 studies initially considered, five meta-analyses were included for a total of five different outcomes. Three adverse outcomes were significantly associated with knee OA (i.e., cardiovascular mortality, falls, and subclinical atherosclerosis). The presence of knee OA was associated with a significantly higher risk of cardiovascular mortality (odds ratio, OR = 1.17; 95%CI, confidence intervals: 1.02-1.34), falls (RR = 1.34; 95%CI: 1.10-1.64), and conditions associated with subclinical atherosclerosis (OR = 1.43; 95%CI: 1.003-2.05). The certainty of each of this evidence was weak.

CONCLUSIONS

Our umbrella review suggests that knee OA can be considered as putative risk factor for some medical conditions, including cardiovascular diseases and falls, however, it is important to note that the evidence is affected by potential biases.

Biopsychosocial Rehabilitation for Inflammatory Arthritis and Osteoarthritis Patients: A Systematic Review and Meta-Analysis of Randomized Trials

OBJECTIVE

To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis and osteoarthritis (OA).

METHODS

We performed a systematic review and meta-analysis. Data were collected through electronic searches of Cochrane CENTRAL, MEDLINE, Embase, PsycInfo, and CINAHL databases up to March 2019. Trials examining the effect of biopsychosocial rehabilitation in adults with inflammatory arthritis and/or OA were considered eligible, excluding rehabilitation adjunct to surgery. The primary outcome for benefit was pain and total withdrawals for harm.

RESULTS

Of the 27 trials meeting the eligibility criteria, 22 trials (3,750 participants) reported sufficient data to be included in the quantitative synthesis. For patient-reported outcome measures, biopsychosocial rehabilitation was slightly superior to control for pain relief (standardized mean difference [SMD] -0.19 [95% confidence interval (95% CI) -0.31, -0.07]), had a small effect on patient global assessment score (SMD -0.13 [95% CI -0.26, -0.00]), with no apparent effect on health-related quality of life, fatigue, self-reported disability/physical function, mental well-being, and reduction in pain intensity ≥30%. Clinician-measured outcomes displayed a small effect on observed disability/physical function (SMD -0.34 [95% CI -0.57, -0.10]), a large effect on physician global assessment score (SMD -0.72 [95% CI -1.18, -0.26]), and no effect on inflammation. No difference in harms existed in terms of the number of withdrawals, adverse events, or serious adverse events.

CONCLUSION

Biopsychosocial rehabilitation produces a significant but clinically small beneficial effect on patient-reported pain among patients with inflammatory arthritis and OA, with no difference in harm. Methodologic weaknesses were observed in the included trials, suggesting low-to-moderate confidence in the estimates of effect.

Prevalence and associated factors of cross-sectional and incident self-reported arthritis or rheumatism among a national community sample of middle-aged and older adults in Thailand

Background

The study aimed to assess the prevalence and associated factors of cross-sectional and incident arthritis or rheumatism among a national community sample of middle-aged and older adults in Thailand.

Methods

We analyzed cross-sectional and longitudinal data from two consecutive waves (2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART) study. Arthritis or rheumatism (SRA) was assessed by self-reported health care provider diagnosis.

Results

The cross-sectional (baseline) sample included 5,616 participants (≥45 years, median age 66 years, interquartile range 57 to 76 years) and the incident (follow-up) sample included 3,545 participants. The prevalence of SRA in the cross-sectional sample (baseline) was 4.0% and in the incident (follow-up) sample 5.3%. In the cross-sectional multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.19 to 2.67), obesity class II (aOR: 1.82, 95% CI: 1.02 to 3.25), hypertension (aOR: 1.90, 95% CI: 1.35 to 2.66), brain disease and/or psychiatric problems (aOR: 4.79, 95% CI: 2.27 to 10.62), sleep problem (aOR: 1.45, 95% CI: 1.01 to 2.07) and prescription drug use (aOR: 1.63, 95% CI: 1.14 to 2.33) were positively associated, and not in the labor force (aOR: 0.53, 95% CI: 0.34 to 0.84), and employed (aOR: 0.63, 95% CI: 0.41 to 0.99) were negatively associated with SRA. In the incident multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.17 to 3.61), obesity class II (aOR: 2.01, 95% CI: 1.12 to 3.61), poor mental health (aOR: 1.69, 95% CI: 1.19 to 2.41), and functional disability (aOR: 2.04, 95% CI: 1.01 to 4.13) were positively associated, and current alcohol use (aOR: 0.50, 95% CI: 0.25 to 0.99) was negatively associated with SRA.

Conclusion

The middle and older Thai adults had a low prevalence and incidence of SRA, and several physical and mental risk factors for cross-sectional and/or incident SRA were identified.

Soluble and EV-Associated Diagnostic and Prognostic Biomarkers in Knee Osteoarthritis Pathology and Detection

Osteoarthritis (OA) is the most common degenerative disease of the connective tissue of the human musculoskeletal system. Despite its widespread prevalence, there are many limitations in its diagnosis and treatment. OA diagnosis currently relies on the presence of clinical symptoms, sometimes accompanied by changes in joint X-rays or MRIs. Biomarkers help not only to diagnose early disease progression but also to understand the process of OA in many ways. In this article, we briefly summarize information on articular joints and joint tissues, the pathogenesis of OA and review the literature about biomarkers in the field of OA, specifically inflammatory cytokines/chemokines, proteins, miRNA, and metabolic biomarkers found in the blood, synovial fluid and in extracellular vesicles.

Patient participation in defining best-practice rheumatology service provision in Aotearoa New Zealand: a qualitative study with service consumers

BACKGROUND

Aotearoa New Zealand (AoNZ) has no agreed models for rheumatology service provision in government-funded health care. We aimed to describe what people with inflammatory rheumatic diseases who have used rheumatology services view as being important in those services, and map these views to previously collated statements describing best practice components of rheumatology services from international recommendations. If these statements did not capture all service aspects that people with inflammatory rheumatic diseases considered important, we aimed to co-create new statements with our patient-participants.

METHODS

We conducted one focus group and an interview with people with inflammatory rheumatic disease who had used a government-funded rheumatology service in the previous 5 years (patient-participants) and analysed data using thematic analysis. The research team mapped subthemes to previously collated best practice recommendations that had been included in a Delphi consensus exercise with rheumatologists in AoNZ and proposed new statements, based on patient-participant data. Patient-participant feedback on thematic analysis and the new statements led to a refining of statements. A patient-partner in the research team informed research design and data analysis.

RESULTS

Patient-participants viewed it as highly valuable for rheumatology services to respect and value their experiences as people and patients, and those of their whānau (Māori word for family). They expected rheumatology services to provide the right care, at the right time. Many of the subthemes mapped to the best-practice statements. However, three new principles and three new statements were developed and refined by patient-participants. The three principles addressed valuing individuals, and their whānau (family) and their experiences, and providing a patient-focused health system that supports patient participation in decision-making and self-management, and patient education. New statements related to having a specific rheumatologist and other staff for comprehensive care, having adequate nurse staffing, and active provision of outside services and support.

CONCLUSION

It was important to patients that rheumatology services demonstrated that patients and their whānau (family) were valued. The inclusion of people with rheumatic diseases who are users of rheumatology services in service development can provide valuable insights to inform how services should be delivered.

Epigenetics as a Therapeutic Target in Osteoarthritis

Osteoarthritis (OA) is a heterogenous, complex disease affecting the integrity of diarthrodial joints that, despite its high prevalence worldwide, lacks effective treatment. In recent years it has been discovered that epigenetics may play an important role in OA. Our objective is to review the current knowledge of the three classical epigenetic mechanisms-DNA methylation, histone post-translational modifications (PTMs), and non-coding RNA (ncRNA) modifications, including microRNAs (miRNAs), circular RNAs (circRNAs), and long non-coding RNAs (lncRNAs)-in relation to the pathogenesis of OA and focusing on articular cartilage. The search for updated literature was carried out in the PubMed database. Evidence shows that dysregulation of numerous essential cartilage molecules is caused by aberrant epigenetic regulatory mechanisms, and it contributes to the development and progression of OA. This offers the opportunity to consider new candidates as therapeutic targets with the potential to attenuate OA or to be used as novel biomarkers of the disease.

Reliability of foot posture index (FPI-6) for evaluating foot posture in patients with knee osteoarthritis

Objective: To determine the reliability of FPI-6 in the assessment of foot posture in patients with knee osteoarthritis (KOA). Methods: Thirty volunteers with KOA (23 females, 7 males) were included in this study, assessed by two raters and at three different moments. Inter-rater and test-retest reliability were assessed with Cohen's Weighted Kappa (Kw) and Intraclass Correlation Coefficient (ICC). Bland-Altman plots and respective 95% limits of agreement (LOA) were used to assess both inter-rater and test-retest agreement and identify systematic bias. Moreover, the internal consistency of FPI-6 was assessed by Spearman's correlation coefficient. Results: FPI-6 total score showed a substantial inter-rater (Kw = .66) and test-retest reliability (Kw = .72). The six items of FPI-6 demonstrated inter-rater and test-retest reliability varying from fair to substantial (Kw = .33 to .76 and Kw = .40 to .78, respectively). Bland-Altman plots and respective 95% LOA indicated that there appeared no systematic bias and the acceptable agreement of FPI-6 total score for inter-rater and test-retest was excellent. There was a statistically significant positive correlation between each item and the total score of FPI-6, which indicated that FPI-6 had good internal consistency. Conclusion: In conclusion, the reliability of FPI-6 total score and the six items of FPI-6 were fair to substantial. The results can provide a reliable way for clinicians and researchers to implement the assessment of foot posture in patients with KOA.

Prediction of knee adduction moment using innovative instrumented insole and deep learning neural networks in healthy female individuals

BACKGROUND

The knee adduction moment, a biomechanical risk factor of knee osteoarthritis, is typically measured in a gait laboratory with expensive equipment and inverse dynamics modeling software. We aimed to develop a framework for a portable knee adduction moment estimation for healthy female individuals using deep learning neural networks and custom instrumented insole and evaluated its accuracy compared to the standard inverse dynamics approach.

METHODS

Feed-forward, convolutional, and recurrent neural networks were applied to the data extracted from five piezo-resistive force sensors attached to the insole of a shoe.

RESULTS

All models predicted knee adduction moment variables during walking with high correlation coefficients, r > 0.72, and low root mean squared errors (RMSE), ranging from 0.5% to 1.2%. The convolutional neural network is the most accurate predictor of average knee adduction moment (r = 0.96; RMSE = 0.5%) followed by the recurrent and feed-forward neural networks.

CONCLUSION

These findings and the methods presented in the current study are expected to facilitate a cost-effective clinical analysis of knee adduction moment for healthy female individuals and to facilitate future research on prediction of other biomechanical risk factors using similar methods.

Artificial-Intelligence-Aided Radiographic Diagnostic of Knee Osteoarthritis Leads to a Higher Association of Clinical Findings with Diagnostic Ratings

BACKGROUND

Radiographic knee osteoarthritis (OA) severity and clinical severity are often dissociated. Artificial intelligence (AI) aid was shown to increase inter-rater reliability in radiographic OA diagnosis. Thus, AI-aided radiographic diagnoses were compared against AI-unaided diagnoses with regard to their correlations with clinical severity.

METHODS

Seventy-one DICOMs (m/f = 27:42, mean age: 27.86 ± 6.5) (X-ray format) were used for AI analysis (KOALA software, IB Lab GmbH). Subjects were recruited from a physiotherapy trial (MLKOA). At baseline, each subject received (i) a knee X-ray and (ii) an assessment of five main scores (Tegner Scale (TAS); Knee Injury and Osteoarthritis Outcome Score (KOOS); International Physical Activity Questionnaire; Star Excursion Balance Test; Six-Minute Walk Test). Clinical assessments were repeated three times (weeks 6, 12 and 24). Three physicians analyzed the presented X-rays both with and without AI via KL grading. Analyses of the (i) inter-rater reliability (IRR) and (ii) Spearman's Correlation Test for the overall KL score for each individual rater with clinical score were performed.

RESULTS

We found that AI-aided diagnostic ratings had a higher association with the overall KL score and the KOOS. The amount of improvement due to AI depended on the individual rater.

CONCLUSION

AI-guided systems can improve the ratings of knee radiographs and show a stronger association with clinical severity. These results were shown to be influenced by individual readers. Thus, AI training amongst physicians might need to be increased. KL might be insufficient as a single tool for knee OA diagnosis.

Multidisciplinary patient-centred model of care for osteoarthritis: scoping review protocol—an initiative by the Egyptian Academy of Bone Health

Background

There is an evidence-practice gap in osteoarthritis (OA) management which has caused several patients living with the disease are receiving suboptimal medical care. Though there are several guidelines and treatment recommendations published, there is a real need to operationalise such evidence-based guidelines and facilitate their implementation by healthcare professionals in their local health systems

Main text

This work was carried out to outline a patient-centred multidisciplinary osteoarthritis care programme for knee and hip joint osteoarthritis that is applicable in standard clinical practice. A scoping review was conducted to identify an evidence-informed osteoarthritis management strategy, which outlines the optimal manner to treat patients living with osteoarthritis and can be implemented by healthcare professionals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Based on this, a “Model of Care” based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including non-pharmacological, pharmacological therapies, psychotherapy, rehabilitation as well as surgery) has been developed aiming to optimise the outcomes. The goals and principles have been identified as well as the key performance indices. An algorithm for the multidisciplinary management of osteoarthritis has been developed.

Conclusion

The developed osteoarthritis care programme (OACP) provided a “Model of Care” for people living with OA which can be implemented in standard practice. The results will give insight into the features, performance, results, and outcome measures assessed. It will also guide future research towards how “Model of Care” can be patient-centred and tailored to the individual medical status.

Individual immune cell and cytokine profiles determine platelet-rich plasma composition

OBJECTIVE

Platelet-rich plasma (PRP) therapy is increasingly popular to treat musculoskeletal diseases, including tendinopathies and osteoarthritis (OA). To date, it remains unclear to which extent PRP compositions are determined by the immune cell and cytokine profile of individuals or by the preparation method. To investigate this, we compared leukocyte and cytokine distributions of different PRP products to donor blood samples and assessed the effect of pro-inflammatory cytokines on chondrocytes.

DESIGN

For each of three PRP preparations (ACP®, Angel™, and nSTRIDE® APS), products were derived using whole blood samples from twelve healthy donors. The cellular composition of PRP products was analyzed by flow cytometry using DURAClone antibody panels (DURAClone IM Phenotyping Basic and DURAClone IM T Cell Subsets). The MESO QuickPlex SQ 120 system was used to assess cytokine profiles (V-PLEX Proinflammatory Panel 1 Human Kit, Meso Scale Discovery). Primary human chondrocyte 2D and 3D in vitro cultures were exposed to recombinant IFN-γ and TNF-α. Proliferation and chondrogenic differentiation were quantitatively assessed.

RESULTS

All three PRP products showed elevated portions of leukocytes compared to baseline levels in donor blood. Furthermore, the pro-inflammatory cytokines IFN-γ and TNF-α were significantly increased in nSTRIDE® APS samples compared to donor blood and other PRP products. The characteristics of all other cytokines and immune cells from the donor blood, including pro-inflammatory T cell subsets, were maintained in all PRP products. Chondrocyte proliferation was impaired by IFN-γ and enhanced by TNF-α treatment. Differentiation and cartilage formation were compromised upon treatment with both cytokines, resulting in altered messenger ribonucleic acid (mRNA) expression of collagen type 1A1 (COL1A1), COL2A1, and aggrecan (ACAN) as well as reduced proteoglycan content.

CONCLUSIONS

Individuals with elevated levels of cells with pro-inflammatory properties maintain these in the final PRP products. The concentration of pro-inflammatory cytokines strongly varies between PRP products. These observations may help to unravel the previously described heterogeneous response to PRP in OA therapy, especially as IFN-γ and TNF-α impacted primary chondrocyte proliferation and their characteristic gene expression profile. Both the individual's immune profile and the concentration method appear to impact the final PRP product.

TRIAL REGISTRATION

This study was prospectively registered in the Deutsches Register Klinischer Studien (DRKS) on 4 November 2021 (registration number DRKS00026175).

A national cross-sectional analysis of selenium intake and risk of osteoarthritis: NHANES 2003-2016

Background

The association between dietary selenium intake and arthritis, rheumatoid arthritis (RA), and osteoarthritis (OA) is inconsistent in previous studies and remain unclear. To investigate their relationship, this study was performed.

Methods

Data from the National Health and Nutrition Examination Survey (2003-2016) were downloaded and further analyzed. Dietary Se intake was classified according to quartiles with quartile 1 (Q1) having the lowest intake and quartile 4 (Q4) having the highest intake. Weighted logistic regression was used to investigate the association between dietary selenium intake and arthritis, RA, and OA. Subgroup analyses were performed to verify the findings. To further examine the non-linear relationship between dietary selenium intake and OA, restricted cubic spline (RCS) was adopted.

Results

In the crude model, the highest level of dietary selenium intake was siginificantly associated with decreased risks of arthritis (OR: 0.40, 95% CI: 0.37, 0.44) and rheumatoid arthritis (OR: 0.47, 95% CI: 0.40, 0.54), respectively. In the fully adjusted model, dietary selenium intake was not associated with risk of arthritis and RA (all P > 0.05). Conversely, the risk of OA was noted for participants with higher selenium intake (odds ratio of quartile 4 = 1.33, 95% CI = 1.07-1.65, P < 0.05). In the subgroup analyses, participants with diabetes had a higher risk of OA when ingested high selenium levels than those without diabetes (P < 0.001). The results of RCS showed that significant overall trends were found between dietary selenium intake and osteoarthritis (P for overall < 0.05). However, non-linear association was not detected in this association (P for non-linear > 0.05).

Conclusion

Using data from NHANES, this study discloses that high dietary selenium intake might be associated with risk of OA. However, the generalization of conclusion needs further examination because of the limitation of dietary questionnaire survey.

A fully automatic target detection and quantification strategy based on object detection convolutional neural network YOLOv3 for one-step X-ray image grading

Methods for automatic image analysis are demanded for dealing with the explosively increased imaging data in clinics. Osteoarthritis (OA) is a typical disease diagnosed based on X-ray imaging. Herein, we propose a novel modeling strategy based on YOLO version 3 (YOLOv3) for automatic simultaneous localization of knee joints and quantification of radiographic knee OA. As an advanced deep convolutional neural network (CNN) algorithm for target detection, YOLOv3 enables simultaneous small object detection and quantification due to its unique residual connection and feature map merging. Hence, a unified CNN model is built for the elegant integration of knee joint detection and corresponding OA severity grading using the YOLOv3 framework. We achieve desirable accuracy in knee OA grading using the public and clinical datasets. It provides improvements in the precision, recall, F₁ score and diagnostic accuracy of knee OA as well. Because of the fully automatic target detection and quantification, the time of handling an image is merely 40 ms from inputting the image to getting its label, supporting quick clinic decisions. It, thus, affords convenient and efficient image analysis for daily clinical diagnosis.

Health Coaching for Low Back Pain and Hip and Knee Osteoarthritis: A Systematic Review with Meta-Analysis

BACKGROUND

Health coaching aims to empower people to reach their goals and is increasingly used in health care settings. Whether health coaching improves pain and disability for people with hip or knee osteoarthritis (OA) or low back pain (LBP) is unknown.

METHODS

Six databases were searched for randomized controlled trials assessing health coaching or motivational programs in adults with hip or knee OA or LBP, with each condition investigated independently. Meta-analyses were performed with random-effects models in the Cochrane Collaboration Review Manager 5.3 program.

RESULTS

Seventeen eligible studies were found. No studies analyzing hip OA alone were found. Pooled analyses found statistically significant decreases in mid-term pain (mean difference [MD]: -7.57; 95% confidence interval [CI]: -10.08 to -5.07; P < 0.001, I2 = 0%), short-term disability (standard mean difference [SMD]: -0.22; 95% CI: -0.41 to -0.03; P = 0.02, z = 2.32, I2 = 0%), and mid-term disability (SMD: -0.42; 95% CI: -0.75 to -0.09; P = 0.01, z = 2.49, I2 = 60%), favoring the intervention for chronic LBP. There were significant improvements in knee OA long-term functional disability (MD: -3.04; 95% CI: -5.70 to -0.38; P = 0.03; z = 2.24; I2 = 0%).

CONCLUSION

Meta-analyses provide evidence that health coaching reduces both disability and pain in people with chronic LBP and reduces disability in people with knee OA, though the clinical significance is unknown. There is currently no evidence supporting or refuting the use of health coaching for hip OA.

Technical aspects of virtual augmented reality-based rehabilitation systems for musculoskeletal disorders of the lower limbs: a systematic review

INTRODUCTION

Musculoskeletal disorders are one of the most common causes of physical disability. The rehabilitation process after musculoskeletal disorders is long and tedious, and patients are not motivated to follow rehabilitation protocols. Therefore, new systems must be used to increase patient motivation. Virtual reality (VR) and augmented reality (AR) technologies can be used in this regard. In developing such systems, various technologies and methods of movement recognition are used; therefore, this study aims to summarize the technical aspects of using VR/AR in rehabilitation and evaluate and discuss efficient methods of investigating studies using the Statement of Standards for Reporting Implementation Studies (StaRI).

METHODS

Search in four scientific databases was done systematically based on PRISMA through online search engines from inception to June 2021. These databases include Medline (PubMed), Scopus, IEEE, and Web of Science. An updated search was also conducted on 17 December 2021. The research used keywords and MeSH terms associated with VR/AR, musculoskeletal disorder, and rehabilitation. Selected articles were evaluated qualitatively using the Standards for Reporting Implementation Studies (StaRI) statement.

RESULTS

A total of 2343 articles were found, and 20 studies were included. We found that 11 (55%) studies used Kinect technology as input tools, and 15 (75%) studies have described the techniques used to analyze human movements, such as dynamic time warping (DTW) and support vector machines (SVM). In 10 (50%) studies, the Unity game engine was used for visualization. In 8 studies (40%), usability was assessed, and high usability was reported. Similarly, the results of the review of studies according to the StaRI checklist showed poor reporting in the title and discussion of the studies.

CONCLUSIONS

We found that academic studies did not describe the technical aspects of rehabilitation systems. Therefore, a good description of the technical aspects of the system in such studies should be considered to provide repeatability and generalizability of these systems for investigations by other researchers.

[Influence of chronic pain in osteoarthritis on the risk of cardiovascular diseases and modern methods of drug prevention]

The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.

No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside cluster randomized controlled trial

BACKGROUND

A stratified approach to exercise therapy may yield superior clinical and economic outcomes, given the large heterogeneity of individuals with knee osteoarthritis (OA).

OBJECTIVE

To evaluate the cost-effectiveness during a 12-month follow-up of a model of stratified exercise therapy compared to usual exercise therapy in patients with knee OA, from a societal and healthcare perspective.

METHODS

An economic evaluation was conducted alongside a cluster-randomized controlled trial in patients with knee OA (n = 335), comparing subgroup-specific exercise therapy for a 'high muscle strength subgroup', 'low muscle strength subgroup', and 'obesity subgroup' supplemented by a dietary intervention for the 'obesity subgroup' (experimental group), with usual ('non-stratified') exercise therapy (control group). Clinical outcomes included quality-adjusted life years - QALYs (EuroQol-5D-5 L), knee pain (Numerical Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score in daily living). Costs were measured by self-reported questionnaires at 3, 6, 9 and 12-month follow-up. Missing data were imputed using multiple imputation. Data were analyzed through linear regression. Bootstrapping techniques were applied to estimate statistical uncertainty.

RESULTS

During 12-month follow-up, there were no significant between-group differences in clinical outcomes. The total societal costs of the experimental group were on average lower compared to the control group (mean [95% confidence interval]: € 405 [-1728, 918]), albeit with a high level of uncertainty. We found a negligible difference in QALYs between groups (mean [95% confidence interval]: 0.006 [-0.011, 0.023]). The probability of stratified exercise therapy being cost-effective compared to usual exercise therapy from the societal perspective was around 73%, regardless of the willingness-to-pay threshold. However, this probability decreased substantially to 50% (willingness-to-pay threshold of €20.000/QALY) when using the healthcare perspective. Similar results were found for knee pain and physical functioning.

CONCLUSIONS

We found no clear evidence that stratified exercise therapy is likely to be cost-effective compared to usual exercise therapy in patients with knee OA. However, results should be interpreted with caution as the study power was lower than intended, due to the Coronavirus disease (COVID-19) pandemic.

Fibroblast growth factor 9 reduces TBHP-induced oxidative stress in chondrocytes and diminishes mouse osteoarthritis by activating ERK/Nrf2 signaling pathway

Osteoarthritis (OA) is a degenerative and progressive disease that affects joints. Pathologically, it is characterized by oxidative stress-mediated excessive chondrocyte apoptosis and mitochondrial dysfunction. Fibroblast growth factor 9 (FGF9) has been shown to exert antioxidant effects and prevent degenerative diseases by activating ERK-related signaling pathways. However, the mechanism of FGF9 in the pathogenesis of OA and its relationship with anti-oxidative stress and related pathways are unclear. In this study, mice with medial meniscus instability (DMM) were used as the in vivo model whereas TBHP-induced chondrocytes served as the in vitro model to explore the mechanism underlying the effects of FGF9 in OA and its association with anti-oxidative stress. Results showed that FGF9 reduced oxidative stress, apoptosis, and mitochondrial dysfunction in TBHP-treated chondrocytes and promoted the nuclear translocation of Nrf2 to activate the Nrf2/HO1 signaling pathway. Interestingly, silencing the Nrf2 gene or blocking the ERK signaling pathway abolished the antioxidant effects of FGF9. FGF9 treatment reduced joint space narrowing, cartilage ossification, and synovial thickening in the DMM model mice. In conclusion, the present findings demonstrate that FGF9 can inhibit TBHP-induced oxidative stress in chondrocytes through the ERK and Nrf2-HO1 signaling pathways and prevent the progression of OA in vivo.

Intra-articular Injection of Bone Marrow Concentrate for Treatment of Patellofemoral Osteoarthritis: Preliminary Results Utilizing an Ultrasound-Guided Marrow Harvesting Technique

OBJECTIVE

To assess the effectiveness of intra-articular injection of bone marrow concentrate (BMC) under ultrasound (US) guidance in the treatment of patellofemoral osteoarthritis (OA), with clinical and volumetric magnetic resonance (MR) imaging follow-up.

METHODS

This retrospective study included 96 consecutive patients referred for US-guided intra-articular injection of BMC for symptomatic patellofemoral OA for which conservative treatment had failed. A control group of 21 patients with symptomatic patellofemoral OA was included for comparison. Data on International Knee Documentation Committee (IKDC), Visual Analog Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as volumetric MR imaging (using T2 mapping sequence) were collected before and 12 months after injection, and the results were compared.

RESULTS

No technical adverse events were noted during bone marrow aspiration, BMC preparation, or intra-articular injection of BMC. No clinical adverse events were reported during long-term follow-up. All mean scores improved between baseline and 12 months after intra-articular injection of BMC (VAS 5.5 to 3.6, P < .0001; WOMAC 36.8 to 22.2, P < .0001; and IKDC 41.8 to 58.2, P < .0001). MR imaging at 1 year of follow-up after BMC treatment showed no statistically significant difference in hyaline cartilage volume compared with that at the baseline (P = .690), suggesting stabilization of the cartilage degradation process. In contrast, the group of untreated patients showed a significant decrease in the cartilage volume (P = .001), corresponding to a cartilage loss of 6.9%.

CONCLUSIONS

The results suggest that intra-articular injection of BMC under US guidance could be a promising option for the treatment of symptomatic patellofemoral OA and could promote the preservation of healthy residual cartilage volume.

Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: a systematic review and meta-analysis

AIMS

Though glucosamine and chondroitin have become common practices for treating knee osteoarthritis, the clinical value of these two drugs in combination are still questionable. To evaluate the efficacy and safety of the combination of glucosamine (GS) and chondroitin (CS) in knee osteoarthritis (KOA) treatment.

METHODS

We searched electronic databases, including PubMed, Embase, Web of Science, SCOPUS, The Cochrane Central Register of Controlled Trials (CENTRAL), OVID, Chinese Clinical Trial Registry (ChiCTR), CBM, CNKI, WanFang and VIP from their inception to August 20, 2020, for literature concerning the combination of glucosamine and chondroitin in knee osteoarthritis treatment. The Cochrane Collaboration's tool for assessing risk of bias and Jadad scale were used to evaluate the risk of bias and quality of literature. The meta-analysis was performed using Review Manager 5.3 software.

RESULTS

Eight randomized controlled trials (RCTs) were included, including 7 studies in English and 1 study in Chinese. While the number of included papers was quite limited, the number of participants was decent, and quality appraisal result is acceptable. The total number of patients was 3793, with 1067 patients receiving a combination of glucosamine and chondroitin and 2726 patients receiving other treatments. The meta-analysis results revealed the following: (1) Regarding the total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, compared with the placebo group, the combination group showed a statistically significant advantage [MD = - 12.04 (- 22.33 ~ - 1.75); P = 0.02], while the other groups showed no significance. (2) Regarding the VAS score, none of the comparisons showed significance. (3) In the secondary outcomes, except the comparison of JSN between the combination and placebo groups (MD = - 0.09 (- 0.18 ~ - 0.00); P = 0.04) and the comparison of the WOMAC stiffness score between the combination and CS groups [MD = - 4.70 (- 8.57 ~ - 0.83); P = 0.02], none of the comparisons showed a significant difference. (4)Safety analysis results show that none of the comparisons have significant differences.

CONCLUSION

Our study confirmed that the combination of glucosamine and chondroitin is effective and superior to other treatments in knee osteoarthritis to a certain extent. It is worthwhile to popularize and apply the combination in KOA treatment considering the point of effect, tolerability and economic costs. Additionally, regarding the limited number of studies and uneven trial quality, more high-quality trials are required to investigate the accurate clinical advantages of the combination.

PROSPERO REGISTRATION ID

CRD42020202093.

Cost Effectiveness of Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Patients with Knee Osteoarthritis

OBJECTIVES

The aim of this study was to assess the cost effectiveness of allogeneic umbilical cord blood-derived mesenchymal stem cells with sodium hyaluronate (hUCB-MSC) compared with microfracture in patients with knee cartilage defects caused by osteoarthritis (OA) in South Korea.

METHODS

A partitioned survival model approach was taken consisting of five mutually exclusive health states: excellent, good, fair, poor, and death over a 20-year time horizon. Utility values were obtained from a randomized clinical trial. Cost data were extracted from a database provided by the Health Insurance Review & Assessment Service, and the utilization of healthcare services was estimated from an expert panel of orthopedic surgeons using a structured questionnaire. The incremental cost-effectiveness ratio (ICER) in terms of quality-adjusted life-years (QALY) was calculated. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS

In the base case, the incremental costs of US$14,410 for hUCB-MSC therapy along with its associated QALY gain of 0.857 resulted in an ICER of US$16,812 (₩18,790,773) per QALY (95% confidence interval [CI] US$13,408-US$20,828) when compared with microfracture treatment from a healthcare payer perspective. From a societal perspective, the ICER was US$268 (₩299,255) per QALY (95% CI -US$2915 to US$3784). When using a willingness-to-pay threshold of US$22,367/QALY, the probability of hUCB being cost effectiveness compared with microfracture was 99% from the healthcare payer perspective and 100% from the societal perspective.

CONCLUSIONS

The study demonstrated that hUCB-MSC therapy was cost effective compared with microfracture when treating patients with knee OA. These findings should inform health policy decision makers about considerations for cost-effective therapy for treating knee OA to ultimately enhance population health.

The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis

OBJECTIVE

To compare the effects of telerehabilitation vs home-based exercise programs for knee osteoarthritis (KOA).

METHOD

Patients diagnosed with moderate/mild KOA were enrolled in the study and randomized into two groups. The patients in the telerehabilitation group did their exercises via video conference simultaneously, accompanied by a physiotherapist, while the patients in the control group were given a brochure showing how to do the exercises and explaining how to do each exercise. Patients completed 30-s chair stand test (30 CST), Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Rating Scale (NRS), International Physical Activity Questionnaire Short Form (IPAQ-SF), Hospital Anxiety and Depression Scale (HADS), TAMPA Kinesiophobia Scale (TKS), Fatigue Severity Scale (FSS) twice before and after 8-week treatment, and Quality Indicators Questionnaire for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) and Exercise Adherence Rating Scale (EARS) after treatment only. Moreover, the number of painkillers that patients used in the last 15 days was recorded before and after treatment, and patient satisfaction with treatment was questioned after treatment.

RESULTS

Forty-eight patients were included in the study. The mean age of patients was 55.83 ± 6.93 years, and 43 (89.6%) patients were women. No significant differences were determined between groups in terms of baseline characteristics. After the 8-week follow-up, telerehabilitation group demonstrated better 30 CST, IPAQ-SF, KOOS, QUIPA, treatment satisfaction, and total and C subscale of EARS scores increment and greater NRS, HADS, TKS, and FSS score reduction than the control group. It was determined that there was a statistically significant difference between the telerehabilitation and control groups for all of the specified parameters; however, no statistically significant difference was found for the B subscale of EARS.

CONCLUSION

This study indicated that telerehabilitation is superior to self-management. Moreover, through this innovative and population specific web-based approach for KOA, a vast number of patients who have internet access could be reached. Thus, patients with KOA received effective treatment.

Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy

Introduction Osteoarthritis (OA) of the knee is a common degenerative disease, relatively more prevalent among middle-aged people. It is one of the major reasons for walking-related disability. Recently, early knee OA has been seen as an imperative concern in many younger patients who struggle with the disabling effect of pain and management is extremely speckled. Degenerative changes such as loss of cartilage, subchondral bone changes, synovial inflammation, and meniscal degeneration are seen in OA. Symptoms are relieved by therapeutic strategies such as lifestyle behaviour changes, exercise, and oral and injectable medications. Intra-articular delivery of drugs acts as a direct effect on the target tissue, which grossly reduces side effects and is commonly preferred nowadays. The current study is a comparative assessment of the functional outcomes associated with various treatment modalities in osteoarthritis of the knee, i.e., arthroscopic debridement, arthroscopic debridement with microfracture, platelet-rich plasma (PRP) injection, and hyaluronic acid. Methods A retrospective observational hospital-based study was conducted among 139 cases of osteoarthritis. Patients aged between 40-60 years with diagnosed Kellgren- Lawrence grade 1 and 2 OA knee, who underwent arthroscopic debridement, arthroscopic debridement with microfracture, PRP injection, or hyaluronic acid in our institute were included. Results The mean age was 52.83 + 6.8 years. The mean BMI was 27.45 + 1.6 kg/m2. At the time of diagnosis of OA, the mean visual analogue scale for pain (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 7.26 +0.7 and 55.30 + 2.21 respectively. Out of the total, 88 (63.3%) were females and 51 (36.7%) were males. Right-sided OA knee was seen in the majority of study participants. Of the total, 93 (66.9%) patients had grade 2 and only 46 (33.1%) had grade 1 OA. A statistically significant difference was found between the mean VAS and WOMAC score at the time of diagnosis, three weeks, three months, as well as at six months of therapy. In the hyaluronic acid treatment, no significant difference was found in mean VAS and WOMAC scores. Conclusion Various treatments are available for early-diagnosed OA. According to the findings of this study, overall improvement was seen in VAS and WOMAC scores at the follow-up after six months of specific treatment. In a period over six months, arthroscopic debridement with micro-fracture was more effective and safe when compared with other modalities of treatment for early OA knee. Also, injection of PRP was superior to other methods for VAS pain reduction, and WOMAC-pain and WOMAC-stiffness scores improved at one month.

High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Osteoarthritis is one of the leading causes of global disability and pain.

OBJECTIVE

To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis.

METHODS

Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration.

RESULTS

Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, -2.04, 95% CI, -2.12 to -1.96; Z= 51.01, P< 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, -0.98, 95% CI, -1.19 to -0.76; Z= 9.02, P< 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, -1.54, 95% CI, -1.84 to -1.24; Z= 10.06, P< 0.01).

CONCLUSION

High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises.

Development and Validation of a New Patient-Reported Outcome Measure in the Arabic Language for Patients with Knee Osteoarthritis in Saudi Arabia

PURPOSE

In Western countries, several patient-reported outcomes (PROs) measures have been developed and validated for knee osteoarthritis (OA) patients. While few PROs have been adopted for these patients in Saudi Arabia, which do not reflect all aspects of the Saudi socio-cultural context. Given this shortcoming, this study aimed to develop a new PRO measure in Arabic that covers all concepts related to health, function, and participation encompassing environmental and personal factors.

PATIENTS AND METHODS

A cross-sectional study was conducted on 73 males and females aged ≥55 diagnosed with radiographic knee OA recruited from the orthopedic and physiotherapy departments of five hospitals in Riyadh, Saudi Arabia, between September 2016 and March 2017. Physicians confirmed knee OA according to the American College of Rheumatology standards. We examined the psychometric properties of the new Arabic PRO measure.

RESULTS

The internal consistency and test-retest (a one-week interval) reliabilities were found acceptable and excellent with Cronbach's alpha and the intra-class correlation coefficient, ranging from 0.69 to 0.85 and 0.88 to 0.91, respectively. The construct validity was found fair with the correlation between the subscales Body Function and Physical Function (rs =0.63), Activity & Participation and Physical Function (rs =0.72), and Body Function and Bodily Pain (rs =0.58). We found a weak to fair correlation between the new Arabic PRO measure's subscales and the SF-36 physical composite scale (PCS: rs =0.34-0.69) compared to the mental-composite scale (MCS: rs =0.16-0.55).

CONCLUSION

The 33-item new Arabic PRO measure is a well-accepted, reliable, and valid tool for use in knee OA patients in the Saudi cultural context.

Global Burden of osteoarthritis associated with high body mass index in 204 countries and territories, 1990-2019: findings from the Global Burden of Disease Study 2019

OBJECTIVE

To quantify the burden of osteoarthritis (OA) associated with high body mass index (BMI) across 204 countries and territories from 1990 to 2019.

METHODS

This study extracted global, regional, and national data on years lived with disability (YLD) of OA associated with high BMI from GBD 2019. The YLD burden of OA associated with high BMI was systematically analyzed by age, SDI, sex, and EAPC.

RESULTS

At the global level, ~2.67 million (95% UI: 1.04, 5.75) YLD were attributable to OA associated with high BMI, with an age-standardized rate of 31.9 (95% UI: 12.4, 68.75) YLD per 100,000 population in 2019. There was a 0.5 increase (95% UI: 0.35, 0.79) over the 30 years with an EAPC of 1.45. In 2019, Australasia {57.49 (95% UI: 23.62, 125.38)}, high-income North America {56.2 (95% UI: 23.32, 121.97)}, and Andean Latin America {49.77 (95% UI: 19.73, 111.73)} had the highest age-standardized YLD rates. The population aged at 60-74 group had a higher YLD rate for both males and females. Females tended to be more sensitive to the OA associated with high BMI than male in any region.

CONCLUSIONS

In summary, the YLD rate of OA associated with high BMI presented a continuous upward trend in most countries. Women and older people are more sensitive to OA due to physiological and psychological factors. Controlling modifiable risk factors such as maintaining an appropriate BMI is needed for disease prevention.

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

Background

Manual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA) for many years. Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised.

Objectives

To conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence.

Methods

The pre-defined search strategies were applied to eight electronic databases from inception to September 2022. Suitable SRs/MAs were included in accordance with the inclusion and exclusion criteria. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate.

Results

A total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, all SRs/MAs were rated low risk in Phase 1 (assessing relevance) and Domain 1 (study eligibility criteria) of Phase 2. Three SRs/MAs (27.27%) were rated low risk in Domain 2 (identification and selection of studies). Ten SRs/MAs (90.91%) were rated low risk in Domain 3 (data collection and study appraisal). Five SRs/MAs (45.45%) were rated low risk in Domain 4 (synthesis and findings). And five SRs/MAs (45.45%) were rated low risk in Phase 3 (risk of bias in the review). By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract (2/11, 18.18%), search strategy (0/11, 0%), preprocessing of merging data (0/11, 0%), heterogeneity exploration (6/11, 54.55%), sensitivity analysis (4/11, 36.36%), publication bias (5/11, 45.45%), evidence quality (3/11, 27.27%), the list of excluded references (3/11, 27.27%), protocol and registration (1/11, 9.09%), funding (1/11, 9.09%), conflict of interest (3/11, 27.27%), and approach to relevant information (0/11, 0%). In GRADE, the evidence quality was defined as moderate quality (8 items, 21.05%), low quality (16 items, 42.11%), and critically low quality (14 items, 36.84%). Among the downgraded factors, risk of bias, inconsistency, imprecision, and publication bias were the main factors. A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (risk ratio = 1.15, 95% confidence interval [1.12, 1.18], p < 0.00001; I² = 0, p = 0.84). There are four reviews that narratively report adverse effects, and no severe adverse reactions occurred in the manual therapy group.

Conclusions

Manual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs. Further rigorous and normative SRs/MAs are expected to be carried out to provide robust evidence for definitive conclusions.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022364672.

Efficacy and Safety of Tramadol for Knee or Hip Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To examine efficacy and safety of tramadol for knee or hip osteoarthritis (OA).

METHODS

PubMed, Embase, Cochrane Library, and Web of Science were searched up to May 2020 for randomized controlled trials (RCTs) comparing any of the following interventions: tramadol 100 mg/day, 200 mg/day, and 300 mg/day, and placebo for knee or hip OA. Pain and function were measured at or near 12 weeks for efficacy. Gastrointestinal, cardiovascular, and central nervous system (CNS) adverse events (AEs), and withdrawals were measured for safety. Bayesian network meta-analysis was conducted.

RESULTS

Six RCTs (3,611 participants) were included. Tramadol 100 mg/day (standardized mean difference [SMD] -0.16 [95% confidence interval (95% CI) -0.34, 0.00]), 200 mg/day (SMD -0.21 [95% CI -0.37, -0.06]), and 300 mg/day (SMD -0.30 [95% CI -0.48, -0.14]) were statistically more effective than placebo in pain relief, but only tramadol 300 mg/day was better than placebo in functional improvement (SMD -0.24 [95% CI -0.47, -0.03]). Tramadol 100 mg/day (relative risk [RR] 2.29 [95% credible interval (CrI) 1.22, 4.25]), 200 mg/day (RR 4.35 [95% CrI 2.31, 8.01]), and 300 mg/day (RR 6.02 [95% CrI 3.22, 11.1]) involved a higher risk of gastrointestinal AEs. Similarly, tramadol 100-300 mg/day showed a higher risk of CNS AEs and withdrawals. However, the risk of cardiovascular AEs remained unclear.

CONCLUSION

Only tramadol 300 mg/day showed minimal improvement in pain and function but with increasing AEs compared with placebo. Tramadol may not be sufficiently recommended for knee or hip OA based on the presented evidence, especially in patients with the risk of gastrointestinal and CNS AEs.

Could Osteopontin be a useful biomarker in the diagnosis and severity assessment of osteoarthritis? A systematic review and meta-analysis of recent evidence

PURPOSE

Osteoarthritis (OA) patients demonstrated higher Osteopontin (OPN) plasma, serum, and synovial fluid concentrations than healthy individuals. In the present study, we aimed to investigate whether OPN could be used as a diagnostic or prognostic marker for OA symptom/disease severity.

METHODS

Using Web of Science, PubMed, Scopus, and Embase, we conducted a systematic review and meta-analysis of studies that measured OPN levels in OA patients' plasma, serum, or synovial fluid. After setting the eligibility criteria, data extraction, and quality assessment of the identified studies, we performed statistical analysis using Revman 5.4 and Open Meta analyst.

RESULTS

OPN has been found to be associated with advanced knee joint damage in OA patients. In addition, higher expression of OPN is thought to be associated with disease progression. Nevertheless, further studies should examine the role of other markers of chronic bone damage, such as leptin and sclerostin. This systematic review and meta-analysis included 14 studies with a total of 776 cases and 530 controls. OPN was significantly elevated in osteoarthritis patients' plasma, serum, and synovial fluid samples, with significant heterogeneity between studies.

CONCLUSION

We recommend that OPN plasma and synovial fluid levels be measured as a diagnostic and prognostic marker to determine the severity of OA symptoms.

Factors associated with self-rated difficulty to descend stairs in persons with knee osteoarthritis

BACKGROUND

Difficulty descending stairs is common in persons with knee osteoarthritis (OA). Clinically, it is important to know if and how this is explained by objectively measured difficulty to descend stairs, muscle weakness, pain, fear of movement, or knee joint status.

OBJECTIVE

To identify the potential of these factors to explain self-reported difficulty descending stairs.

DESIGN

Cross sectional, case-control.

SETTING

Hospital outpatient and physiotherapy clinic.

PARTICIPANTS

Twenty-eight men and women with knee OA (age 62.2 SD 5.9 years) and 31 controls (age 50.0 SD 8.5 years).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Using multivariate statistics, group comparisons were made for lower extremity kinematics (incorporating hip, knee, and ankle angles) and stance time in stair descent and lower extremity muscle strength. Then, a stepwise linear regression analysis was performed within the OA group to explain self-reported difficulties in stair descent where pain, kinesiophobia, radiographic signs, and outcomes that differed from controls for stair-descent kinematics and muscle strength were independent variables.

RESULTS

Multivariate statistics showed that the OA group displayed different all-over lower extremity kinematics (F_8,42 = 2.44 p = .029, η²  = 0.32) and a longer stance time (F_3,50 = 6.46; p = .001, η²  = 0.28) in stair descent and lower muscle strength (F_7,47 = 2.39; p = .035, η²  = 0.26) compared to controls. Regression analysis within the OA group to explain self-rated difficulties to descend stairs showed that the strongest association with kinesiophobia (ß = 0.607, p = .001) that combined with pain last week and radiographic signs explained almost 100% (ß = 0.972). Stair descent kinematics and strength variables that differed between groups did not explain self-rated difficulties to descend stairs.

CONCLUSION

Kinesiophobia and pain rather than stair-descent kinematics and reduced muscle-strength explained self-rated difficulties in stair descent in the OA group.

Advanced MR Imaging for Knee Osteoarthritis: A Review on Local and Brain Effects

Knee osteoarthritis is one of the leading causes of chronic disability worldwide and is a significant social and economic burden on healthcare systems; hence it has become essential to develop methods to identify patients at risk for developing knee osteoarthritis at an early stage. Standard morphological MRI sequences are focused mostly on alterations seen in advanced stages of osteoarthritis. However, they possess low sensitivity for early, subtle, and potentially reversible changes of the degenerative process. In this review, we have summarized the state of the art with regard to innovative quantitative MRI techniques that exploit objective and quantifiable biomarkers to identify subtle alterations that occur in early stages of osteoarthritis in knee cartilage before any morphological alteration occurs and to capture potential effects on the brain. These novel MRI imaging tools are believed to have great potential for improving the current standard of care, but further research is needed to address limitations before these compositional techniques can be robustly applied in research and clinical settings.

Relationship between knee joint discomfort, self-management behavior, and quality of life in the middle-aged and elderly people in China: A cross-sectional study

Background

The aim of this study was to describe the knee joint discomfort, self-management behavior, and quality of life (QoL) in the middle-aged and elderly people in China and to clarify the relationship between the knee joint discomfort, self-management behavior, and QoL.

Methods

It is a cross-sectional study and in this study, a stratified multistage random sampling method was used to collect data on the three factors such as knee joint discomfort, self-management behavior, and QoL among the middle-aged and elderly people in the Hunan Province. Spearman's correlation analysis was used to test the relationship between the knee joint discomfort, self-management behavior, and QoL.

Results

The results of the present study showed that among them, the prevalence of knee pain was the highest (52.1%), followed by knee weakness (42.5%), numbness (41.8%), cold feeling (40.0%), tenderness (38.3%), and distension feeling (37.5%). Average score of self-management of knee joint discomfort in the middle-aged and elderly people was 2.14 ± 0.67. The level of self-management in each dimension ranged from high to low as emotional management, daily management, symptoms management, and information management. The average scores of physical component summary (PCS) and mental component summary (MCS) were 42.85 ± 5.34 and 43.62 ± 8.43, respectively. The occurrence, frequency, and severity of discomfort symptoms were positively correlated with the symptoms management, daily management, information management, and self-management behaviors, and negatively correlated with the emotional management, PCS and MSC, except for the occurrence of discomfort symptoms (P < 0.05).

Conclusion

Knee joint discomfort was prevalent in the middle-aged and elderly people. In addition, they displayed a low level of self-management behavior and poor QoL. The middle-aged and elderly people faced knee discomfort symptoms, the more frequent and severe symptoms, the higher level of symptom management, daily management, and information management, and the lower level of emotional management and QoL.

The association between lower socioeconomic position and functional limitations is partially mediated by obesity in older adults with symptomatic knee osteoarthritis: Findings from the English Longitudinal Study of Ageing

Objective

To assess the longitudinal associations of socioeconomic position (SEP) with functional limitations and knee joint replacement surgery (JRS) in people with symptomatic knee osteoarthritis (OA), and whether body mass index (BMI) mediated these relationships.

Methods

Data came from the English Longitudinal Study of Ageing, a national longitudinal panel study of adults aged ≥50 years. A total of 1,499 participants (62.3% female; mean age 66.5 (standard deviation (SD) 9.4) years; 47.4% obese) self-reporting an OA diagnosis and knee pain, with at least one BMI measurement were included. Mixed effect models estimated longitudinal associations of each SEP variable (education, occupation, income, wealth and deprivation index) and obesity (BMI ≥30.0 kg/m²) with repeated measures of functional limitations. Cox regression analyses estimated associations between SEP indicators and obesity at baseline and risk of knee JRS at follow-up. Structural equation modeling estimated any mediating effects of BMI on these relationships.

Results

Lower SEP and obesity at baseline were associated with increased odds of functional limitations in people with knee OA [e.g., difficulty walking 100 yards: no qualification vs. degree adjOR 4.33 (95% CI 2.20, 8.55) and obesity vs. no obesity adjOR 3.06 (95% CI 2.14, 4.37); similar associations were found for the other SEP indicators]. A small proportion of the association between lower SEP and functional limitations could be explained by BMI (6.2-12.5%). Those with lower income, lower wealth and higher deprivation were less likely to have knee JRS [e.g., adjHR most vs. least deprived 0.37 (95% CI 0.19, 0.73)]; however, no clear association was found for education and occupation. Obesity was associated with increased hazards of having knee JRS [adjHR 1.87 (95% CI 1.32, 2.66)]. As the direction of the associations for SEP and obesity with knee JRS were in opposite directions, no mediation analyses were performed.

Conclusions

Lower SEP was associated with increased odds of functional limitations but lower hazards of knee JRS among people with knee OA, potentially indicating underutilization of JRS in those with lower SEP. Obesity partially mediated the relationship between lower SEP and increased odds of functional limitations, suggesting adiposity as a potential interventional target.

Morphological reflection of highly purified chondroitin sulfate action in patients with decompensated form of knee osteoarthritis

Objective: to study the morphological reflection of the parenteral form of highly purified chondroitin sulfate (CS) action in patients with osteoarthritis (OA) of the knee joints (KJ) during total knee arthroplasty (TA).

Patients and methods. An open, prospective, controlled, randomized study included 67 patients (24 men and 43 women aged 41—73 years) with stage III knee OA and grade 2 functional insufficiency. The 1st (control) group included 35 patients, the 2nd (main) group included 32 patients. At baseline of the study, all patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) at a standard daily dose. Patients of the 2nd group 2 months before the TA of KJ, additionally received a parenteral form of CS (Honrogard®), intramuscularly every other day: the first 3 injections at a dose of 100 mg/day; and if tolerability was good starting from the 4th injection, at a dose of200 mg / day (course — 25 injections). The intensity of pain was assessed according to the visual analog scale, WOMAC index, functional status according to the KOOS (Knee and Osteoarthritis Outcome Score) scale and the Lequesne index, standard radiography and magnetic resonance imaging of the knee joint were performed with an assessment of the T2 relaxation time. TA KJ was carried out according to C. Ranawat method.

Results and discussion. In contrast to patients who took only NSAIDs, in patients who received CS during 50 days within 2 months before surgery, there were signs of adaptive restructuring in all layers of the preserved volume of hyaline cartilage and a decrease in the synovial membrane inflammation at the time of TA of KJ.

Conclusion. The obtained results allow us to recommend the use of the parenteral form of CS (Honrogard®) according to the described scheme within 2 months before the TA of KJ in order to improve the morphological characteristics of cartilage and synovial tissue in the joints of the contralateral lower limb, taking into account the increase in the load on it in the postoperative period.

Efficacy of rectus femoris stretching on pain, range of motion and spatiotemporal gait parameters in patients with knee osteoarthritis: a randomised controlled trial

OBJECTIVE

This study aimed to investigate the efficacy of rectus femoris stretching on pain intensity, knee range of motion (ROM), spatiotemporal gait parameters and function in patients with knee osteoarthritis (KOA).

METHODS

This parallel group, single-blinded randomised controlled trial was conducted in two outpatient physical therapy clinics. Study participants (n=60, with age>45 years) with mild-to-moderate bilateral KOA were randomised into the study group (SG) and control group (CG). SG received rectus femoris stretching exercises together with stretching exercises of the calf, hamstring and iliotibial band, strength exercises for the quadriceps, gluteus medius, gluteus maximus and calf muscles, whereas, the CG received all exercises mentioned for SG except rectus femoris stretching. Pain intensity, ROM, spatiotemporal gait parameters and function were measured before and after 4 weeks of treatment.

RESULTS

The SG showed a significant improvement in the visual analogue scale, Western Ontario and McMaster Universities measure and ROM (p<0.001). The SG also had a significantly greater step length and speed than CG (p<0.001). Extension ROM did not significant difference between the groups (p>0.05).

CONCLUSION

Simple rectus femoris stretching exercises are easy to perform even at home and are beneficial for pain, flexion ROM, function and spatiotemporal gait parameters, such as step length and speed, in KOA patients if the compliance with the exercise regimen is good.

TRIAL REGISTRATION NUMBER

Pan African Clinical Trials Registry PACTR202003828737019.

Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and grade recommendations

Objective

To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials.

Data Sources

The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo.

Review methods

We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND (“knee joint”) AND (“Extracorporeal Shockwave Therapy”). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597).

Results

We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = −1.93; 95%CI: [−2.77; −1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = −2.05; 95%CI: [−2.59; −1.51]; I² = 84%; P < 0.01), medium (MD = −3.46; 95%CI: [−4.03; −2.89]; I² = 0%; P < 0.01) and long-term (MD = −2.01; 95%CI: [−3.36; −0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [−2.98; −0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = −1.44; 95%CI: [−1.81; −1.07]; I² = 37%; P = 0.14), medium (MD = −1,31; 95%CI: [−1.76; −0,85]; I² = 0%; P = 0.41), and long terms (MD = −1.63; 95%CI: [−1.73; −1.52]; I² = 0%; P = 0.43).

Conclusion

Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.

Automatic assessment of knee osteoarthritis severity in portable devices based on deep learning

BACKGROUND

For knee osteoarthritis, the commonly used radiology severity criteria Kellgren-Lawrence lead to variability among surgeons. Most existing diagnosis models require preprocessed radiographs and specific equipment.

METHODS

All enrolled patients diagnosed with KOA who met the criteria were obtained from **** Hospital. This study included 2579 images shot from posterior-anterior X-rays of 2,378 patients. We used RefineDet to train and validate this deep learning-based diagnostic model. After developing the model, 823 images of 697 patients were enrolled as the test set. The whole test set was assessed by up to 5 surgeons and this diagnostic model. To evaluate the model's performance we compared the results of the model with the KOA severity diagnoses of surgeons based on K-L scales.

RESULTS

Compared to the diagnoses of surgeons, the model achieved an overall accuracy of 0.977. Its sensitivity (recall) for K-L 0 to 4 was 1.0, 0.972, 0.979, 0.983 and 0.989, respectively; for these diagnoses, the specificity of this model was 0.992, 0.997, 0.994, 0.991 and 0.995. The precision and F1-score were 0.5 and 0.667 for K-L 0, 0.914 and 0.930 for K-L 1, 0.978 and 0.971 for K-L 2, 0.981 and 0.974 for K-L 3, and 0.988 and 0.985 for K-L 4, respectively. All K-L scales perform AUC > 0.90. The quadratic weighted Kappa coefficient between the diagnostic model and surgeons was 0.815 (P < 0.01, 95% CI 0.727-0.903). The performance of the model is comparable to the clinical diagnosis of KOA. This model improved the efficiency and avoided cumbersome image preprocessing.

CONCLUSION

The deep learning-based diagnostic model can be used to assess the severity of KOA in portable devices according to the Kellgren-Lawrence scale. On the premise of improving diagnostic efficiency, the results are highly reliable and reproducible.

Effects of Internet of Things-based power cycling and neuromuscular training on pain and walking ability in elderly patients with KOA: protocol for a randomized controlled trial

BACKGROUND

Osteoarthritis (OA) is a common and highly disabling disease that imposes a heavy burden on individuals and society. Although physical therapy is recommended as an important method to relieve OA symptoms, patients cannot continue treatment after returning home. Research on Internet telerehabilitation for knee osteoarthritis (KOA) can reduce pain and improve patient quality of life, and Internet of Things (IoT)-based telerehabilitation is a new form of delivering rehabilitation. This study will evaluate the effect of telerehabilitation via IoT, as a medium to deliver exercises, on pain and walking in patients with KOA.

METHODS

This study is a single-blind randomized controlled trial. We will recruit 42 middle-aged and elderly patients with KOA aged ≥ 50 years and randomly divided into power cycling group, neuromuscular exercise group, and control group, and intervention will last for 12 weeks. Outcome measures will be taken at baseline and 4 weeks, 8 weeks, and 12 weeks post-intervention. The pre- and posttreatment differences in knee pain and physical function between participants undergoing power cycling and neuromuscular training and those in the control group will be determined by each scale. The effectiveness will be assessed by the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and an 11-point numerical pain rating scale. Walking function and quality of life will be assessed by the timed up and go and walk test, 6-min walk test, and quality of life health status questionnaires.

DISCUSSION

The findings from this trial will establish the feasibility and effectiveness of IoT-based power cycling and neuromuscular training on elderly patients with KOA in the community. As a result, this trial may help provide experimental evidence for finding a better exercise method suitable for elderly patients with KOA in the community.

TRAIL REGISTRATION

Chinese Clinical Trials Registry ChiCTR2200058924. Prospectively registered on 6 May 2022.

Overview of Anti-Inflammatory and Anti-Nociceptive Effects of Polyphenols to Halt Osteoarthritis: From Preclinical Studies to New Clinical Insights

Knee osteoarthritis (OA) is one of the most multifactorial joint disorders in adults. It is characterized by degenerative and inflammatory processes that are responsible for joint destruction, pain and stiffness. Despite therapeutic advances, the search for alternative strategies to target inflammation and pain is still very challenging. In this regard, there is a growing body of evidence for the role of several bioactive dietary molecules (BDMs) in targeting inflammation and pain, with promising clinical results. BDMs may be valuable non-pharmaceutical solutions to treat and prevent the evolution of early OA to more severe phenotypes, overcoming the side effects of anti-inflammatory drugs. Among BDMs, polyphenols (PPs) are widely studied due to their abundance in several plants, together with their benefits in halting inflammation and pain. Despite their biological relevance, there are still many questionable aspects (biosafety, bioavailability, etc.) that hinder their clinical application. This review highlights the mechanisms of action and biological targets modulated by PPs, summarizes the data on their anti-inflammatory and anti-nociceptive effects in different preclinical in vitro and in vivo models of OA and underlines the gaps in the knowledge. Furthermore, this work reports the preliminary promising results of clinical studies on OA patients treated with PPs and discusses new perspectives to accelerate the translation of PPs treatment into the clinics.

Epidemiological trends of hand osteoarthritis from 1990 to 2019: Estimates from the 2019 Global Burden of Disease study

Background

Hand osteoarthritis (OA) is a chronic progressive disease characterized by disabling pain in the hand, with a high clinical burden. This study is designed to assess the epidemiological patterns of hand OA from 1990 to 2019 and analyze its secular trends based on sex, age, and socio-demographic index (SDI) at global, regional, and national levels.

Methods

Data on the incidence and disability-adjusted life years (DALYs) of hand OA were extracted from the 2019 Global Burden of Disease (GBD), and their respective age-standardized rates (ASRs) were calculated. The estimated annual percentage changes (EAPCs) in ASR were calculated to assess the prevalent trends of the incidence and DALYs of hand OA over the recent three decades. The relationship between ASR and SDI was analyzed by Pearson's correlation analysis.

Results

The incidence of hand OA increased from 371.30 million in 1990 to 676.02 million in 2019, increasing by 82.07%, whereas its age-standardized incidence rate (ASIR) decreased, with a downward trend [EAPC = -0.34; 95% confidence interval: -0.39--0.28]. With the changes in age, the incidence of hand OA exhibited a unimodal distribution before 70 years of age, peaking at 50-54 years, while its incidence had an upward trend in the >70 years age groups. Overall, hand OA-related DALYs increased in the recent 30 years. Meanwhile, its annual age-standardized DALY rate decreased, with EAPCs of -0.35 (95% CI, -0.38 --0.32). The DALYs increased with age. In 2019, the ASIR and age-standardized DALY rate were positively associated with the SDI regions. The incidence and DALYs presented predominance in female patients. The burden of hand OA over the recent three decades displayed obvious geographical diversity.

Conclusion

The incident cases of hand OA increased globally from 1990 to 2019, while the ASIR and age-standardized DALY rate decreased. However, in many countries and regions, there was a rising trend of ASR related to incidence and DALYs. In addition, the prevalence revealed geographical, sex, and age diversity. Thus, governments and medical institutions should reallocate medical resources based on the epidemiological characteristics of hand OA.