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Perruccio AV, Young JJ, Wilfong JM, Denise Power J, Canizares M, Badley EM. Osteoarthritis year in review 2023: Epidemiology & therapy. Osteoarthritis Cartilage 2024; 32:159-165. [PMID: 38035975 DOI: 10.1016/j.joca.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To highlight some important findings from osteoarthritis (OA) epidemiology and therapy research undertaken over the past year. METHODS Search of MEDLINE and EMBASE databases between April 1, 2022 to March 3, 2023 using "exp *Osteoarthritis/" as the preliminary search term. The search was limited to articles published in English and including human subjects. Final inclusions were based on perceived importance and results that may inform improved identification of risk factors or OA treatments, as well as OA subgroups of potential relevance to risk factors or treatment approaches. RESULTS 3182 studies were screened, leaving 208 eligible for inclusion. This narrative review of thirty-three selected studies was arranged into: a) OA predictors - population-based studies, b) Specific predictors of OA and OA outcome; c) Intra-articular injections, and d) OA phenotypes. There was some suggestion of sex differences in predictors of incidence or outcomes. Body mass index changes appear largely to affect knee OA outcomes. Evidence points to a lack of benefit of viscosupplementation in knee OA; findings were variable for other injectables. Studies of OA phenotypes reveal potentially relevant clinical and pathophysiological differences. CONCLUSIONS Identifying risk factors for the incidence/progression of OA represents an ongoing and important area of OA research. Sex may play a role in this understanding and bears consideration and further study. For knee injectables other than viscosupplementation, additional high-quality trials appear warranted. Continued investigation and application of phenotyping across the OA disease, illness and care spectrum may be key to developing disease-modifying agents and their appropriate selection for individuals.
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Affiliation(s)
- Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Andreo‐García MV, Navarro‐Flores E, Losa‐Iglesias ME, Becerro‐de‐Bengoa‐Vallejo R, López‐López L, Saavedra‐García MÁ, López‐López D, Gómez‐Salgado J. Influence of quality of life related to perceived foot health between in a rural an urban population: A case-control research. Int Wound J 2024; 21:e14713. [PMID: 38356326 PMCID: PMC10867538 DOI: 10.1111/iwj.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Foot problems are very common in the community. Studies indicate that between 18% and 63% of people have foot pain or stiffness and that foot problems have a large impact on people's functional decline and a significant detrimental impact on measures of quality of life related to health. The general objective of this research was to compare foot health in people from the rural population compared to people from the urban population and its relationship with quality of life. A case-control descriptive study was developed with a sample of 304 patients, 152 patients from the rural population and 152 patients from the urban population. Quality of life was measured through the SF-36 Health Questionnaire in its Spanish version. The rural population group had a mean age of 46.67 ± 13.69 and the urban population group 49.02 ± 18.29. Regarding the score of the lowest levels of quality of life related to foot problems, the rural population group compared to the urban population group showed: for body pain (52.21 ± 30.71 vs. 67.80 ± 25.28, p < 0.001); and for mental health (69.58 ± 18.98 vs. 64.60 ± 14.88, p < 0.006). Differences between groups were analysed using Student's t-test for independent samples, which showed statistical significance (p < 0.05). This research offers evidence that the rural population presents better levels of mental health and lower levels of bodily pain in the domains of the SF-36 Health Questionnaire comparing with the urban population.
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Affiliation(s)
- María Victoria Andreo‐García
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of FerrolUniversidade da CoruñaFerrolSpain
| | - Emmanuel Navarro‐Flores
- Faculty of Nursing and Podiatry, Department of Nursing, University of ValenciaFrailty Research Organizaded Group (FROG)ValenciaSpain
| | | | | | - Luis López‐López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of FerrolUniversidade da CoruñaFerrolSpain
| | - Miguel Ángel Saavedra‐García
- Group of Research in Sport Science (INCIDE), Department of Physical Education and SportUniversidade da CoruñaA CoruñaSpain
| | - Daniel López‐López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of FerrolUniversidade da CoruñaFerrolSpain
| | - Juan Gómez‐Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour SciencesUniversity of HuelvaHuelvaSpain
- Safety and Health Postgraduate ProgrammeUniversidad Espíritu SantoGuayaquilEcuador
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Bieganowski T, Kugelman DN, Feng JE, Schwarzkopf R, Rozell JC. Opioid Consumption and Mobilization in Staged Bilateral Total Joint Arthroplasty: Did We Learn Our Lesson the First Time? J Arthroplasty 2024; 39:49-53. [PMID: 37331439 DOI: 10.1016/j.arth.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND In patients who require bilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), staged procedures are a reasonable option for treatment of bilateral osteoarthritis. We sought to determine whether perioperative outcomes differed between first and second total joint arthroplasty (TJA). METHODS This was a retrospective review of all patients who underwent staged, bilateral THA or TKA between January 30, 2017, and April 8, 2021. All patients who were included underwent their second procedure within 1 year of the first. Patients were separated based on whether both their procedures took place before or subsequently after an institution-wide opioid-sparing protocol that was implemented on October 1, 2018. A total of 961 patients who underwent 1,922 procedures met the inclusion criteria for this study. For THA, 388 unique patients comprised 776 procedures, while 573 unique patients comprised 1,146 TKAs. Opioid prescriptions were prospectively documented on nursing opioid administration flowsheets and converted to morphine milligram equivalents (MME) for comparison. Activity measure scores for postacute care (AM-PAC) were used as a measurement of physical therapy progression. RESULTS Hospital stays, home discharges, perioperative opioid usages, pain scores, and AM-PAC scores were not significantly different for the second THA or TKA compared to first procedure, regardless of timing in relation to the opioid-sparing protocol. CONCLUSION Patients experienced similar outcomes following their first versus their second TJA. Limited opioid prescriptions following TJA do not negatively impact pain and functional outcomes. These protocols can safely be instituted to help mitigate the opioid epidemic. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - David N Kugelman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
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Kirschbaum S, Hube R, Perka C, Najfeld M. Bilateral simultaneous knee arthroplasty shows comparable early outcome and complication rate as staged bilateral knee arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon: a retrospective cohort study of 127 cases. Arch Orthop Trauma Surg 2024; 144:417-424. [PMID: 37814008 PMCID: PMC10774180 DOI: 10.1007/s00402-023-05078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE The study compares early outcomes after simultaneous and staged knee arthroplasty in patients with bilateral knee osteoarthritis (OA) to evaluate whether simultaneous bilateral TKA shows comparable early outcomes and complication rates to staged bilateral TKA. METHODS A retrospective cohort study including all patients scheduled for primary TKA for bilateral knee OA (n = 127) was conducted. Patients received either simultaneous (n = 53, 41.7%) or staged (n = 74, 58.3%) bilateral TKA by a single, high-volume surgeon-depending on their individual preference. Demographic data, haemoglobin drop (Hb), length of stay (LOS), operation time, 30-day complication rate and achievement of rehabilitation key points were evaluated. RESULTS There was no difference between the groups concerning age, sex, BMI or complication rate. ASA scoring was better in the simultaneous group [2.2, (15.1% ASA 1, 49.1% ASA 2, 35.8% ASA 3) vs. 2.4 (2.7% ASA 1, 51.4% ASA 2, 45.9% ASA 3)]. Average LOS was 7.8 ± 2.1 days for simultaneous TKA, 7.4 ± 1.7 days for single procedure of staged group (p < 0.453) and 14.7 ± 3.1 days if combined (p < 0.001). Cumulative Hb loss was significantly higher in the staged group (3.8 ± 1.2 g/dl vs. 2.4 ± 0.8 g/dl, p < 0.001). Detailed comparison of early outcome parameters between staged and simultaneous procedure depending on ASA score only revealed slightly slower assessment of stairs (p < 0.001) and increased Hb drop per surgery in case of simultaneous procedure (p < 0.011) if ASA score was ≥ 2. Only patients scored ASA 3 demonstrated a significant longer LOS per procedure in simultaneous group (8.5 ± 2.4 vs.7.3 ± 1.6 days, p = 0.034). INTERPRETATION Simultaneous bilateral TKA results in comparable early outcome and complication rate than staged bilateral procedure-even for patients scored ASA 3. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Hube
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Najfeld
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
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Perruccio AV, Badley EM, Antflek D, Power JD, Baltzer H. Frequency of multisite non-hand joint involvement in patients with thumb-base osteoarthritis, and associations with functional and patient-reported outcomes. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100397. [PMID: 37609061 PMCID: PMC10440563 DOI: 10.1016/j.ocarto.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose In OA studies, the focus often is on an index-joint; other affected joint sites are often overlooked. In this thumb-base OA study, we documented the frequency of symptomatic non-hand joint sites and investigated whether their count was associated with thumb-specific functional and patient-reported outcome measures. Design Patients seeking care for thumb-base OA (conservative or surgical) were included. A patient-completed questionnaire captured sociodemographic and health characteristics, symptomatic hand and non-hand joint sites, and outcome measures (thumb-base pain intensity, symptoms and disability (TASD) and upper-extremity disability/symptoms (quickDASH)). Grip and pinch strength were measured. Linear regressions examined the association between each outcome and symptomatic joint site count, adjusted for several covariates. Results The mean age of the 145 patients was 62 years, 72% were female. Mean symptomatic non-hand joint site count was 3.6. Ten percent reported only their hands as symptomatic; 30% reported 2-3 other symptomatic sites, and 49% reported 4+. From cross-sectional multivariable analyses, a higher symptomatic non-hand joint site count was associated with worse scores for all patient-reported outcomes and grip strength. Every unit increase in joint site count (49% had a 4+ count) was associated with a 2.1-3.3 unit increase (worse) in patient-reported outcome scores (all p < 0.02). Conclusions In this sample, nearly 80% of patients had 2+ symptomatic non-hand joint sites. These symptoms were associated with worse thumb- and hand-specific outcomes, suggesting a need for awareness of whole body OA burden, with implications for outcome score interpretations, study designs, and provision of care in thumb-base OA.
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Affiliation(s)
- Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
| | - Elizabeth M. Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daniel Antflek
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - Heather Baltzer
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
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Badley EM, Zahid S, Wilfong JM, Perruccio AV. Relationship Between Body Mass Index and Osteoarthritis for Single and Multisite Osteoarthritis of the Hand, Hip, or Knee: Findings From a Canadian Longitudinal Study on Aging. Arthritis Care Res (Hoboken) 2022; 74:1879-1887. [PMID: 34121361 DOI: 10.1002/acr.24729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/10/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether an apparent association between hand osteoarthritis (OA) and adiposity is explained by the presence of OA at other joint sites. METHODS Data from the Canadian Longitudinal Study on Aging, first cycle, comprehensive cohort, were used. Respondents age 45-85 years (n = 18,279) were asked separate questions about doctor-diagnosed OA in the hand, hip, or knee. Multinomial logistic regression was used to investigate the relationship between all combinations of hand, hip, and knee OA and body mass index (BMI) and waist-to-height ratio (WHtR). RESULTS OA was reported by 34.6% of respondents, 28.0% with OA at >1 joint site. Hand OA was not significantly associated with BMI after accounting for OA at other joint sites, with similar findings for WHtR. All joint site combinations containing the knee were strongly associated with BMI, with odds ratios (ORs) ranging from OR 2.92 (95% confidence interval [95% CI] 2.53-3.37) for knee OA only with obesity class I to OR 9.98 (95% CI 7.12-13.88) for multi-joint knee, hip, hand OA with obesity class II/III. BMI distributions including knee OA were broader and shifted to higher BMI levels than those for hand or hip OA. CONCLUSION Apparent associations between hand OA and BMI may be explained by concurrent OA at other joint sites. Recognizing that OA is a multi-joint disease is crucial for studies of the associations of adiposity with OA in a particular joint, especially the hand. The association between knee OA and BMI appears to be distinct from those for OA at other joint sites.
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Affiliation(s)
- Elizabeth M Badley
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shatabdy Zahid
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Jessica M Wilfong
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Krembil Research Institute and Schroeder Arthritis Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Nam S, Downer B, Bae S, Hong I. Social, behavioural, and functional characteristics of community-dwelling South Korean adults with moderate and severe cognitive impairment. Int J Methods Psychiatr Res 2022; 31:e1908. [PMID: 35278012 PMCID: PMC9159685 DOI: 10.1002/mpr.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study used the 2016 Korean Longitudinal Study on Aging to investigate the social, behavioural, and functional characteristics of community-dwelling South Korean adults with cognitive impairment. METHODS Participants were classified as normal, moderate impairment, and severe impairment according to an algorithm that combined the Korean Mini-Mental State Examination score and the number of difficulties in performing instrumental activities of daily living. Selected characteristics included grip strength, depression, participation in exercise and social activities, and living in a rural, urban, or suburban community. RESULTS Most (72.7%) participants were classified as having normal cognition, 20.1% were classified as moderate impairment, and 7.2% were classified as severe impairment. Regardless of sex, the differences in grip strength across the cognitive status classifications were statistically significant, except for the difference between moderate and severe cognitive impairment in males (p = 0.8477). Greater number of depressive symptoms and living in rural areas were associated with significantly higher odds for severe cognitive impairment. Participants with moderate (OR = 0.51) and severe (OR = 0.33) cognitive impairment were less likely to participate in social activities than those with normal cognition. CONCLUSIONS The study findings revealed that social, behavioural, and functional characteristics are closely related to the cognitive status of community-dwelling adults in South Korea.
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Affiliation(s)
- Sanghun Nam
- Department of Occupational TherapyGraduate SchoolYonsei UniversityWonju‐siGangwon‐doRepublic of Korea
| | - Brian Downer
- Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Suyeong Bae
- Department of Occupational TherapyGraduate SchoolYonsei UniversityWonju‐siGangwon‐doRepublic of Korea
| | - Ickpyo Hong
- Department of Occupational TherapyCollege of Software and Digital Healthcare ConvergenceYonsei UniversityWonju‐siGangwon‐doRepublic of Korea
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Perruccio AV, Roos EM, Skou ST, Grønne DT, Davis AM. Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:1140-1146. [PMID: 35587461 DOI: 10.1002/acr.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. METHODS Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8-week education and exercise program. The following factors were recorded at program entry: age; education; mental well-being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program-specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post-program) on a 0-100-mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post-program. Logistic regression was used and conducted separately in male and female subjects. RESULTS The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4-48.1) and male subjects had a score of 41.7 (95% CI 40.3-43.1). By post-program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program-specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well-being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program-specific factors were not associated with response, while better mental well-being and fewer comorbidities were associated with being a responder. CONCLUSION Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.
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Affiliation(s)
- Anthony V Perruccio
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | | | - Aileen M Davis
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Perry TA, Segal NA, Bowen C, Gates L, Arden N, Nevitt MC. Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 3:100210. [PMID: 34977597 PMCID: PMC8683744 DOI: 10.1016/j.ocarto.2021.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To examine whether foot and/or ankle pain increases the risk of knee OA. Design We utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. Results No statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. Conclusions Ankle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.
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Affiliation(s)
- Thomas A. Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Corresponding author. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom.
| | - Neil A. Segal
- University of Kansas Medical Centre, Kansas City, KS, USA
- The University of Iowa, Iowa City, USA
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Lucy Gates
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Nigel Arden
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA 94158, USA
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Hall M, van der Esch M, Hinman RS, Peat G, de Zwart A, Quicke JG, Runhaar J, Knoop J, van der Leeden M, de Rooij M, Meulenbelt I, Vliet Vlieland T, Lems WF, Holden MA, Foster NE, Bennell KL. How does hip osteoarthritis differ from knee osteoarthritis? Osteoarthritis Cartilage 2022; 30:32-41. [PMID: 34600121 DOI: 10.1016/j.joca.2021.09.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
Hip and knee osteoarthritis (OA) are leading causes of global disability. Most research to date has focused on the knee, with results often extrapolated to the hip, and this extends to treatment recommendations in clinical guidelines. Extrapolating results from research on knee OA may limit our understanding of disease characteristics specific to hip OA, thereby constraining development and implementation of effective treatments. This review highlights differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain and non-surgical treatment recommendations and management.
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Affiliation(s)
- M Hall
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
| | - M van der Esch
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, University of Applied Sciences Amsterdam, the Netherlands
| | - R S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
| | - G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - A de Zwart
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - J G Quicke
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J Knoop
- Vrije Universiteit Amsterdam, the Netherlands
| | - M van der Leeden
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Amsterdam UMC, Location VUmc, Department of Rheumatology, Amsterdam, the Netherlands
| | - M de Rooij
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | | | | | - W F Lems
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Amsterdam UMC, Location VUmc, Department of Rheumatology, Amsterdam, the Netherlands
| | - M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - N E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Hospital and Health Service, Queensland, Australia
| | - K L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
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11
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Mattap SM, Laslett LL, Squibb K, Wills K, Otahal P, Pan F, Aitken D, Keen H, Cicuttini F, Winzenberg T, Jones G. Hand Examination, Ultrasound, and the Association With Hand Pain and Function in Community‐Based Older Adults. Arthritis Care Res (Hoboken) 2021; 73:347-354. [DOI: 10.1002/acr.24128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/10/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Siti Maisarah Mattap
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Laura L. Laslett
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Kathryn Squibb
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Karen Wills
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Petr Otahal
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Feng Pan
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Helen Keen
- University of Western Australia Crawley Western Australia Australia
| | | | - Tania Winzenberg
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Graeme Jones
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
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12
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Badley EM, Wilfong JM, Yip C, Millstone DB, Perruccio AV. The contribution of age and obesity to the number of painful joint sites in individuals reporting osteoarthritis: a population-based study. Rheumatology (Oxford) 2021; 59:3350-3357. [PMID: 32306046 PMCID: PMC7590415 DOI: 10.1093/rheumatology/keaa138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To investigate the association of OA risk factors with number of painful joint sites in a representative population sample. Methods Analysis of the 2009 Survey on Living with Chronic Diseases in Canada – Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample. Results The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample. Conclusion The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.
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Affiliation(s)
- Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jessica M Wilfong
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto
| | - Calvin Yip
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dov B Millstone
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto
| | - Anthony V Perruccio
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto.,Arthritis Program, Krembil Research Institute, University Health Network, Toronto.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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13
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Perruccio AV, Power JD, Yip C, Badley EM, Canizares M, Rampersaud YR. The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis. Spine J 2021; 21:80-89. [PMID: 32805432 DOI: 10.1016/j.spinee.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. PURPOSE Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. DESIGN Prospective study of consecutive patients followed to 12-month postsurgery. PATIENT SAMPLE Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. OUTCOMES MEASURES Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and "pain/stiffness/swelling most days of the month" indicated on a homunculus (a joint site count was derived). ASSESSMENTS Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. METHODS Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. RESULTS In all, 165 patients were included. The mean age was 67 years (range: 44-90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). CONCLUSIONS Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.
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Affiliation(s)
- Anthony V Perruccio
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Calvin Yip
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elizabeth M Badley
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Y Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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14
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Ueda K, Takura T, Fujikoshi S, Meyers J, Nagar SP, Enomoto H. Long-Term Pain Management and Health Care Resource Use Among an Employed Population in Japan with Knee Osteoarthritis Combined with Low Back Pain. PAIN MEDICINE 2020; 22:3041-3050. [PMID: 33377491 PMCID: PMC8666001 DOI: 10.1093/pm/pnaa424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Assess long-term comorbidity burden and pain management patterns among working-age patients with knee osteoarthritis (KOA) only without low back pain (LBP) (KOA-noLBP) and patients with KOA plus LBP (KOA+LBP) in Japan. Methods Retrospective claims data analyses were conducted on data from the Japan Medical Data Center (JMDC) database. Adult patients (≥40 years) with a diagnosis of knee osteoarthritis (KOA) (January 1, 2011–December 31, 2012) and 5 years of follow-up were evaluated. The first claim with a KOA diagnosis defined the index date. Longitudinal pain management patterns were assessed in both cohorts. Results Overall, 1,828 patients met study criteria (717 with KOA-noLBP; 1,111 with KOA+LBP). The mean age of patients with KOA-noLBP was 52.1 years, and that of patients with KOA+LBP was 53.1 years, with more females in the KOA+LBP cohort (49.4% vs. 55.0%). Regardless of cohort, >90% of patients received pharmacological intervention during the 5-year follow-up period. The most common regimen first received was either topical or oral nonsteroidal anti-inflammatory drugs. A higher mean number of pharmaceutical treatments were received by patients in the KOA+LBP cohort (3.6) than by patients in the KOA-noLBP cohort (2.7) during the follow-up period. Regardless of cohort, most of the direct medical cost was derived from medication. Conclusion This study demonstrates that a greater proportion of the JMDC population of working individuals with KOA were comorbid with LBP and received pain-related treatment in the long-term perspective relative to patients with KOA without LBP. Appropriate pain management for both KOA and LBP would be key for effective resource utilization in an aging society facing socioeconomic burdens
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Affiliation(s)
- Kaname Ueda
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, University of Tokyo, Tokyo, Japan
| | - Shinji Fujikoshi
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Juliana Meyers
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Saurabh P Nagar
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Hiroyuki Enomoto
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
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15
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Chean CS, Lingham A, Rathod-Mistry T, Thomas MJ, Marshall M, Menz HB, Roddy E. Identification of patterns of foot and ankle pain in the community: Cross-sectional findings from the clinical assessment study of the foot. Musculoskeletal Care 2020; 19:9-19. [PMID: 32996230 DOI: 10.1002/msc.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes. METHODS Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed. RESULTS Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes. CONCLUSIONS Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.
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Affiliation(s)
- Chung Shen Chean
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Aranghan Lingham
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,East Kent Hospitals NHS Trust, William Harvey Hospital, Ashford, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Hylton B Menz
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
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16
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Ueda K, Takura T, Fujikoshi S, Meyers J, Nagar SP, Enomoto H. Longitudinal Assessment of Pain Management Among the Employed Japanese Population with Knee Osteoarthritis. Clin Interv Aging 2020; 15:1003-1012. [PMID: 32617001 PMCID: PMC7326174 DOI: 10.2147/cia.s242083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess comorbidity burden and pain-management patterns among working-aged patients with knee osteoarthritis only (KOA/O) and patients with knee osteoarthritis plus osteoarthritis at another site (KOA/+) in Japan. Patients and Methods Retrospective claims data analysis was conducted using the Japan Medical Data Center database. Working-aged adults (aged 40 to 71 years) with 5 years of follow-up and diagnosed with knee osteoarthritis (KOA) between January 1, 2011, and December 31, 2012, were evaluated. The first claim with a KOA diagnosis defined the index date. Patients were divided into two mutually exclusive cohorts: KOA/O and KOA/+. Longitudinal pain-management patterns during each year of follow-up were analyzed. Results A total of 2542 patients met study criteria: 1575 KOA/O and 967 KOA/+. Mean age and number of comorbidities were higher among the KOA/+ versus KOA/O cohort. Pharmaceutical treatment was received by 91.5% of patients in the KOA/+ compared with 85.1% of patients in the KOA/O cohort during the first year of follow-up. The most common pharmacological treatment received during the first year of follow-up was either topical or oral nonsteroidal anti-inflammatory drugs for both cohorts. During each year of follow-up, the KOA/+ cohort had greater proportion of patients with at least one health-care encounter (ie, hospital admissions, outpatient and pharmacy visits) and higher direct medical costs compared with the KOA/O cohort. Conclusion This study demonstrates that a greater proportion of the working population with KOA/+ received pain-related treatment compared with patients with KOA/O. Further studies are necessary to evaluate appropriate pain management for both KOA only and KOA with other sites.
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Affiliation(s)
- Kaname Ueda
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, University of Tokyo, Tokyo, Japan
| | - Shinji Fujikoshi
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | | | | | - Hiroyuki Enomoto
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
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17
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Taylor S, Room J, Barker K. Physical activity levels in men with Haemophilia-A single centre UK survey. Haemophilia 2020; 26:718-725. [PMID: 32364278 DOI: 10.1111/hae.14009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Historically persons with haemophilia (PWH) were not encouraged to participate in exercise due to the risk of bleeding and the lack of factor products available. This has now changed, and the availability of safe products allows PWH to be active and participate in sports. Studies have found that exercise has a positive effect on pain, joint health and movement with PWH. AIM To record the amount and types of physical activity undertaken by a haemophilia population at a single treatment centre. METHODS An observational cross-sectional study to assess physical activity and quality of life of all registered patients over the age of 18 at the Oxford Haemophilia and Thrombosis Centre. Participants were posted questionnaires including the International Physical activity Questionnaire (IPAQ), Haemophilia Activity List (HAL), EQ-5D-5L and asked to list their physical activities. RESULTS A total of 256 questionnaires were sent, with a 40% response rate for severe and 28% for mild patients. 85% met the UK physical activity guidelines. Sedentary behaviour for an average weekday was 6.4 hours, and weekends were 5.3 hours. Joint disease and severity type influenced the amount of activity undertaken, together with values for HAL and EQ-5D-5L. Twenty two types of activities were listed. CONCLUSION It is encouraging to see the amount of physical activity PWH participate in, however, time spent in a sedentary state needs monitoring. PWH want to be active and the challenge for caregivers is to find activities they can do and strategies to maintain participation.
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Affiliation(s)
- Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Headington, UK
| | - Jonathan Room
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Headington, UK.,NDORMS (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences), University of Oxford, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Headington, UK.,NDORMS (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences), University of Oxford, Oxford, UK
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18
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Zadro JR, Nilsen TIL, Shirley D, Amorim AB, Ferreira PH, Lier R, Mork PJ. Parental Multisite Chronic Pain and the Risk of Adult Offspring Developing Additional Chronic Pain Sites: Family-Linkage Data From the Norwegian HUNT Study. THE JOURNAL OF PAIN 2020; 21:968-978. [PMID: 31904500 DOI: 10.1016/j.jpain.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
We investigated if parental multisite chronic pain increases the risk of adult offspring developing additional chronic pain sites, and if offspring body mass index (BMI) and leisure time physical activity modify this association. We used longitudinal data on 7,654 offspring linked with their parents who participated in the population-based HUNT Study (Norway) in 1995 to 1997 and 2006 to 2008. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence interval (CI). One-third of offspring (n = 2,573) developed additional chronic pain sites. Having both parents with 1-2 chronic pain sites increased the risk of developing additional pain sites compared to having parents free of chronic pain (OR = 1.33; 95% CI 1.05-1.68), with larger effects observed when both parents had ≥3 chronic pain sites (OR = 1.46; 95% CI 1.17-1.82). These associations were largely driven by maternal pain, that is, there was no association between paternal chronic pain and risk of additional pain sites in offspring. The parent-offspring transfer of additional pain sites (when both parents had ≥3 pain sites) strengthened when offspring were obese (OR = 2.56; 95% CI 1.75-3.75) or physically inactive (OR = 1.73; 95% CI 1.33-2.27). In conclusion, parental multisite chronic pain increases the risk of offspring developing additional chronic pain sites, particularly those with obesity or inactivity. PERSPECTIVE: This longitudinal analysis investigated the parent-offspring transmission of multisite chronic pain, and whether lifestyle behaviors in offspring modify this association. The findings suggest that having parents with multisite chronic pain increases the risk of offspring developing additional chronic pain sites, particularly if offspring are obese or inactive.
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Affiliation(s)
- Joshua R Zadro
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Debra Shirley
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita B Amorim
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Ragnhild Lier
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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19
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Keenan AM, Drake C, Conaghan PG, Tennant A. The prevalence and impact of self-reported foot and ankle pain in the over 55 age group: a secondary data analysis from a large community sample. J Foot Ankle Res 2019; 12:53. [PMID: 31788030 PMCID: PMC6858640 DOI: 10.1186/s13047-019-0363-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background While the prevalence and impact of musculoskeletal problems are high, most attention has been directed towards the back, knee and hip disorders. Foot pain is known to be common in older adults and accounts for a significant burden on health services. The aim of this study was to assess the impact of foot and ankle joint pain, considering age, presence of co-morbidities and other site joint pain, in a large community sample. Methods In the North Yorkshire Health study, 16,222 people over 55 years participated in a detailed survey of the prevalence and impact of lower limb joint problems. Self-assessment of overall body pain and functional activities of daily living were assessed. Participants indicated the presence of joint pain, stiffness or swelling during the last 3 months which had lasted for more than 6 weeks on a manikin: data were captured on the foot and the ankle. Results The prevalence of self-reported foot and ankle joint pain was substantial: 184.33 per 1000, second only to knee problems. While foot pain was common, it was mostly associated with joint pain at other sites; only 1 in 11 of those with foot and ankle pain reported it only in the foot. Logistic regression modeling revealed while established factors such as co-morbidities, knee and hip problems contributed to functional impairment, foot and ankle problems contributed to an additional increased risk of having difficulty standing and walking by two fold (OR = 2.314, 95%CI 2.061–2.598), going up and down stairs by 71% (OR = 1.711, 95%CI 1.478–1.980) and getting up from a seated position by 44% (OR = 1.438, 95%CI 1.197–1.729). Conclusion These results suggest that not only are foot problems in the over 55 age group extremely prevalent, they have a considerable impact on functional abilities.
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Affiliation(s)
- Anne-Maree Keenan
- 1NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, School of Healthcare, University of Leeds, Leeds, England
| | - Chris Drake
- 2Mid Yorkshire Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, England
| | - Philip G Conaghan
- 3Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, England
| | - Alan Tennant
- 4Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England
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20
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Comparing the association of widespread pain, multi-joint pain and low back pain with measures of pain sensitization and function in people with knee osteoarthritis. Clin Rheumatol 2019; 39:873-879. [PMID: 31713734 DOI: 10.1007/s10067-019-04828-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/13/2019] [Accepted: 10/17/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION/OBJECTIVES To compare 1. measures of pain sensitization (PS) in people with widespread pain (WSP), multi-joint pain, low back pain (LBP) and knee osteoarthritis (KOA) only, in people with knee OA and 2. results of self-reported function and physical performance tests amongst these sub groups. METHODOLOGY Patients with knee OA consulting an orthopaedic surgeon were recruited from three Montreal area hospitals. A body homunculus was used to identify the presence of WSP (Y/N), multi-joint pain using a joint count (≥ 2 joints) and LBP (Y/N). Tests included pressure pain thresholds (PPT), temporal summation (TS), conditioned pain modulation and three physical performance tests. The Knee Injury and Osteoarthritis Outcome Score (KOOS) assessed self-reported function. Means were compared with Welch's ANOVA, post hoc tests and multiple regression analysis were performed. RESULTS Two hundred twenty-one participants were evaluated (mean age: 63.4 ± 9.9 years, females n = 135 (61.1%)). Those with WSP significantly differed from those with LBP on PPT mean - 1.4, 95%CI (- 2.4, - 0.4), TS 10.3 (2.1, 18.5) and the stair climb test (SCT) 5.6 (1.3, 9.9). Those with WSP significantly differed from those with KOA only on TS 9.5 (1.0, 18.1), SCT 6.3 (2.0, 10.6) and KOOS - 14.2 (- 26.5, - 2.0). CONCLUSION In patients with knee OA, those with WSP demonstrated greater degrees of PS compared with those with knee OA only, LBP and multi-joint pain. They also demonstrated a slower SCT compared with those with KOA only and LBP and decreased self-reported function compared with those with KOA only. These results should be confirmed in a longitudinal study.Key Points• In people with knee OA and widespread pain, measures of sensitization, self-reported function and physical performance were poorer compared with those with knee OA and LBP, knee OA and multi-joint pain or knee OA only.• Clinicians can consider these outcomes when planning management for these subgroups planning a comprehensive treatment program for this subgroup.
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Thapa S, Shmerling RH, Bean JF, Cai Y, Leveille SG. Chronic multisite pain: evaluation of a new geriatric syndrome. Aging Clin Exp Res 2019; 31:1129-1137. [PMID: 30361952 DOI: 10.1007/s40520-018-1061-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites. AIMS To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome. METHODS The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed. RESULTS The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations. CONCLUSION Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.
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Affiliation(s)
- Saurja Thapa
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Robert H Shmerling
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan F Bean
- Harvard Medical School, Boston, MA, USA
- New England Geriatric, Research, Education and Clinical Center, Boston Veterans Administration Health System, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Yurun Cai
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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22
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Blagojevic-Bucknall M, Thomas MJ, Wulff J, Porcheret M, Dziedzic KS, Peat GM, Foster NE, Jowett S, van der Windt DA. Predictors of pain interference and potential gain from intervention in community dwelling adults with joint pain: A prospective cohort study. Musculoskeletal Care 2019; 17:231-240. [PMID: 31199067 DOI: 10.1002/msc.1406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is little research on identifying modifiable risk factors that predict future interference of pain with daily activity in people with joint pain, and the estimation of the corresponding population attributable risk (PAR). The present study therefore investigated modifiable predictors of pain interference and estimated maximum potential gain from intervention in adults with joint pain. METHODS A population-based cohort aged ≥50 years was recruited from eight general practices in North Staffordshire, UK. Participants (n = 1878) had joint pain at baseline lasting ≥3 months and indicated no pain interference. Adjusted associations of self-reported, potentially modifiable prognostic factors (body mass index, anxiety/depressive symptoms, widespread pain, inadequate joint pain control, physical inactivity, sleep problems, smoking and alcohol intake) with onset of pain interference 3 years later were estimated via Poisson regression, and corresponding PAR estimates were obtained. RESULTS Inadequate joint-specific pain control, insomnia and infrequent walking were found to be independently significantly associated with the onset of pain interference after 3 years, with associated PARs of 6.3% (95% confidence interval -0.3, 12.4), 7.6% (-0.4, 15.0) and 8.0% (0.1, 15.2), respectively, with only the PAR for infrequent walking deemed statistically significant. The PAR associated with insomnia, infrequent walking and inadequate control of joint pain simultaneously was 20.3% (8.6, 30.4). CONCLUSIONS There is potential to reduce moderately the onset of pain interference from joint pain in the over-50s if clinical and public health interventions targeted pain management and insomnia, and promoted an active lifestyle. However, most of the onset of significant pain interference in the over-50s, would not be prevented, even assuming that these factors could be eliminated.
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Affiliation(s)
- Milica Blagojevic-Bucknall
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| | - Jerome Wulff
- Intensive Care National Audit and Research Centre, London, UK
| | - Mark Porcheret
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - George M Peat
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
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Lin KY, Yang CC, Hsu CJ, Yeh ML, Renn JH. Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial. Arthroscopy 2019; 35:106-117. [PMID: 30611335 DOI: 10.1016/j.arthro.2018.06.035] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively compare the efficacy of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) with a sham control group (normal saline solution [NS]) for knee osteoarthritis in a randomized, dose-controlled, placebo-controlled, double-blind, triple-parallel clinical trial. METHODS A total of 87 osteoarthritic knees (53 patients) were randomly assigned to 1 of 3 groups receiving 3 weekly injections of either leukocyte-poor PRP (31 knees), HA (29 knees), or NS (27 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and International Knee Documentation Committee (IKDC) subjective score were collected at baseline and at 1, 2, 6, and 12 months after treatment. Data were analyzed using generalized estimating equations. RESULTS All 3 groups showed statistically significant improvements in both outcome measures at 1 month; however, only the PRP group sustained the significant improvement in both the WOMAC score (63.71 ± 20.67, increased by 21%) and IKDC score (49.93 ± 17.74, increased by 40%) at 12 months. For the intergroup comparison, except for the first month, there was a statistically significant difference between the PRP and NS groups in both scores throughout the study duration (regression coefficients of 8.72 [P = .0015], 7.94 [P = .0155], and 11.92 [P = .0014] at 2, 6, and 12 months, respectively, for WOMAC score, and 9.1 [P = .0001], 10.28 [P = .0002], and 13.97 [P < .0001], respectively, for IKDC score). There was no significant difference in both functional outcomes between the HA and NS groups at any time point. Only the PRP group reached the minimal clinically important difference in the WOMAC score at every evaluation (15%, 21%, 18%, and 21% at 1, 2, 6, and 12 months, respectively) and the minimal clinically important difference in the IKDC score at 6 months (improvement of 11.6). CONCLUSIONS Intra-articular injections of leukocyte-poor PRP can provide clinically significant functional improvement for at least 1 year in patients with mild to moderate osteoarthritis of the knee. LEVEL OF EVIDENCE Level I, randomized controlled single-center trial.
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Affiliation(s)
- Kuan-Yu Lin
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, Meiho University, Neipu, Taiwan; Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Chia-Chi Yang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Ming-Long Yeh
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
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24
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Hendry GJ, Fenocchi L, Woodburn J, Steultjens M. Foot pain and foot health in an educated population of adults: results from the Glasgow Caledonian University Alumni Foot Health Survey. J Foot Ankle Res 2018; 11:48. [PMID: 30140313 PMCID: PMC6098653 DOI: 10.1186/s13047-018-0290-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
Background Foot pain is common amongst the general population and impacts negatively on physical function and quality of life. Associations between personal health characteristics, lifestyle/behaviour factors and foot pain have been studied; however, the role of wider determinants of health on foot pain have received relatively little attention. Objectives of this study are i) to describe foot pain and foot health characteristics in an educated population of adults; ii) to explore associations between moderate-to-severe foot pain and a variety of factors including gender, age, medical conditions/co-morbidity/multi-morbidity, key indicators of general health, foot pathologies, and social determinants of health; and iii) to evaluate associations between moderate-to-severe foot pain and foot function, foot health and health-related quality-of-life. Methods Between February and March 2018, Glasgow Caledonian University Alumni with a working email address were invited to participate in the cross-sectional electronic survey (anonymously) by email via the Glasgow Caledonian University Alumni Office. The survey was constructed using the REDCap secure web online survey application and sought information on presence/absence of moderate-to-severe foot pain, patient characteristics (age, body mass index, socioeconomic status, occupation class, comorbidities, and foot pathologies). Prevalence data were expressed as absolute frequencies and percentages. Multivariate logistic and linear regressions were undertaken to identify associations 1) between independent variables and moderate-to-severe foot pain, and 2) between moderate-to-severe foot pain and foot function, foot health and health-related quality of life. Results Of 50,228 invitations distributed, there were 7707 unique views and 593 valid completions (median age [inter-quartile range] 42 [31–52], 67.3% female) of the survey (7.7% response rate). The sample was comprised predominantly of white Scottish/British (89.4%) working age adults (95%), the majority of whom were overweight or obese (57.9%), and in either full-time or part-time employment (82.5%) as professionals (72.5%). Over two-thirds (68.5%) of the sample were classified in the highest 6 deciles (most affluent) of social deprivation. Moderate-to-severe foot pain affected 236/593 respondents (39.8%). High body mass index, presence of bunions, back pain, rheumatoid arthritis, hip pain and lower occupation class were included in the final multivariate model and all were significantly and independently associated with moderate-to-severe foot pain (p < 0.05), except for rheumatoid arthritis (p = 0.057). Moderate-to-severe foot pain was significantly and independently associated lower foot function, foot health and health-related quality of life scores following adjustment for age, gender and body mass index (p < 0.05). Conclusions Moderate-to-severe foot pain was highly prevalent in a university-educated population and was independently associated with female gender, high body mass index, bunions, back pain, hip pain and lower occupational class. Presence of moderate-to-severe foot pain was associated with worse scores for foot function, foot health and health-related quality-of-life. Education attainment does not appear to be protective against moderate-to-severe foot pain.
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Affiliation(s)
- Gordon J Hendry
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland, UK
| | - Linda Fenocchi
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland, UK
| | - Jim Woodburn
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland, UK
| | - Martijn Steultjens
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA Scotland, UK
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25
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Healey EL, Afolabi EK, Lewis M, Edwards JJ, Jordan KP, Finney A, Jinks C, Hay EM, Dziedzic KS. Uptake of the NICE osteoarthritis guidelines in primary care: a survey of older adults with joint pain. BMC Musculoskelet Disord 2018; 19:295. [PMID: 30115048 PMCID: PMC6097435 DOI: 10.1186/s12891-018-2196-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake. Methods A cross-sectional survey mailed to adults aged ≥45 years (n = 28,443) from eight general practices in the UK as part of the MOSAICS study. Respondents who reported the presence of joint pain, a consultation in the previous 12 months for joint pain, and gave consent to medical record review formed the sample for this study. Results Four thousand fifty-nine respondents were included in the analysis (mean age 65.6 years (SD 11.2), 2300 (56.7%) females). 502 (12.4%) received an OA diagnosis in the previous 12 months. More participants reported using pharmacological treatments (e.g. paracetamol (31.3%), opioids (40.4%)) than non-pharmacological treatments (e.g. exercise (3.8%)). Those with an OA diagnosis were more likely to use written information (OR 1.57; 95% CI 1.26,1.96), paracetamol (OR 1.30; 95% CI 1.05,1.62) and topical NSAIDs (OR 1.30; 95% CI 1.04,1.62) than those with a joint pain code. People aged ≥75 years were less likely to use written information (OR 0.56; 95% CI 0.40,0.79) and exercise (OR 0.37; 95% CI 0.25,0.55) and more likely to use paracetamol (OR 1.91; 95% CI 1.38,2.65) than those aged < 75 years. Conclusion The cross-sectional population survey was conducted to examine the uptake of the treatments that are recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and to determine whether patient characteristics or OA diagnosis impact uptake. Non-pharmacological treatment was suboptimal compared to pharmacological treatment. Implementation of NICE guidelines needs to examine why non-pharmacological treatments, such as exercise, remain under-used especially among older people.
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Affiliation(s)
- Emma Louise Healey
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Ebenezer K Afolabi
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Martyn Lewis
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - John J Edwards
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Andrew Finney
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Staffordshire, UK
| | - Clare Jinks
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Elaine M Hay
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Krysia S Dziedzic
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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26
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Gur G, Turgut E, Dilek B, Baltaci G, Bek N, Yakut Y. Validity and Reliability of Visual Analog Scale Foot and Ankle: The Turkish Version. J Foot Ankle Surg 2018; 56:1213-1217. [PMID: 28864388 DOI: 10.1053/j.jfas.2017.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 02/03/2023]
Abstract
The present study tested the reliability and validity of the Turkish version of the visual analog scale foot and ankle (VAS-FA) among healthy subjects and patients with foot problems. A total of 128 participants, 65 healthy subjects and 63 patients with foot problems, were evaluated. The VAS-FA was translated into Turkish and administered to the 128 subjects on 2 separate occasions with a 5-day interval. The test-retest reliability and internal consistency were assessed with the intraclass correlation coefficient and Cronbach's α. The validity was assessed using the correlations with Turkish versions of the Foot Function Index, the Foot and Ankle Outcome Score, and the Short-Form 36-item Health Survey. A statistically significant difference was found between the healthy group and the patient group in the overall score and subscale scores of the VAS-FA (p < .001). The internal consistency of the VAS-FA was very good, and the test-retest reliability was excellent. Adequate to good correlations were found between the overall VAS-FA score and the Foot Function Index, Foot and Ankle Outcome Score, and Short-Form 36-item Health Survey scores in the healthy and patient groups both. The Turkish version of the VAS-FA is sensitive enough to distinguish foot and ankle-specific pathologic conditions from asymptomatic conditions. The Turkish version of the VAS-FA is a reliable and valid method and can be used for foot-related problems.
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Affiliation(s)
- Gozde Gur
- Research Assistant, School of Physical Therapy and Rehabilitation Sciences, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Elif Turgut
- Research Assistant, School of Physical Therapy and Rehabilitation Sciences, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Burcu Dilek
- Assistant Professor, Department of Physical Therapy And Rehabilitation, Medipol University, Istanbul, Turkey
| | | | - Nilgun Bek
- Professor, School of Physical Therapy and Rehabilitation Sciences, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Yavuz Yakut
- Professor, Physiotherapy and Rehabilitation Department, Hasan Kalyoncu University, Gaziantep, Turkey
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27
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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The role of pain in chronic pain patients’ perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients. Scand J Pain 2018; 18:417-429. [DOI: 10.1515/sjpain-2018-0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/24/2018] [Indexed: 01/03/2023]
Abstract
Abstract
Background and aims
Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics.
Methods
Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects.
Results
There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables.
Conclusions
Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.
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Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Ther Adv Musculoskelet Dis 2018; 10:91-103. [PMID: 29619094 DOI: 10.1177/1759720x17753337] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023] Open
Abstract
Foot osteoarthritis (OA) is a common problem in older adults yet is under-researched compared to knee or hand OA. Most existing studies focus on the first metatarsophalangeal joint, with evidence relating to midfoot OA being particularly sparse. Symptomatic radiographic foot OA affects 17% of adults aged 50 years and over. The first metatarsophalangeal joint is most commonly affected, followed by the second cuneometatarsal and talonavicular joints. Epidemiological studies suggest the existence of distinct first metatarsophalangeal joint and polyarticular phenotypes, which have differing clinical and risk factor profiles. There are few randomized controlled trials in foot OA. Existing trials provide some evidence of the effectiveness for pain relief of physical therapy, rocker-sole shoes, foot orthoses and surgical interventions in first metatarsophalangeal joint OA and prefabricated orthoses in midfoot OA. Prospective epidemiological studies and randomized trials are needed to establish the incidence, progression and prognosis of foot OA and determine the effectiveness of both commonly used and more novel interventions.
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Affiliation(s)
- Edward Roddy
- Reader in Rheumatology, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK; and Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, UK
| | - Hylton B Menz
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; and School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Bossmann T, Brauner T, Horstmann T. Differences in pain intensity in anti- and pro-nociceptive pain profile subgroups in patients with knee osteoarthritis. Pain Manag 2018; 8:27-36. [DOI: 10.2217/pmt-2017-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim: Facilitated temporal summation is one component of central sensitization. The aim of this exploratory study was to classify pro-, eu- and antinociceptive subgroups based on wind-up ratio cut-off scores in patients with knee osteoarthritis (OA). Patients & methods: A total of 56 patients with knee OA met the inclusion criteria. Temporal summation was measured and wind-up ratio was calculated. Reference values of 180 healthy subjects were used to define wind-up ratio cut-off scores. Results: Twenty-seven percent of patients showed a pro-nociceptive pain profile. Sixteen percent of patients showed an anti-nociceptive pain profile. A eu-nociceptive pain profile was present in 57% of patients. Conclusion: Central pain sensitization was present in approximately a third of knee OA patients. The results should be confirmed in larger studies.
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Affiliation(s)
- Tanja Bossmann
- Department of Conservative & Rehabilitative Orthopaedics, Faculty of Sports & Health Sciences, Technical University of Munich, Germany
| | - Torsten Brauner
- Department of Conservative & Rehabilitative Orthopaedics, Faculty of Sports & Health Sciences, Technical University of Munich, Germany
| | - Thomas Horstmann
- Department of Conservative & Rehabilitative Orthopaedics, Faculty of Sports & Health Sciences, Technical University of Munich, Germany
- Medical Park Bad Wiessee, Klinik St. Hubertus, Bad Wiessee, Germany
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31
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Finney A, Dziedzic KS, Lewis M, Healey E. Multisite peripheral joint pain: a cross-sectional study of prevalence and impact on general health, quality of life, pain intensity and consultation behaviour. BMC Musculoskelet Disord 2017; 18:535. [PMID: 29246141 PMCID: PMC5732469 DOI: 10.1186/s12891-017-1896-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Research into musculoskeletal conditions often focusses on pain at single sites, such as the knee, yet several studies have previously reported the high prevalence of multiple sites of musculoskeletal pain. The most common form of musculoskeletal condition is arthritis, with osteoarthritis (OA) the most common cause of joint pain in adults 45 years and over. However, there is limited recognition of the prevalence of multisite peripheral joint pain in those either living with or at risk of OA, therefore this study set out to estimate the prevalence of multisite peripheral joint pain in adults 45 years and older, and its impact on several dimensions of health. Methods A cross-sectional population survey was mailed to adults (n = 28,443) aged 45 years and over from eight general practices in the North West Midlands, United Kingdom (UK). Prevalence rates were established for multisite peripheral joint pain (pain in two or more sites; hands, hips, knees, feet). Impact was measured for general health (SF-12 MCS & PCS), QoL (EQ-5D), pain intensity (0-10 numerical ratings scale) and the number of consultations with a range of health care professionals. Results Of 15,083 responders (53%), multisite peripheral joint pain was reported by 54%. Peripheral joint pain was present in n = 11,928, of which 68% reported pain in multiple sites. Multisite peripheral joint pain was shown to be significantly associated with reduced physical (Mean difference = −5.9 95% CI -6.3,-5.5) and mental (−2.8 95% CI -3.2,-2.4) components of the SF-12, reduced QoL (−0.14 95% CI -0.15, −0.13), increased pain (+0.70 95% CI 0.62, 0.79) and increased odds of consultations with GPs (OR 2.4 95% CI 2.2, 2.6) and practice nurses (OR 2.6 (95% CI 2.1, 3.2) when compared to single site pain. Conclusions Multisite peripheral joint pain is prevalent in the population in adults 45 years and over and has a significant negative impact on several dimensions of health. Health care professionals should consider joint pain beyond the index site in order to address holistic management.
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Affiliation(s)
- Andrew Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK. .,Keele University, School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Staffordshire, ST4 6QG, UK.
| | - Krysia S Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
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32
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Affiliation(s)
- F. Guidozzi
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg, South Africa
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Paterson KL, Kasza J, Hunter DJ, Hinman RS, Menz HB, Peat G, Bennell KL. Longitudinal association between foot and ankle symptoms and worsening of symptomatic radiographic knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2017; 25:1407-1413. [PMID: 28506843 PMCID: PMC5565691 DOI: 10.1016/j.joca.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether foot and/or ankle symptoms are associated with an increased risk of worsening of knee pain and radiographic change in people with knee osteoarthritis (OA). METHODS The presence and laterality of foot/ankle symptoms were recorded at baseline in 1368 participants from the Osteoarthritis Initiative (OAI) with symptomatic radiographic knee OA. Knee pain severity (measured using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale) and minimum medial tibiofemoral joint space (minJSW) width measured on X-ray were assessed yearly over the subsequent 4 years. Associations between foot/ankle symptoms and worsening of (1) knee pain, and (2) both knee pain and minJSW (i.e., symptomatic radiographic knee OA) were assessed using logistic regression. RESULTS Foot/ankle symptoms in either foot/ankle significantly increased the odds of knee pain worsening (adjusted OR 1.54, 95% CI 1.25 to 1.91). Laterality analysis showed ipsilateral (adjusted OR 1.50, 95% CI 1.07 to 2.10), contralateral (adjusted OR 1.44, 95% CI 1.02 to 2.06) and bilateral foot/ankle symptoms (adjusted OR 1.61, 95% CI 1.22 to 2.13) were all associated with knee pain worsening in the follow up period. There was no association between foot/ankle symptoms and worsening of symptomatic radiographic knee OA. CONCLUSION The presence of foot/ankle symptoms in people with symptomatic radiographic knee OA was associated with increased risk of knee pain worsening, but not worsening of symptomatic radiographic knee OA, over the subsequent 4 years. Future studies should investigate whether treatment of foot/ankle symptoms reduces the risk of knee pain worsening in people with knee OA.
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Affiliation(s)
- Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital Australia, Sydney, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Hylton B Menz
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
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Dragioti E, Larsson B, Bernfort L, Levin LÅ, Gerdle B. A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+ cohort. J Pain Res 2017; 10:2009-2019. [PMID: 28883740 PMCID: PMC5574683 DOI: 10.2147/jpr.s143060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. OBJECTIVE This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldest-old ages using a new method (APSs) to assess the location of pain on the body. MATERIALS AND METHODS The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. RESULTS Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. CONCLUSION Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.
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Affiliation(s)
- Elena Dragioti
- Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Centre
| | - Britt Larsson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Centre
| | - Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Centre
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Paterson KL, Kasza J, Hunter DJ, Hinman RS, Menz HB, Peat G, Bennell KL. The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2017; 25:639-646. [PMID: 27939621 PMCID: PMC5403611 DOI: 10.1016/j.joca.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether foot and/or ankle symptoms increase the risk of developing (1) knee symptoms and (2) symptomatic radiographic knee osteoarthritis (OA). DESIGN 1020 Osteoarthritis Initiative (OAI) participants who were at-risk of knee OA, but were without knee symptoms or radiographic knee OA, were investigated. Participants indicated the presence and laterality of foot/ankle symptoms at baseline. The main outcome was development of knee symptoms (pain, aching or stiffness in and around the knee on most days of the month for at least 1 month in the past year). A secondary outcome was development of symptomatic radiographic knee OA (symptoms plus Kellgren and Lawrence [KL] grade ≥2), over the subsequent 4 years. Associations between foot/ankle symptoms and study outcomes were assessed by logistic regression models. RESULTS Foot/ankle symptoms in either or both feet significantly increased the odds of developing knee symptoms (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.10 to 2.19), and developing symptomatic radiographic knee OA (adjusted OR 3.28, 95% CI 1.69 to 6.37). Based on laterality, contralateral foot/ankle symptoms were associated with developing both knee symptoms (adjusted OR 1.68, 95% CI 1.05 to 2.68) and symptomatic radiographic knee OA (adjusted OR 3.08, 95% CI 1.06 to 8.98), whilst bilateral foot/ankle symptoms were associated with developing symptomatic radiographic knee OA (adjusted OR 4.02, 95% CI 1.76 to 9.17). CONCLUSION In individuals at-risk of knee OA, the presence of contralateral foot/ankle symptoms in particular increases risk of developing both knee symptoms and symptomatic radiographic knee OA.
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Affiliation(s)
- K L Paterson
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia; Rheumatology Department, Royal North Shore Hospital Australia, Sydney, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
| | - H B Menz
- School of Allied Health, La Trobe University, Melbourne, Australia.
| | - G Peat
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
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36
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Hubert J, Hawellek T, Hischke S, Bertrand J, Krause M, Püschel K, Rüther W, Niemeier A. Hyaline cartilage calcification of the first metatarsophalangeal joint is associated with osteoarthritis but independent of age and BMI. BMC Musculoskelet Disord 2016; 17:474. [PMID: 27842586 PMCID: PMC5109667 DOI: 10.1186/s12891-016-1324-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 11/01/2016] [Indexed: 01/09/2023] Open
Abstract
Background Hyaline cartilage calcification (CC) is associated with osteoarthritis (OA) in hip and knee joints. The first metatarsophalangeal joint (1stMTPJ) is frequently affected by OA, but it is unclear if CC occurs in the 1stMTPJ. The aim of the present study was to analyze the prevalence of CC of the 1stMTPJ in the general population by high-resolution digital contact radiography (DCR) and to determine its association with histological OA severity, age and body mass index (BMI). Methods 168 metatarsal heads of 84 donors (n = 47 male, n = 37 female; mean age 62.73 years, SD ±18.8, range 20–93) were analyzed by DCR for the presence of CC. Histological OA grade (hOA) by OARSI was analyzed in the central load-bearing zone of the first metatarsal head (1st MH). Structural equation modeling (SEM) was performed to analyze the interrelationship between CC, hOA, age and BMI. Results The prevalence of CC of 1stMH was 48.8 % (41/84) (95 %-CI [37.7 %, 60.0 %]), independent of the affected side (p = 0.42), gender (p = 0.41) and BMI (p = 0.51). The mean amount of CC of one MH correlated significantly with that of the contralateral side (rs = 0.4, 95 %-CI [0.26, 0.52], p < 0.001). The mean amount of CC (in % of total cartilage area) of the MH correlated significantly with the severity of hOA (rs = 0.51, 95 %-CI [0.32, 0.65], p < 0.001). SEM revealed significant associations between CC and hOA (r = 0.74, p < 0.001) and between hOA and age (β = 0.62, p = 0.001), but not between CC and age (p = 0.15). There was no significant influence of BMI on either CC (p = 0.37) or hOA (p = 0.16). Conclusion The observation that CC of the 1stMH is significantly associated with the severity of OA but independent of age and BMI, suggests an intimate relationship between CC and the pathogenesis of OA, the exact nature of which will have to be explored by future studies. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1324-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Hubert
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Thelonius Hawellek
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Sandra Hischke
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Jessica Bertrand
- Institute of Experimental Musculoskeletal Medicine, University Hospital Münster, Domagkstrasse 3, Münster, 48149, Germany.,Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Matthias Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, Hamburg, 22529, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Wolfgang Rüther
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Andreas Niemeier
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
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Laslett LL, Otahal P, Hensor EMA, Kingsbury SR, Conaghan PG. Knee Pain Predicts Subsequent Shoulder Pain and the Association Is Mediated by Leg Weakness: Longitudinal Observational Data from the Osteoarthritis Initiative. J Rheumatol 2016; 43:2049-2055. [PMID: 27803343 DOI: 10.3899/jrheum.160001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess whether the "spread" of joint pain is related to pain-associated muscle loss in 1 joint leading to increased loading and subsequent pain in other joints. METHODS Associations between persistent knee pain (pain in 1 or 2 knees over 0-3 years vs no persistent pain) and incident shoulder pain at Year 4 were examined in participants from the longitudinal National Institutes of Health Osteoarthritis Initiative. Associations were assessed using log multinomial modeling, adjusted for age, sex, body mass index, depression score, other lower limb pain, and baseline leg weakness (difficulty standing from a sitting position). RESULTS In older adults with clinically significant knee osteoarthritis (OA) or at risk of knee OA (n = 3486), the number of painful joints increased yearly, from 2.1 joints (95% CI 2.0-2.2) at baseline increasing by 5.2% (95% CI 2.2-8.3) at Year 4. Shoulders were the next most commonly affected joints after knees (28.5%). Persistent pain in 1 or 2 knees increased risk of bilateral shoulder pain at Year 4 [1 knee: relative risk (RR) 1.59, 95% CI 0.97-2.61; 2 knees: RR 2.02, 95% CI 1.17-3.49] after adjustment for confounders. Further adjustment for leg weakness attenuated effect sizes (1 knee: RR 1.13, 95% CI 0.60-2.11; 2 knees: RR 1.44, 95% CI 0.75-2.77), indicating mediation by functional leg weakness. CONCLUSION Spread of joint pain is not random. Persistently painful knees predict new bilateral shoulder pain, which is likely mediated by leg weakness, suggesting that biomechanical factors influence the spread of pain.
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Affiliation(s)
- Laura L Laslett
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK.,L.L. Laslett was funded by an Osteoarthritis Research International Young Investigator Scholarship while at the University of Leeds. She is also supported by an Arthritis Australia - Australian Rheumatology Association Heald Fellowship and a National Health and Medical Research Council Early Career Fellowship (Clinical Research Fellowship; GNT1070586). This study was supported by an Arthritis Research UK project grant (ref 20800), the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (ref 20083), and the NIHR Leeds Musculoskeletal Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. The Osteoarthritis Initiative (OAI) is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the US National Institutes of Health, a branch of the US Department of Health and Human Services and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corp., GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset, and does not necessarily reflect the opinions or views of the OAI investigators, the National Institutes of Health, or the private funding partners.,L.L. Laslett, GDPH, PhD, Postdoctoral Research Fellow, Menzies Institute for Medical Research, University of Tasmania, and Visiting Scholar, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P. Otahal, BSc, GDipSc, Statistician, Menzies Institute for Medical Research, University of Tasmania; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; S.R. Kingsbury, PhD, Postdoctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P.G. Conaghan, FRACP, FRCP, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds
| | - Petr Otahal
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK.,L.L. Laslett was funded by an Osteoarthritis Research International Young Investigator Scholarship while at the University of Leeds. She is also supported by an Arthritis Australia - Australian Rheumatology Association Heald Fellowship and a National Health and Medical Research Council Early Career Fellowship (Clinical Research Fellowship; GNT1070586). This study was supported by an Arthritis Research UK project grant (ref 20800), the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (ref 20083), and the NIHR Leeds Musculoskeletal Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. The Osteoarthritis Initiative (OAI) is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the US National Institutes of Health, a branch of the US Department of Health and Human Services and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corp., GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset, and does not necessarily reflect the opinions or views of the OAI investigators, the National Institutes of Health, or the private funding partners.,L.L. Laslett, GDPH, PhD, Postdoctoral Research Fellow, Menzies Institute for Medical Research, University of Tasmania, and Visiting Scholar, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P. Otahal, BSc, GDipSc, Statistician, Menzies Institute for Medical Research, University of Tasmania; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; S.R. Kingsbury, PhD, Postdoctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P.G. Conaghan, FRACP, FRCP, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds
| | - Elizabeth M A Hensor
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK.,L.L. Laslett was funded by an Osteoarthritis Research International Young Investigator Scholarship while at the University of Leeds. She is also supported by an Arthritis Australia - Australian Rheumatology Association Heald Fellowship and a National Health and Medical Research Council Early Career Fellowship (Clinical Research Fellowship; GNT1070586). This study was supported by an Arthritis Research UK project grant (ref 20800), the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (ref 20083), and the NIHR Leeds Musculoskeletal Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. The Osteoarthritis Initiative (OAI) is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the US National Institutes of Health, a branch of the US Department of Health and Human Services and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corp., GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset, and does not necessarily reflect the opinions or views of the OAI investigators, the National Institutes of Health, or the private funding partners.,L.L. Laslett, GDPH, PhD, Postdoctoral Research Fellow, Menzies Institute for Medical Research, University of Tasmania, and Visiting Scholar, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P. Otahal, BSc, GDipSc, Statistician, Menzies Institute for Medical Research, University of Tasmania; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; S.R. Kingsbury, PhD, Postdoctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P.G. Conaghan, FRACP, FRCP, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds
| | - Sarah R Kingsbury
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK.,L.L. Laslett was funded by an Osteoarthritis Research International Young Investigator Scholarship while at the University of Leeds. She is also supported by an Arthritis Australia - Australian Rheumatology Association Heald Fellowship and a National Health and Medical Research Council Early Career Fellowship (Clinical Research Fellowship; GNT1070586). This study was supported by an Arthritis Research UK project grant (ref 20800), the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (ref 20083), and the NIHR Leeds Musculoskeletal Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. The Osteoarthritis Initiative (OAI) is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the US National Institutes of Health, a branch of the US Department of Health and Human Services and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corp., GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset, and does not necessarily reflect the opinions or views of the OAI investigators, the National Institutes of Health, or the private funding partners.,L.L. Laslett, GDPH, PhD, Postdoctoral Research Fellow, Menzies Institute for Medical Research, University of Tasmania, and Visiting Scholar, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P. Otahal, BSc, GDipSc, Statistician, Menzies Institute for Medical Research, University of Tasmania; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; S.R. Kingsbury, PhD, Postdoctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P.G. Conaghan, FRACP, FRCP, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds
| | - Philip G Conaghan
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK. .,L.L. Laslett was funded by an Osteoarthritis Research International Young Investigator Scholarship while at the University of Leeds. She is also supported by an Arthritis Australia - Australian Rheumatology Association Heald Fellowship and a National Health and Medical Research Council Early Career Fellowship (Clinical Research Fellowship; GNT1070586). This study was supported by an Arthritis Research UK project grant (ref 20800), the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (ref 20083), and the NIHR Leeds Musculoskeletal Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. The Osteoarthritis Initiative (OAI) is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the US National Institutes of Health, a branch of the US Department of Health and Human Services and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corp., GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset, and does not necessarily reflect the opinions or views of the OAI investigators, the National Institutes of Health, or the private funding partners. .,L.L. Laslett, GDPH, PhD, Postdoctoral Research Fellow, Menzies Institute for Medical Research, University of Tasmania, and Visiting Scholar, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P. Otahal, BSc, GDipSc, Statistician, Menzies Institute for Medical Research, University of Tasmania; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; S.R. Kingsbury, PhD, Postdoctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds; P.G. Conaghan, FRACP, FRCP, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds.
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Ajidahun AT, Mudzi W, Myezwa H, Wood WA. Upper extremity disability among string instrumentalists–use of the quick DASH and the NDI. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1234535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Adedayo Tunde Ajidahun
- Faculty of Health Sciences, Department of Physiotherapy, University of the Witwatersrand, 7 York road, Parktown, 2193, Johannesburg, South Africa
| | - Witness Mudzi
- Faculty of Health Sciences, Department of Physiotherapy, University of the Witwatersrand, 7 York road, Parktown, 2193, Johannesburg, South Africa
| | - Hellen Myezwa
- Faculty of Health Sciences, Department of Physiotherapy, University of the Witwatersrand, 7 York road, Parktown, 2193, Johannesburg, South Africa
| | - Wendy-Ann Wood
- Faculty of Health Sciences, Department of Physiotherapy, University of the Witwatersrand, 7 York road, Parktown, 2193, Johannesburg, South Africa
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Chapman GJ, Halstead J, Redmond AC. Comparability of off the shelf foot orthoses in the redistribution of forces in midfoot osteoarthritis patients. Gait Posture 2016; 49:235-240. [PMID: 27459418 PMCID: PMC5038933 DOI: 10.1016/j.gaitpost.2016.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Midfoot osteoarthritis (OA) is more prevalent and strongly associated with pain than previously thought. Excessive mechanical loading of the midfoot structures may contribute to midfoot OA and studies suggest that functional foot orthoses (FFO) may relieve pain through improving function. This exploratory study aimed to evaluate the mechanical effect of two off-the-shelf FFOs, compared to a sham orthosis in people with midfoot OA. METHODS Thirty-three participants with radiographically confirmed symptomatic midfoot OA were randomly assigned to wear either a commercially available FFO or a sham orthosis. After wearing their assigned orthoses for 12 weeks, plantar pressure measurements were obtained under shoe-only and assigned orthoses conditions. Participants assigned to the sham, were additionally tested wearing a second type of FFO at the end of trial. Descriptive mean change (±95% confidence intervals) in plantar pressure for each orthoses condition, versus a shoe only baseline condition are presented. FINDINGS Compared to the shoe only conditions, both FFOs decreased hindfoot and forefoot maximum force and peak pressure, whilst increasing maximum force and contact area under the midfoot. The sham orthosis yielded plantar pressures similar to the shoe-only condition. INTERPRETATION Findings suggest that both types of off-the-shelf FFO may provide mechanical benefit, whilst the sham orthoses produced similar findings to the shoe only condition, indicating appropriate sham properties. This paper provides insight into the mechanisms of action underpinning the use of FFOs and sham orthoses, which can inform future definitive RCTs examining the effect of orthoses on midfoot OA.
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Affiliation(s)
- Graham J. Chapman
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK,Corresponding author at: Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Road, Leeds, LS7 4SA, UK.
| | - Jill Halstead
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK
| | - Anthony C. Redmond
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK,Arthritis Research UK, Sports, Exercise and Osteoarthritis Centre, UK
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Abstract
OBJECTIVES This study aimed to evaluate functional biomechanics in patients who undergo total knee arthroplasty (TKA). METHODS Lower limb joint kinematics and kinetics were evaluated in 25 TKA patients at 3 months following TKA and 25 age-matched controls after 12 months following TKA. Participants were evaluated in a gait laboratory, with self-selected gait speed. RESULTS Experimental group walked significantly slower (p < 0.01), using a shorter stride length (p < 0.01), compared to those for the controls. The experimental group exhibited significantly greater knee motion, lower knee extension moment (p < 0.01), and lower peak power generation (p < 0.01) compared to those for the control group. Additionally, the TKA group showed significantly smaller peak ankle motion (p < 0.01), lower ankle dorsiflexion moments (p < 0.05), and ankle power generation (p < 0.01) compared to those for the control group. DISCUSSION These biomechanical properties of gait in the experimental group may be a compensatory response to lesser recovered knee function to allow sufficient power generation for propulsion. Therefore, rehabilitative strategies at 3 months following TKA are needed to improve not only knee function but also hip and ankle function after TKA.
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Gill TK, Menz HB, Landorf KB, Arnold JB, Taylor AW, Hill CL. Predictors of foot pain in the community: the North West Adelaide health study. J Foot Ankle Res 2016; 9:23. [PMID: 27418949 PMCID: PMC4944307 DOI: 10.1186/s13047-016-0150-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/30/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Foot pain has been shown to be prevalent across all age groups. The presence of foot pain may reduce mobility and impact on the ability to undertake activities of daily living. The aim of this study was to determine factors that are predictive of foot pain in a community based sample of the general population. METHODS This study analysed data from the North West Adelaide Health Study, a cohort study located in the northwestern suburbs of Adelaide, South Australia. Data were obtained between 2004-2006 and 2008-2010, using a self-completed questionnaire, computer assisted telephone interviewing, and a clinical assessment. The sensitivity, specificity and positive predictive values of variables were determined and generalised linear models ascertained the variables associated with the highest relative risk of self-reporting foot pain in 2008-2010 based on the data obtained in 2004-2006. RESULTS The prevalence of foot pain in 2004-2006 was 14.9 % (95 % CI 13.6-16.4) and in 2008-2010, 29.9 % (95 % CI 27.5-32.5). Variables with the highest sensitivity were: female sex, ever having back pain, self-reported arthritis, body mass index (BMI) classified as obese and having foot pain in 2004-2006, while most variables demonstrated high specificity. Those with the highest risk of reporting foot pain in 2008-2010 were those with depressive symptoms, self-reported arthritis, high BMI, self-reported upper limb pain and foot pain (in general or in specific regions of the foot) in 2004-2006. CONCLUSION Foot pain is common in the general population and those with the greatest risk of foot pain potentially represent a high level of chronicity and potential burden on the health system. Addressing the factors that predict foot pain, as well as the provision of targeted messages to highlight the importance of managing foot pain, may help reduce the impact on the population.
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Affiliation(s)
- Tiffany K. Gill
- />School of Medicine, Faculty of Health Sciences, The University of Adelaide, Level 7, SAHMRI, North Tce, Adelaide, SA 5000 Australia
| | - Hylton B. Menz
- />School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3083 Australia
| | - Karl B. Landorf
- />School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3083 Australia
- />Melbourne Health, Allied Health Department, 300 Grattan Street, Parkville, VIC 3050 Australia
| | - John B. Arnold
- />Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5000 Australia
| | - Anne W. Taylor
- />Population Research and Outcome Studies, Discipline of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Catherine L. Hill
- />Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Rd, Woodville, SA 5011 Australia
- />School of Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
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Raja R, Dube B, Hensor EMA, Hogg SF, Conaghan PG, Kingsbury SR. The clinical characteristics of older people with chronic multiple-site joint pains and their utilisation of therapeutic interventions: data from a prospective cohort study. BMC Musculoskelet Disord 2016; 17:194. [PMID: 27139716 PMCID: PMC4853864 DOI: 10.1186/s12891-016-1049-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic multiple-site joint pain (MSJP) is common in older people and associated with poor outcomes, yet under-researched. Our aim was to detail the clinical characteristics of people with MSJP and their utilisation of therapies. Methods MSJP was defined as pain in at least one large joint and one other joint for >6 weeks in the last three months. A mixed community, primary and secondary care cohort of people >50 years old underwent detailed history and examination by a single clinician. Treatment utilisation was recorded comprehensively. Results 201 adults were recruited, 82 % women, mean age 63, BMI 31 kg/m2. Median number of painful joints per patient was 6 (IQR 4–9; range 2–17); most common painful sites were knee (84 %), lower back (62 %) and shoulder (47 %). 194/201 (96 %) had an osteoarthritis (OA) diagnosis, 155/194 (80 %) also had soft tissue pathology and 72 % had back problems. 85 % had OA at multiple sites. Upper and lower limb weakness was common (90 and 77 % respectively). Lower limb weakness was significantly associated with obesity. Only 26 % had received written information about their joints. Though 79 % had attended physiotherapy, the majority (93 %) had muscle weakness. Only 36 % of overweight participants had accessed weight-loss support. Half of those with foot pain had seen a podiatrist or used appliances. Multiple concurrent pharmacological therapies were used by 47 %. Conclusion MSJP represents a combination of OA, back pain and soft tissue disorders; muscle weakness is extremely common. Therapies appear underutilised in people with MJSP. Identifying the reasons for this should guide effective intervention research. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1049-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rafi Raja
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK
| | - Bright Dube
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK
| | - Sarah F Hogg
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK.
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK
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Kim C, Nevitt MC, Niu J, Clancy MM, Lane NE, Link TM, Vlad S, Tolstykh I, Jungmann PM, Felson DT, Guermazi A. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ 2015; 351:h5983. [PMID: 26631296 PMCID: PMC4667842 DOI: 10.1136/bmj.h5983] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY QUESTION Is there concordance between hip pain and radiographic hip osteoarthritis? METHODS In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most days and the location of the pain: anterior, groin, lateral, buttocks, or low back. In the Framingham study, participants with hip pain were also examined for hip pain with internal rotation. The authors analysed the agreement between radiographic hip osteoarthritis and hip pain, and for those with hip pain suggestive of hip osteoarthritis they calculated the sensitivity, specificity, positive predictive value, and negative predictive value of radiographs as the diagnostic test. STUDY ANSWER AND LIMITATIONS In the Framingham study (n=946), only 15.6% of hips in patients with frequent hip pain showed radiographic evidence of hip osteoarthritis, and 20.7% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of radiographic hip osteoarthritis for hip pain localised to the groin was 36.7%, specificity 90.5%, positive predictive value 6.0%, and negative predictive value 98.9%. Results did not differ much for hip pain at other locations or for painful internal rotation. In the Osteoarthritis Initiative study (n=4366), only 9.1% of hips in patients with frequent pain showed radiographic hip osteoarthritis, and 23.8% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of definite radiographic hip osteoarthritis for hip pain localised to the groin was 16.5%, specificity 94.0%, positive predictive value 7.1%, and negative predictive value 97.6%. Results also did not differ much for hip pain at other locations. WHAT THIS STUDY ADDS Hip pain was not present in many hips with radiographic osteoarthritis, and many hips with pain did not show radiographic hip osteoarthritis. Most older participants with a high suspicion for clinical hip osteoarthritis (groin or anterior pain and/or painful internal rotation) did not have radiographic hip osteoarthritis, suggesting that in many cases, hip osteoarthritis might be missed if diagnosticians relied solely on hip radiographs. FUNDING, COMPETING INTERESTS, DATA SHARING See the full paper on thebmj.com for funding. The authors have no competing interests. Additional data are available from bevochan@bu.edu.
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Affiliation(s)
- Chan Kim
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany St, Room X200, Boston, MA 02116, USA Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jingbo Niu
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany St, Room X200, Boston, MA 02116, USA
| | - Mary M Clancy
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany St, Room X200, Boston, MA 02116, USA
| | - Nancy E Lane
- Department of Rheumatology, University of California, Davis, CA, USA
| | - Thomas M Link
- Department of Rheumatology, University of California, San Francisco, CA, USA
| | - Steven Vlad
- Department of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - David T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany St, Room X200, Boston, MA 02116, USA NIHR Manchester Biomedical Research Unit, Manchester, UK
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Lacey RJ, Strauss VY, Rathod T, Belcher J, Croft PR, Natvig B, Wilkie R, McBeth J. Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project. BMJ Open 2015; 5:e008389. [PMID: 26553828 PMCID: PMC4654278 DOI: 10.1136/bmjopen-2015-008389] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Most pain in patients aged ≥50 years affects multiple sites and yet the predominant mode of presentation is single-site syndromes. The aim of this study was to investigate if pain sites form clusters in this population and if any such clusters are associated with health factors other than pain. SETTING Six general practices in North Staffordshire, UK. DESIGN Cross-sectional, postal questionnaire, study. PARTICIPANTS Community-dwelling adults aged ≥50 years registered at the general practices. MAIN OUTCOMES MEASURES Number of pain sites was measured by asking participants to shade sites of pain lasting ≥1 day in the past 4 weeks on a blank body manikin. Health factors measured included anxiety and depression (Hospital and Anxiety Depression Scale), cognitive complaint (Sickness Impact Profile) and sleep. Pain site clustering was investigated using latent class analysis. Association of clusters with health factors, adjusted for age, sex, body mass index and morbidities, was analysed using multinomial regression models. RESULTS 13 986 participants (adjusted response 70.6%) completed a questionnaire, of whom 12 408 provided complete pain data. Four clusters of participants were identified: (1) low number of pain sites (36.6%), (2) medium number of sites with no back pain (31.5%), (3) medium number of sites with back pain (17.9%) and (4) high number of sites (14.1%). Compared to Cluster 1, other clusters were associated with poor health. The strongest associations (relative risk ratios, 95% CI) were with Cluster 4: depression (per unit change in score) 1.11 (1.08 to 1.14); cognitive complaint 2.60 (2.09 to 3.24); non-restorative sleep 4.60 (3.50 to 6.05). CONCLUSIONS These results indicate that in a general population aged ≥50 years, pain forms four clusters shaped by two dimensions-number of pain sites (low, medium, high) and, within the medium cluster, the absence or presence of back pain. The usefulness of primary care treatment approaches based on this simple classification should be investigated.
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Affiliation(s)
- R J Lacey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - V Y Strauss
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK Centre for Statistics in Medicine, University of Oxford, Botnar Research Centre, Oxford, UK
| | - T Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - J Belcher
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK School of Computing and Mathematics, Keele University, Keele, Staffordshire, UK
| | - P R Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - B Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - R Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
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Paterson KL, Hinman RS, Hunter DJ, Wrigley TV, Bennell KL. Impact of concurrent foot pain on health and functional status in people with knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 2015; 67:989-95. [PMID: 25581254 DOI: 10.1002/acr.22537] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/16/2014] [Accepted: 12/16/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To document the prevalence of foot pain and foot pain laterality in people with knee osteoarthritis (OA) and to examine its impact on health and function. METHODS Participants from the Progression subcohort (n = 1,255, ages 45-79 years) of the Osteoarthritis Initiative with symptomatic tibiofemoral knee OA were included. Prevalence of foot pain, defined as pain in the foot/ankle, and foot pain laterality were determined. Health status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form-12 Health Survey, and the Center for Epidemiological Studies Depression Scale. Function was assessed using the 20-meter walk test (WT) and a repeated chair stand test. Differences in health and functional measures were compared between groups with and without foot pain using multivariate analysis of covariance. RESULTS One-fourth (n = 317 [25%]) of people with knee OA experienced concurrent foot pain, with the majority (n = 174 [55%]) reporting pain in both feet. After adjusting for covariates, people with foot pain scored worse on all health measures and on the 20-meter WT, compared to those without (P < 0.05). Differences in health and function were found between the bilateral and ipsilateral foot pain groups compared to those without foot pain (P < 0.05), but no differences were found with the contralateral group. CONCLUSION Foot pain is common in people with knee OA, and bilateral and ipsilateral foot pain adversely affect health and function, suggesting laterality is important. Further research is needed to establish the mechanism and interaction of pathology at these sites and to evaluate foot pain treatment in this population.
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Affiliation(s)
- Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Hunter
- Royal North Shore Hospital, Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, and University of Sydney, Sydney, New South Wales, Australia
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Smith TO, Purdy R, Latham SK, Kingsbury SR, Mulley G, Conaghan PG. The prevalence, impact and management of musculoskeletal disorders in older people living in care homes: a systematic review. Rheumatol Int 2015; 36:55-64. [PMID: 26245357 DOI: 10.1007/s00296-015-3322-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022]
Abstract
The aim was to systematically review the literature describing the prevalence, impact and current management of musculoskeletal pain in older people living in care homes. Published literature (AMED, CINAHL, EMBASE, psycINFO, MEDLINE, Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, UK National Research Register Archive) were searched on 1 March 2015. All studies assessing the prevalence, impact and management of musculoskeletal disorders in older people living in care homes were included. Literature was appraised using the CASP cohort and qualitative critical appraisal tools. Data were analysed using descriptive statistical approaches, meta-analysis and meta-ethnography techniques. Twenty-four papers reporting the results of 263,775 care home residents in 12 countries were identified. The evidence base was moderate in quality. Prevalence of musculoskeletal pain for people in care homes was 30.2 % (95 % confidence intervals 29.9-30.5 %; n = 105,463). Care home residents reported that musculoskeletal pain had a significant impact on their perceived independence and overall ability to participate in everyday activities of daily living. Three papers which presented data on interventions demonstrated that whilst multi-component assessment and management packages did not significantly change clinical outcomes, these empowered care home staff to feel more confident in managing these patients. Musculoskeletal pain is a common problem in care homes worldwide, and residents report significant impact on their lives. However, there is uncertainty regarding how to assess and manage such pain. PROSPERO Registration Number: CRD42014009824.
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Affiliation(s)
- Toby O Smith
- Faculty of Medicine and Health Sciences, Norwich Research Park, University of East Anglia, Queen's Building, Norwich, NR4 7TJ, UK.
| | | | | | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Graham Mulley
- Emeritus Professor of Elderly Medicines, St James' University Hospital, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Biomechanics of Lower Limbs during Walking among Candidates for Total Knee Arthroplasty with and without Low Back Pain. BIOMED RESEARCH INTERNATIONAL 2015; 2015:142562. [PMID: 26171387 PMCID: PMC4480238 DOI: 10.1155/2015/142562] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/02/2015] [Accepted: 05/20/2015] [Indexed: 12/01/2022]
Abstract
The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.
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Zeni J, Abujaber S, Pozzi F, Raisis L. Relationship between strength, pain, and different measures of functional ability in patients with end-stage hip osteoarthritis. Arthritis Care Res (Hoboken) 2015; 66:1506-12. [PMID: 24664893 DOI: 10.1002/acr.22329] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Performance tests and self-reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance-based tests and self-reported questionnaires of functional ability of individuals with end-stage hip osteoarthritis. METHODS Fifty-six patients scheduled to undergo unilateral total hip arthroplasty were included in this cross-sectional analysis. Subjects completed the Hip Outcome Survey (HOS) and pain in the affected hip was quantified on a scale from 0-10. Performance-based tests included the Six-Minute Walk Test (6MWT), the Timed Up & Go (TUG), and the Stair Climbing Test (SCT). Isometric strength of the hip abductors and knee extensors was tested and recorded. Hierarchical linear regressions were created to determine the contributions of pain, knee extensor strength, and hip strength for each outcome measure (TUG, 6MWT, SCT, and HOS). Height and body mass index were entered first, followed by pain, then knee extensor strength, and then hip abduction strength. RESULTS Greater pain significantly predicted lower HOS scores, but hip strength did not significantly improve the model. Hip pain was also significantly related to TUG, SCT, and 6MWT values, but hip and knee strength explained additional variance for these performance-based measures. CONCLUSION Self-report and performance-based measures capture different aspects of disability and are influenced by different underlying impairments. Both types of outcome measures should be used in studies that evaluate functional changes in patients with hip osteoarthritis.
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Zlatar ZZ, McGregor KM, Towler S, Nocera JR, Dzierzewski JM, Crosson B. Self-reported physical activity and objective aerobic fitness: differential associations with gray matter density in healthy aging. Front Aging Neurosci 2015; 7:5. [PMID: 25691866 PMCID: PMC4315095 DOI: 10.3389/fnagi.2015.00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/15/2015] [Indexed: 11/26/2022] Open
Abstract
Aerobic fitness (AF) and self-reported physical activity (srPA) do not represent the same construct. However, many exercise and brain aging studies interchangeably use AF and srPA measures, which may be problematic with regards to how these metrics are associated with brain outcomes, such as morphology. If AF and PA measures captured the same phenomena, regional brain volumes associated with these measures should directly overlap. This study employed the general linear model to examine the differential association between objectively-measured AF (treadmill assessment) and srPA (questionnaire) with gray matter density (GMd) in 29 cognitively unimpaired community-dwelling older adults using voxel based morphometry. The results show significant regional variance in terms of GMd when comparing AF and srPA as predictors. Higher AF was associated with greater GMd in the cerebellum only, while srPA displayed positive associations with GMd in occipito-temporal, left perisylvian, and frontal regions after correcting for age. Importantly, only AF level, and not srPA, modified the relationship between age and GMd, such that higher levels of AF were associated with increased GMd in older age, while decreased GMd was seen in those with lower AF as a function of age. These results support existing literature suggesting that both AF and PA exert beneficial effects on GMd, but only AF served as a buffer against age-related GMd loss. Furthermore, these results highlight the need for use of objective PA measurement and comparability of tools across studies, since results vary dependent upon the measures used and whether these are objective or subjective in nature.
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Affiliation(s)
- Zvinka Z Zlatar
- Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Keith M McGregor
- Department of Neurology, Emory University Atlanta, GA, USA ; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center Decatur, GA, USA
| | - Stephen Towler
- Department of Neurology, Emory University Atlanta, GA, USA ; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center Decatur, GA, USA
| | - Joe R Nocera
- Department of Neurology, Emory University Atlanta, GA, USA ; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center Decatur, GA, USA
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Bruce Crosson
- Department of Neurology, Emory University Atlanta, GA, USA ; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center Decatur, GA, USA ; Department of Psychology, Georgia State University Atlanta, GA, USA
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Association between the severity of femoral condylar cartilage erosion related to knee osteoarthritis by ultrasonographic evaluation and the clinical symptoms and functions. Arch Phys Med Rehabil 2015; 96:837-44. [PMID: 25596002 DOI: 10.1016/j.apmr.2015.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/18/2014] [Accepted: 01/03/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the association between the severity of femoral condylar cartilage erosion resulting from knee osteoarthritis (OA) by an ultrasonographic grading system and the clinical symptoms and functions. DESIGN Cross-sectional study. SETTING A tertiary center. PARTICIPANTS Participants (N=101) with and without subjective complaints of knee discomfort were consecutively enrolled. Patients who had ever received knee arthroplasty, who had inflammatory arthritis, and whose knee flexion range of motion was <90° were excluded. A total of 194 knees were evaluated. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A semiquantitative ultrasonographic grading system was used to evaluate the severity of femoral condylar cartilage erosion. The clinical symptoms and functions were evaluated with the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. The association of the VAS/WOMAC/Lequesne index with the ultrasonographic grading was assessed. RESULTS Positive linear associations were found between the ultrasonographic grading and the following: the VAS and the total scores and pain subscales of both the Lequesne index and WOMAC. Multivariate logistic regression analysis revealed grade-dependent association between VAS and ultrasonographic grading after adjusting for age, sex, and body mass index. The WOMAC and Lequesne index scores were associated with the ultrasonographic grading in more severe degrees, particularly in the pain subscales. CONCLUSIONS This semiquantitative ultrasonographic grading system may well reflect the clinical symptoms and functions related to knee OA as evaluated by the VAS, WOMAC, and Lequesne index. This method provides a more comprehensive description and measurement of knee OA.
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