Network Meta-Analysis of Various Nonpharmacological Interventions on Pain Relief in Older Adults With Osteoarthritis

Platelet-rich plasma relieves inflammation and pain by regulating M1/M2 macrophage polarization in knee osteoarthritis rats

Knee osteoarthritis (KOA) is a common, chronic, degenerative disease. Platelet-rich plasma (PRP) can significantly relieve KOA pain; however, the mechanism of PRP-induced analgesia remains to be studied. Macrophages are closely related to KOA pain, and regulating macrophage polarization may be an effective way to relieve KOA pain. Therefore, the aim of this study is: First, to explore whether PRP can effectively relieve pain in a KOA animal model and whether it relieves pain by regulating macrophage polarization. Second, to explore the mechanism by which PRP regulates macrophage polarization. Thirty-six healthy male SD rats were randomly divided into sham group, MIA group and PRP group. The KOA rat model was established by injecting 1 mg of MIA into the joint cavity. Behavioral tests, including weight-bearing asymmetry, hot plate, and von Frey hairs tests, were performed. The positive expression rates of inducible nitric oxide synthase (iNOS) and CD163 in the synovium were detected via immunohistochemical staining. Meanwhile, RAW 264.7 cells induced by lipopolysaccharide were treated with PRP in vitro. The production levels of the nuclear factor kappa-B (NF-κB) pathway-related proteins NF-κB p65, inhibitor-κ binding protein α (IκBα), p-NF-κB p65, p-IκBα and the iNOS and CD163 proteins were measured via western blotting. An enzyme-linked immunosorbent assay was used to detect the release of tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β), interleukin-10 (IL-10), and nerve growth factor (NGF). The behavioral results revealed that PRP relieved pain. PRP reduced the proportion of M1/M2 macrophages among synovial macrophages, significantly inhibited the secretion of TNF-α and IL-1β in the synovium, and increased the secretion of IL-10. In addition, in vivo experiments revealed that PRP decreased the protein expression of iNOS, p-IκBα/IκBα, and p-p65/p65 and increased the protein expression of CD163. Furthermore, PRP decreased TNF-α, IL-1β, and NGF levels in RAW 264.7 cells and increased the secretion of IL-10. Our findings indicate that PRP can improve long-term relief from KOA pain. The analgesic mechanism promotes the transformation of M1 macrophages to M2 macrophages by inhibiting the NF-κB signaling pathway, which reduces the release of downstream pain-causing factors, thus relieving inflammation and pain.

Yoga or Strengthening Exercise for Knee Osteoarthritis: A Randomized Clinical Trial

Importance

There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA).

Objective

To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA.

Design, Setting, and Participants

This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024.

Interventions

Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24.

Main Outcomes and Measures

The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle.

Results

In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI, -30.9 to -4.3 mm]), patient global assessment (-7.6 mm [95% CI, -15.1 to -0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, -1.1 [95% CI, -1.9 to -0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild.

Conclusion and relevance

In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA.

Trial registration

ANZCTR.org Identifier: ACTRN12621000066886.

The effects of digital health on exercise adherence and intervention outcomes in older adults with knee diseases: A systematic review

BACKGROUND

Poor adherence is commonly observed as one of the characteristics of exercise interventions and there is little consensus as to whether digital interventions promote exercise adherence in people undergoing physiotherapy, especially in older adults with knee diseases.

PURPOSE

To investigate the effects of digital health for improving the exercise adherence and intervention outcomes.

METHODS

A systematic search was conducted on 4 databases; PRISMA reporting guidelines were followed. Journal articles in English (published till June 30, 2024) reporting digital health on exercise adherence and intervention outcomes for older adults with knee diseases were searched, and eligible articles underwent data extraction and a thematic synthesis.

RESULTS

Of the 1015 potentially relevant trials, 13 studies totaling 1258 participants were eligible for inclusion. Digital health was slightly better but not significant than non-digital health on total adherence (SMD 0.29, 95 % CI -0.02 to 0.60; P = 0.07; I2 = 77 %). At short-term follow-up, digital health improved adherence compared with nondigital health (SMD 0.70, 95 % CI 0.39-1.01; P< 0.001; I2 = 4 %), with a very low certainty of evidence. At mid- and long-term, digital health was no better than non-digital health on adherence (mid-term: SMD 0.01, 95 % CI -0.55 to 0.58; P= 0.97; I2 = 86 %; long-term: SMD 0.09, 95 % CI -0.31 to 0.49, P = 0.66; I2 = 48 %). For the intervention outcomes, digital health reduced the pain only at short-term and was no better than non-digital health on physical function, ADL or QoL at any time point.

CONCLUSION

The available evidence is insufficient to draw the conclusion that digital health technology improves exercise adherence and intervention outcomes in older people with knee disease, and there is very low to low certainty of evidence supporting improvements of adherence and pain only at short-term. Larger-scale, more reliable studies and strategies are needed to enhance mid- and long-term adherence and intervention outcomes in older adults.

Mesenchymal Stem Cells Injection Is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis With Similar Safety: A Systematic Review and Meta-analysis

PURPOSE

To evaluate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA).

METHODS

Eligible randomized controlled trials (RCTs) were identified through a search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety were evaluated by the incidence of adverse events. Two researchers independently read the included literature, extracted data and evaluated the quality, used the Cochrane risk bias assessment tool for bias risk assessment, and used RevMan5.3 software for meta-analysis.

RESULTS

Ten RCTs involving 818 patients with KOA ranging from I to Ⅲ on the Kellgren-Lawrence grading scale were included in this meta-analysis. Meta-analysis results showed that at 12 months, the WOMAC total score (mean difference [MD] = -10.22, 95% confidence interval [CI]: -14.86 to -5.59, P < .0001, Z = 4.32), VAS score (MD = -1.31, 95% CI: -1.90 to -0.73, P < .0001, Z = 4.40); and WORMS score (MD = -26.01, 95% CI: -31.88 to -20.14, P < .001, Z = 8.69) of the MSCs group all decreased significantly (P < .05) compared with the HA control group and reached the minimal clinically important differences. Furthermore, there was no significant difference in the incidence of adverse events (relative risk = 1.54, 95% CI: 0.85-2.79, P = .16, I2 = 0) between the 2 groups (P > .05).

CONCLUSIONS

In terms of efficacy, the clinical effects of intra-articular injection therapy using MSCs for KOA are superior to those of HA, and the cartilage repair effect of MSCs is also markedly better than that of HA. Although the clinical effects varied across time periods, the functional score reached the minimum clinically significant difference at both 6 and 12 months. In terms of safety, adverse reactions mainly manifest as joint pain, swelling, and joint effusion. Both intra-articular injections of MSCs and HA did not result in severe adverse reactions, indicating that MSCs and HA have similar safety profiles.

LEVEL OF EVIDENCE

Level I, meta-analysis of Level I studies.

Effects of three types of resistance training on knee osteoarthritis: A systematic review and network meta-analysis

BACKGROUND

Resistance training (RT) is recognized in clinical guidelines as a beneficial treatment for knee osteoarthritis (KOA), but the efficacy of different RT types is not well-established.

OBJECTIVE

This network meta-analysis (NMA) aimed to compare the effects of different types of RT, namely, isometric muscle strengthening (IMMS), isokinetic muscle strengthening (IKMS) and isotonic muscle strengthening (ITMS), on pain, function and quadriceps muscle strength of patients with KOA.

METHODS

A systematic search was conducted up to September 2023 on databases, including PubMed, Cochrane Library, EMbase, Web of Science and China National Knowledge Infrastructure. The included studies comprised randomised controlled trials (RCTs) comparing RT with conventional rehabilitation and physiotherapy or other types of RT.

RESULTS

Compared with the control group (CG) that received conventional physiotherapy, IKMS was optimal in terms of pain relief (MD = -1.33, 95% CI: -1.83 to -0.83), function (MD = -12.24, 95% CI: -17.29 to -7.19) and knee extension torque (SMD = -0.44, 95% CI: -0.74 to -0.14).

CONCLUSIONS

Compared with conventional rehabilitation therapy, all three types of RT can improve pain and knee-joint function in KOA patients. IKMS demonstrated the best results among the different RT modalities.

PROSPERO REGISTRATION

PROSPERO registration number: CRD42023448579.

Effectiveness of Rehabilitation for Osteoarthritis of the Knee: A Scoping Review of Network Meta-Analyses

BACKGROUND

 Although an increasing number of network meta-analyses have been conducted on the effectiveness of conservative therapy for knee osteoarthritis, these may have been poorly planned and executed.We aimed to review the qualities of a comprehensive set of network meta-analyses on rehabilitation therapies for knee osteoarthritis and provide an overview of the effectiveness of each therapy.

METHODS

The eligibility criteria were as follows: (i) conservative rehabilitation was the primary treatment in the intervention group, (ii) included patients were diagnosed with knee osteoarthritis, and (iii) patient groups were aged ≤75 years, and rehabilitation interventions comprised exercise, orthotic, or physical therapies or patient education. Two independent reviewers screened the titles and abstracts of the identified records and selected the eligible reviews; their full texts were further assessed for eligibility. Then, a checklist derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for the reporting of systematic reviews incorporating network meta-analyses of healthcare Interventions was used to validate the completeness of the reporting of each network meta-analysis. Furthermore, the statistical and outcome data regarding the quality of life, knee joint function and pain, adverse events, and physical functions were extracted using a customized spreadsheet.

RESULTS

Overall, 2701 titles and abstracts were screened, and eight network meta-analyses were ultimately selected. Nearly all reviews adequately addressed the PRISMA extension checklist, and the completeness of reporting was adequate; therefore, all expected information could be extracted. However, the methodology used to confirm the transitivity assumption was insufficient in many reviews. The following interventions were effective in reducing pain and improving physical function: (i) strengthening, flexibility, aerobic, and mind-body exercises, (ii) pulsed ultrasound, (iii) focused and radial extracorporeal shockwave therapy, and (iv) continuous ultrasound. The following interventions were effective in improving the quality of life: (i) strengthening, (ii) mixed, and (iii) mind-body exercises.

CONCLUSIONS

Our results suggested that exercise therapies, including muscle-strengthening, aerobic, flexibility, and mind-body exercises, are likely to be effective for pain relief and functional improvement in knee osteoarthritis. This may be the first review to provide a comprehensive perspective for considering priorities for future rehabilitation interventions for knee osteoarthritis.

Rehabilitation interventions in osteoarthritis

The goals of the management of osteoarthritis (OA) are to relieve joint pain and stiffness, maintain or increase joint mobility and stability, improve activities and participation, and enhance quality of life. The first step in the management is to make a comprehensive holistic assessment to understand the impact of the disease on the individual. Then, an individualized management plan can be set via a shared-decision making process between the patient and the clinician taking into account all components of functioning affected by the disease. Rehabilitation interventions serve as the basis of OA management whereas pharmacological modalities are usually administered for additional symptom control. This study aimed to overview the rehabilitation interventions used for people with OA with an update of the recent evidence. First, core management approaches that include patient education, physical activity and exercises, and weight loss were addressed; then adjunctive treatments including biomechanical interventions (e.g. orthoses, assistive devices) and physical modalities were overviewed.

A Descriptive Study of Treatment of Pain in Acute Care for Patients Living With Dementia

BACKGROUND

During the hospital stay pain is very common among patients living with dementia.

METHODS

Descriptive data was obtained from chart review and included age, gender, race, comorbidities and admitting diagnosis.

AIMS

The purpose of this study was to describe pain among patients living with dementia, the use of pharmacologic and nonpharmacologic treatment, and to compare treatments among those with and without pain.

DESIGN

This was a descriptive study using baseline data from the first 233 participants from the study "Testing the Implementation of Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT)".

PARTICIPANTS/SUBJECTS

The mean age of participants was 83 (SD=5) and the majority was female (65%) and White (67%) with evidence of dementia (based on a mean Saint Louis University Mental Status Test = 7.23, SD=5.85).

RESULTS

Overall 98 (42%) participants had pain and 135 (58%) no pain. Only 14 (6%) participants received no nonpharmacologic or pharmacologic interventions for pain and five of these individuals had pain. The most frequently used pharmacologic intervention among all participants was acetaminophen (n = 121, 52%), then tramadol (n = 19, 8%). Comfort measures and general nonpharmacologic approaches were the most frequently used non-pharmacologic approaches, then physical activity and therapeutic communication. From admission to discharge, there was a trend towards a decrease in pain. There was more use of opioids, physical activity, and therapeutic communication in the no pain group versus the pain group.

CONCLUSIONS

The majority of hospitalized medical patients living with dementia were treated for pain, but an ongoing focus is needed to assure optimal pain management for all patients.

Effects of traditional Chinese herb hot compress combined with therapeutic exercise on pain, proprioception, and functional performance among older adults with knee osteoarthritis: A randomized controlled trial

Background: Knee osteoarthritis (KOA) is one of the most common chronic progressive diseases with degenerative destruction of articular cartilage and bone, leading to knee pain, impaired proprioception, and reduced functional performance. This study was to investigate the effects of an 8-week Traditional Chinese herb hot compress (TCHHC) combined with therapeutic exercise (TE) on pain, proprioception, and functional performance among older adults with KOA. Methods: Twenty-seven older adults with KOA were recruited and randomly assigned to the TCHHC + TE or TE groups. Thirteen participants received TCHHC + TE, and fourteen received TE. At pre- (week 0) and post-intervention (week 9), their pain, joint proprioception, and functional performance were measured. Two-way ANOVA with repeated measures was adopted to analyze the data. Results: Compared with week 0, the pain score, proprioception thresholds of knee extension and ankle plantarflexion, and the times of TUG and 20-m walk tests decreased more significantly in the TCHHC + TE group than in the TE group at week 9. Conclusion: Compared with TE, the 8-week TCHHC + TE was superior in relieving pain, recovering proprioception, and improving functional performance among older adults with KOA. It is recommended that TCHHC should be adopted prior to TE to enhance the effects of KOA rehabilitation.

Evaluation of the Reporting Standard Guidelines of Network Meta-Analyses in Physical Therapy: A Systematic Review

The concept of network meta-analyses (NMA) has been introduced to the field of physical therapy. However, the reporting standard guidelines of these studies have not been evaluated. In this systematic review, we included all published NMA physical therapy studies that compared the clinical efficacy of three or more interventions to evaluate whether NMAs in physical therapy exhibit adequate reporting recommendations. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched up to 30 June 2022. Among the 252 identified articles, 19 NMAs including 805 randomized controlled trials were included. We applied both preferred reporting items for systematic reviews and meta-analysis (PRISMA) and PRISMA-NMA checklists, which are 27- and 32-item reporting standard guidelines assessment tools, respectively. Protocol registrations (68.4%), risk of bias across studies (63.2%), additional analysis (57.9%), and funding (31.6%) were problematic items considering the PRISMA guidelines. Four studies reported all five new NMA-reporting items, and 15 (78.9%) did not address items S1-5 from the PRISMA-NMA guidelines. The median score (interquartile range) of the reporting standard guidelines was 27.0 (25.8-28.0). The identified shortcomings of published NMAs should be addressed while training researchers, and they should be encouraged to apply PRISMA-NMA, as a recognized tool for assessing NMA reporting guidelines is required.

Effects of a Fall Prevention Program Based on Goal Attainment Theory for Homebound Older Adults With Osteoarthritis of the Lower Extremities

This study implemented and evaluated a community-based fall prevention program based on goal attainment theory that targeted older adults with osteoarthritis. The program included education, exercise, and one-on-one counseling during which the participant and the provider set individual fall prevention goals. This study used a nonequivalent control group pre-/posttest design. Participants were older adults in senior centers with lower extremity osteoarthritis. A fall prevention program in the experimental group included group (70 minutes, once/week; education and exercise) and individual counseling (10 minutes, twice/week; emotional support and goal setting). Data analysis was conducted using SPSS/WIN 22.0 with the χ2 test, Fisher's exact test, independent t test, and Mann-Whitney U test. The experimental group experienced significantly fewer falls, less stiffness, less difficulty performing activity; more muscular strength, walking ability, and balance; as well as less fear of falling and higher falls efficacy in comparison with the control group. However, pain did not improve in either of the two groups. Fall prevention programs need to include the active involvement of carers in ensuring environmental changes to reduce fall risks. In addition, health professionals who care for community patients with osteoarthritis could strengthen interactions and exchanges to prevent falls and actively modify home hazards.

A Randomised Controlled Trial of YOGa and Strengthening Exercise for Knee OsteoArthritis: Protocol for a Comparative Effectiveness Trial (YOGA Trial)

Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, balance, and fitness and potentially reduce symptoms of OA. However, there is a scarcity of robust, high-quality conclusive evidence on the efficacy of yoga in knee OA. We are currently conducting the first randomised comparative effectiveness and cost-effectiveness trial of a yoga program compared with a strengthening exercise program in patients with symptomatic knee OA. This study protocol describes the design and conduct of this trial. The YOGA study is a phase III, single-centre, parallel, superiority, randomised, active-controlled trial which will be conducted in Hobart, Australia. One hundred and twenty-six participants (63 in each arm) aged over 40 years with symptomatic knee OA will be recruited from the community and randomly allocated to receive either a 24-week yoga program (3×/week) or a strengthening exercise program (3×/week). The primary outcome will be change in knee pain over 12 weeks, assessed using a 100 mm visual analogue scale (VAS). The secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life, gait speed, biomarkers, and others over 12 and 24 weeks. We will also assess whether the presence of neuropathic pain moderates the effects of yoga compared to strengthening exercise. Additional data, such as cost and resource utilization, will be collected for the cost-effectiveness analysis. The primary analysis will be conducted using an intention-to-treat approach. Adverse events will be monitored throughout the study. Once completed, this trial will contribute to the knowledge of whether yoga can be used as a simple, effective, low-cost option for the management of knee OA, thus saving economic costs in the healthcare system.

Evaluation of a single-shot of a high-density viscoelastic solution of hyaluronic acid in patients with symptomatic primary knee osteoarthritis: the no-dolor study

BACKGROUND

Pronolis®HD mono 2.5% is a novel, one-shot, high-density sterile viscoelastic solution, recently available in Spain, which contains a high amount of intermediate molecular weight hyaluronic acid (HA), highly concentrated (120 mg in 4.8 mL solution: 2.5%). The objective of the study was to analyze the efficacy and safety of this treatment in symptomatic primary knee osteoarthritis (OA).

METHODS

This observational, prospective, multicenter, single-cohort study involved 166 patients with knee OA treated with a single-shot of Pronolis®HD mono 2.5% and followed up as many as 24 weeks.

RESULTS

Compared with baseline, the score of the Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC) pain subscale reduced at the 12-week visit (primary endpoint, median: 9 interquartile range [IQR]: 7-11 versus median: 4; IQR: 2-6; p < 0.001). The percentage of patients achieving > 50% improvement in the pain subscale increased progressively from 37.9% (at 2 weeks) to 66.0% (at 24 weeks). Similarly, WOMAC scores for pain on walking, stiffness subscale, and functional capacity subscale showed significant reductions at the 12-week visit which were maintained up to the 24-week visit. The EuroQol visual analog scale score increased after 12 weeks (median: 60 versus 70). The need for rescue medication (analgesics/nonsteroidal anti-inflammatory drugs) also decreased in all post-injection visits. Three patients (1.6%) reported local adverse events (joint swelling) of mild intensity.

CONCLUSIONS

In conclusion, a single intra-articular injection of the high-density viscoelastic gel of HA was associated with pain reduction and relief of other symptoms in patients with knee OA.

TRIAL REGISTRATION

ClinicalTrial# NCT04196764.

State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions

For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.

Recent Advances in the Neural Control of Movements: Lessons for Functional Recovery

We review the current views on the control and coordination of movements following the traditions set by Nikolai Bernstein. In particular, we focus on the theory of neural control of effectors - from motor units to individual muscles, to joints, limbs, and to the whole body - with spatial referent coordinates organized into a hierarchy with multiple few-to-many mappings. Further, we discuss synergies ensuring stability of natural human movements within the uncontrolled manifold hypothesis. Synergies are organized within the neural control hierarchy based on the principle of motor abundance. Movement disorders are discussed as consequences of an inability to use the whole range of changes in referent coordinates (as in spasticity) and an inability to ensure controlled stability of salient variables as reflected in indices of multi-element synergies and their adjustments in preparation to actions (as in brain disorders, including Parkinson's disease, multiple-system atrophy, and stroke). At the end of the review, we discuss possible implications of this theoretical approach to peripheral disorders and their rehabilitations using, as an example, osteoarthritis. In particular, "joint stiffening" is viewed as a maladaptive strategy, which can compromise stability of salient variables during walking.

A systematic review of the effectiveness of yoga on pain, physical function, and quality of life in older adults with chronic musculoskeletal conditions

OBJECTIVES

Exercise interventions suitable for older adults can help to slow and manage age-related conditions. This systematic review looks at age-related musculoskeletal conditions in a population with a mean age over 50 years, evaluating the effectiveness of yoga for pain, physical function, and quality of life.

METHODS

CENTRAL,CINAHL, Pubmed, PsycInfo, SCOPUS, Sports Discus, Web of Science Core Collection, and Google Scholar were searched. Study selection and quality screening using the Cochrane risk of bias tool were conducted by two reviewers to mitigate bias. PRISMA guidelines were followed in conducting and reporting the review.

RESULTS

11 studies met inclusion criteria with a total sample of 2221 (≥70% female). Eight studies measured pain, six showing significant effectiveness (p=≤0.05), for lower limb osteoarthritis (OA), hand OA, and neck pain. Nine studies measured physical function, four showing significant effects, for lower limb OA and sarcopenia. Significant quality of life effects were found for restless leg syndrome compared to baseline.

CONCLUSION

Moderate evidence was found for pain effects, generalisable for OA based on sub-group analysis. Effective trials were mostly short-term using at minimum one 60-min group class, and an average of four 30-min home practice sessions weekly. Findings support the use of props and modifications to address age-related physical limitations. Yoga was well-received with good adherence, but effects on a par with other exercise. There was an absence of quality of life effects in short term. Mixed methods studies could lead to further insight into the qualitative aspects of yoga practice for older adults.

Osteoarthritis year in review 2020: rehabilitation and outcomes

OBJECTIVE

Systematically review and synthesize guidelines, systematic reviews, or randomized controlled trials (RCTs) published between April 1, 2019 and April 30, 2020 which evaluated or made recommendations for rehabilitation of persons with osteoarthritis.

DESIGN

Five electronic databases (Medline, EMBASE, Cochrane CENTRAL, CINHAL, Web of Science) were searched with a comprehensive search strategy. Guidelines for rehabilitation of persons with osteoarthritis, and systematic reviews and RCTs evaluating osteoarthritis rehabilitation that included at least one patient-reported outcome measure and/or clinical test of function were included. Two authors independently screened records and assessed methodological quality using the AGREE-II (guidelines), AMSTAR-2 (systematic reviews) or PEDro scale (RCTs). Data were extracted to summarize included records and a narrative synthesis of findings related to core recommended osteoarthritis rehabilitation treatments performed.

RESULTS

Of 2,479 potential records, 253 records were reviewed. Two guidelines, 18 systematic reviews and 38 RCTs were included. 84% (n = 49) of included records related to knee osteoarthritis, 13% (n = 8) to hip, 10% (n = 6) to hand, 3% (n = 2) to mixed, and 1% (n = 1) to foot osteoarthritis. Exercise-therapy, methods to deliver exercise-therapy remotely, and approaches to facilitate exercise-therapy behaviour change were the most commonly evaluated interventions (n = 27). 94% of systematic reviews and 63% of RCTs rated high-quality.

CONCLUSIONS

Osteoarthritis rehabilitation research continues to focus on knee osteoarthritis and exercise-based interventions. Emerging topics include rehabilitation of comorbid populations, exercise behaviour change and technology supports. A better understanding of rehabilitation of osteoarthritis in joints other than the knee, and methods to determine and promote ideal exercise-therapy prescription are needed.

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Background

This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for patients undergoing knee osteoarthritis.

Methods

We systematically searched electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library on January 23, 2020 to identify relevant studies issued in English languages. The outcomes evaluating the efficacy of knee osteoarthritis (KOA) treatment were Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC pain, function, stiffness, and total scores) at 1, 3, 6, and 12 months; International Knee Documentation Committee (IKDC) scores, Lequesne Index score, Visual Analog Scale (VAS) scores, EQ-VAS scores, and KOOS scores. The pooled data were analyzed by Stata 12.0.

Results

A total of 20 RCTs were enrolled in the present meta-analysis. The pooled results demonstrated that platelet-rich plasma (PRP) injection reduced pain more effectively than hyaluronic acid (HA) injection at 6-month and 12-month follow-up evaluated by WOMAC pain scores and VAS scores. EQ-VAS in the patients treated with PRP injection was lower than that in patients with HA injection at 12 months. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1-month, 3-month, 6-month, and 12-month follow-up, as evaluated by WOMAC function scores. WOMAC total scores showed significant difference at 6-month and 12-month follow-up. The IKDC scores indicated PRP injection was significantly more effective than HA injection at 3 months and 6 months. However, the Lequesne Index scores, KOOS scores, and adverse events did not show any significant difference between groups.

Conclusion

Intra-articular PRP injection appeared to be more efficacious than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection did not increase the risk of adverse events compared to HA injection.

Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis

Background

Osteoarthritis (OA) is a progressive disease of the joints, leading to decreased function and disability.

Objectives

The study aimed to investigate the effect of self-management (SM) program on disability index and pain in aging men with knee OA.

Methods

The study included an SM group and a control group. Given the sample size of the previous studies, 83 patients were recruited. The study tools included a demographic profile questionnaire, visual analogue scale (VAS), and HAQ 8-item DI. The intervention included 10 SM sessions for patients in the SM group (8 sessions of in-person intervention and 2 sessions of telephone intervention). Patients were placed in groups of 7, and the sessions were held weekly each for a period of 45 to 60 minutes. Data were analyzed using descriptive and analytical tests by SPSS V. 16 software.

Results

The two groups(SM and control group) were homogeneous in terms of demographic characteristics (P > 0.05). The mean (SD) disability score was 19.12 (1.92) in the SM group before the intervention, which reduced to 14.70 (1.63) after the intervention (P = 0.000, T = 10.02). The mean (SD) pain score, was 9.19 (0.71) in the SM group before the intervention, which reduced to 6.48 (0.84) after the intervention (P = 0.000, T = 18.15).

Conclusions

Training can help patients perform SM measures and improve their health status by enhancing the information needed for the disease.