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Runhaar J, Holden MA, Hattle M, Quicke J, Healey EL, van der Windt D, Dziedzic KS, Middelkoop MV, Bierma-Zeinstra S, Foster NE. Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank. RMD Open 2023; 9:e003220. [PMID: 37640513 PMCID: PMC10462947 DOI: 10.1136/rmdopen-2023-003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA). METHODS For Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA), individual participant data (IPD) were sought from all published randomised controlled trials (RCTs) comparing therapeutic exercise to non-exercise controls in people with knee/hip OA. Using the Counterfactual framework, the effect of the exercise intervention and the percentage mediated through each potential mediator (muscle strength, proprioception and range of motion (ROM)) for knee OA and muscle strength for hip OA were determined. RESULTS Data from 12 of 31 RCTs of STEER OA (1407 participants) were available. Within the IPD data sets, there were generally statistically significant effects from therapeutic exercise for pain and physical function in comparison to non-exercise controls. Of all potential mediators, only the change in knee extension strength was statistically and significantly associated with the change in pain in knee OA (β -0.03 (95% CI -0.05 to -0.01), 2.3% mediated) and with physical function in knee OA (β -0.02 (95% CI -0.04 to -0.00), 2.0% mediated) and hip OA (β -0.03 (95% CI -0.07 to -0.00), no mediation). CONCLUSIONS This first IPD mediation analysis of this scale revealed that in people with knee OA, knee extension strength only mediated ±2% of the effect of therapeutic exercise on pain and physical function. ROM and proprioception did not mediate changes in outcomes, nor did knee extension strength in people with hip OA. As 98% of the effectiveness of therapeutic exercise compared with non-exercise controls remains unexplained, more needs to be done to understand the underlying mechanisms of actions.
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Affiliation(s)
- Jos Runhaar
- General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Miriam Hattle
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Jonathan Quicke
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Chartered Society of Physiotherapy, London, UK
| | - Emma Louise Healey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | | | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | | | - Sita Bierma-Zeinstra
- General Practice, Erasmus MC, Rotterdam, The Netherlands
- Orthopedics & Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
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Holden MA, Hattle M, Runhaar J, Riley RD, Healey EL, Quicke J, van der Windt DA, Dziedzic K, van Middelkoop M, Burke D, Corp N, Legha A, Bierma-Zeinstra S, Foster NE. Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. THE LANCET. RHEUMATOLOGY 2023; 5:e386-e400. [PMID: 38251550 DOI: 10.1016/s2665-9913(23)00122-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. METHODS We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). FINDINGS Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0-100 scale (with 100 corresponding to worst pain), with a difference of -6·36 points (95% CI -8·45 to -4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, -3·77 points (-5·97 to -1·57, BoS 30·0%, τ2 14·4) in the medium term, and -3·43 points (-5·18 to -1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0-100 scale (with 100 corresponding to worst physical function), with a difference of -4·46 points in the short term (95% CI -5·95 to -2·98, BoS 10·5%, τ2 10·1), -2·71 points in the medium term (-4·63 to -0·78, BoS 33·6%, τ2 11·9), and -3·39 points in the long term (-4·97 to -1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). INTERPRETATION There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. FUNDING Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.
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Affiliation(s)
- Melanie A Holden
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
| | - Miriam Hattle
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jos Runhaar
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Erasmus MC University, Medical Center, Rotterdam, Netherlands
| | - Richard D Riley
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Chartered Society of Physiotherapy, London, UK
| | | | - Krysia Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Danielle Burke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Nadia Corp
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Amardeep Legha
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Nadine E Foster
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Herston, Brisbane, QLD, Australia
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Ochoa M, Yang A, Kollias C, Bakir C, Carsen S, Lazier J, Innes AM, Pagé M, Dawrant J, Robinson ME, Koujok K, Shenouda N, Rauch F, Ward LM. From " ACAN" to "I CAN": Restoring wellness in a boy with severe osteochondritis dissecans through diagnostic precision combined with optimal medical, surgical and rehabilitation management. Bone Rep 2023; 18:101663. [PMID: 36950254 PMCID: PMC10025132 DOI: 10.1016/j.bonr.2023.101663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a disease of the joints characterized by idiopathic focal subchondral lesions. Aggrecan, a proteoglycan encoded by the ACAN gene, is important for cartilage structure and function. We describe the clinical evolution of a patient with short stature, multi-focal OCD, and subchondral osteopenia that appeared linked to a novel pathogenic ACAN variant. A multi-disciplinary approach including medical (bisphosphonate) therapy, surgical intervention and rehabilitation were successful in restoring wellness and physical function.
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Affiliation(s)
- Maria Ochoa
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Endocrinology Unit, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pediatric Genetic and Metabolic Bone Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ashlee Yang
- Department of Pediatrics, Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Carrie Kollias
- Royal Children's Hospital Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Christina Bakir
- Department of Orthopedic Surgery, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Sasha Carsen
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Ottawa, Division of Pediatric Orthopedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanna Lazier
- Department of Medical Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - A. Micheil Innes
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marika Pagé
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatric Genetic and Metabolic Bone Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jonathan Dawrant
- Department of Pediatrics, Division of Endocrinology, University of Calgary, Calgary, Alberta, Canada
| | - Marie-Eve Robinson
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University Of Ottawa, Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatric Genetic and Metabolic Bone Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Khaldoun Koujok
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Medical Imaging, University of Ottawa, Division of Pediatric Radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nazih Shenouda
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Medical Imaging, University of Ottawa, Division of Pediatric Radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Frank Rauch
- Shriners Hospital for Children, McGill University, Montreal, Quebec, Canada
| | - Leanne M. Ward
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University Of Ottawa, Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatric Genetic and Metabolic Bone Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Corresponding author at: Tier 1 Clinical Research Chair in Pediatric Bone Disorders, University of Ottawa and Pediatric Endocrinologist Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario KIH 8L1, Canada.
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Wainwright TW, Parkinson EP, Immins T, Docherty S, Goodwin E, Hawton A, Low M, Samways J, Rees T, Saunders G, Middleton RG. CycLing and EducATion (CLEAT): protocol for a single centre randomised controlled trial of a cycling and education intervention versus standard physiotherapy care for the treatment of hip osteoarthritis. BMC Musculoskelet Disord 2023; 24:344. [PMID: 37138278 PMCID: PMC10155408 DOI: 10.1186/s12891-023-06456-0] [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: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic degenerative joint disorder for which there is no known cure. Non-surgical management for people with mild-to-moderate hip OA focuses mainly on alleviating pain and maximising function via the National Institute for Health and Care Excellence (NICE) recommended combination of education and advice, exercise, and, where appropriate, weight loss. The CHAIN (Cycling against Hip pAIN) intervention is a group cycling and education intervention conceived as a way of implementing the NICE guidance. METHODS CycLing and EducATion (CLEAT) is a pragmatic, two parallel arm, randomised controlled trial comparing CHAIN with standard physiotherapy care for the treatment of mild-to-moderate hip OA. We will recruit 256 participants referred to the local NHS physiotherapy department over a 24-month recruitment period. Participants diagnosed with hip OA according to NICE guidance and meeting the criteria for GP exercise referral will be eligible to participate. Primary outcome is the difference in Hip Disability and Osteoarthritis Outcome Score (HOOS) function, daily living subscale between those receiving CHAIN and standard physiotherapy care. Secondary outcomes include performance-based functional measures (40 m walking, 30s chair stand and stair climb tests), ability for patient to self-care (patient activation measure) and self-reported health-related resource use including primary and secondary care contacts. The primary economic endpoint is the number of quality adjusted life years (QALYs) at 24 weeks follow-up. The study is funded by the National Institute for Health Research, Research for Patient Benefit PB-PG-0816-20033. DISCUSSION The literature identifies a lack of high-quality trials which inform on the content and design of education and exercise in the treatment of patients with hip OA and explore cost-effectiveness. CLEAT is a pragmatic trial which seeks to build further evidence of the clinical benefits of the CHAIN intervention compared to standard physiotherapy care within a randomised, controlled trial setting, and examine its cost-effectiveness. TRIAL REGISTRATION NUMBER ISRCTN19778222. Protocol v4.1, 24th October 2022.
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Affiliation(s)
- Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK.
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.
| | | | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Sharon Docherty
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Elizabeth Goodwin
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Annie Hawton
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration - South West (PenARC), University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Research Design Service South West, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Matthew Low
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Joanna Samways
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Tim Rees
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Geoff Saunders
- University of Southampton Clinical Trials Unit, Southampton, UK
| | - Robert G Middleton
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
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Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e238050. [PMID: 37052919 PMCID: PMC10102876 DOI: 10.1001/jamanetworkopen.2023.8050] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Importance Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results. Objective To evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery. Data Sources Bibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022. Study Selection Randomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included. Data Extraction and Synthesis Two independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Main Outcomes and Measures Pain, function, muscle strength, and health-related quality of life (HRQOL). Results Forty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], -0.70 [95% CI, -1.08 to -0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, -8.20 [95% CI, -8.85 to -7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, -0.51 [95% CI, -0.85 to -0.17]) and at 6 months in those undergoing lumbar surgery (SMD, -2.35 [95% CI, -3.92 to -0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence. Conclusions and Relevance In this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.
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Affiliation(s)
- Anuj Punnoose
- Young Adult Hip Service, Physiotherapy Department, Addenbrooke's-Cambridge University Hospitals NHS (National Health Service) Trust, Cambridge, United Kingdom
- School of Allied Health, Anglia Ruskin University, Chelmsford and Cambridge, United Kingdom
| | | | - Ori Weiss
- Department of Orthopedics, Meir Medical Centre, Kfar-Saba, Israel
| | - Jufen Zhang
- School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's-Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside cluster randomized controlled trial. Braz J Phys Ther 2023; 27:100469. [PMID: 36657217 PMCID: PMC9860430 DOI: 10.1016/j.bjpt.2022.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A stratified approach to exercise therapy may yield superior clinical and economic outcomes, given the large heterogeneity of individuals with knee osteoarthritis (OA). OBJECTIVE To evaluate the cost-effectiveness during a 12-month follow-up of a model of stratified exercise therapy compared to usual exercise therapy in patients with knee OA, from a societal and healthcare perspective. METHODS An economic evaluation was conducted alongside a cluster-randomized controlled trial in patients with knee OA (n = 335), comparing subgroup-specific exercise therapy for a 'high muscle strength subgroup', 'low muscle strength subgroup', and 'obesity subgroup' supplemented by a dietary intervention for the 'obesity subgroup' (experimental group), with usual ('non-stratified') exercise therapy (control group). Clinical outcomes included quality-adjusted life years - QALYs (EuroQol-5D-5 L), knee pain (Numerical Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score in daily living). Costs were measured by self-reported questionnaires at 3, 6, 9 and 12-month follow-up. Missing data were imputed using multiple imputation. Data were analyzed through linear regression. Bootstrapping techniques were applied to estimate statistical uncertainty. RESULTS During 12-month follow-up, there were no significant between-group differences in clinical outcomes. The total societal costs of the experimental group were on average lower compared to the control group (mean [95% confidence interval]: € 405 [-1728, 918]), albeit with a high level of uncertainty. We found a negligible difference in QALYs between groups (mean [95% confidence interval]: 0.006 [-0.011, 0.023]). The probability of stratified exercise therapy being cost-effective compared to usual exercise therapy from the societal perspective was around 73%, regardless of the willingness-to-pay threshold. However, this probability decreased substantially to 50% (willingness-to-pay threshold of €20.000/QALY) when using the healthcare perspective. Similar results were found for knee pain and physical functioning. CONCLUSIONS We found no clear evidence that stratified exercise therapy is likely to be cost-effective compared to usual exercise therapy in patients with knee OA. However, results should be interpreted with caution as the study power was lower than intended, due to the Coronavirus disease (COVID-19) pandemic.
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Duan X, Wei W, Zhou P, Liu X, Yu J, Xu Y, Huang L, Yang S. Effectiveness of aquatic exercise in lower limb osteoarthritis: a meta-analysis of randomized controlled trials. Int J Rehabil Res 2022; 45:126-136. [PMID: 35437296 DOI: 10.1097/mrr.0000000000000527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the short-term and follow-up effectiveness of aquatic training on the health status of lower limb osteoarthritis. Randomized controlled trials (RCTs) on related topics were systematically searched in PubMed, Embase, Web of Science, the Cochrane Library, Physiotherapy Evidence Database (PEDro), the China National Knowledge Infrastructure and Wanfang databases from inception to January 2021. RevMan 5.3 was used for statistical analysis, and the standardized mean difference (SMD) was used to present pooled effect sizes. As a result, 19 RCTs (1592 patients) were included. Compared with unsupervised home exercise or usual care (land-based training excluded), aquatic training showed short-term pain relief (SMD, -0.54; 95% CI, -0.81 to -0.28), physical function improvement (SMD, -0.64; 95% CI, -1.00 to -0.28), stiffness reduction (SMD, -0.40; 95% CI, -0.79 to -0.01) and improved function in sport and recreation (SMD, -0.30; 95% CI, -0.59 to -0.02). Analyses restricted to patients with knee osteoarthritis only also confirmed the positive effects of aquatic training on most dimensions excluding physical function. At medium-term follow-ups, improvements in physical function and function in sport and recreation were observed. No significant difference was observed between arms in the above four outcomes at long-term follow-ups. All studies reported no major adverse event with relation to aquatic training, and the minor adverse events were not common. It is concluded that aquatic training likely has short-term benefits on pain, physical function, stiffness and sport ability in lower limb osteoarthritis patients, but these positive effects may not last long.
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Affiliation(s)
| | - Wei Wei
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | | | - Xi Liu
- Department of Rehabilitation
| | | | - Yang Xu
- Department of Rehabilitation
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Lee CH, Kim IH. Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:589. [PMID: 34201120 PMCID: PMC8229167 DOI: 10.3390/medicina57060589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.
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Affiliation(s)
- Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea;
| | - In-Hye Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
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Mazzei DR, Ademola A, Abbott JH, Sajobi T, Hildebrand K, Marshall DA. Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review. Osteoarthritis Cartilage 2021; 29:456-470. [PMID: 33197558 DOI: 10.1016/j.joca.2020.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/08/2020] [Accepted: 10/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.
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Affiliation(s)
- D R Mazzei
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - A Ademola
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand.
| | - T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - K Hildebrand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Wilson R, Chua J, Briggs AM, Abbott JH. The cost-effectiveness of recommended adjunctive interventions for knee osteoarthritis: Results from a computer simulation model. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100123. [DOI: 10.1016/j.ocarto.2020.100123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
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Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi R, Dures E, Estévez-López F, Gossec L, Iagnocco A, Negrón JB, Nudel M, Marques A, Moholt E, Skrubbeltrang C, Van den Bemt B, Viktil K, Voshaar M, Carmona L, de Thurah A. Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider. RMD Open 2020; 6:e001432. [PMID: 33161377 PMCID: PMC7856118 DOI: 10.1136/rmdopen-2020-001432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs). METHODS An overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews. RESULTS After reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise. CONCLUSIONS The results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V., Bonn, Germany
| | - Razvan Dragoi
- University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- University of the West of England Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - José B Negrón
- Instituto de Investigación Social y Sanitaria, Puerto Rico
| | | | - Andréa Marques
- Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, UICISA-E, Coimbra, Portugal
| | - Ellen Moholt
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
| | | | - Bart Van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Kirsten Viktil
- University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care 2020; 18:575-595. [PMID: 32643252 DOI: 10.1002/msc.1492] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this paper is to revise the 2010 Dutch guideline for physical therapy (PT) in patients with hip or knee osteoarthritis (OA), issued by the Royal Dutch Society for Physical Therapy (KNGF). METHOD This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation (AGREE) and Guidelines International Network (G-I-N) standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers to current care. A narrative or systematic literature review was undertaken in response to each clinical question. The panel formulated recommendations based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS A comprehensive assessment should be based on the International Classification of Functioning Disability and Health (ICF) core set for OA, including the identification of OA-related red flags. Based on the assessment, four treatment profiles were distinguished: (1) education and instructions for unsupervised exercises, (2) education and short-term supervised exercise therapy, (3) education and longer term supervised exercise therapy, and (4) education and exercise therapy before and/or after total hip or knee surgery. Education included individualized information, advice, instructions, and self-management support. Exercise programs were tailored to individual OA-related issues, were adequately dosed, and were in line with public health recommendations for physical activity. Recommended measurement instruments included the Patient-Specific Complaints Instrument, the Numeric Pain Rating Scale, the Hip Disability and Osteoarthritis Outcome Score/the Knee Injury Osteoarthritis Outcome Score, and the Six Minute Walk Test. CONCLUSION An evidence-based PT guideline for the management of patients with hip or knee OA was developed. To improve quality of care for these patients, an extensive implementation strategy is necessary.
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Affiliation(s)
| | - Guus A Meerhoff
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands.,Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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13
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Masiero S, Litwocenko S, Agostini F. Rehabilitation in an Italian thermal setting: a new therapeutic strategy for patients with musculoskeletal disability-the results of an Italian survey. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:951-954. [PMID: 31342242 DOI: 10.1007/s00484-019-01765-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 05/24/2023]
Abstract
Traditionally, in the past, patients with musculoskeletal diseases visit the spa centers (Salus per aquam) for traditional treatments, including mud therapy, or for holiday. Spas have begun to offer, as the only means of treatment, rehabilitation therapy for patients with musculoskeletal disabilities alone or in association with other traditional thermal therapies. The purpose of this paper is to describe the results of a recent survey on Italian thermal centers conducted by a section of "Rehabilitation in the Thermal Environment" of the Italian Society of Physical Medicine and Rehabilitation. The study investigated the current diffusion, type, and overall quality of rehabilitation treatments performed at the Italian spas. The survey requested information from 174 centers, but only 132 responded by returning the completed questionnaire. Eighty-nine percent of the centers offered rehabilitation therapy for orthopedic-rheumatological diseases, including post-operative conditions (after hip or knee replacement), 37% offered rehabilitation therapy for neurological diseases and 10% rehabilitation for lymph-vascular conditions. Seventy-one percent employed a multidisciplinary team (which included a physiatrist, a physiotherapist, and other figures such as a hydrologist or rheumatologist). The rehabilitative approach generally included therapeutic exercises (land or aquatic therapies), instrumental physical therapies (ultrasounds, electrotherapy, LASER-therapy, and others), and, less frequently, health education and preventive measures. The survey did not investigate respiratory or nasopharyngeal diseases. In conclusion, the results of this survey suggest that rehabilitation, performed in the thermal environment, could be a new opportunity to treat many musculoskeletal disabilities.
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Affiliation(s)
- Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, General Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Svetlana Litwocenko
- Rehabilitation Unit, Department of Neuroscience, General Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
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14
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Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports Med 2020; 49:743-761. [PMID: 30830561 PMCID: PMC6459784 DOI: 10.1007/s40279-019-01082-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations. Objectives The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks. Methods We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865). Findings We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65). Conclusion The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation. Electronic supplementary material The online version of this article (10.1007/s40279-019-01082-0) contains supplementary material, which is available to authorized users.
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15
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Sahin HG, Kunduracilar Z, Sonmezer E, Ayas S. Effects of two different aquatic exercise trainings on cardiopulmonary endurance and emotional status in patients with knee osteoarthritis. J Back Musculoskelet Rehabil 2019; 32:539-548. [PMID: 30584113 DOI: 10.3233/bmr-171116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aquatic exercises are often recommended for people with osteoarthritis (OA), however, there is a lack of evidence about the effects of these exercises. OBJECTIVES The purpose of this study was to investigate the effects of two different aquatic exercise trainings on cardiopulmonary endurance and emotional status in patients with knee osteoarthritis. METHODS Eighty-nine patients who had been diagnosed with knee osteoarthritis were divided into three groups as two different aquatic exercise training groups (only lower extremity training vs. lower extremity + upper extremity and trunk exercises) or the control group. All groups have received the conventional therapy which consisted of hotpack, ultrasound, transcutaneous electrical nerve stimulation (TENS), and home exercises. Six-minute walk test (6MWT) and the Hospital Anxiety and Depression Scale (HAD) were used for assessing cardiopulmonary endurance and emotional status, respectively. RESULTS Following the treatment, all groups improved in terms of systolic blood pressure, walking distance and total HAD scores. Group 1 showed additional improvements in diastolic blood pressure, heart rate and perceived exertion, while Group 2 showed additional improvements only in perceived exertion. Greater changes before and after the treatment in diastolic blood pressure at rest and following 6MWT, perceived exertion following 6MWT, walking distance, HAD depression scores and HAD anxiety scores were observed in Group 1. CONCLUSIONS Exercise therapy consisting of only lower extremity exercises in water might be more effective in improving exercise capacity and depression levels in comparison to upper extremity and trunk added exercises or conventional physical therapy.
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Affiliation(s)
| | - Zuhal Kunduracilar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bulent Ecevit University, Zonguldak, Turkey
| | - Emel Sonmezer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| | - Sehri Ayas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
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16
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Xie G, Wang T, Jiang B, Su Y, Tang X, Guo Y, Liao J. Effects of hydrokinesitherapy on balance and walking ability in stroke survivors: a systematic review and meta-analysis of randomized controlled studies. Eur Rev Aging Phys Act 2019; 16:21. [PMID: 31754406 PMCID: PMC6854709 DOI: 10.1186/s11556-019-0227-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balance and walking impairment are common dysfunctions after stroke. Emerging data has demonstrated that hydrokinesitherapy may have a positive influence on improvement of balance and walking ability. However, there is no firm evidence to support these results. Therefore, the aim of this review is to evaluate the effects of hydrokinesitherapy in stroke survivors systematically. METHODS Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL and SPORTDiscus were systemic searched from their inception to Septemter 30, 2018. RevMan 5.3 software was used to perform data synthesis. The fixed-effect model or random-effect model was employed according to the results of heterogeneity test. The mean differences (MD) or standardized mean difference (SMD) was used to evaluate the pooled effect of hydrokinesitherapy on balance function, walking ability and activty of daily life (ADL). RESULTS A total of 13 studies were included involving 381 stroke survivors. Meta-analysis results indicated that hydrokinesitherapy could improve balance ability based on three test: Berg balance scale (BBS: MD = 3.84, 95% confidence interval (95% CI) 2.84 to 4.86, P < 0.001), Time Up To Go Test (TUGT: MD = - 1.22, 95% CI - 2.25 to - 0.18, P = 0.02, fixed-effect model), Functional Reach Test (FRT: MD = 2.41, 95% CI 1.49 to 3.33, P < 0.001). Additionally, we found a weakly positive effect on walking speed (SMD = 0.75, 95% CI 0.26 to 1.25, P = 0.003) and walking ability test (SMD = 0.36, 95% CI 0.04 to 0.68, P = 0.03). There was no significant difference between experimental group and control group in terms of ADL. SHORT CONCLUSION Hydrokinesitherapy can improve balance function and had a weakly positive effect on walking ability in stroke survivors. We did not find sufficient evidence to indicate that hydrokinesitherapy could improve the ADL of stroke survivors. However, due to the methodological shortcoming and small number of included studies, caution is needed when interpreting these results. Due to imprecision and publication bias, the quality of the evidence was downgraded to "low-quality" for the primary outcomes of balance and walking ability. TRIAL REGISTRATION CRD42018110787.
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Affiliation(s)
- Guanli Xie
- Yunnan University of Chinese Medicine, Kunming, Yunnan China
| | - Tao Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine, 2628 Xianyuan Road, Cheng Gong District, Kunming, 650500 Yunnan China
| | - Bo Jiang
- Kunming Municipal Hospital of Traditional Chinese Medicine and the Jiang Bo Famous Medical Studio, Kunming, Yunnan China
| | - Yan Su
- Kunming Municipal Hospital of Traditional Chinese Medicine, 2628 Xianyuan Road, Cheng Gong District, Kunming, 650500 Yunnan China
| | - Xiaoxia Tang
- Kunming Municipal Hospital of Traditional Chinese Medicine, 2628 Xianyuan Road, Cheng Gong District, Kunming, 650500 Yunnan China
| | - Ying Guo
- Kunming Municipal Hospital of Traditional Chinese Medicine, 2628 Xianyuan Road, Cheng Gong District, Kunming, 650500 Yunnan China
| | - Jianglong Liao
- Kunming Combination of Chinese and Western Medicine Minimally Invasive Spine Technology Center, Kunming, Yunnan China
- Kunming Municipal Hospital of Traditional Chinese Medicine, 223 Guanxing Road, Guan Du District, Kunming, 650200 Yunnan China
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Shahabi S, Rezapour A, Arabloo J. Economic evaluations of physical rehabilitation interventions in older adults with hip and/or knee osteoarthritis: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1672785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Saeed Shahabi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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18
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Fenocchi L, Riskowski JL, Mason H, Hendry GJ. A systematic review of economic evaluations of conservative treatments for chronic lower extremity musculoskeletal complaints. Rheumatol Adv Pract 2019; 2:rky030. [PMID: 31431975 PMCID: PMC6649923 DOI: 10.1093/rap/rky030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/19/2018] [Indexed: 11/12/2022] Open
Abstract
Objective The aim was to appraise and synthesize studies evaluating the clinical and cost effectiveness of conservative interventions for chronic lower extremity musculoskeletal (MSK) conditions and describe their characteristics, including the type of economic evaluation, primary outcomes and which conditions. Methods The search strategy related to economic evaluations of lower limb MSK conditions that used conservative therapies. Eight electronic databases were searched (CENTRAL, MEDLINE, PubMed, EMBASE, CINAHL, PEDro, NHSEED and Proquest), as were the reference lists from included articles. The quality of articles was appraised using a modified version of the economic evaluations’ reporting checklist (economic) and The Cochrane Collaboration’s tool for assessing risk of bias (clinical). Results Twenty-six studies were eligible and included in the review. Economic evaluations of conservative interventions for OA or pain affecting the knee/hip (n = 25; 93%) were most common. The main approaches adopted were cost–utility analysis (n = 17; 68%) or cost–effectiveness analysis (n = 5; 19%). Two studies involved interventions including footwear/foot orthoses; for heel pain (n = 1; 4%) and overuse injuries (n = 1; 4%). Fifty per cent of economic evaluations adopted the EQ-5D-3L as the primary outcome measure for quality of life and quality-adjusted life year calculations. Conclusion Economic evaluations have been conducted largely for exercise-based interventions for MSK conditions of the hip and knee. Few economic evaluations have been conducted for other clinically important lower limb MSK conditions. A matrix presentation of costs mapped with outcomes indicated increasing costs with either no difference or improvements in clinical effectiveness. The majority of economic evaluations were of good reporting quality, as were the accompanying clinical studies.
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Affiliation(s)
- Linda Fenocchi
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University.,Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
| | - Jody L Riskowski
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University
| | - Helen Mason
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
| | - Gordon J Hendry
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University
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19
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Teng M, Zhou HJ, Lin L, Lim PH, Yeo D, Goh S, Tjan SY, Lim BP. Cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders in Singapore. J Public Health (Oxf) 2019. [PMID: 29534234 DOI: 10.1093/pubmed/fdy044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study evaluated the cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders (MSDs) in Singapore. METHODS A decision-analytic model was constructed to compare the cost-effectiveness of hydrotherapy to land-based therapy over 3 months from societal perspective. Target population comprised patients with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), total hip replacement (THR) and total knee replacement (TKR). Subgroup analyses were carried out to determine the cost-effectiveness of hydrotherapy in individual MSDs. Relative treatment effects were obtained through a systematic review of published data. RESULTS Compared to land-based therapy, hydrotherapy was associated with an incremental cost-effectiveness ratio (ICER) of SGD 27 471 per quality-adjusted life-year (QALY) gained, which was below the willingness-to-pay threshold of SGD 70 000 per QALY (one gross domestic product per capita in Singapore in 2015). For the respective MSDs, hydrotherapy were dominant (more effective and less costly) in THR and TKR, cost-effective for LBP and RA, and not cost-effective for OA. Treatment adherence and cost of hydrotherapy were key drivers to the ICER values. CONCLUSIONS Hydrotherapy was a cost-effective rehabilitation compared to land-based therapy for a population with MSDs in Singapore. However, the benefit of hydrotherapy was not observed in patients with OA.
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Affiliation(s)
- Monica Teng
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, Singapore, Singapore
| | - Hui Jun Zhou
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, Singapore, Singapore
| | - Liang Lin
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, Singapore, Singapore
| | - Pang Hung Lim
- Rehabilitation Centre Allied Health Services, Tan Tock Seng Hospital, Singapore
| | - Doreen Yeo
- Rehabilitation Centre Allied Health Services, Tan Tock Seng Hospital, Singapore
| | - Suzanne Goh
- Allied Health Services and Pharmacy Operations Division, Tan Tock Seng Hospital, Singapore
| | - Soon Yin Tjan
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, Singapore, Singapore
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Abbott JH, Wilson R, Pinto D, Chapple CM, Wright AA. Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis Cartilage 2019; 27:424-434. [PMID: 30553932 DOI: 10.1016/j.joca.2018.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the clinical- and cost-effectiveness at 2-year follow-up of providing individual, supervised exercise physiotherapy and/or manual physiotherapy in addition to usual medical care. METHOD People with hip or knee osteoarthritis meeting the American College of Rheumatology clinical diagnostic criteria were randomised (1:1, concealed, assessor-blinded) to four groups: usual medical care; supervised exercise physiotherapy; manual physiotherapy; or combined exercise and manual physiotherapy. Physiotherapy group participants were provided 10 50-min treatment sessions including booster sessions at 4 and 13 months, in addition to usual care. The primary outcome at 2-year follow-up was incremental cost-utility ratio (ICUR) of each physiotherapy intervention in addition to usual care, compared with usual care alone, from the health system and societal perspectives. To allow interpretation of negative ICURs, we report incremental net benefit (INB). The primary clinical outcome was the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS Of 206 patients, 186 (90·3%) were retained at 2-year follow-up. Exercise physiotherapy and manual physiotherapy dominated usual care, demonstrating cost savings; combined therapy did not. Exercise therapy had the highest incremental net benefits (INBs), statistically significant at all willingness-to-pay (base-case: societal New Zealand (NZ)$6,312, 95%CI 334 to 12,279; health system NZ$8,065, 95%CI 136 to 15,994). Clinical improvements were superior to usual care only in the exercise physiotherapy group (-28.2 WOMAC points, 95%CI -49.2 to -7.1). No serious adverse events were recorded. CONCLUSION Individually supervised exercise therapy is cost-effective and clinically effective in addition to usual medical care at 2-year follow-up, and leads to cost savings for the health system and society. TRIAL REGISTRATION Prospectively registered with the Australian NZ Clinical Trials Registry, reference ACTRN12608000130369.
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Affiliation(s)
- J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - R Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - D Pinto
- College of Health Sciences, Program in Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - C M Chapple
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, 9054, New Zealand.
| | - A A Wright
- Department of Physical Therapy, High Point University, High Point, NC, USA.
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Polaski AM, Phelps AL, Kostek MC, Szucs KA, Kolber BJ. Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain. PLoS One 2019; 14:e0210418. [PMID: 30625201 PMCID: PMC6326521 DOI: 10.1371/journal.pone.0210418] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Increasing evidence purports exercise as a first-line therapeutic for the treatment of nearly all forms of chronic pain. However, knowledge of efficacious dosing respective to treatment modality and pain condition is virtually absent in the literature. The purpose of this analysis was to calculate the extent to which exercise treatment shows dose-dependent effects similar to what is seen with pharmacological treatments. METHODS A recently published comprehensive review of exercise and physical activity for chronic pain in adults was identified in May 2017. This report reviewed different physical activity and exercise interventions and their effectiveness in reducing pain severity and found overall modest effects of exercise in the treatment of pain. We analyzed this existing data set, focusing specifically on the dose of exercise intervention in these studies. We re-analyzed data from 75 studies looking at benefits of time of exercising per week, frequency of exercise per week, duration of intervention (in weeks), and estimated intensity of exercise. RESULTS Analysis revealed a significant positive correlation with exercise duration and analgesic effect on neck pain. Multiple linear regression modeling of these data predicted that increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients. DISCUSSION Modest effects were observed with one significant correlation between duration and pain effect for neck pain. Overall, these results provide insufficient evidence to conclude the presence of a strong dose effect of exercise in pain, but our modeling data provide tes predictions that can be used to design future studies to explicitly test the question of dose in specific patient populations.
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Affiliation(s)
- Anna M. Polaski
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Amy L. Phelps
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Palumbo Donahue School of Business, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Matthew C. Kostek
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Kimberly A. Szucs
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Department of Occupational Therapy, Duquesne University, Pittsburgh, Pennsylvania, United States of America
| | - Benedict J. Kolber
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, United States of America
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, United States of America
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22
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Bartholdy C, Nielsen SM, Warming S, Hunter DJ, Christensen R, Henriksen M. Poor replicability of recommended exercise interventions for knee osteoarthritis: a descriptive analysis of evidence informing current guidelines and recommendations. Osteoarthritis Cartilage 2019; 27:3-22. [PMID: 30248500 DOI: 10.1016/j.joca.2018.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/28/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the reporting completeness of exercise-based interventions for knee osteoarthritis (OA) in studies that form the basis of current clinical guidelines, and examine if the clinical benefit (pain and disability) from exercise is associated with the intervention reporting completeness. DESIGN Review of clinical OA guidelines METHODS: We searched MEDLINE and EMBASE for guidelines published between 2006 and 2016 including recommendations about exercise for knee OA. The studies used to inform a recommendation were reviewed for exercise reporting completeness. Reporting completeness was evaluated using a 12-item checklist; a combination of the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT). Each item was scored 'YES' or 'NO' and summarized as a proportion of interventions with complete descriptions and each intervention's completeness was summarized as the percentage of completely described items. The association between intervention description completeness score and clinical benefits was analyzed with a multilevel meta-regression. RESULTS From 10 clinical guidelines, we identified 103 original studies of which 100 were retrievable (including 133 interventions with 6,926 patients). No interventions were completely described on all 12 items (median 33% of items complete; range 17-75%). The meta-regression analysis indicated that poorer reporting was associated with greater effects on pain and no association with effects on disability. CONCLUSION The inadequate description of recommended interventions for knee OA is a serious problem that precludes replication of effective interventions in clinical practice. By consequence, the relevance and usability of clinical guideline documents and original study reports are diminished. PROSPERO CRD42016039742.
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Affiliation(s)
- C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - S M Nielsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.
| | - S Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
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Kigozi J, Jowett S, Nicholls E, Tooth S, Hay EM, Foster NE. Cost-utility analysis of interventions to improve effectiveness of exercise therapy for adults with knee osteoarthritis: the BEEP trial. Rheumatol Adv Pract 2018; 2:rky018. [PMID: 30506022 PMCID: PMC6251481 DOI: 10.1093/rap/rky018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives Evidence regarding the cost-effectiveness of enhancing physical therapy exercise programmes in order to improve outcomes for patients with knee OA remains unclear. This study investigates the cost-effectiveness of two enhanced physical therapy interventions compared with usual physical therapy care (UC) for adults with knee OA. Methods A trial-based cost–utility analysis of individually tailored exercise (ITE) or targeted exercise adherence (TEA) compared with UC was undertaken over a period of 18 months. Patient-level costs were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a base-case UK health-care perspective. Results The UC group was associated with lower National Health Service (NHS) costs [ITE-UC: £273.30, 95% CI: £−62.10 to £562.60; TEA-UC: £141.80, 95% CI: £−135.60 to £408.10)] and slightly higher QALY gains (ITE-UC: −0.015, 95% CI: −0.057 to 0.026; TEA-UC: −0.003, 95% CI: −0.045 to 0.038). In the base case, UC was the most likely cost-effective option (probability <40% of ITE or TEA cost-effective at £20 000/QALY). Differences in total costs were attributable to intervention costs, number of visits to NHS consultants and knee surgery, which were higher in both ITE and TEA groups. Conclusion This is the first economic evaluation comparing usual physical therapy care vs enhanced exercise interventions for knee OA that involves greater exercise individualization, supervision and progression or that focuses on exercise and physical activity adherence over the longer term. Our findings show that UC is likely to be the most cost-effective option. Trial registration Current Controlled Trials ISRCTN 93634563. Trial protocol Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at http://www.biomedcentral.com/1471-2474/15/254 doi: 10.1186/1471-2474-15-254
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Affiliation(s)
- Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Stephanie Tooth
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
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Wang X, Guo T, Wang T, Jiang B, Su Y, Tang X, Liao J, Xie G. Effect of hydrokinesitherapy on balance and walking ability in post-stroke patients: A systematic review protocol. Medicine (Baltimore) 2018; 97:e13763. [PMID: 30572525 PMCID: PMC6320127 DOI: 10.1097/md.0000000000013763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Brain stroke is the second most common cause of death and major cause of disability in adults, representing a huge burden on patients and their families. Hydrokinesitherapy, a type of physical rehabilitation, may be beneficial to post-stroke recovery. We will systematically assess the clinical effectiveness and safety of hydrokinesitherapy for rehabilitation of stroke survivors in this review. METHODS We will perform a systematic search to identify all potentially relevant published studies on this topic. Online electronic databases including MEDLINE (via PubMed), EMBASE (via embase.com), Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL (via EBSCOhost) and SPORTDiscus (via EBSCOhost) will be searched without language restrictions from their inception to September 30, 2018. All relevant randomized controlled trails (RCTs) will be screened according to predetermined inclusion criteria. Two independent reviewers will evaluate the methodological quality of each study included. One reviewer will extract data and another reviewer will check the accuracy. Any disagreements will be discussed with a third reviewer. The posture balance and walking ability will be defined as primary outcomes. Activities of daily living (ADL), drop-out and adverse events will also be assessed as secondary outcomes. The evaluation of methodological quality, data analysis will be completed using Cochrane Review Manager 5.3 according to Cochrane Handbook for Systematic Reviews of Interventions. TRIAL REGISTRATION NUMBER CRD42018110787.
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Affiliation(s)
- Xin Wang
- The Geriatitcs Hospital of Yunnan Province
| | - Taipin Guo
- College of Rehabilitation Medicine, Yunnan University of Traditional Chinese Medicine
| | - Tao Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine
| | - Bo Jiang
- Kunming Municipal Hospital of Traditional Chinese Medicine, and The Jiang Bo Famous Medical Studio
| | - Yan Su
- Kunming Municipal Hospital of Traditional Chinese Medicine
| | - Xiaoxia Tang
- Kunming Municipal Hospital of Traditional Chinese Medicine
| | - Jianglong Liao
- Kunming Municipal Hospital of Traditional Chinese Medicine, and Kunming Combination of Chinese and Western Medicine Minimally Invasive Spine Technology Center
| | - Guanli Xie
- College of Rehabilitation Medicine, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
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Deidda M, Coll-Planas L, Giné-Garriga M, Guerra-Balic M, Roqué i Figuls M, Tully MA, Caserotti P, Rothenbacher D, Salvà Casanovas A, Kee F, Blackburn NE, Wilson JJ, Skjødt M, Denkinger M, Wirth K, McIntosh E. Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ Open 2018; 8:e022266. [PMID: 30327403 PMCID: PMC6194476 DOI: 10.1136/bmjopen-2018-022266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Promoting physical activity (PA) and reducing sedentary behaviour (SB) may exert beneficial effects on the older adult population, improving behavioural, functional, health and psychosocial outcomes in addition to reducing health, social care and personal costs. This paper describes the planned economic evaluation of SITLESS, a multicountry three-armed pragmatic randomised controlled trial (RCT) which aims to assess the short-term and long-term effectiveness and cost-effectiveness of a complex intervention on SB and PA in community-dwelling older adults, based on exercise referral schemes enhanced by a group intervention providing self-management strategies to encourage lifestyle change. METHODS AND ANALYSIS A within-trial economic evaluation and long-term model from both a National Health Service/personal social services perspective and a broader societal perspective will be undertaken alongside the SITLESS multinational RCT. Healthcare costs (hospitalisations, accident and emergency visits, appointment with health professionals) and social care costs (eg, community care) will be included in the economic evaluation. For the cost-utility analysis, quality-adjusted life-years will be measured using the EQ-5D-5L and capability well-being measured using the ICEpop CAPability measure for Older people (ICECAP-O) questionnaire. Other effectiveness outcomes (health related, behavioural, functional) will be incorporated into a cost-effectiveness analysis and cost-consequence analysis.The multinational nature of this RCT implies a hierarchical structure of the data and unobserved heterogeneity between clusters that needs to be adequately modelled with appropriate statistical and econometric techniques. In addition, a long-term population health economic model will be developed and will synthesise and extrapolate within-trial data with additional data extracted from the literature linking PA and SB outcomes with longer term health states.Methods guidance for population health economic evaluation will be adopted including the use of a long-time horizon, 1.5% discount rate for costs and benefits, cost consequence analysis framework and a multisector perspective. ETHICS AND DISSEMINATION The study design was approved by the ethics and research committee of each intervention site: the Ethics and Research Committee of Ramon Llull University (reference number: 1314001P) (Fundació Blanquerna, Spain), the Regional Committees on Health Research Ethics for Southern Denmark (reference number: S-20150186) (University of Southern Denmark, Denmark), Office for Research Ethics Committees in Northern Ireland (ORECNI reference number: 16/NI/0185) (Queen's University of Belfast) and the Ethical Review Board of Ulm University (reference number: 354/15) (Ulm, Germany). Participation is voluntary and all participants will be asked to sign informed consent before the start of the study.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634 270. This article reflects only the authors' view and the Commission is not responsible for any use that may be made of the information it contains.The findings of the study will be disseminated to different target groups (academia, policymakers, end users) through different means following the national ethical guidelines and the dissemination regulation of the Horizon 2020 funding agency.Use of the EuroQol was registered with the EuroQol Group in 2016.Use of the ICECAP-O was registered with the University of Birmingham in March 2017. TRIAL REGISTRATION NUMBER NCT02629666; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
| | - Laura Coll-Planas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Míriam Guerra-Balic
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Marta Roqué i Figuls
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Mark A Tully
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | | | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Frank Kee
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nicole E Blackburn
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Jason J Wilson
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mathias Skjødt
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Katharina Wirth
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
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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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Effects of aquatic exercise and land-based exercise on postural sway in elderly with knee osteoarthritis. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: Knee Osteoarthritis (knee OA) is the most common joint disease in the elderly. It is a major cause of walking disability and balance impairment. The balance impairment or increase postural sway may result in increased risk of fall. Objectives: Compare effects of aquatic exercise and land-based exercise on postural sway and physical performance (pain, quality of life, leg muscle strength and leg muscle flexibility) in the elderly with knee OA. Subjects and methods: Fifty elderly women with knee OA were recruited for this study. They were randomized into aquatic exercise (n=25) and land-based exercise group (n=25). Postural sway views by anterior-posterior amplitude, medio-lateral amplitude, and total area were measured in subjects with eye opened or closed during double and single leg stance after six-week training, using the Force platform. Functional outcome was tested by the modified WOMAC. Knee injury and Osteoarthritis Outcome Score (KOOS), and pain scale were tested by Visual Analog Scale (VAS). Leg muscle strength was measured by chair stand, and leg muscle flexibility was measured by sit-andreach test. Aquatic group exercised at King Chulalongkorn Memorial Hospital therapeutic pool, while landbased group exercised at home. Results: In comparing postural sway before and after exercise, reduction in postural sway and pain, and increase in strength, the aquatic group were significantly better than those for land-based group (p <0.05). WOMAC, KOOS scores, and sit-and-reach test after six-weeks training were improved after exercise, but these were not significantly different between groups (p >0.05). Conclusion: Elderly patients with knee OA need exercise to improve balance and reduce sway. Six-week aquatic exercise was better than land-based exercise in sway reduction.
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Kunduracilar Z, Guvenir Sahin H, Sonmezer E, Sozay S. The effects of two different water exercise trainings on pain, functional status and balance in patients with knee osteoarthritis. Complement Ther Clin Pract 2018; 31:374-378. [PMID: 29475802 DOI: 10.1016/j.ctcp.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/10/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
METHODS Eighty-nine female patients who had been diagnosed with knee osteoarthritis were divided into three groups as two experimental and a control group. All groups have received the standard therapy (hotpack, ultrasound, TENS). Both experimental groups underwent water exercise program. While Group 1 performed lower extremity exercise training, Group 2 performed upper extremity exercises as well as trunk exercises in addition to the lower extremity exercises used in the Group 1. The third group was control group who did not receive water exercise treatment. The pain severity was measured with the Visual Analog Scale (VAS). Functional status was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Balance was evaluated by using the single leg stance test. RESULTS The change in VAS scores from pre-to post-treatment was highest in Group 1 (p < 0.001). On the other hand, the change in WOMAC pain, stiffness and physical function values from pre-to post-treatment was highest in Group 2 (p < 0.001). DISCUSSION Water exercise training was found to be beneficial in the treatment of knee osteoarthritis in both groups. Moreover, adding upper extremity and trunk exercises to the lower extremity exercises was found to be more effective for improving the function.
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Affiliation(s)
- Zuhal Kunduracilar
- Bulent Ecevit University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Zonguldak, Turkey.
| | | | - Emel Sonmezer
- Baskent University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Seyhan Sozay
- Baskent University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey.
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Raftery J, Hanney S, Greenhalgh T, Glover M, Blatch-Jones A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme. Health Technol Assess 2018; 20:1-254. [PMID: 27767013 DOI: 10.3310/hta20760] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme. DATA SOURCES We searched databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and The Cochrane Library from January 2005 to August 2014. REVIEW METHODS This narrative systematic literature review comprised an update, extension and analysis/discussion. We systematically searched eight databases, supplemented by personal knowledge, in August 2014 through to March 2015. RESULTS The literature on impact assessment has much expanded. The Payback Framework, with adaptations, remains the most widely used approach. It draws on different philosophical traditions, enhancing an underlying logic model with an interpretative case study element and attention to context. Besides the logic model, other ideal type approaches included constructionist, realist, critical and performative. Most models in practice drew pragmatically on elements of several ideal types. Monetisation of impact, an increasingly popular approach, shows a high return from research but relies heavily on assumptions about the extent to which health gains depend on research. Despite usually requiring systematic reviews before funding trials, the HTA programme does not routinely examine the impact of those trials on subsequent systematic reviews. The York/Patient-Centered Outcomes Research Institute and the Grading of Recommendations Assessment, Development and Evaluation toolkits provide ways of assessing such impact, but need to be evaluated. The literature, as reviewed here, provides very few instances of a randomised trial playing a major role in stopping the use of a new technology. The few trials funded by the HTA programme that may have played such a role were outliers. DISCUSSION The findings of this review support the continued use of the Payback Framework by the HTA programme. Changes in the structure of the NHS, the development of NHS England and changes in the National Institute for Health and Care Excellence's remit pose new challenges for identifying and meeting current and future research needs. Future assessments of the impact of the HTA programme will have to take account of wider changes, especially as the Research Excellence Framework (REF), which assesses the quality of universities' research, seems likely to continue to rely on case studies to measure impact. The HTA programme should consider how the format and selection of case studies might be improved to aid more systematic assessment. The selection of case studies, such as in the REF, but also more generally, tends to be biased towards high-impact rather than low-impact stories. Experience for other industries indicate that much can be learnt from the latter. The adoption of researchfish® (researchfish Ltd, Cambridge, UK) by most major UK research funders has implications for future assessments of impact. Although the routine capture of indexed research publications has merit, the degree to which researchfish will succeed in collecting other, non-indexed outputs and activities remains to be established. LIMITATIONS There were limitations in how far we could address challenges that faced us as we extended the focus beyond that of the 2007 review, and well beyond a narrow focus just on the HTA programme. CONCLUSIONS Research funders can benefit from continuing to monitor and evaluate the impacts of the studies they fund. They should also review the contribution of case studies and expand work on linking trials to meta-analyses and to guidelines. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Steve Hanney
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Glover
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Amanda Blatch-Jones
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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David GB, Andrade LS, Schaun GZ, Alberton CL. HR, V̇o 2, and RPE Relationships in an Aquatic Incremental Maximum Test Performed by Young Women. J Strength Cond Res 2017; 31:2852-2858. [DOI: 10.1519/jsc.0000000000001719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther 2017; 21:449-456. [PMID: 28733093 PMCID: PMC5693429 DOI: 10.1016/j.bjpt.2017.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 12/04/2022] Open
Abstract
Elderly women with knee osteoarthritis are at risk of developing limitations physical. Hidrotherapy improves pain, function, muscle power and strength in older women with knee osteoarthritis. Hydrotherapy is likely to be an effective treatment option for these patients.
Background Currently, there is poor evidence of the effect of hydrotherapy alone on patients with hip or knee osteoarthritis. Objectives The study aimed to assess the impact of hydrotherapy on pain, function, and muscle function in older women with knee osteoarthritis. Methods A randomized controlled trial was conducted to evaluate the efficacy of hydrotherapy in women with knee osteoarthritis. Seventy-three women aged 65 and older were randomized to hydrotherapy (n = 36) or a control group (n = 37). The hydrotherapy group received the intervention program in a heated pool (twice per week for six weeks) and an educational protocol while the control group received an educational protocol only. Primary outcomes (before and post-treatment) were pain intensity (0–100) and function (0–100), assessed with the WOMAC questionnaire. Secondary outcomes (before and post-treatment) were knee extensor and knee flexor muscle performance (strength, power, and endurance), assessed by an isokinetic dynamometer. The magnitude of change between the groups for the outcomes was calculated using linear regression models adjusted by baseline outcome values. Results The hydrotherapy group had better outcomes for pain (adjusted mean difference = 11 points, 95% CI: 3–18) and function (adjusted mean difference = 12 points, 95% CI: 5–18). Patients receiving hydrotherapy had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance. Conclusion Older women with knee osteoarthritis are likely to have benefits from a course of hydrotherapy exercises. Registry of clinical trials (Trial number RBR-8F57KR) – http://www.ensaiosclinicos.gov.br/rg/RBR-8f57kr/.
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Tsujimoto T, Ikemoto T, Kurisuno M, Akao M, Miyagawa H, Inoue M, Arai YCP, Ushida T, Deie M. Effects of regular water- and land-based exercise on physical function after 5 years: A long-term study on the well-being of older Japanese adults. Geriatr Gerontol Int 2017; 17:2116-2123. [DOI: 10.1111/ggi.13045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/24/2017] [Accepted: 02/20/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Tomoya Tsujimoto
- Department of Orthopedic Surgery; Aichi Medical University; Nagakute Japan
| | - Tatsunori Ikemoto
- Institute of Physical Fitness, Sports Medicine and Rehabilitation; Aichi Medical University; Nagakute Japan
- Sports Medical Science Center; Aichi Medical University; Nagakute Japan
| | - Makoto Kurisuno
- Department of Orthopedic Surgery; Aichi Medical University; Nagakute Japan
| | - Machiko Akao
- Department of Orthopedic Surgery; Aichi Medical University; Nagakute Japan
- Sports Medical Science Center; Aichi Medical University; Nagakute Japan
| | - Hirofumi Miyagawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation; Aichi Medical University; Nagakute Japan
- Sports Medical Science Center; Aichi Medical University; Nagakute Japan
| | - Msayuki Inoue
- Institute of Physical Fitness, Sports Medicine and Rehabilitation; Aichi Medical University; Nagakute Japan
| | - Young-Chang P. Arai
- Institute of Physical Fitness, Sports Medicine and Rehabilitation; Aichi Medical University; Nagakute Japan
| | - Takahiro Ushida
- Institute of Physical Fitness, Sports Medicine and Rehabilitation; Aichi Medical University; Nagakute Japan
| | - Masataka Deie
- Department of Orthopedic Surgery; Aichi Medical University; Nagakute Japan
- Sports Medical Science Center; Aichi Medical University; Nagakute Japan
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McIlroy S, Sayliss L, Browning P, Bearne LM. Aquatic therapy for people with persistent knee pain: A feasibility study. Musculoskeletal Care 2017; 15:350-355. [PMID: 28101996 DOI: 10.1002/msc.1179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fernandes L, Roos EM, Overgaard S, Villadsen A, Søgaard R. Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial. BMC Musculoskelet Disord 2017; 18:5. [PMID: 28061841 PMCID: PMC5217578 DOI: 10.1186/s12891-016-1369-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022] Open
Abstract
Background There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery. Methods The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied. Results HOOS/KOOS quality of life [8.25 (95% CI, 0.42 to 16.10)] and QALYs [0.04 (95% CI, 0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of €326 per patient, there was no difference in total cost between groups [€132 (95% CI −3942 to 3679)]. At a threshold of €40,000, preoperative exercise was found to be cost effective at 84% probability. Conclusion Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group, but only statistically significant for quality of life measures. Trial registration ClinicalTrials.gov (NCT01003756) October 28, 2009.
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Affiliation(s)
- Linda Fernandes
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark. .,Department of Rehabilitation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Allan Villadsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Heywood S, McClelland J, Mentiplay B, Geigle P, Rahmann A, Clark R. Effectiveness of Aquatic Exercise in Improving Lower Limb Strength in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:173-186. [DOI: 10.1016/j.apmr.2016.08.472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/28/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
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Enblom A, Wicher M, Nordell T. Health-related quality of life and musculoskeletal function in patients with musculoskeletal disorders: after compared to before short-term group-based aqua-exercises. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016; 18:218-225. [PMID: 28251037 PMCID: PMC5309865 DOI: 10.1080/21679169.2016.1181208] [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] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/03/2016] [Indexed: 01/15/2023]
Abstract
This study assessed health-related quality of life (HRQoL) and musculoskeletal function in patients with musculoskeletal disorders after participation in group-based aqua-exercising, compared to before participation. Physiotherapists instructed group-based aqua-exercising for 30 min twice a week for 8 weeks in 39 patients (81% women, mean age 55 ± 12 years), with musculoskeletal disorders located in the back (28%), neck (17%), general myalgia (21%), lower extremities (9%), shoulder (7%) and multiple/other regions (18%). Before and after the aqua-exercising, physiotherapists assessed patients’ musculoskeletal function categorized using Goal Attainment Scaling, and HRQoL was measured using EuroQol 5 Dimensions (EQ-5D). The median EQ-5D score was 0.36 (25th–75th percentiles 0.09–0.69) at the start, and after the intervention improved to 0.62 (0.09–0.73) (p = 0.038). The EQ-5D score and musculoskeletal function improved in 49% (EQ-5D) and 34% (physiotherapist assessment), were stable in 33% and 63%, and worsened in 18% and 7% of patients, respectively. In conclusion, comparable with improvements previously seen after more time-consuming exercise periods, patients with musculoskeletal disorders had improved HRQoL after 8 weeks of aqua-exercising compared to before exercising. This uncontrolled feasibility study does not reveal whether this was the result of aqua-exercising. The effects and costs need to be evaluated in randomized controlled studies.
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Affiliation(s)
- Anna Enblom
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Martin Wicher
- Brickegårdens Care-Central, Primary Care Unit , Karlskoga , Sweden
| | - Therese Nordell
- Oxelösunds Care-Central, Primary Care Unit , Oxelösund , Sweden
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37
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Applying the Evidence for Exercise Prescription in Older Adults with Knee Osteoarthritis. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Beckwée D, Vaes P, Raeymaeckers S, Shahabpour M, Scheerlinck T, Bautmans I. Exercise in knee osteoarthritis: do treatment outcomes relate to bone marrow lesions? A randomized trial. Disabil Rehabil 2016; 39:1847-1855. [DOI: 10.1080/09638288.2016.1212110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- David Beckwée
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Vaes
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, UZ Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium
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Laubenstein S, Beissner K. Exercise and Movement-based Therapies in Geriatric Pain Management. Clin Geriatr Med 2016; 32:737-762. [PMID: 27741967 DOI: 10.1016/j.cger.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exercise is often recommended for older adults with pain, but pain itself is often a barrier to increased activity. This article reviews the evidence on the impact of various forms of exercise and related movement therapies on older adults with pain problems. The literature is reviewed with respect to published guidelines. When prescribing exercise, it is important to consider appropriate intensity, type, and duration of exercise as well as incorporating a plan for progression. Strategies to ensure adherence to exercise programs are also important.
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Affiliation(s)
| | - Katherine Beissner
- Department of Physical Therapy Education, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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40
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Covill LG, Utley C, Hochstein C. Comparison of Ai Chi and Impairment-Based Aquatic Therapy for Older Adults With Balance Problems: A Clinical Study. J Geriatr Phys Ther 2016; 40:204-213. [PMID: 27490823 DOI: 10.1519/jpt.0000000000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Older adults with balance deficits often fear falling and limit their mobility. Poor balance is multifactorial, influenced by medication interactions, musculoskeletal and sensory system changes, and poor neuromuscular response to changes in body positions. Aquatic physical therapy (APT) is an intervention used to improve balance and decrease falls. Ai Chi is a water-based exercise program. It incorporates slow movements of progressive difficulty utilizing the upper and lower extremities and trunk coordinated with deep breathing. It is used for relaxation, strengthening, and balance training. The purpose of this study was to determine whether Ai Chi provides better results than conventional impairment-based aquatic therapy (IBAT) for older adults with balance deficits. METHODS Thirty-two community-dwelling adults, 65 to 85 years old, were referred to 2 different community pools for APT. Fifteen participants received Ai Chi-based aquatic interventions and 17 participants received an IBAT program. Physical therapists trained in both programs completed interventions and determined discharge. Physical balance measures, which included the Berg Balance Scale (BBS) and Timed Up and Go (TUG), were collected pre- and posttherapy. Self-reported outcome measures, the Activities-Specific Balance Confidence Scale (ABC) and Numerical Pain Rating Scale (NPRS), were collected pre- and posttherapy and 3- and 6-month postdischarge. RESULTS A 2-way (group by time) mixed-model analysis of covariance with initial outcome scores as a covariate revealed no difference between groups in any of the outcome measures (BBS, P = .53; TUG, P = .39; ABC, P = .63; NPRS, P = .27). Repeated-measures analysis and dependent t tests showed significant improvements in the BBS (P = .00) and TUG (P = .03) after APT. The ABC and NPRS did not improve significantly (ABC, P = .27; NPRS, P = .77). CONCLUSIONS There were no significant differences found in balance measures, balance confidence, or pain levels for community-dwelling older adults between the Ai Chi and IBAT programs. Physical outcome measures improved with APT but patient-reported measures did not. Further study is indicated to determine the most effective treatment frequency and duration for this population.
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Affiliation(s)
- Laura G Covill
- 1Des Moines University, Des Moines, Iowa. 2Mercy Physical Therapy Clinics, Des Moines, Iowa
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Henriksen M, Hansen JB, Klokker L, Bliddal H, Christensen R. Comparable effects of exercise and analgesics for pain secondary to knee osteoarthritis: a meta-analysis of trials included in Cochrane systematic reviews. J Comp Eff Res 2016; 5:417-31. [PMID: 27346368 DOI: 10.2217/cer-2016-0007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Evidence of comparative effectiveness of different treatment approaches is important for clinical decision-making, yet absent for most recommended treatments of knee osteoarthritis pain. The objective of this study was to estimate the comparative effectiveness of exercise versus orally administered analgesics for pain in patients with knee osteoarthritis. METHODS The Cochrane Database of systematic reviews was searched for meta-analyses of randomized controlled studies comparing exercise or analgesics with a control group (placebo or usual care) and with pain as an outcome. Individual study estimates were identified and effect sizes were calculated from group differences. We combined study-level effects on pain with a random effects meta-analysis and compared effect sizes between exercise trials and trials with analgesic interventions. RESULTS We included six Cochrane reviews (four pharmacology, two exercise). From these, 54 trials were eligible (20 pharmacology, 34 exercise), with 9806 participants (5627 pharmacology, 4179 exercise). The pooled effect size of pharmacological pain interventions was 0.41 (95% CI: 0.23-0.59) and for exercise 0.46 standardized mean difference (95% CI: 0.34-0.59). There was no statistically significant difference between the two types of intervention (difference: 0.06 standardized mean difference [95% CI: -0.28-0.16; p = 0.61]). CONCLUSION This meta-epidemiological study provides indirect evidence that for knee osteoarthritis pain, the effects from exercise and from oral analgesics are comparable. These results may support shared decision-making where a patient for some reason is unable to exercise or who consider exercise as unviable and analgesics as a more feasible choice. PROSPERO registration: CRD42013006924.
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Affiliation(s)
- Marius Henriksen
- The Parker Institute, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark.,Department of Physical & Occupational Therapy, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Julie B Hansen
- The Parker Institute, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital at Bispebjerg & Frederiksberg, Copenhagen, Denmark
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Tan SS, Teirlinck CH, Dekker J, Goossens LMA, Bohnen AM, Verhaar JAN, van Es PP, Koes BW, Bierma-Zeinstra SMA, Luijsterburg PAJ, Koopmanschap MA. Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care. Osteoarthritis Cartilage 2016; 24:581-8. [PMID: 26620092 DOI: 10.1016/j.joca.2015.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 10/16/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care. METHOD This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data. RESULTS A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (€ 1233) compared to the control group (€ 1331). The average annual societal costs per patient were lower in the intervention group (€ 2634 vs € 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02). CONCLUSION Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects. TRIAL REGISTRATION NUMBER NTR1462.
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Affiliation(s)
- S S Tan
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands.
| | - C H Teirlinck
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - J Dekker
- VU University Medical Center, Department of Rehabilitation Medicine & EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - L M A Goossens
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - A M Bohnen
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - J A N Verhaar
- Erasmus MC University Medical Center, Department of Orthopaedics, Rotterdam, The Netherlands.
| | - P P van Es
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - B W Koes
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands; Erasmus MC University Medical Center, Department of Orthopaedics, Rotterdam, The Netherlands.
| | - P A J Luijsterburg
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - M A Koopmanschap
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold‐Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev 2016; 3:CD005523. [PMID: 27007113 PMCID: PMC9942938 DOI: 10.1002/14651858.cd005523.pub3] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis is a chronic disease characterized by joint pain, tenderness, and limitation of movement. At present, no cure is available. Thus only treatment of the person's symptoms and treatment to prevent further development of the disease are possible. Clinical trials indicate that aquatic exercise may have advantages for people with osteoarthritis. This is an update of a published Cochrane review. OBJECTIVES To evaluate the effects of aquatic exercise for people with knee or hip osteoarthritis, or both, compared to no intervention. SEARCH METHODS We searched the following databases up to 28 April 2015: the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library Issue 1, 2014), MEDLINE (from 1949), EMBASE (from 1980), CINAHL (from 1982), PEDro (Physiotherapy Evidence Database), and Web of Science (from 1945). There was no language restriction. SELECTION CRITERIA Randomized controlled clinical trials of aquatic exercise compared to a control group (e.g. usual care, education, social attention, telephone call, waiting list for surgery) of participants with knee or hip osteoarthritis. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included trials. We analysed the pooled results using standardized mean difference (SMD) values. MAIN RESULTS Nine new trials met the inclusion criteria and we excluded two earlier included trials. Thus the number of participants increased from 800 to 1190 and the number of included trials increased from six to 13. Most participants were female (75%), with an average age of 68 years and a body mass index (BMI) of 29.4. Osteoarthritis duration was 6.7 years, with a great variation of the included participants. The mean aquatic exercise duration was 12 weeks. We found 12 trials at low to unclear risk of bias for all domains except blinding of participants and personnel. They showed that aquatic exercise caused a small short term improvement compared to control in pain (SMD -0.31, 95% CI -0.47 to -0.15; 12 trials, 1076 participants) and disability (SMD -0.32, 95% CI -0.47 to -0.17; 12 trials, 1059 participants). Ten trials showed a small effect on quality of life (QoL) (SMD -0.25, 95% CI -0.49 to -0.01; 10 trials, 971 participants). These effects on pain and disability correspond to a five point lower (95% CI three to eight points lower) score on mean pain and mean disability compared to the control group (scale 0 to 100), and a seven point higher (95% CI 0 to 13 points higher) score on mean QoL compared with control group (scale 0 to 100). No included trials performed a radiographic evaluation. No serious adverse events were reported in the included trials with relation to aquatic exercise. AUTHORS' CONCLUSIONS There is moderate quality evidence that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and QoL in people with knee and hip OA. The conclusions of this review update does not change those of the previous published version of this Cochrane review.
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Affiliation(s)
- Else Marie Bartels
- Copenhagen University Hospital, Bispebjerg og FrederiksbergThe Parker InstituteFrederiksbergDenmarkDK‐2000
| | - Carsten B Juhl
- University of Southern Denmark,SEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmark5230
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg og FrederiksbergMusculoskeletal Statistics Unit, The Parker InstituteNordre Fasanvej 57CopenhagenDenmarkDK‐2000
| | - Kåre Birger Hagen
- Diakonhjemmet HospitalNational Advisory Unit for Rehabilitation in RheumatologyPO Box 23 VindernOsloNorway0319
| | | | - Hanne Dagfinrud
- Diakonhjemmet HospitalNational Advisory Unit for Rehabilitation in RheumatologyPO Box 23 VindernOsloNorway0319
| | - Hans Lund
- University of Southern DenmarkSEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmarkDK‐5230
- Bergen University CollegeCenter for Evidence‐Based PracticeMøllendalsveien 6BergenNorwayN‐5009
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Jumping into the deep-end: results from a pilot impact evaluation of a community-based aquatic exercise program. Clin Rheumatol 2015; 35:1593-601. [DOI: 10.1007/s10067-015-3096-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/28/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients. Rev Bras Hematol Hemoter 2015; 37:82-9. [PMID: 25818817 PMCID: PMC4382580 DOI: 10.1016/j.bjhh.2014.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients. METHODS Informed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25-67) and conventional physiotherapy with a mean age of 49 years (range: 43-59). Both groups were submitted to a twelve-week program of two sessions weekly. RESULTS After the intervention, significant improvements were observed regarding the Lequesne index (p-value=0.0217), Oswestry Disability Index (p-value=0.0112), range of motion of trunk extension (p-value=0.0320), trunk flexion muscle strength (p-value=0.0459), hip extension and abduction muscle strength (p-value=0.0062 and p-value=0.0257, respectively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference. CONCLUSION Physical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results.
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Brody LT. Knee osteoarthritis: Clinical connections to articular cartilage structure and function. Phys Ther Sport 2014; 16:301-16. [PMID: 25783021 DOI: 10.1016/j.ptsp.2014.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
Articular cartilage is a unique biphasic material that supports a lifetime of compressive and shear forces across joints. When articular cartilage deteriorates, whether due to injury, wear and tear or normal aging, osteoarthritis and resultant pain can ensue. Understanding the basic science of the structure and biomechanics of articular cartilage can help clinicians guide their patients to appropriate activity and loading choices. The purpose of this article is to examine how articular cartilage structure and mechanics, may interact with risk factors to contribute to OA and how this interaction provides guidelines for intervention choices This paper will review the microstructure of articular cartilage, its mechanical properties and link this information to clinical decision making.
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Affiliation(s)
- Lori Thein Brody
- University of Wisconsin Hospital and Clinics, Research Park Clinic, 621 Science Drive, Madison, WI 53711, USA; Orthopaedic and Sports Science, Rocky Mountain University of Health Professions, 122 East 1700 South, Bldg. C, Provo, UT 84606, USA.
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Oh S, Lim JM, Kim Y, Kim M, Song W, Yoon B. Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: a single-blind, randomized controlled trial. Arch Gerontol Geriatr 2014; 60:288-93. [PMID: 25522928 DOI: 10.1016/j.archger.2014.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 09/12/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life (QOL) in community-dwelling elderly people with history of falling. MATERIALS AND METHODS Participants were randomly assigned to the water-based exercise group (n=34) or land-based exercise groups (n=32). To identify the effects on physical functions, muscle strength, flexibility, and mobility were measured. QOL and fear of falling were evaluated using the Short Form 36-item questionnaire and the modified falls efficacy scale (M-FES). The measurements were performed before and after the 10-week training period. RESULTS Within-group analysis indicated that hip abduction and adduction strength improved significantly in both groups (p=0.005; p=0.007). However, no statistically significant within-group differences were found in the back scratch test (p=0.766) and chair sit-and-reach test (p=0.870). QOL was significantly different in both groups (health transition: p=0.014, physical functioning: p<0.001, role physical: p<0.001, role emotional: p=0.002, bodily pain: p<0.001, vitality: p<0.001, and mental health: p<0.001). There was a significant difference in the M-FES in both groups (p=0.040). CONCLUSIONS These results indicate that water-based exercises are beneficial to improve the QOL, as well as physical activities, of community-dwelling elderly compared with land-based exercise. Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling.
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Affiliation(s)
- SeJun Oh
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Jong-Min Lim
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Yushin Kim
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
| | - MinSeock Kim
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
| | - WoonGang Song
- Department of Tourism Administration, College of Business Administration, Kangwon National University, Chuncheon, Republic of Korea
| | - BumChul Yoon
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea.
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Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Phys Ther 2014; 94:1383-95. [PMID: 24903110 DOI: 10.2522/ptj.20130417] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Current management of osteoarthritis (OA) focuses on pain control and maintaining physical function through pharmacological, nonpharmacological, and surgical treatments. Exercise, including therapeutic aquatic exercise (TAE), is considered one of the most important management options. Nevertheless, there is no up-to-date systematic review describing the effect of TAE on symptoms and function associated with lower limb OA. PURPOSE The purpose of this study was to conduct a systematic review with meta-analysis to determine the effect of TAE on symptoms and function associated with lower limb OA. DATA SOURCES The data sources used in this study were: MEDLINE, PubMed, EMBASE, CINAHL, PEDro, and SPORTDiscus. STUDY SELECTION All studies selected for review were randomized controlled trials with an aquatic exercise group and a nontreatment control group. In total, 11 studies fulfilled the inclusion criteria and were included in the synthesis and meta-analysis. DATA EXTRACTION Data were extracted and checked for accuracy by 3 independent reviewers. DATA SYNTHESIS Standardized mean difference (SMD) with 95% confidence interval (95% CI) was calculated for all outcomes. The meta-analysis showed a significant TAE effect on pain (SMD=0.26 [95% CI=0.11, 0.41]), self-reported function (SMD=0.30 [95% CI=0.18, 0.43]), and physical functioning (SMD=0.22 [95% CI=0.07, 0.38]). Additionally, a significant effect was seen on stiffness (SMD=0.20 [95% CI=0.03, 0.36]) and quality of life (SMD=0.24 [95% CI=0.04, 0.45]). LIMITATIONS Heterogeneity of outcome measures and small sample sizes for many of the included trials imply that conclusions based on these results should be made with caution. CONCLUSIONS The results indicate that TAE is effective in managing symptoms associated with lower limb OA.
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Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM. Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis. Arch Phys Med Rehabil 2014; 95:1776-86. [DOI: 10.1016/j.apmr.2014.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/18/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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Furnari A, Calabrò RS, Gervasi G, La Fauci-Belponer F, Marzo A, Berbiglia F, Paladina G, De Cola MC, Bramanti P. Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation. Brain Inj 2014; 28:1109-14. [DOI: 10.3109/02699052.2014.910700] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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