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Ahler JR, Busk H, Holm PM, Bricca A, Poulsen DV, Skou ST, Tang LH. Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis. Prev Med 2024; 183:107966. [PMID: 38641081 DOI: 10.1016/j.ypmed.2024.107966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases. METHODS We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE. RESULTS From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low. CONCLUSION Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.
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Affiliation(s)
- Jonas R Ahler
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Henriette Busk
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands
| | - Alessio Bricca
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Dorthe V Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Swithenbank Z, Bricca A, Black N, Hartmann Boyce J, Johnston M, Scott N, West R, Courtney RJ, Treweek S, Michie S, de Bruin M. Tailoring CONSORT-SPI to improve the reporting of smoking cessation intervention trials: An expert consensus study. Addiction 2024; 119:225-235. [PMID: 37724014 PMCID: PMC10952324 DOI: 10.1111/add.16340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/20/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND AIMS Inadequate reporting of smoking cessation intervention trials is common and leads to significant challenges for researchers. The aim of this study was to tailor CONSORT (Consolidated Standards of Reporting Trials)-SPI (Social and Psychological Interventions) guidelines to improve reporting of trials of behavioural interventions to promote smoking cessation. METHOD Informed by missing data from the IC-SMOKE (Intervention and Comparison group support provided in SMOKing cEssation) systematic review project, this study used a multi-stage Delphi process to examine which items could be added or modified to improve the reporting of smoking cessation trials. The first stage involved an on-line survey of 17 international experts in smoking cessation and trial methodology voting on the importance of items for inclusion in the updated guidelines. This was followed by a face-to-face expert consensus meeting attended by 15 of these experts, where the final inclusion and exclusion of new items and modifications were agreed upon. A nine-point Likert scale was used to establish consensus, with suggested modifications requiring agreement of 75% or more. Disagreements in the first stage were presented again at the second stage for discussion and a second round of voting. Only items which reached the threshold for agreement were included. RESULTS The experts agreed on the inclusion of 10 new items and the specification of 12 existing items. This included modifications that could apply to trials more widely (e.g. the rationale for the comparator), but also modifications that were very specific to smoking cessation trials (e.g. the reporting of smoking cessation outcomes). CONCLUSIONS A Delphi study has developed a modified CONSORT-SPI guideline (CONSORT-SPI-SMOKE) to improve the reporting of trials of behavioural interventions to promote smoking cessation.
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Affiliation(s)
- Zoe Swithenbank
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and PhysiotherapyUniversity of Southern DenmarkOdenseDenmark
- The Research Unit PROgrezNæstved‐Slagelse‐Ringsted HospitalsSlagelseDenmark
| | - Nicola Black
- National Drug and Alcohol Research CentreUniversity of New South Wales SydneyKensingtonAustralia
| | | | - Marie Johnston
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland, UK
| | - Neil Scott
- Medical Statistics TeamUniversity of AberdeenAberdeenScotland, UK
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ryan J. Courtney
- National Drug and Alcohol Research CentreUniversity of New South Wales SydneyKensingtonAustralia
| | - Shaun Treweek
- Health Services Research UnitUniversity of AberdeenAberdeenScotlandUK
| | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Marijn de Bruin
- IQ Healthcare, Institute of Health SciencesRadboud University Medical CenterNijmegenthe Netherlands
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Souilla L, Larsen AC, Juhl CB, Skou ST, Bricca A. Childhood and adolescence physical activity and multimorbidity later in life: A systematic review. J Multimorb Comorb 2024; 14:26335565241231403. [PMID: 38333053 PMCID: PMC10851728 DOI: 10.1177/26335565241231403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
Background No systematic summary exists on childhood physical activity and later-life multimorbidity risks. We primarily investigated the association of physical activity in childhood and adolescence and the development of multimorbidity in adulthood. Secondarily, we examined whether physical activity level differ in children and adolescents with and without multimorbidity and whether there is a cross-sectional association between physical activity and multimorbidity. Methods Following Cochrane Handbook guidelines and adhering to PRISMA recommendations, we included cross-sectional, case-control and longitudinal studies that investigated the association between physical activity in children and adolescents and development of multimorbidity. Results were summarized narratively and we assessed the certainty of the evidence using the GRADE approach. The protocol was registered in PROSPERO, CRD42023407063. Results Of 9064 studies identified, 11 were included in 13 papers. Longitudinals studies suggested that being physically active in childhood and adolescence was associated with a lower risk of multimorbidity in adulthood. Three out of five studies reported lower physical activity level in children and adolescents with multimorbidity compared to those without, and two did not find a between-group difference. Cross-sectional evidence on the association between multimorbidity and lower physical activity was uncertain. Overall, the evidence certainty for all outcomes was considered low due to the indirectness and inconsistency in findings. Conclusions Childhood and adolescence physical activity appeared to be linked with a reduced risk of later-life multimorbidity but the certainty of the evidence is low. These results support the promotion of physical activity during childhood and adolescence.
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Affiliation(s)
- Luc Souilla
- University of Montpellier, PhyMedExp, INSERM, CNRS UMR, Montpellier, France
- CHRU Montpellier, Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, Montpellier, France
| | - Anders C. Larsen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Carsten B. Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Busk H, Ahler J, Bricca A, Mikal Holm P, Varning Poulsen D, Skou ST, Tang LH. Exercise-based rehabilitation in and with nature: a scoping review mapping available interventions. Ann Med 2023; 55:2267083. [PMID: 37839417 PMCID: PMC10578088 DOI: 10.1080/07853890.2023.2267083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Exercise is an effective component in rehabilitation of a range of chronic conditions. There is a growing interest in the use of exercise-based nature interacted rehabilitation (EBNIR), but an overview of current evidence is missing. The objective of this scoping review was to map existing exercise-based rehabilitation interventions conducted with incidental or intentional nature interaction focusing on its populations, types of outcomes, and theoretical rationale for people with physical and mental disabilities. METHODS This scoping review identified peer-reviewed publications, registered upcoming trials and grey literature. To map all available knowledge, a comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Cochrane; Web of Science; Pedro) from inception to October 2022. Data were synthesized in a thematic presentation guided by TIDieR, supplemented by a checklist developed for this study accounting nature incidental or intentional interaction. RESULTS Twelve studies including 856 participants met the inclusion criteria. Eleven were completed trials and one was registered in clinicaltrials.gov to be run in 2023. A total of 856 patients were enrolled in the 12 studies (range 18-262, median 50). The included studies had great variation. The incidental or intentional interacted exercise-based interventions consisted of outdoor walks, neck exercises and surfing interventions in patients with physical or mental health conditions. CONCLUSIONS This scoping review presents an overview of limited and diverse evidence within the field of EBNIR, in patients with physical or mental health conditions. Our review provides an overview that will be helpful in the design of future EBNIR trials.
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Affiliation(s)
- Henriette Busk
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Frederiksberg C, Denmark
| | - Jonas Ahler
- Department of Physiotherapy and Occupational Therapy, The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- Department of Physiotherapy and Occupational Therapy, The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Pætur Mikal Holm
- Department of Physiotherapy and Occupational Therapy, The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Dorthe Varning Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Frederiksberg C, Denmark
| | - Søren T. Skou
- Department of Physiotherapy and Occupational Therapy, The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Lars Hermann Tang
- Department of Physiotherapy and Occupational Therapy, The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Kraiss J, Viechtbauer W, Black N, Johnston M, Hartmann‐Boyce J, Eisma M, Javornik N, Bricca A, Michie S, West R, de Bruin M. Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression. Addiction 2023; 118:1835-1850. [PMID: 37132077 PMCID: PMC10952237 DOI: 10.1111/add.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions. METHODS A systematic review and meta-regression was conducted including 172 randomised controlled trials with at least 6 months follow-up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta-regression was used to create a model predicting smoking cessation outcomes. This model was used to re-estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta-regression models and smoking cessation differences and ratios to compare relative effectiveness. RESULTS The meta-regression model predicted smoking cessation rates well (pseudo R2 = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self-help was 1.33 times (95% CI = 1.16-1.49), brief physician advice 1.61 times (95% CI = 1.31-1.90), nurse individual counselling 1.76 times (95% CI = 1.62-1.90), psychologist individual counselling 2.04 times (95% CI = 1.95-2.15) and group psychologist interventions 2.06 times (95% CI = 1.92-2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness. CONCLUSIONS Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components.
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Affiliation(s)
- Jannis Kraiss
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Nicola Black
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Marie Johnston
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | | | - Maarten Eisma
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Neza Javornik
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and PhysiotherapyUniversity of Southern DenmarkOdenseDenmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrezNæstved‐Slagelse‐Ringsted HospitalsSlagelseDenmark
| | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Marijn de Bruin
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
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Zangger G, Bricca A, Liaghat B, Juhl CB, Mortensen SR, Andersen RM, Damsted C, Hamborg TG, Ried-Larsen M, Tang LH, Thygesen LC, Skou ST. Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46439. [PMID: 37410534 PMCID: PMC10359919 DOI: 10.2196/46439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. OBJECTIVE This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. CONCLUSIONS Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. TRIAL REGISTRATION PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.
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Affiliation(s)
- Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
| | - Sofie Rath Mortensen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camma Damsted
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Trine Grønbek Hamborg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Young JJ, Pedersen JR, Bricca A. Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription? Curr Treatm Opt Rheumatol 2023; 9:1-17. [PMID: 37362069 PMCID: PMC10199279 DOI: 10.1007/s40674-023-00205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review Exercise therapy is the first line treatment for patients with knee and hip osteoarthritis (OA) but is consistently underutilized. In this review, we aim to provide health care professionals with an overview of the latest evidence in the areas of exercise therapy for OA, which can serve as a guide for incorporating the ideal exercise therapy prescription in the overall management plan for their patients with OA. Recent findings Evidence continues to be produced supporting the use of exercise therapy for all patients with knee or hip OA. Ample evidence exists suggesting exercise therapy is a safe form of treatment, for both joint structures and the patient overall. Several systematic reviews show that exercise therapy is likely to improve patient outcomes, regardless of disease severity or comorbidities. However, no single type of exercise therapy is superior to others. Summary Health care practitioners and patients should be encouraged to incorporate exercise therapy into treatment plans and can be assured of the safety profile and likelihood of improvement in important patient outcomes. Since no single exercise therapy program shows vastly superior benefit, patient preference and contextual factors should be central to the shared decision-making process when selecting and individualising appropriate exercise therapy prescriptions.
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Affiliation(s)
- James J. Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Julie Rønne Pedersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Ringsted, Denmark
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Holm PM, Juhl CB, Culvenor AG, Whittaker JL, Crossley KM, Roos EM, Patterson BE, Larsson S, Struglics A, Bricca A. The Effects of Different Management Strategies or Rehabilitation Approaches on Knee Joint Structural and Molecular Biomarkers Following Traumatic Knee Injury: A Systematic Review of Randomized Controlled Trials for the OPTIKNEE Consensus. J Orthop Sports Phys Ther 2023; 53:1-22. [PMID: 36802814 DOI: 10.2519/jospt.2023.11576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE: To summarize the effectiveness of management strategies and rehabilitation approaches for knee joint structural and molecular biomarker outcomes following anterior cruciate ligament (ACL) and/or meniscal tear. DESIGN: Intervention systematic review. LITERATURE SEARCH: We searched the MEDLINE, Embase, CINAHL, CENTRAL, and SPORTDiscus databases from their inception up to November 3, 2021. STUDY SELECTION CRITERIA: We included randomized controlled trials (RCTs) investigating the effectiveness of management strategies or rehabilitation approaches for structural/molecular biomarkers of knee joint health following ACL and/or meniscal tear. DATA SYNTHESIS: We included 5 RCTs (9 papers) with primary ACL tear (n = 365). Two RCTs compared initial management strategies (rehabilitation plus early vs optional delayed ACL surgery), reporting on structural biomarkers (radiographic osteoarthritis, cartilage thickness, meniscal damage) in 5 papers and molecular biomarkers (inflammation, cartilage turnover) in 1 paper. Three RCTs compared different post-ACL reconstruction (ACLR) rehabilitation approaches (high vs low intensity plyometric exercises, accelerated vs nonaccelerated rehabilitation, continuous passive vs active motion), reporting on structural biomarkers (joint space narrowing) in 1 paper and molecular biomarkers (inflammation, cartilage turnover) in 2 papers. RESULTS: There were no differences in structural or molecular biomarkers between post-ACLR rehabilitation approaches. One RCT comparing initial management strategies demonstrated that rehabilitation plus early ACLR was associated with greater patellofemoral cartilage thinning, elevated inflammatory cytokine response, and reduced incidence of medial meniscal damage over 5 years compared to rehabilitation with no/delayed ACLR. CONCLUSION: Very low-certainty evidence suggests that different initial management strategies (rehabilitation plus early vs optional delayed ACL surgery) but not postoperative rehabilitation approaches may influence the incidence of meniscal damage, patellofemoral cartilage loss and cytokine concentrations over 5 years post-ACL tear. J Orthop Sports Phys Ther 2023;53(4):1-22. Epub: 20 February 2023. doi:10.2519/jospt.2023.11576.
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Bricca A, Jäger M, Johnston M, Zangger G, Harris LK, Midtgaard J, Skou ST. Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis. Int J Behav Med 2023; 30:167-189. [PMID: 35484462 PMCID: PMC10036283 DOI: 10.1007/s12529-022-10092-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. METHODS Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence. RESULTS Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI -0.12-0.87) and the effect on weight loss was uncertain (BMI mean difference -0.17, 95% CI -1.1-0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17-0.42) and physical function (SMD 0.42, 95% CI 0.12-0.73), and moderate improvements were seen for depression symptoms (SMD -0.70, 95% CI -0.97-0.42). Studies using the BCTs 'action planning' and 'social support (practical)' reported greater physical activity and weight loss. CONCLUSIONS Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.
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Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Lasse K Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Julie Midtgaard
- University Hospitals Centre for Health Care Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
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11
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Skou ST, Nyberg M, Dideriksen M, Overgaard JA, Bodilsen C, Soja AMB, Attarzadeh AP, Bieder MJ, Dridi NP, Heltberg A, Gæde PH, Reventlow JL, Arnfred S, Bodtger U, Thygesen LC, Jäger M, Bricca A. Study protocol for a multicenter randomized controlled trial of personalized exercise therapy and self-management support for people with multimorbidity: The MOBILIZE study. J Multimorb Comorb 2023; 13:26335565231154447. [PMID: 36762033 PMCID: PMC9903016 DOI: 10.1177/26335565231154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 12/01/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
Background Despite the great individual and societal burden associated with multimorbidity, little is known about how to effectively manage it. Objective The aim of this multicenter randomized controlled trial (RCT) is to investigate the 12-month effects of a personalized exercise therapy and self-management support program in addition to usual care in people with multimorbidity. Design This is a protocol for a pragmatic, parallel-group (1:1 ratio), superiority RCT conducted at five intervention sites (two hospitals, a private practice physiotherapy clinic and two municipal rehabilitation centers) in Region Zealand, Denmark. A total of 228 persons with multimorbidity aged 18 years or older, will be randomly allocated to one of two groups. Both groups will receive usual care, defined as routine care for multimorbidity at the discretion of the treating doctor, while the intervention group will also participate in a 12-week exercise therapy and self-management support program tailored to people with multimorbidity at one of the intervention sites. The primary outcome will be the between-group difference in change in EQ-5D-5L from baseline to the follow-up at 12 months. Secondary outcomes include objectively-measured physical function and physical activity, inflammatory markers, disease and treatment burden, anxiety, depression, stress, sleep, pain and other self-reported parameters. In parallel with the RCT, an observational cohort will follow persons aged ≥18 years with multimorbidity not adhering to all eligibility criteria, as well as people fulfilling all eligibility criteria, but unwilling to participate in the RCT. This study was approved by the Regional Committee on Health Research Ethics for Region Zealand (SJ-857) and results will be communicated in scientific papers, at relevant conferences and to a broader audience. Discussion Exercise therapy and self-management support is safe and effective in people with single conditions. However, it is still unclear whether this holds true for individuals with multimorbidity. This pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice.
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Affiliation(s)
- Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Søren T Skou, Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark.
| | - Mette Nyberg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Mette Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan A Overgaard
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Department of Rehabilitation, Lolland Municipality, Maribo, Denmark
| | - Christine Bodilsen
- Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark
| | - Anne MB Soja
- Department of Internal Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Amir P Attarzadeh
- Centre for Evidence-Based Orthopaedics, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Manuel J Bieder
- Department of Orthopaedic Surgery, Næstved Hospital, Næstved, Denmark
| | - Nadia P Dridi
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Andreas Heltberg
- Department of General Practice, Institute of Public Health, University of Copenhagen, København K, Denmark
| | - Peter H Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark,Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | | | - Sidse Arnfred
- Psychiatric Research Unit, Copenhagen University Hospital – Psychiatry Region Zealand, Slagelse, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark.,Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Madalina Jäger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark,Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense M, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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12
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Skou ST, Brødsgaard RH, Nyberg M, Dideriksen M, Bodtger U, Bricca A, Jäger M. Personalised exercise therapy and self-management support for people with multimorbidity: feasibility of the MOBILIZE intervention. Pilot Feasibility Stud 2023; 9:12. [PMID: 36653858 PMCID: PMC9847074 DOI: 10.1186/s40814-023-01242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Exercise therapy is safe and effective in people with single conditions, but the feasibility in people with two or more conditions is unclear. Therefore, the aim was to evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomised, controlled trial (RCT). METHODS This was a mixed-methods feasibility study performed in two general hospitals and one psychiatric hospital. 20 adult patients (8 females; mean age (SD) 67 (6.9)) with at least two long-term conditions and a score of ≥ 3 on Disease Burden Impact Scale for at least one condition (at least moderate limitations of daily activities) and of ≥ 2 for at least one other condition. Patients with unstable health conditions, at risk of serious adverse events (SAE) or with terminal conditions were excluded. Participants received 12 weeks of exercise (18 60-min group-based and 6 home-based sessions) and self-management support (6 90-min group-based sessions) supervised by physiotherapists. Pre-defined progression to RCT criteria were the primary outcomes and included recruitment rate (acceptable 20 participants in 3 months), retention through follow-up (75% retention), compliance (75% complete > 9 of exercise and > 3 self-management sessions), outcome burden (80% do not find outcomes too burdensome), improvement in quality of life (EQ-5D-5L) and function (6-min walk test; ≥ 50% experience clinically relevant improvements) and intervention-related SAEs (No SAEs). Furthermore, a purposeful sample including eleven participants and two facilitators were interviewed about their experiences of participating/facilitating. Qualitative data was analysed using thematic analysis. RESULTS Recruitment rate (20 in 49 days), retention (85%), outcome burden (95%), and SAEs (0 related to intervention) were acceptable, while compliance (70%) and improvements (35% in quality of life, 46% in function) were not (amendment needed before proceeding to RCT). The intervention was found acceptable by both participants and physiotherapists with some barriers among participants relating to managing multiple chronic conditions while caring for others or maintaining a job. Physiotherapists expressed a need for additional training. CONCLUSIONS Exercise therapy and self-management are feasible in people with multimorbidity. The subsequent RCT, amending the intervention according to progression criteria and feedback, will determine whether the intervention is superior to usual care alone. TRIAL REGISTRATION ClinicalTrials.gov registration: NCT04645732 Open Science Framework https://osf.io/qk6yg/.
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Affiliation(s)
- Søren T. Skou
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Rasmus H. Brødsgaard
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Mette Nyberg
- grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Mette Dideriksen
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Uffe Bodtger
- grid.512923.e0000 0004 7402 8188Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Naestved, 4700 Naestved, Denmark ,grid.10825.3e0000 0001 0728 0170Institute for Regional Health Research, University of Southern Denmark, 5230 Odense M, Denmark
| | - Alessio Bricca
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Madalina Jäger
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
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13
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Bricca A, Smith SM, Skou ST. Management of multimorbidity. J Multimorb Comorb 2023; 13:26335565231156693. [PMID: 36911182 PMCID: PMC9996704 DOI: 10.1177/26335565231156693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
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14
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Bricca A, Jäger M, Dideriksen M, Rasmussen H, Nyberg M, Pedersen JR, Zangger G, Andreasson KH, Skou ST. Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention. Pilot Feasibility Stud 2022; 8:244. [PMID: 36461048 PMCID: PMC9717541 DOI: 10.1186/s40814-022-01204-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity. METHODS We followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention. RESULTS The intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained physiotherapists. The intervention targets physiological, psychosocial, behavioural, and contextual factors to improve health-related quality of life and physical function in people living with multimorbidity. CONCLUSIONS We developed a personalised exercise therapy and self-management support programme for people with multimorbidity. The intervention will be tested for its safety and effectiveness in a randomised controlled trial.
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Affiliation(s)
- Alessio Bricca
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Madalina Jäger
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark ,grid.10825.3e0000 0001 0728 0170Danish centre for motivation and behaviour science, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Mette Dideriksen
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Hanne Rasmussen
- grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Nyberg
- grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julie Rønne Pedersen
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
| | - Graziella Zangger
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Karen Hjerrild Andreasson
- grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Søren T. Skou
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark ,grid.10825.3e0000 0001 0728 0170Danish centre for motivation and behaviour science, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Pedersen JR, Sari DM, Juhl CB, Thorlund JB, Skou ST, Roos EM, Bricca A. Variability in effect sizes of exercise therapy for knee osteoarthritis depending on comparator interventions. Ann Phys Rehabil Med 2022; 66:101708. [PMID: 36191859 DOI: 10.1016/j.rehab.2022.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/01/2022] [Accepted: 09/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Systematic reviews of exercise therapy for knee osteoarthritis (OA) have largely ignored the variability in comparator interventions. OBJECTIVE To assess how effect estimates of exercise therapy for knee OA as reported in randomized controlled trials vary depending on the comparator interventions. METHODS We followed the Cochrane Handbook and PRISMA guidance to conduct and report this meta-epidemiological study. Randomised controlled trials (RCTs) were identified from systematic reviews published in 2015 or later and reference lists of included studies. Exercise therapy RCTs testing interventions that adhered to the American College of Sports Medicine (ACSM) guidelines compared to any comparator intervention in people with knee OA and reporting outcomes of knee pain, physical function and/or quadriceps strength at the end of intervention were included. RESULTS Thirty-five RCTs with 2412 participants were included. Comparator interventions included no intervention, non-ACSM compliant exercise therapy, education/self-management, and passive modalities. For pain, standardized mean difference (SMD) for ACSM compliant exercise therapy compared to passive modalities was 1.76 (95% CI 0.49, 3.04), no intervention 0.93 (95% CI 0.50; 1.36), education/self-management 0.27 (95% CI 0.07, 0.47), and non-ACSM compliant exercise therapy 0.09 (95% CI -0.06, 0.23). For physical function, SMD for ACSM compliant exercise therapy compared to passive modalities was 1.29 (95% CI 0.41, 2.17), no intervention 0.76 (95% CI 0.15, 1.36), non-ACSM compliant exercise therapy 0.25 (95% CI -0.00, 0.51) and education/self-management 0.21 (95% CI -0.14, 0.55). For quadriceps strength, SMD for ACSM compliant exercise therapy compared to no intervention was 0.69 (95% CI 0.42, 0.96), non-ACSM compliant exercise therapy 0.23 (95% CI -0.01, 0.46), education/self-management -0.02 (95% CI -0.45, 0.42) and passive modalities 0.80 (95% CI -0.10, 1.71). CONCLUSION The effect of exercise therapy for knee OA varies significantly depending on the comparator intervention. This variability should be assessed routinely in systematic reviews.
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Affiliation(s)
- Julie Rønne Pedersen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark.
| | - Dilara Merve Sari
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark; Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Marmara University, Turkey
| | - Carsten Bogh Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev and Gentofte, Denmark
| | - Jonas Bloch Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campus 55, Odense 5230, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
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16
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Whittaker JL, Culvenor AG, Juhl CB, Berg B, Bricca A, Filbay SR, Holm P, Macri E, Urhausen AP, Ardern CL, Bruder AM, Bullock GS, Ezzat AM, Girdwood M, Haberfield M, Hughes M, Ingelsrud LH, Khan KM, Le CY, Losciale JM, Lundberg M, Miciak M, Øiestad BE, Patterson B, Räisänen AM, Skou ST, Thorlund JB, Toomey C, Truong LK, Meer BLV, West TJ, Young JJ, Lohmander LS, Emery C, Risberg MA, van Middelkoop M, Roos EM, Crossley KM. OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. Br J Sports Med 2022; 56:1393-1405. [DOI: 10.1136/bjsports-2022-106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
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17
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Jørgensen LB, Bricca A, Bernhardt A, Juhl CB, Tang LH, Mortensen SR, Eriksen JA, Walløe S, Skou ST. Objectively measured physical activity levels and adherence to physical activity guidelines in people with multimorbidity-A systematic review and meta-analysis. PLoS One 2022; 17:e0274846. [PMID: 36223336 PMCID: PMC9555650 DOI: 10.1371/journal.pone.0274846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To determine levels of objectively measured physical activity (PA) and the proportion of adults with multimorbidity that adheres to PA guidelines. Methods All studies, where PA was measured at baseline using an activity monitor in an adult (≥18 years) multimorbid (≥80% of the population had ≥2 chronic conditions) population. A systematic literature search was performed in Medline, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, opengrey.eu and google.com from inception up until 18th of January 2022. Risk of bias was assessed with a modified version of the Quality Assessment Tool for Quantitative Studies. A random-effects meta-analyses was performed to estimate daily minutes of sedentary behavior (SB), light PA (LPA), moderate PA (MPA), moderate to vigorous PA (MVPA) and steps. Proportions adhering to PA guidelines was narratively synthesized. Certainty of evidence was determined using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Fifteen studies (2,172 participants) were included. The most frequent combination of conditions were type 2 diabetes and hypertension (six studies). Participants spent a daily average of 500.5 (95% CI: 407.1 to 593.9) minutes in SB, 325.6 (95% CI: 246.4 to 404.7 minutes in LPA and 32.7 (95% CI: 20.2 to 45.3) minutes in MVPA. The mean daily number of steps was 5,145 (95% CI: 4264 to 6026) for people in free-living conditions. The proportion adhering to PA guidelines ranged widely (7.4% to 43%). All studies were rated as at high risk of bias and the certainty of evidence was very low. Conclusions PA levels and adherence varied from low to above guideline recommended levels for adults with chronic conditions, depending on PA intensity. The very low certainty of evidence calls for high quality studies focusing on detailed descriptions of PA behavior in people with multimorbidity. PROSPERO registration number CRD42020172456.
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Affiliation(s)
- Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Alessio Bricca
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Anna Bernhardt
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Carsten B. Juhl
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Lars Hermann Tang
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sofie Rath Mortensen
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Jonas Ahler Eriksen
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Sisse Walløe
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Søren T. Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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18
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Zacher Kjeldsen MM, Bricca A, Liu X, Frokjaer VG, Madsen KB, Munk-Olsen T. Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:1004-1013. [PMID: 35976654 PMCID: PMC9386615 DOI: 10.1001/jamapsychiatry.2022.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Abstract
Importance Current evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial risk of postpartum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not. Objective To investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum. Data Sources Literature searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and updated in March 2022, accompanied by citation and reference search. Study Selection Studies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by 2 independent reviewers: title and abstract screening followed by full-text screening. Data Extraction and Synthesis Reporting was performed using the MOOSE checklist. Two reviewers independently extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a meta-analysis using a random-effects model. Heterogeneity was investigated with meta-regression, subgroup, and sensitivity analyses. Publication bias was investigated using a funnel plot, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the overall certainty of the findings. Main Outcomes and Measures The primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression. Results A total of 26 studies were included, containing information on 100 877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE. Conclusions and Relevance In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.
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Affiliation(s)
- Mette-Marie Zacher Kjeldsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Vibe G. Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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19
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Pedersen JR, Andreucci A, Thorlund JB, Koes B, Møller M, Storm LK, Bricca A. Prevalence, frequency, adverse events, and reasons for analgesic use in youth athletes: A systematic review and meta-analysis of 44,381 athletes. J Sci Med Sport 2022; 25:810-819. [PMID: 36100523 DOI: 10.1016/j.jsams.2022.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. DESIGN Systematic review and meta-analysis. METHODS Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15-24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively. RESULTS Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance. CONCLUSIONS Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.
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Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - Alessandro Andreucci
- Center for General Practice, Aalborg University, Denmark. https://twitter.com/Andreucci_Ale
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Department of Public Health, University of Southern Denmark, Denmark. https://twitter.com/jbthorlund
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Denmark. https://twitter.com/bartkoes
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark. https://twitter.com/Merete_Moller
| | - Louise Kamuk Storm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark. https://twitter.com/StormKamuk
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark. https://twitter.com/a_bricca
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20
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Culvenor AG, Girdwood MA, Juhl CB, Patterson BE, Haberfield MJ, Holm PM, Bricca A, Whittaker JL, Roos EM, Crossley KM. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1445-1453. [PMID: 35768181 DOI: 10.1136/bjsports-2022-105495] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes. DESIGN Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. DATA SOURCES MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library. ELIGIBILITY CRITERIA Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults. RESULTS We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion. CONCLUSION The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
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Affiliation(s)
- Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Pætur M Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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21
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Jäger M, Lindhardt MC, Pedersen JR, Dideriksen M, Nyberg M, Bricca A, Bodtger U, Midtgaard J, Skou ST. Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates. J Multimorb Comorb 2022; 12:26335565221100172. [PMID: 35615752 PMCID: PMC9125109 DOI: 10.1177/26335565221100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022]
Abstract
Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a “burning platform.” Subsequent deductive application of the COM-B profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and self-management support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.
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Affiliation(s)
- Madalina Jäger
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | | | - Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Mette Dideriksen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Mette Nyberg
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark.,Institute for Regional Heath Research, University of Southern Denmark, Odense M, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
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22
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Kjeldsen MMZ, Bricca A, Liu X, Frokjaer VG, Madsen KB, Munk-Olsen T. Family history of psychiatric disorders as a risk factor for maternal postpartum depression: a systematic review protocol. Syst Rev 2022; 11:68. [PMID: 35422027 PMCID: PMC9011941 DOI: 10.1186/s13643-022-01952-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is the most common postpartum psychiatric disorder, affecting 11-15% of new mothers, and initiatives towards early identification and treatment are essential due to detrimental consequences. Family history of psychiatric disorders is a risk factor for developing psychiatric episodes outside the postpartum period, but evidence of the association between familial risk and PPD is not clear. Hence, the objective of this systematic review is to summarize the current literature on the association between family history of psychiatric disorders and PPD. METHODS This protocol has been developed and reported according to the PRISMA-P guidelines for systematic reviews. A comprehensive literature search will be conducted in PubMed, Embase, and PsycINFO from inception of the databases, supplemented with citation tracking and reference screening of the included studies. Two independent authors will examine all retrieved articles for inclusion in two steps: title/abstract screening and full-text screening. Eligible studies are case-control and cohort studies reporting a risk estimate for the association between family history of psychiatric disorders and PPD. Studies will be assessed for risk of bias using the Newcastle-Ottawa Scale. The association between family psychiatry and PPD will be combined in a meta-analysis using a restricted maximum likelihood method (REML). Heterogeneity will be quantified using I2 and investigated through meta-regression, subgroup and sensitivity analyses, and publication bias will be evaluated via visual inspection of a funnel plot. The overall strength and quality of the findings will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. If meta-analysis is not possible, data will be synthesized narratively in text and tables. DISCUSSION This systematic review will be the first to summarize current knowledge and present an overall estimate for the association between family history of psychiatric disorders and PPD. Evaluation of psychiatric family history as a PPD risk factor is essential to assist early identification of women at high risk of PPD in routine perinatal care. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID: 277998 (registered 10th of September 2021).
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Affiliation(s)
- Mette-Marie Zacher Kjeldsen
- National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210 Aarhus V, Aarhus, Denmark. .,Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210 Aarhus V, Aarhus, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Bang Madsen
- National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210 Aarhus V, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210 Aarhus V, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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23
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Bricca A, Pellegrini A, Zangger G, Ahler J, Jäger M, Skou ST. The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play. JMIR Mhealth Uhealth 2022; 10:e33168. [PMID: 35119367 PMCID: PMC8857691 DOI: 10.2196/33168] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022] Open
Abstract
Background Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered. Objective We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change. Methods We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change. Results We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63%), weight and diet (apps: 25/60, 42%), or physical activity (apps: 22/60, 37%) and stress management (apps: 22/60, 37%). Only 8 out of the 60 apps (13%) were completely free. Conclusions Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change.
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Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessandro Pellegrini
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jonas Ahler
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Bricca A, Swithenbank Z, Scott N, Treweek S, Johnston M, Black N, Hartmann-Boyce J, West R, Michie S, de Bruin M. Predictors of recruitment and retention in randomized controlled trials of behavioural smoking cessation interventions: a systematic review and meta-regression analysis. Addiction 2022; 117:299-311. [PMID: 34159677 DOI: 10.1111/add.15614] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/06/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023]
Abstract
AIM To investigate predictors of participant eligibility, recruitment and retention in behavioural randomized controlled trials (RCTs) for smoking cessation. METHOD Systematic review and pre-specified meta-regression analysis of behavioural RCTs for smoking cessation including adult (≥ 18-year-old) smokers. The pre-specified predictors were identified through a literature review and experts' consultation and included participant, trial and intervention characteristics and recruitment and retention strategies. Outcome measures included eligibility rates (proportion of people eligible for the trials), recruitment rates, retention rates and differential retention rates. RESULTS A total of 172 RCTs with 89 639 participants. Eligibility [median 57.6%; interquartile range (IQR) = 34.7-83.7], recruitment (median 66.4%; IQR = 42.7-85.2) and retention rates (median 80.5%; IQR = 68.5-89.5) varied considerably across studies. For eligibility rates, the recruitment strategy appeared not to be associated with eligibility rates. For recruitment rates, use of indirect recruitment strategies (e.g. public announcements) [odds ratio (OR) = 0.30, 95% confidence interval (CI) = 0.11-0.82] and self-help interventions (OR = 0.14, 95% CI = 0.03-0.67) were associated with lower recruitment rates. For retention rates, higher retention was seen if the sample had ongoing physical health condition/s (OR = 1.66, 95% CI = 1.04-2.63), whereas lower retention was seen amongst primarily female samples (OR = 0.83, 95% CI = 0.71-0.98) and those motivated to quit smoking (OR = 0.74, 95% CI = 0.55-0.99) when indirect recruitment methods were used (OR = 0.60, 95% CI = 0.38-0.97) and at longer follow-up assessments (OR = 0.83, 95% CI = 0.79-0.87). For differential retention, higher retention in the intervention group occurred when the intervention but not comparator group received financial incentives for smoking cessation (OR = 1.35, 95% CI = 1.02-1.77). CONCLUSIONS In randomized controlled trials of behavioural smoking cessation interventions, recruitment and retention rates appear to be higher for smoking cessation interventions that include a person-to-person rather than at-a-distance contact; male participants, smokers with chronic conditions, smokers not initially motivated to quit and shorter follow-up assessments seems to be associated with improved retention; financial incentive interventions improve retention in groups receiving them relative to comparison groups.
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Affiliation(s)
- Alessio Bricca
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark, Slagelse, Denmark
| | - Zoe Swithenbank
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Neil Scott
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Technology Addiction Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
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Nissen N, Holm PM, Bricca A, Dideriksen M, Tang LH, Skou ST. Clinicians' beliefs and attitudes to physical activity and exercise therapy as treatment for knee and/or hip osteoarthritis: a scoping review. Osteoarthritis Cartilage 2022; 30:260-269. [PMID: 34800632 DOI: 10.1016/j.joca.2021.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore clinicians' attitudes and beliefs about physical activity and exercise therapy as treatment for individuals with knee and/or hip osteoarthritis (OA). METHOD This was a scoping review, mapping available knowledge about the topic derived from qualitative research designs and methods. A comprehensive search of selected databases (MEDLINE, EMBASE; CINAHL; Web of Science) was conducted and data were analysed thematically. RESULTS Twelve articles met inclusion criteria. Thematic analysis identified three interrelated main themes: 1) Understandings of OA and its trajectory and management; 2) Attitudes to activity and exercise as part of OA management; 3) Clinicians' perceived knowledge of and expertise in OA management. Findings highlight that many clinicians involved in knee/hip OA management, particularly general practitioners and physiotherapists, perceive OA to be a low priority 'wear-and-tear' disease with expected progression of symptoms, making joint replacement surgery eventually inevitable. Further, many clinicians appear to lack knowledge about and interest in physical activity and exercise therapy in the management of knee/hip OA, and seem to show uncertainty about the effectiveness and safety of physical activity and exercise therapy on joint health. CONCLUSION Clinicians' attitudes and beliefs about physical activity and exercise therapy in OA seem to reflect an outdated narrative which describes OA as a wear-and-tear disease with inevitable disease progression to joint replacement surgery. Clinicians need to adopt a contemporary narrative, which accurately reflects current knowledge and evidence-based practice, thereby ensuring consistent utilisation of exercise therapy as first-line care as recommended in OA guidelines.
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Affiliation(s)
| | - P M Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - M Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - S T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Harris LK, Skou ST, Juhl CB, Jäger M, Bricca A. Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis. Trials 2021; 22:396. [PMID: 34127042 PMCID: PMC8204443 DOI: 10.1186/s13063-021-05346-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/30/2021] [Indexed: 12/18/2022] Open
Abstract
AIM To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. DATA SOURCES MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020. STUDY SELECTION RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms. DATA EXTRACTION AND SYNTHESIS Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects model was used to estimate pooled proportions. Methodological quality was assessed using Cochrane ´Risk of Bias tool 2.0´ for individual studies, and the GRADE approach was used to assess the overall quality of the evidence. RESULTS Twenty-three RCTs with 3363 people were included. The pooled prevalence for recruitment rate was 75% (95%CI 66 to 84%). The pooled prevalence for retention rate was 90% (95%CI 86 to 94%) at the end of the intervention (12 weeks; interquartile range (IQR) (12 to 12)). Meta-regression analyses showed that increasing age and including a higher proportion of people with hypertension was associated with lower retention rates. Retention rates did not differ between the intervention and comparator groups. The overall quality of the evidence was deemed very low. CONCLUSION Three in four eligible people with multimorbidity were randomised to RCTs using exercise therapy, of which nine out of 10 provided end of treatment outcomes with no difference seen between the intervention and comparison groups. However, the results must be interpreted with caution due to large differences between the included studies. TRIAL REGISTRATION ClinicalTrials.gov CRD42020161329 . Registered on 28 April 2020.
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Affiliation(s)
- Lasse K. Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Carsten B. Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
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Bricca A, Harris LK, Jäger M, Smith S, Juhl CB, Skou ST. Infographic. Benefits and harms of exercise therapy in people with multimorbidity. Br J Sports Med 2021; 55:1059-1060. [PMID: 34108222 PMCID: PMC8408580 DOI: 10.1136/bjsports-2021-104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark .,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Lasse Kindler Harris
- Clinical Orthopaedic Research Hvidovre, Københavns Universitetshospital, Copenhagen, Denmark
| | - Madalina Jäger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Susan Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skou ST. Corrigendum to "Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials" [Ageing Res. Rev. 63C (2020) 101166]. Ageing Res Rev 2020; 64:101190. [PMID: 33039345 DOI: 10.1016/j.arr.2020.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skou ST. Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev 2020; 63:101166. [PMID: 32896665 PMCID: PMC7116122 DOI: 10.1016/j.arr.2020.101166] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the benefits and harms of exercise therapy on physical and psychosocial health in people with multimorbidity. DESIGN Systematic review of randomised controlled trials (RCTs). Data sources MEDLINE, EMBASE, CENTRAL and CINAHL from 1990 to April 20th, 2020 and Cochrane reviews on the effect of exercise therapy for each of the aforementioned conditions, reference lists of the included studies, the WHO registry and citation tracking on included studies in Web of Science. ELIGIBILITY CRITERIA FOR STUDY SELECTION RCTs investigating the benefit of exercise therapy in people with multimorbidity, defined as two or more of the following conditions: osteoarthritis (of the knee or hip), hypertension, type 2 diabetes, depression, heart failure, ischemic heart disease, and chronic obstructive pulmonary disease on at least one of the following outcomes: Health-related quality of life (HRQoL), physical function, depression or anxiety. SUMMARY AND QUALITY OF THE EVIDENCE Meta-analyses using a random-effects model to assess the benefit of exercise therapy and the risk of non-serious and serious adverse events according to the Food and Drug Administration definition. Meta-regression analyses to investigate the impact of pre-specified mediators of effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence. RESULTS Twenty-three RCTs with 3363 people, testing an exercise therapy intervention (mean duration 13.0 weeks, SD 4.0) showed that exercise therapy improved HRQoL (standardised mean difference (SMD) 0.37, 95 % CI 0.14 to 0.61) and objectively measured physical function (SMD 0.33, 95 % CI 0.17 to 0.49), and reduced depression symptoms (SMD -0.80, 95 % CI -1.21 to -0.40) and anxiety symptoms (SMD -0.49, 95 % CI -0.99 to 0.01). Exercise therapy was not associated with an increased risk of non-serious adverse events (risk ratio 0.96, 95 % CI 0.53-1.76). By contrast, exercise therapy was associated with a reduced risk of serious adverse events (risk ratio 0.62, 95 % CI 0.49 to 0.78). Meta-regression showed that increasing age was associated with lower effect sizes for HRQoL and greater baseline depression severity was associated with greater reduction of depression symptoms. The overall quality of evidence for all the outcomes was downgraded to low, mainly due to risk of bias, inconsistency and indirectness. CONCLUSIONS Exercise therapy appears to be safe and to have a beneficial effect on physical and psychosocial health in people with multimorbidity. Although the evidence supporting this was of low quality, it highlights the potential of exercise therapy in the management and care of this population.
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Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.
| | - Lasse K Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
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Bricca A, Struglics A, Larsson S, Steultjens M, Juhl CB, Roos EM. Impact of Exercise Therapy on Molecular Biomarkers Related to Cartilage and Inflammation in Individuals at Risk of, or With Established, Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken) 2020; 71:1504-1515. [PMID: 30320965 DOI: 10.1002/acr.23786] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/09/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in individuals at risk of, or with established, knee osteoarthritis by conducting a systematic review of randomized controlled trials (RCTs). METHODS We conducted a literature search up to September 2017 in 5 major databases with no restriction on publication year or language. Data were extracted from the first available follow-up time point, and we performed a narrative synthesis for the effect of exercise therapy on molecular biomarkers related to cartilage and inflammation. A subset of studies reporting sufficient data was combined in a meta-analysis, using an adjusted random-effects model. RESULTS Twelve RCTs involving 57 study comparisons at 4 to 24 weeks following an exercise-therapy intervention were included. Exercise therapy decreased molecular biomarkers in 17 study comparisons (30%), had no effect in 36 (63%), and increased molecular biomarkers in 4 study comparisons (7%). Meta-analyses of 9 biomarkers showed that exercise therapy was associated with nonsignificant reductions of the C-reactive protein level, C-terminal crosslinking telopeptide of type II collagen, tumor necrosis factor (TNF), soluble TNF receptors 1 and 2, C2C neoepitope of type II collagen, and cartilage oligomeric matrix protein, compared to nonexercising control groups, and exercise therapy had no effect on interleukin-6 and soluble interleukin-6 receptor. CONCLUSION Exercise therapy is not harmful, because it does not increase the concentration of molecular biomarkers related to cartilage turnover and inflammation, implicated in osteoarthritis progression. The overall quality of evidence was downgraded to low because of the limited number of RCTs available.
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Affiliation(s)
- Alessio Bricca
- Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Carsten B Juhl
- University of Southern Denmark, Odense, and Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Ewa M Roos
- Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
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Bricca A, Harris LK, Saracutu M, Smith SM, Juhl CB, Skou ST. The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review. J Comorb 2020; 10:2235042X20920458. [PMID: 32426294 PMCID: PMC7218324 DOI: 10.1177/2235042x20920458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/24/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022]
Abstract
AIM The aim of this study is to investigate the benefits and harms of therapeutic exercise in people with multimorbidity defined as the combination of two or more of the following conditions: knee and hip osteoarthritis, hypertension, diabetes type 2, depression, heart failure, ischaemic heart disease and chronic obstructive pulmonary disease, by performing a systematic review of randomized controlled trials (RCTs). METHODS This study will be performed according to the recommendations from the Cochrane Collaboration and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We will search for RCTs investigating the effect of therapeutic exercise in multimorbidity, as defined above, in MEDLINE, EMBASE, CENTRAL and CINAHL from 1990. Cochrane reviews on the effect of therapeutic exercise for each of the aforementioned conditions and references of the included studies will be checked for eligible studies and citation tracking will be performed in Web of Science. We will assess the risk of bias of the included studies using the Cochrane 'Risk of Bias Tool' 2.0 and the Grading of Recommendations Assessment, Development and Evaluation assessment for judging the overall quality of evidence. Meta-analyses will be performed, if possible, using a random-effects model as heterogeneity is expected due to differences in interventions and participant characteristics and outcome measures. Subgroup and meta-regression analyses will be performed to explore potential predictors of outcomes. DISSEMINATION The results of this systematic review will be published in a peer-review journal, presented at national and international conferences and made available to end users via infographics, podcasts, press releases and videos.
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Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Lasse K Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Madalina Saracutu
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
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Bricca A, Lund H, Roos EM, Juhl CB. When enough is enough - How to determine when the evidence for the effectiveness of a treatment is sufficient? Osteoarthritis Cartilage 2019; 27:1253-1256. [PMID: 31212032 DOI: 10.1016/j.joca.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Affiliation(s)
- A Bricca
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill Campus, Aberdeen, UK.
| | - H Lund
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - C B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
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Bricca A, Roos EM, Juhl CB, Skou ST, Silva DO, Barton CJ. Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation. Br J Sports Med 2019; 54:118-119. [PMID: 31227490 DOI: 10.1136/bjsports-2019-100727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Alessio Bricca
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK .,Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Danilo Oliveira Silva
- Physiotherapy, Sao Paulo State University, Presidente Prudente, Brazil.,La Trobe Sport and Exercise Medicine ResearchCentre (LASEM), La Trobe University, Melbourne, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine ResearchCentre (LASEM), La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, Universityof Melbourne, Melbourne, Victoria, Australia
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Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med 2019; 53:1454-1463. [PMID: 31072840 DOI: 10.1136/bjsports-2018-100022] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls. STUDY APPRAISAL AND SYNTHESIS Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis. RESULTS 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively. CONCLUSION The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates. CLINICAL RELEVANCE Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.
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Affiliation(s)
- Erik Poulsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Glaucia H Goncalves
- Department of Physical Therapy, Universidade Federal de Sao Carlos, Sao Carlos, Brazil
| | - Alessio Bricca
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Occupational and Physical Therapy, Gentofte and Herlev Hospitals, Copenhagen University Hospital, Copenhagen, Denmark
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Bricca A, Wirth W, Juhl CB, Kemnitz J, Hunter DJ, Kwoh CK, Eckstein F, Culvenor AG. Moderate Physical Activity and Prevention of Cartilage Loss in People With Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2019; 71:218-226. [DOI: 10.1002/acr.23791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/15/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alessio Bricca
- University of Southern Denmark, Odense, Denmark, and University of Aberdeen Aberdeen UK
| | - Wolfgang Wirth
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and Chondrometrics GmbH Ainring Germany
| | - Carsten B. Juhl
- University of Southern Denmark, Odense, University of Copenhagen, Herlev, and Gentofte Hospital Copenhagen Denmark
| | - Jana Kemnitz
- Paracelsus Medical University Salzburg and Nuremberg Salzburg Austria
| | - David J. Hunter
- Royal North Shore Hospital and University of Sydney Sydney New South Wales Australia
| | | | - Felix Eckstein
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and Chondrometrics GmbH Ainring Germany
| | - Adam G. Culvenor
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and La Trobe University Bundoora Australia
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Bricca A, Juhl CB, Bizzini M, Andersen TE, Thorborg K. There are more football injury prevention reviews than randomised controlled trials. Time for more RCT action! Br J Sports Med 2018; 52:1477-1478. [DOI: 10.1136/bjsports-2018-099373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/04/2022]
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Bricca A. Exercise does not 'wear down my knee': systematic reviews and meta-analyses. Br J Sports Med 2018; 52:1591-1592. [PMID: 30181324 DOI: 10.1136/bjsports-2018-099705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/04/2022]
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van Tunen JAC, Peat G, Bricca A, Larsen LB, Søndergaard J, Thilsing T, Roos EM, Thorlund JB. Association of osteoarthritis risk factors with knee and hip pain in a population-based sample of 29-59 year olds in Denmark: a cross-sectional analysis. BMC Musculoskelet Disord 2018; 19:300. [PMID: 30126395 PMCID: PMC6102878 DOI: 10.1186/s12891-018-2183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to a) describe the prevalence of knee and hip osteoarthritis risk factors in a population of 29–59 year old individuals, b) estimate the association between persistent knee/hip pain and osteoarthritis risk factors, and c) describe the prevalence of osteoarthritis risk factors, including specific biomechanical risk factors, in individuals with prolonged persistent knee or hip pain. Methods Participants completed the “Early Detection and Prevention” pilot study questionnaire, including items on presence of knee/hip pain within the last month and osteoarthritis risk factors. Individuals reporting knee/hip problems completed a second questionnaire, including items about most problematic joint and specific biomechanical osteoarthritis risk factors. After describing the prevalence of persistent knee/hip pain and osteoarthritis risk factors among respondents stratified for sex and age, logistic regression was used to estimate the strength of associations between osteoarthritis risk factors and presence of knee/hip pain. The prevalence of prolonged persistent pain (i.e. knee/hip pain reported at both questionnaires) and osteoarthritis risk factors among respondents with prolonged persistent knee and hip pain, were described. Results Two thousand six hundred sixty-one respondents completed the first survey. The one-month prevalence of persistent knee/hip pain was 27%. Previous knee/hip injury was associated with persistent knee/hip pain for both sexes in all age groups, while a family history of osteoarthritis was associated with persistent knee/hip pain in all age groups except for 29–39 year old men. A higher BMI was associated with persistent knee/hip pain in 40–59 year old women, and 50–59 year old men. Eight hundred sixty seven respondents completed the second questionnaire. Knee/hip injuries and surgeries were more common in individuals with prolonged persistent knee than hip pain. Conclusions Knee/hip pain within the last month was frequent among individuals aged 29–59 years. Multiple known osteoarthritis risk factors were associated with presence of knee/hip pain. Joint injury and previous surgery were more common in individuals with knee than hip pain. The results support the notion that joint injury and overweight during early adulthood are signs of a trajectory towards symptomatic osteoarthritis later in life and may help earlier identification of groups at high risk of future symptomatic osteoarthritis. Trial registration ClinicalTrials.gov (NCT02797392). Registered April 29,2016.
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Affiliation(s)
- Joyce A C van Tunen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - George Peat
- Research Institute for Primary Care & Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars B Larsen
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Trine Thilsing
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med 2018; 53:940-947. [PMID: 29934429 DOI: 10.1136/bjsports-2017-098661] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/17/2018] [Accepted: 06/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the impact of knee joint loading exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis (OA) by conducting a systematic review of randomised controlled trials (RCTs). DESIGN We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. DATA SOURCES We performed a literature search with no restriction on publication year or language in MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science up to September 2017. ELIGIBILITY CRITERIA RCTs investigating the impact of exercise on MRI-assessed articular cartilage in people over 18 years of age. RESULTS We included nine trials, including a total of 14 comparisons of cartilage morphometry, morphology and composition outcomes, of which two included participants at increased risk of knee OA and 12 included participants with knee OA. In participants at increased risk, one study comparison reported no effect on cartilage defects and one had positive effects on glycosaminoglycans (GAG). In participants with OA, six study comparisons reported no effect on cartilage thickness, volume or defects; one reported a negative effect and one no effect on GAG; two reported a positive effect and two no effect on collagen. CONCLUSIONS Knee joint loading exercise seems to not be harmful for articular cartilage in people at increased risk of, or with, knee OA. However, the quality of evidence was low, including some interventions studying activities considered outside the therapeutic loading spectrum to promote cartilage health.
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Affiliation(s)
| | - Carsten B Juhl
- University of Southern Denmark, Odense, Denmark.,Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Wolfgang Wirth
- Paracelsus Medical University (PMU) Salzburg and Nuremberg, Salzburg, Austria.,Medical Data Processing, Chondrometrics GmbH, Ainring, Germany
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
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