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Bhardwaj A, FitzGerald C, Graham M, MacFarlane A, Kennedy N, Toomey CM. Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research. Rheumatol Int 2024; 44:1035-1050. [PMID: 38649534 DOI: 10.1007/s00296-024-05590-9] [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] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants' needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.
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Affiliation(s)
- Avantika Bhardwaj
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland.
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Christine FitzGerald
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Margaret Graham
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Nursing & Midwifery, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Anne MacFarlane
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- Participatory Health Research Unit, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Norelee Kennedy
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Clodagh M Toomey
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Participatory Health Research Unit, University of Limerick, Limerick, V94 T9PX, Ireland
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Bendrik R, Kallings LV, Bröms K, Emtner M. Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis: A randomised controlled trial. Clin Rehabil 2024; 38:770-782. [PMID: 38409798 PMCID: PMC11059830 DOI: 10.1177/02692155241234666] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. DESIGN Randomised, assessor-blinded, controlled trial. SETTING Primary care. SUBJECTS Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40-74. INTERVENTION The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. MAIN MEASURES Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. RESULTS There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups). CONCLUSIONS There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.
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Affiliation(s)
- Regina Bendrik
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University/ Region Gävleborg, Gävle, Sweden
| | - Lena V Kallings
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Department of Physical Activity and Health, the Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024; 83:730-740. [PMID: 38212040 PMCID: PMC11103326 DOI: 10.1136/ard-2023-225041] [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] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
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Affiliation(s)
- Tuva Moseng
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Simone Battista
- University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Vladimira Boyadzhieva
- UMHAT "St. Iv. Rilski" Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Andrew G Finney
- Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ingvild Kjeken
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Hans Lund
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Karel Pavelka
- Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Dieter Wiek
- EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy
| | - Nina Østerås
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Kjeldsen T, Skou ST, Dalgas U, Tønning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, Mechlenburg I. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial. Ann Intern Med 2024; 177:573-582. [PMID: 38588540 DOI: 10.7326/m23-3225] [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] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). However, randomized controlled trials providing evidence for the optimal exercise type are lacking. OBJECTIVE To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance in patients with hip OA. DESIGN Multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT04714047). SETTING Hospitals and physiotherapy clinics. PARTICIPANTS 160 participants with clinically diagnosed hip OA were enrolled from 18 January 2021 to 28 April 2023 and randomly assigned to PRT (n = 82) or NEMEX (n = 78). INTERVENTION Twelve weeks of PRT or NEMEX with 2 supervised 60-minute group sessions each week. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability. MEASUREMENTS The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS). RESULTS The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, -0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX (difference, -0.7 [CI, -5.3 to 4.0] points). For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX (difference, 2.3 [CI, -3.0 to 7.6] points). LIMITATION Participants and physiotherapists were not blinded. CONCLUSION In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL. PRIMARY FUNDING SOURCE Independent Research Fund Denmark.
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Affiliation(s)
- Troels Kjeldsen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; and Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark (T.K.)
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark, and Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (S.T.S.)
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark (U.D.)
| | - Lisa U Tønning
- Department of Orthopedic Surgery, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (L.U.T.)
| | - Kim G Ingwersen
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, and Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark (K.G.I.)
| | - Sara Birch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Physiotherapy and Occupational Therapy, Gødstrup Regional Hospital, Herning, Denmark; and Department of Orthopedic Surgery, Gødstrup Regional Hospital, Herning, Denmark (S.B.)
| | - Pætur M Holm
- The Research and Implementation 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; and Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands (P.M.H.)
| | - Thomas Frydendal
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Odense, Denmark; and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (T.F.)
| | - Mette Garval
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark (M.G.)
| | - Claus Varnum
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark, and Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Odense, Denmark (C.V.)
| | - Bo M Bibby
- Department of Biostatistics, Institute of Public Health, Aarhus University, Aarhus, Denmark (B.M.B.)
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; and Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark (I.M.)
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Macri EM, Selles RW, Stefanik JJ, Reijman M. OARSI year in review 2023: Rehabilitation and outcomes. Osteoarthritis Cartilage 2023; 31:1534-1547. [PMID: 37673295 DOI: 10.1016/j.joca.2023.08.011] [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: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE We systematically reviewed the literature to identify comparative studies of core treatments (exercise, education, or weight management), adjunct treatments (e.g. electrotherapeutical modalities, bracing), or multimodal treatments (core plus other treatments), for treating osteoarthritis (OA) complaints, published between 1 March 2022 and 1 March 2023. DESIGN We searched three electronic databases for peer-reviewed comparative studies evaluating core treatments, adjunct treatments, or multimodal treatments for OA affecting any joint, in comparison to other OA treatments. Two authors independently screened records. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis focusing on pain and function outcomes was performed in studies with a mean sample size of at least 46 participants per treatment arm. RESULTS 33 publications (28 studies), 82% with PEDro ratings of good or excellent, were eligible for narrative synthesis: 23 studies evaluated knee OA; one knee OA or chronic low back pain; two knee or hip OA; one hip OA only; and one thumb OA. No studies identified a dose, duration or type of exercise that resulted in better pain or function outcomes. Core treatments generally showed modest benefits compared to no or minimal intervention controls. CONCLUSIONS Rehabilitation research continues to be focused on the knee. Most studies are not adequately powered to assess pain efficacy. Further work is needed to better account for contextual effects, identify treatment responder characteristics, understand treatment mechanisms, and implement guideline care.
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Affiliation(s)
- E M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - R W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - J J Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
| | - M Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Bobunov DN, Kolesnikova EE, Demin AA, Gromova VS, Kurbal PM, Andryushchenko ND, Tarabrina EA. [Physical rehabilitation for degenerative-dystrophic diseases of the hip joint in elderly and senile people (stage 1).]. Adv Gerontol 2023; 36:845-854. [PMID: 38426922] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Changes in the age structure of the planet's population are leading to an increase in the number of geriatric patients requiring replacement of large joints. Age-related weakness, loss of muscle mass, testosterone deficiency, excess weight, and the presence of concomitant diseases make the process of rehabilitation treatment labor-intensive and lead to various complications. The purpose of our work was to evaluate the effectiveness of the modernized method of physical therapy at the first stage of rehabilitation treatment in elderly and senile patients with osteoarthritis of the hip joint. All patients received standard complex therapy, including orthopedic treatment methods, drug therapy, myostimulation, massage, and manual therapy. For patients in the main group, in addition to the traditional complex, the method of physical therapy according to the stated method was added and it was recommended to wear compression hosiery (stockings) while performing the exercises. The advantage of the technique is the absence of complications and side effects, which is an important component compared to other methods of restorative treatment. Minimum costs, general availability and autonomy of performing exercises, high results achieved during the treatment process confirm the value and importance of creating similar techniques for other large joints. The developed method of physical therapy has shown its effectiveness and relevance among elderly patients and can be recommended for use among different population groups as a method of restorative treatment of osteoarthritis of the hip joint.
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Affiliation(s)
- D N Bobunov
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - E E Kolesnikova
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - A A Demin
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - V S Gromova
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - P M Kurbal
- Pacific State Medical University, 2 Ostryakova ave., Vladivostok 690002, Primorsky Territory, Russian Federation
| | - N D Andryushchenko
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - E A Tarabrina
- I.I.Mechnikov North-West State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
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James KA, von Heideken J, Iversen MD. Reporting of Adverse Events in Randomized Controlled Trials of Therapeutic Exercise for Hip Osteoarthritis: A Systematic Review. Phys Ther 2021; 101:pzab195. [PMID: 34730830 PMCID: PMC8565302 DOI: 10.1093/ptj/pzab195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/10/2020] [Revised: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study was to describe adverse events (AEs) and dropouts (DOs) in randomized controlled trials of therapeutic exercise for hip osteoarthritis (HOA) and to identify whether Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed. METHODS The Cochrane Library, Embase, PubMed, and CINAHL databases were searched. Randomized controlled trials of therapeutic exercise for HOA published in English from January 1, 1980 to August 1, 2020 were included. Studies were excluded if other interventions were provided, if participants had previous hip arthroplasty, or if AEs and DOs for HOA participants were not reported separately. The internal validity of each study (Physiotherapy Evidence Database [PEDro] scoring) was assessed, participant and intervention characteristics were extracted, and the existence of a clear statement and reasons for AEs and DOs was reported. Descriptive statistics characterized results. Data heterogeneity prohibited the use of meta-analysis. RESULTS Fourteen studies (mean PEDro score = 7.4; range = 6-10) from 10 countries were included, with 707 participants exercising. Exercise intensity was unspecified in 72.2% of exercise arms. Six studies (42.9%) included a statement of AEs, and 32 AEs were reported. All studies had a DO statement, but 29.0% of DOs occurred for unknown reasons. Six studies (42.9%) gave reasons for DOs that could be classified as AEs in 9 participants; 41 participants (5.8%) experienced exercise-related AEs. CONCLUSION Reports of AEs were inconsistent, some DOs were potentially misclassified, and primary components of exercise interventions were frequently unreported. Despite these limitations, the overall low number of nonserious AEs suggests that the exercise-related risk of harm is minimal for individuals with HOA. IMPACT Understanding the risk of harm associated with exercise for HOA can better inform safe dosing of exercise, clinical implementation, and replicability. Informative, consistent reporting of AEs, DOs, and exercise is needed. Greater use of the CONSORT harms-reporting checklist is warranted.
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Affiliation(s)
- Khara A James
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Intitutet, Stockholm, Sweden
| | - Maura D Iversen
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Women’s and Children’s Health, Karolinska Intitutet, Stockholm, Sweden
- Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Brigham & Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- College of Health Professions, Sacred Heart University, Fairfield, Connecticut, USA
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Roos EM, Grønne DT, Skou ST, Zywiel MG, McGlasson R, Barton CJ, Kemp JL, Crossley KM, Davis AM. Immediate outcomes following the GLA:D® program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis. Osteoarthritis Cartilage 2021; 29:502-506. [PMID: 33561542 DOI: 10.1016/j.joca.2020.12.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/30/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report outcomes across three countries for patients with symptomatic knee or hip OA attending the evidence-based education and exercise therapy program Good Life with osteoArthritis from Denmark (GLA:D®). DESIGN GLA:D® is a structured treatment program including 2-3 patient education sessions and 12 supervised exercise sessions delivered over 8 weeks by certified health care practitioners. The program was introduced in Denmark in 2013, in Canada 2015 and in Australia 2016. Absolute mean change in pain intensity, number of chair stands in 30 s, 40 m walk test time and Knee injury and Osteoarthritis Outcome Score (KOOS)/Hip dysfunction and Osteoarthritis Outcome Score (HOOS) QOL subscale scores from baseline to immediately after treatment were reported as means and 95 % CIs and proportion of responders for each country. RESULTS Patients from the three countries improved 26-33% in mean pain intensity, 8-12% in walking speed, 18-30% in chair stand ability and 12-26% in joint-related quality of life from baseline to immediately after treatment, with no clinically relevant differences between patients with hip and knee OA. These improvements correspond with moderate to large within-group effect sizes and 43-47 % of the patients experienced clinically relevant pain reductions. CONCLUSION About half or more of patients across the three countries were categorized as responders for pain and objective function following the implementation of GLA:D®. These findings indicate positive patient outcomes associated with GLA:D® participation across varying health care systems from implementation of guideline-based patient education and exercise therapy for knee and hip OA.
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Affiliation(s)
- E M Roos
- Center for Muscle and Joint Health, University of Southern, Denmark.
| | - D T Grønne
- Center for Muscle and Joint Health, University of Southern, Denmark
| | - S T Skou
- Center for Muscle and Joint Health, University of Southern, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - M G Zywiel
- Arthritis Program and Krembil Research Institute, University Health Network and Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | | | - C J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia; Department of Surgery, St Vincents's Hospital, University of Melbourne, Australia
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia
| | - A M Davis
- Arthritis Program and Krembil Research Institute, University Health Network and Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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Ismailidis P, Kvarda P, Vach W, Appenzeller-Herzog C, Mündermann A. Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e035413. [PMID: 32690507 PMCID: PMC7371135 DOI: 10.1136/bmjopen-2019-035413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/05/2020] [Accepted: 06/07/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Conservation of abductor muscle strength is directly associated with physical function after total hip replacement (THA). Although many studies have tried to explore and quantify a potential abductor muscle strength deficit after THA as well as identify possible causes and treatment options, this topic has not been addressed systematically. METHODS AND ANALYSIS Human-based studies reporting measurements of hip abductor strength will be included in this review. Studies reporting on hip abductor strength measured manually or isometric measurements at an abduction angle other than 0° will not be considered. No restriction will be placed on study design, publication date operative approach, prosthesis design, age and sex of the patients or severity of OA. Data sources will be Embase via embase.com, Medline ALL via Ovid and the Cochrane Central Register of Controlled Trials. The preliminary search was conducted on 5 May 2019. Data regarding absolute values or torque ratio of hip abductor torque between sides as well as patient demographic data, surgical approaches and rehabilitation protocols will be extracted. The assessment of quality and risk of bias will be performed with the modified Newcastle-Ottawa Scale. The screening, data extraction and quality assessment will be performed by two reviewers independently. Where necessary, a third review author will make a final judgement. Narrative synthesis as well as tabular presentation of the extracted data will be included. Whenever possible, metaregression and subgroup specific meta-analyses will be used to investigate the influence of time since THA and type of measurement (isokinetic or isometric) on the different outcomes. In case of sufficient information, these analyses will be extended to include characteristics such as age, sex, surgical approach or rehabilitation programme. ETHICS AND DISSEMINATION No ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020153185.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Peter Kvarda
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Basel-Landschaft, Switzerland
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Hansen S, Mikkelsen LR, Overgaard S, Mechlenburg I. Effectiveness of supervised resistance training for patients with hip osteoarthritis - a systematic review. Dan Med J 2020; 67:A08190424. [PMID: 32741435] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The overall effectiveness of supervised progressive resistance training among patients with hip osteoarthritis is only scarcely investigated. The objective of this study was to estimate the effectiveness of supervised progressive resistance training compared with common treatment for patients with hip osteoarthritis, focusing on patient-reported function, pain, health-related quality of life, performance-based function at end of treatment and patient-reported function at 6-12 months. METHODS This was a systematic review and meta-analysis. A systematic search was performed on 30 January 2019 in eight electronic databases (Medline, Embase, Cochrane, Pedro, AMED, Scopus, SPORTDiscus and Cinahl). The methodology of the included studies and the overall quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS A total of 189 participants with hip osteoarthritis > 50 years of age were included in the three studies. A significant difference in favour of the supervised progressive resistance groups was found in patient-reported function (weighted mean difference (MD) = 9.13 (95% confidence interval (CI): 4.45-13.80)), hip-related pain (weighted MD = 7.83 (95% CI: 2.64-13.02)) and health-related quality of life (weighted MD = 6.80 (95% CI: 1.96-11.63)) at end of treatment. The overall quality of evidence was downgraded to low due to a lack of blinding in the included studies and due to imprecision. CONCLUSIONS Supervised progressive resistance training might be of clinical relevance for patients with hip osteoarthritis and was effective in improving patient-reported function, hip-related pain and health-related quality of life. The level of evidence is low and future studies may therefore affect the findings reported herein.
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11
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Peter WF, Poolman RW, Scholtes VAB, de Vet HCW, Terwee CB. Responsiveness and interpretability of the Animated Activity Questionnaire for assessing activity limitations of patients with hip or knee osteoarthritis. Musculoskeletal Care 2019; 17:327-334. [PMID: 31402572 DOI: 10.1002/msc.1418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/30/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of the study was to determine the responsiveness and interpretability of the Animated Activity Questionnaire (AAQ), an online questionnaire in which osteoarthritis patients select animations that best match their performance of daily activities. METHODS A longitudinal study was carried out, in which 94 patients with hip or knee osteoarthritis were assessed at baseline, and 3 and 6 months after treatment (conservative and surgical). Responsiveness was assessed by means of testing hypotheses about expected correlations between change in AAQ, a Global Rating Scale of change (GRS) and change in the Activities of Daily Living subscale of the Hip disability or Knee injury and Osteoarthritis Outcome Score (H/KOOS), and a combination of performance-based tests (the 30 s chair-stand test, the timed up-and-go test and the nine-step stair climbing test). The minimal important change (MIC) was estimated by means of the receiving operating characteristics (ROC) method. RESULTS The correlations of the AAQ with the H/KOOS were as expected, but other correlations were lower than anticipated. The area under the ROC curve was 0.74 at 6 months. At 3 months' follow-up, the correlations were too low to calculate a MIC. A total of 20% of the results at 3 months and 80% of the results at 6 months were in accordance with the hypotheses. The MIC was 9 points at 6 months. CONCLUSIONS The AAQ was sufficiently responsive at the six-months follow-up, but not at the three-month follow-up. The MIC at the 6-month follow-up (9 points) was slightly lower than the smallest detectable change of 14 points found in a previous study.
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Affiliation(s)
- Wilfred F Peter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Amsterdam Rehabilitation Research Center|Reade, Amsterdam, the Netherlands
| | - Rudolf W Poolman
- Department of Orthopedics, Joint Research, OLVG, Amsterdam, the Netherlands
| | | | - Henrika C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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12
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Wang X, Hunter DJ, Vesentini G, Pozzobon D, Ferreira ML. Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:506. [PMID: 31679511 PMCID: PMC6825714 DOI: 10.1186/s12891-019-2900-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/16/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/trends
- Humans
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/rehabilitation
- Osteoarthritis, Knee/surgery
- Randomized Controlled Trials as Topic/methods
- Telerehabilitation/methods
- Telerehabilitation/trends
- Walk Test/methods
- Walk Test/trends
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Affiliation(s)
- Xia Wang
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
| | - David J. Hunter
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, San Paulo State University, São Paulo, Brazil
| | - Giovana Vesentini
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, San Paulo State University, São Paulo, Brazil
| | - Daniel Pozzobon
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
| | - Manuela L. Ferreira
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
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Goh SL, Persson MSM, Stocks J, Hou Y, Lin J, Hall MC, Doherty M, Zhang W. Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 62:356-365. [PMID: 31121333 PMCID: PMC6880792 DOI: 10.1016/j.rehab.2019.04.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another. OBJECTIVE To evaluate the efficacy of exercise and its potential determinants for pain, function, performance, and quality of life (QoL) in knee and hip osteoarthritis (OA). METHODS We searched 9 electronic databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, PEDro, PubMed, SPORTDiscus and Google Scholar) for reports of randomised controlled trials (RCTs) comparing exercise-only interventions with usual care. The search was performed from inception up to December 2017 with no language restriction. The effect size (ES), with its 95% confidence interval (CI), was calculated on the basis of between-group standardised mean differences. The primary endpoint was at or nearest to 8 weeks. Other outcome time points were grouped into intervals, from<1 month to≥18 months, for time-dependent effects analysis. Potential determinants were explored by subgroup analyses. Level of significance was set at P≤0.10. RESULTS Data from 77 RCTs (6472 participants) confirmed statistically significant exercise benefits for pain (ES 0.56, 95% CI 0.44-0.68), function (0.50, 0.38-0.63), performance (0.46, 0.35-0.57), and QoL (0.21, 0.11-0.31) at or nearest to 8 weeks. Across all outcomes, the effects appeared to peak around 2 months and then gradually decreased and became no better than usual care after 9 months. Better pain relief was reported by trials investigating participants who were younger (mean age<60 years), had knee OA, and were not awaiting joint replacement surgery. CONCLUSIONS Exercise significantly reduces pain and improves function, performance and QoL in people with knee and hip OA as compared with usual care at 8 weeks. The effects are maximal around 2 months and thereafter slowly diminish, being no better than usual care at 9 to 18 months. Participants with younger age, knee OA and not awaiting joint replacement may benefit more from exercise therapy. These potential determinants, identified by study-level analyses, may have implied ecological bias and need to be confirmed with individual patient data.
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Affiliation(s)
- Siew-Li Goh
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK; Sports Medicine Unit, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Monica S M Persson
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Joanne Stocks
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Yunfei Hou
- Arthritis Clinical and Research Centre, Peking University People's Hospital, Beijing, China
| | - Jianhao Lin
- Arthritis Clinical and Research Centre, Peking University People's Hospital, Beijing, China
| | - Michelle C Hall
- Division of Physiotherapy Rehabilitation Sciences Education, University of Nottingham, NG5 1PB Nottingham, UK
| | - Michael Doherty
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK
| | - Weiya Zhang
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, NG5 1PB Nottingham, UK.
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Abstract
This retrospective cohort study evaluated the effects of different frequencies of physical therapy intervention on the total knee arthroplasty (TKA) and total hip arthroplasty (THA) risk of osteoarthritis (OA) patients.We sampled 438,833 insurants from Taiwan National Health Insurance Research Database for patients diagnosed as having OA during 2000 to 2013. OA who received physical therapy within in the first year of OA diagnosis were divided based on the number of sessions they received in that first year: >24, 13-23, and <12 sessions.The results revealed that the TKA and THA incidence rates among patients aged 60 to 80 years were respectively 3.5% and 0.9% in the >24 cohort and 4.9% and 1.4% (all P < .001) in the comparison cohort. Moreover, the HRs of TKA and THA in the >24 cohort were 0.77 (0.67-0.87, P < .001) and 0.71 (0.53-0.96, P = .024), respectively. By contrast, no significant differences were noted between the 13-23 and <12 cohorts and their respective comparison cohorts.In conclusion, our study results indicated that elderly patients aged 60 to 80 years who underwent >24 physical therapy sessions within 1 year of receiving an OA diagnosis exhibited reduced of TKA and THA risks.
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Affiliation(s)
- Wei-Heng Chen
- Departments of Rehabilitation, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City
| | - Wen-Ching Tsai
- Departments of Rehabilitation, Chang Bing Show-Chwan Memorial Hospital, Changhua County
| | | | | | - Yuan-Tsung Tseng
- Department of Medical Research, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan City, Taiwan ROC
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Dorontsev AV, Svetlichinkina AA, Zinchuk NA. [Example of physical training health activities after total hip replacement with Wright implant.]. Adv Gerontol 2019; 32:207-210. [PMID: 31228391] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The article presents the results of post-clinical observation of F., who had total replacement of two hip joints and goes to the gym, taking an individual programme with an elective part on training machines with a preset load vector that excludes a sharp dynamic effect on the musculoskeletal system. In 2014, based on the diagnosis of bilateral dysplastic coxarthrosis of the 3rd stage (function impairment 2), F. had total replacement of a right hip joint, followed by total replacement of a left hip joint in 2015; in both cases, the postsurgical period included the symptomatic therapy, rehabilitation exercises, joint movement training, and a physiotherapeutic treatment course. During the rehabilitation period, the patient's condition significantly improved, and after 3 months and the second operation, the orthopedist and physician admitted the patient to have health activities in a gum with some restrictions - to exclude inertial loads on a hip joint (running, jumps, free-weight exercises). The obtained results indicate that an individual programme with the use of training machines allows to solve medical and social tasks.
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Affiliation(s)
- A V Dorontsev
- Astrakhan State Medical University, 121 Bakinskaya str., Astrakhan 414000, Russian Federation; e-mail:
| | - A A Svetlichinkina
- Astrakhan State Medical University, 121 Bakinskaya str., Astrakhan 414000, Russian Federation; e-mail:
| | - N A Zinchuk
- Astrakhan State University, 20 A Taticheva str., Astrakhan 414056, Russian Federation; e-mail:
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Grant S, Blom AW, Whitehouse MR, Craddock I, Judge A, Tonkin EL, Gooberman-Hill R. Using home sensing technology to assess outcome and recovery after hip and knee replacement in the UK: the HEmiSPHERE study protocol. BMJ Open 2018; 8:e021862. [PMID: 30056388 PMCID: PMC6067391 DOI: 10.1136/bmjopen-2018-021862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Over 160 000 people with severe hip or knee pain caused by osteoarthritis undergo total hip (THR) or knee replacement (TKR) surgery each year in the UK within the National Health Service (NHS), and this number is expected to increase. Innovative approaches to evaluating surgical outcomes will be needed to respond to the increasing burden of joint replacement surgery. The Sensor Platform for Healthcare in a Residential Environment, Interdisciplinary Research Collaboration (SPHERE-IRC) have developed a system of sensors that can monitor the health-related behaviours of people living at home. The system includes sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage), a wristband body-worn activity monitor and silhouette (body outline) sensors. The aim of HEmiSPHERE (Hip and knEe study of a Sensor Platform of HEalthcare in a Residential Environment) is to (1) determine the accuracy and feasibility of the sensory data as it compares with conventional assessment of health outcomes after surgery using patient self-reported questionnaires, and (2) to explore how the SPHERE system is useful for everyday clinical decision-making. METHODS AND ANALYSIS A feasibility study recruiting and installing the SPHERE system in the homes of up to 30 NHS adult patients as they undergo a THR or TKR. Through a mixed-methods design, the SPHERE system will monitor and record continuous measurements of daily behaviour. Main outcomes will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the standard clinical assessments measuring patient outcomes over time. Patient interviews and focus groups with consultant orthopaedic surgeons will provide in-depth understanding of the acceptability, feasibility and accuracy of the data. ETHICS AND DISSEMINATION We aim to disseminate the findings through regional talks and seminars, international conferences and peer-reviewed journals and social media.
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MESH Headings
- Accelerometry
- Aged
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/rehabilitation
- Cost-Benefit Analysis
- Feasibility Studies
- Female
- Focus Groups
- Health Services Research
- Humans
- Male
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/rehabilitation
- Osteoarthritis, Knee/surgery
- Patient Reported Outcome Measures
- Quality of Life
- Recovery of Function/physiology
- Surveys and Questionnaires
- Technology Assessment, Biomedical
- Treatment Outcome
- United Kingdom
- Wearable Electronic Devices
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Affiliation(s)
- Sabrina Grant
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Ian Craddock
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Tonkin
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N, Stansfield C, Oliver S. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database Syst Rev 2018; 4:CD010842. [PMID: 29664187 PMCID: PMC6494515 DOI: 10.1002/14651858.cd010842.pub2] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic peripheral joint pain due to osteoarthritis (OA) is extremely prevalent and a major cause of physical dysfunction and psychosocial distress. Exercise is recommended to reduce joint pain and improve physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) in this population is unknown. OBJECTIVES To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise. SEARCH METHODS Review authors searched 23 clinical, public health, psychology and social care databases and 25 other relevant resources including trials registers up to March 2016. We checked reference lists of included studies for relevant studies. We contacted key experts about unpublished studies. SELECTION CRITERIA To be included in the quantitative synthesis, studies had to be randomised controlled trials of land- or water-based exercise programmes compared with a control group consisting of no treatment or non-exercise intervention (such as medication, patient education) that measured either pain or function and at least one psychosocial outcome (self-efficacy, depression, anxiety, quality of life). Participants had to be aged 45 years or older, with a clinical diagnosis of OA (as defined by the study) or self-reported chronic hip or knee (or both) pain (defined as more than six months' duration).To be included in the qualitative synthesis, studies had to have reported people's opinions and experiences of exercise-based programmes (e.g. their views, understanding, experiences and beliefs about the utility of exercise in the management of chronic pain/OA). DATA COLLECTION AND ANALYSIS We used standard methodology recommended by Cochrane for the quantitative analysis. For the qualitative analysis, we extracted verbatim quotes from study participants and synthesised studies of patients' views using framework synthesis. We then conducted an integrative review, synthesising the quantitative and qualitative data together. MAIN RESULTS Twenty-one trials (2372 participants) met the inclusion criteria for quantitative synthesis. There were large variations in the exercise programme's content, mode of delivery, frequency and duration, participant's symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Comparator groups were varied and included normal care; education; and attention controls such as home visits, sham gel and wait list controls. Risk of bias was high in one and unclear risk in five studies regarding the randomisation process, high for 11 studies regarding allocation concealment, high for all 21 studies regarding blinding, and high for three studies and unclear for five studies regarding attrition. Studies did not provide information on adverse effects.There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6% (95% confidence interval (CI) -9% to -4%, (9 studies, 1058 participants), equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6% (95% CI -7.6% to 2.0%; standardised mean difference (SMD) -0.27, 95% CI -0.37 to -0.17, equivalent to reducing (improving) WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function on a 0 to 100 scale from 49.9 to 44.3) (13 studies, 1599 participants)). Self-efficacy was increased by an absolute percent of 1.66% (95% CI 1.08% to 2.20%), although evidence was low quality (SMD 0.46, 95% CI 0.34 to 0.58, equivalent to improving the ExBeliefs score on a 17 to 85 scale from 64.3 to 65.4), with small benefits for depression from moderate quality evidence indicating an absolute percent reduction of 2.4% (95% CI -0.47% to 0.5%) (SMD -0.16, 95% CI -0.29 to -0.02, equivalent to improving depression measured using HADS (Hospital Anxiety and Depression Scale) on a 0 to 21 scale from 3.5 to 3.0) but no clinically or statistically significant effect on anxiety (SMD -0.11, 95% CI -0.26 to 0.05, 2% absolute improvement, 95% CI -5% to 1% equivalent to improving HADS anxiety on a 0 to 21 scale from 5.8 to 5.4; moderate quality evidence). Five studies measured the effect of exercise on health-related quality of life using the 36-item Short Form (SF-36) with statistically significant benefits for social function, increasing it by an absolute percent of 7.9% (95% CI 4.1% to 11.6%), equivalent to increasing SF-36 social function on a 0 to 100 scale from 73.6 to 81.5, although the evidence was low quality. Evidence was downgraded due to heterogeneity of measures, limitations with blinding and lack of detail regarding interventions. For 20/21 studies, there was a high risk of bias with blinding as participants self-reported and were not blinded to their participation in an exercise intervention.Twelve studies (with 6 to 29 participants) met inclusion criteria for qualitative synthesis. Their methodological rigour and quality was generally good. From the patients' perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual's preferences, abilities and needs; challenge inappropriate health beliefs and provide better support.An integrative review, which compared the findings from quantitative trials with low risk of bias and the implications derived from the high-quality studies in the qualitative synthesis, confirmed the importance of these implications. AUTHORS' CONCLUSIONS Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people.
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Affiliation(s)
- Michael Hurley
- St George's, University of London and Kingston UniversitySchool of Rehabilitation Sciences, Faculty of Health, Social Care and Education2nd Floor Grosvenor WingCrammer Terrace, TootingLondonUKSW17 0RE
| | - Kelly Dickson
- UCL Institute of EducationSocial Science Research Unit18 Woburn SquareLondonUKWC1H 0NR
| | - Rachel Hallett
- St George's, University of London and Kingston UniversityCenter for Health and Social Care ResearchLondonUK
| | - Robert Grant
- St George's, University of London and Kingston UniversityCenter for Health and Social Care ResearchLondonUK
| | - Hanan Hauari
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Nicola Walsh
- University of the West of EnglandGlenside CampusBristolUKBS16 1DD
| | - Claire Stansfield
- UCL Institute of Education, University College LondonEPPI‐Centre, Social Science Research Unit18 Woburn SquareLondonUKWC1H 0NR
| | - Sandy Oliver
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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18
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Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, Duda JL. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open 2017; 7:e017042. [PMID: 29282257 PMCID: PMC5770915 DOI: 10.1136/bmjopen-2017-017042] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes. OBJECTIVES The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance. METHODS Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme-Qualitative checklist and Lincoln and Guba's criteria were used for quality appraisal. Thematic synthesis was applied. FINDINGS Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a 'keep going' attitude, adjusting and prioritising PA, having healthcare professionals' and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored. CONCLUSION Our findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required. TRIAL REGISTRATION NUMBER CRD42016030024.
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Affiliation(s)
- Archontissa M Kanavaki
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Nursing, Institute of Clinical Sciences, Medical School, University of Birmingham, Birmingham, UK
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Asma Alrushud
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rainer Klocke
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Abhishek Abhishek
- Academic Rheumatology Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
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19
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Holden MA, Burke DL, Runhaar J, van Der Windt D, Riley RD, Dziedzic K, Legha A, Evans AL, Abbott JH, Baker K, Brown J, Bennell KL, Bossen D, Brosseau L, Chaipinyo K, Christensen R, Cochrane T, de Rooij M, Doherty M, French HP, Hickson S, Hinman RS, Hopman-Rock M, Hurley MV, Ingram C, Knoop J, Krauss I, McCarthy C, Messier SP, Patrick DL, Sahin N, Talbot LA, Taylor R, Teirlinck CH, van Middelkoop M, Walker C, Foster NE. Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol. BMJ Open 2017; 7:e018971. [PMID: 29275348 PMCID: PMC5770908 DOI: 10.1136/bmjopen-2017-018971] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/09/2017] [Accepted: 10/19/2017] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER CRD42017054049.
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Affiliation(s)
- Melanie A Holden
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle L Burke
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Danielle van Der Windt
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Richard D Riley
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Amardeep Legha
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Amy L Evans
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kristin Baker
- Sargent College, Boston University, Boston, Massachusetts, USA
| | - Jenny Brown
- Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniël Bossen
- Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Kanda Chaipinyo
- Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Bangkok, Thailand
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Tom Cochrane
- Centre for Research Action in Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Mariette de Rooij
- Amsterdam Rehabilitation Research Centre, Centre for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sheila Hickson
- Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Marijke Hopman-Rock
- TNO Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael V Hurley
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
- Health Innovation Network South London, London, UK
| | - Carol Ingram
- Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesper Knoop
- Amsterdam Rehabilitation Research Centre, Centre for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands
| | - Inga Krauss
- Department of Sports Medicine, Medical Clinic, University Hospital of Tübingen, Tübingen, Germany
| | - Chris McCarthy
- Manchester Movement Unit, Manchester School of Physiotherapy, Manchester Metropolitan University, Manchester, UK
| | - Stephen P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Worrell Professional Center, Wake Forest University, Winston Salem, USA
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Nilay Sahin
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Balikesir University, Balikesir, Turkey
| | - Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Robert Taylor
- Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolien H Teirlinck
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christine Walker
- Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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20
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Krastanova MS, Ilieva EM, Vacheva DE. Rehabilitation of Patients with Hip Joint Arthroplasty (Late Post-surgery Period - Hospital Rehabilitation). Folia Med (Plovdiv) 2017; 59:217-221. [PMID: 28704193 DOI: 10.1515/folmed-2017-0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/08/2015] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hip joint replacement (endoprosthesis, alloplasty) has become one of the most frequent surgery interventions of the 20th century. AIM To conduct rehabilitation therapy in the late post-surgery period of hospital rehabilitation (45 days after surgery), to track patients' progress and measure the results. MATERIALS AND METHODS One hundred and fifty-two patients with hip joint endoprosthesis were included in the study. All underwent surgery and rehabilitation at the Department of Clinical Rehabilitation of the Physical and Rehabilitation Medicine Clinic at Doctor G. Stranski University Hospital, Pleven. Kinesitherapy included therapeutic massage, isometric exercises for gluteal and hip muscles, isotonic exercises for the hip and the knee joint, breathing exercises, analytical gymnastics, exercises for balance and posture stability; gait control, exercises with gym equipment; occupational exercises included all activities of daily living (ADL) that were practiced at home; treatment with performed physical factors included applying magnetic field, interferential current therapy, electrostimulation of the m. quadriceps femoris and the gluteal muscles. RESULTS The scores from the pain visual analog scale (VAS), the muscle strength test and the test for the movement volume of the hip joint were obtained at the beginning and at the end of the rehabilitation process and stored in an individual file for each patient. CONCLUSION The results of the present study suggest that the complex rehabilitation program (kinesitherapy, performed physical factors and occupational therapy) can result in a considerably faster recovery and ensures that patients reach optimal functional results.
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Affiliation(s)
- Maya S Krastanova
- Department of Physical Medicine, Rehabilitation, Ergotherapy and Sport, Medical University of Pleven, Pleven Bulgaria
| | - Elena M Ilieva
- Department of Physical Therapy and Rehabilitation, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Danelina E Vacheva
- Clinic of Physical and Rehabilitation Medicine, University Hospital, Pleven, Bulgaria
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21
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Szypuła J, Cabak A, Kiljański M, Boguszewski D, Tomaszewski W. Comparison of Biocompatibility of Cemented vs. Cementless Hip Joint Endoprostheses Based on Postoperative Evaluation of Proinflammatory Cytokine Levels. Med Sci Monit 2016; 22:4830-4835. [PMID: 27935873 PMCID: PMC5154708 DOI: 10.12659/msm.900032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The yearly increase in the number of procedures involving implantation of hip joint endoprostheses forces prosthetics manufacturers to search for biologically neutral implants. The goal of this study was to assess the concentration of Interleukin-6 (IL-6) and its correlation with C-reactive protein (CRP), depending on the type of hip joint endoprosthesis (cemented or cementless endoprosthesis) in order to determine implant biotolerance during the early postoperative period. MATERIAL AND METHODS The sample comprised 200 patients [mean age=64 (31-81) years] with coxarthrosis. All patients underwent hip joint arthroplasty using a cemented or cementless endoprosthesis. Blood samples were collected 3 times: before the procedure, on the first day after the procedure, and after 6 weeks. IL-6 and CRP levels were assayed using immunoenzymatic methods. The results were subjected to statistical analysis using the Shapiro-Wilk test. RESULTS On the 1st day after the procedure, CRP and IL-6 concentration increased rapidly after implantation of both cemented and cementless endoprostheses. At 6 weeks postoperatively, the CRP value remained at a similar level in patients after cemented arthroplasty and was almost 2-fold lower in patients who underwent cementless arthroplasty. The IL-6 value returned to the baseline level in patients after cementless arthroplasty and showed an ongoing increasing tendency in patients after cemented arthroplasty. CONCLUSIONS 1. The measurement of C-reactive protein and Interleukin-6 is a high-sensitivity test, assessing implant biotolerance. 2. The implantation of a cemented endoprosthesis induces a higher increase in the level of proinflammatory cytokines as compared with a cementless endoprosthesis. 3. For a complete assessment of both early and later body responses to implantation and the related surgical procedure, further studies using available approaches and tools are recommended.
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Affiliation(s)
- Jan Szypuła
- Department of Orthopedic Surgery, Luxmed Hospital, Warsaw, Poland
| | - Anna Cabak
- Department of Rehabilitation, University of Physical Education, Warsaw, Poland
| | - Marek Kiljański
- Jan Kochanowski University, Kielce Poland
- University of Computer Science and Skills, Łódź, Poland
| | - Dariusz Boguszewski
- Department of Rehabilitation, Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
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22
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Abstract
Objective: To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis (OA). Design: A quasi-experimental design consisting of an exercise group and an age-matched control group. Setting: Public community swimming pool in Sheffield, UK. Subjects: One hundred and six community-dwelling sedentary older people, with confirmed knee-hip osteoarthritis, enrolled in an experimental controlled trial for 12 months. Sixty-six subjects in the exercise group were offered a water-exercise programme. Forty age-matched, nonexercising, ‘control’ subjects received monthly education material and quarterly telephone calls. Interventions: Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors. Main measures: Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Secondary outcomes included a battery of performance-based physical function tests. Results: Adherence to exercise averaged 70% (±14%) over the year: 77% of the exercising subjects and 89% control subjects completed both pre- and post-outcome measures. After one year, participants in the exercise group experienced a significant improvement in physical function (4.0 ± 9.1 versus -0.4 ± 7.3 units; 95% confidence interval (CI) 0.96–7.96, p < 0.05) and reduction in the perception of pain (1.3 ± 3.7 versus 0.2 ± 2.5 units; 95% CI -0.19-2.52, p < 0.05) compared with the control group, as measured by the WOMAC Osteoarthritis Index. In addition, the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05), had significantly greater improvements in knee range of movement ( p < 0.01) and hip range of movements ( p < 0.005). There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being (Arthritis Impact Measurement Scales 2 questionnaire). Conclusions: Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function, pain, general mobility and flexibility after participating in 12 months of community-based water exercise.
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Affiliation(s)
- S Y-C Lin
- Centre for Sports Medicine, Sheffield University, UK
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23
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Tan SS, Teirlinck CH, Dekker J, Goossens LMA, Bohnen AM, Verhaar JAN, van Es PP, Koes BW, Bierma-Zeinstra SMA, Luijsterburg PAJ, Koopmanschap MA. Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care. Osteoarthritis Cartilage 2016; 24:581-8. [PMID: 26620092 DOI: 10.1016/j.joca.2015.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [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: 01/08/2015] [Revised: 10/16/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care. METHOD This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data. RESULTS A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (€ 1233) compared to the control group (€ 1331). The average annual societal costs per patient were lower in the intervention group (€ 2634 vs € 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02). CONCLUSION Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects. TRIAL REGISTRATION NUMBER NTR1462.
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Affiliation(s)
- S S Tan
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands.
| | - C H Teirlinck
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - J Dekker
- VU University Medical Center, Department of Rehabilitation Medicine & EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - L M A Goossens
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - A M Bohnen
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - J A N Verhaar
- Erasmus MC University Medical Center, Department of Orthopaedics, Rotterdam, The Netherlands.
| | - P P van Es
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - B W Koes
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands; Erasmus MC University Medical Center, Department of Orthopaedics, Rotterdam, The Netherlands.
| | - P A J Luijsterburg
- Erasmus MC University Medical Center, Department of General Practice, Rotterdam, The Netherlands.
| | - M A Koopmanschap
- Erasmus University Rotterdam, Institute for Medical Technology Assessment & Institute of Health Policy and Management, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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24
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Macovei LA, Rezus E. ANATOMICAL AND CLINICAL ORBSERVATIONS ON STRUCTURAL CHANGES OF THE HIP JOINT. Rev Med Chir Soc Med Nat Iasi 2016; 120:273-281. [PMID: 27483704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The hip, the second largest joint of the human body, with its primary contribution to locomotion, is exposed to numerous traumatic or non-traumatic risks. Regardless of the initial pathology, there is always almost the same result: diminution of range of motion, onset of pain and functional impotence, as well as change of biomechanics of walking. Through its high frequency, morpho-functional imbalance (clinically expressed both imagistic and biologically, in one or several joints), osteoarthritis is a disease with a multifactorial etiology and a complex pathogeny. MATERIAL AND METHOD The study included 244 patients aged between 18-85 years, clinically and paraclinically investigated, especially for the osteoarthritis of the hip, admitted to Rheumatology Clinic I, Rehabilitation Hospital in Iasi, from January 2012 to December 2014. RESULTS AND DISCUSSION The high prevalence of degenerative diseases of the joints in old age is analyzed in accordance with the results of the estimations, which showed that, in fact, most of the patients remain undetected, undiagnosed and untreated. Main symptoms are pain in the coxofemoral joint, radiating or not on the lateral or anterior face of the thigh down to the knee, morning stiffness after a long rest, limping or walking with small steps, and muscle atrophy of the group of muscles that are responsible for the stability of the joint. CONCLUSIONS A strict discipline is needed from the patient's side, in order to keep and apply the doctor's indications in a chronic disease that requires a long therapy, on one hand; on the other hand, a close cooperation between various experts is needed, in order to customize and apply the most effective program, at the right time.
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25
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Wang L, Lee M, Zhang Z, Moodie J, Cheng D, Martin J. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e009857. [PMID: 26839013 PMCID: PMC4746481 DOI: 10.1136/bmjopen-2015-009857] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The clinical impact of preoperative physiotherapy on recovery after joint replacement remains controversial. This systematic review aimed to assess the clinical impact of prehabilitation before joint replacement. DESIGN We searched PubMed, Embase and Cochrane CENTRAL up to November 2015 for randomised controlled trials comparing prehabilitation versus no prehabilitation before joint replacement surgery. Postoperative pain and function scores were converted to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales (0-100, high scores indicate worse outcome). Random effects meta-analysis was performed to calculate weighted mean differences (WMD, 95% CI), subgrouped by hip and knee surgery. PRIMARY AND SECONDARY OUTCOMES Postoperative pain and function scores, time to resume activities of daily living, quality of life, length of hospital stay, total cost, patient satisfaction, postoperative complications, any adverse events and discontinuations. RESULTS Of 22 studies (1492 patients), 18 had high risk of bias. Prehabilitation slightly reduced pain scores within 4 weeks postoperatively (WMD -6.1 points, 95% CI -10.6 to -1.6 points, on a scale of 0-100), but differences did not remain beyond 4 weeks. Prehabilitation slightly improved WOMAC function score at 6-8 and 12 weeks (WMD -4.0, 95% CI -7.5 to -0.5), and time to climbing stairs (WMD -1.4 days, 95% CI -1.9 to -0.8 days), toilet use (-0.9 days, 95% CI -1.3 to -0.5 days) and chair use (WMD -1.2 days, 95% CI -1.7 to -0.8 days). Effects were similar for knee and hip surgery. Differences were not found for SF-36 scores, length of stay and total cost. Other outcomes of interest were inadequately reported. CONCLUSIONS Existing evidence suggests that prehabilitation may slightly improve early postoperative pain and function among patients undergoing joint replacement; however, effects remain too small and short-term to be considered clinically-important, and did not affect key outcomes of interest (ie, length of stay, quality of life, costs).
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Affiliation(s)
- Li Wang
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
- Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Myeongjong Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Chungju, South Korea
| | - Zhe Zhang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jessica Moodie
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
| | - Davy Cheng
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
| | - Janet Martin
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
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Hermann A, Holsgaard-Larsen A, Zerahn B, Mejdahl S, Overgaard S. Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty--a randomized controlled trial. Osteoarthritis Cartilage 2016; 24:91-8. [PMID: 26285180 DOI: 10.1016/j.joca.2015.07.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 11/20/2014] [Revised: 07/19/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the efficacy and feasibility of progressive explosive-type resistance training (RT) in patients with osteoarthritis (OA) of the hip scheduled for total hip arthroplasty (THA). METHOD Randomized controlled trial (1:1) in patients diagnosed with hip OA and scheduled for THA. The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8-12 repetition maximum). The control group (CG) received 'care as usual'. Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported as adherence, exercise related pain and adverse effects. Post-surgical follow up will be reported separately. ClinicalTrials.gov registration: NCT01164111. RESULTS Eighty patients (age 70.4 ± 7.6 years, BMI 27.8 ± 4.6, 52 females (65%) were included. Adherence was high (93%) with acceptable exercise related pain (VAS score ≤ 5) reported in 83% of sessions and no adverse events. Changes in HOOS 'function' was 10.0 points 95%CI [4.7; 15.3] higher in IG compared to CG (P < 0.001). For all the remaining HOOS subscales IG scored significantly better (P < 0.03) and had higher leg extension muscle power (P < 0.0001) compared to CG. CONCLUSION Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power.
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Affiliation(s)
- A Hermann
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Orthopedic Surgery, Herlev University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark.
| | - A Holsgaard-Larsen
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - B Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Denmark
| | - S Mejdahl
- Department of Orthopedic Surgery, Herlev University Hospital, Denmark
| | - S Overgaard
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
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Unver B, Kahraman T, Kalkan S, Yuksel E, Karatosun V, Gunal I. Test-retest reliability of the 50-foot timed walk and 30-second chair stand test in patients with total hip arthroplasty. Acta Orthop Belg 2015; 81:435-41. [PMID: 26435238 DOI: pmid/26435238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose was to investigate the test-retest reliability of the 50-Foot Timed Walk (50FWT), and 30-Second Chair Stand Test (30CST) in the patients with total hip arthroplasty (THA). The study was a test-retest study. Thirty-seven patients with THA performed two trials for both the 30CTS and 50FWT on the same day with one hour interval. To assess reliability, the intra-class correlation coefficient [ICC(2,1)], standard error of measurement (SEM), the smallest real difference at the 95% confidence level (SRD95) were calculated. The ICCs for the 50FWT and 30CTS were 0.98 and 0.94, respectively. The SEM and SRD95 for the 50FWT and 30CTS were 0.3 and 0.8 seconds and 0.4 and 1.2 repeats, respectively. The test-retest reliability of the tests was very high. The 50FWT and 30CST are very reliable to measure the functional performance in patients with THA in the clinical settings.
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Williamson W, Kluzek S, Roberts N, Richards J, Arden N, Leeson P, Newton J, Foster C. Behavioural physical activity interventions in participants with lower-limb osteoarthritis: a systematic review with meta-analysis. BMJ Open 2015; 5:e007642. [PMID: 26260348 PMCID: PMC4538274 DOI: 10.1136/bmjopen-2015-007642] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess effectiveness of osteoarthritis interventions to promote long-term physical activity behaviour change. DESIGN A systematic review and meta-analysis. Protocol registration PROSPERO CRD4201300444 5 (http://www.crd.york.ac.uk/prospero/). STUDY SELECTION Randomised controlled trials (RCTs) comparing physical activity interventions with placebo, no/or minimal intervention in community-dwelling adults with symptomatic knee or hip osteoarthritis. Primary outcomes were change in physical activity or cardiopulmonary fitness after a minimum follow-up of 6 months. DATA EXTRACTION Outcomes were measures of physical activity (self-reported and objectively measured) and cardiovascular fitness. Standard mean differences between postintervention values were used to describe the effect sizes. RESULTS 27,984 titles were screened and 180 papers reviewed in full. Eleven RCTs satisfied inclusion criteria, total study population of 2741 participants, mean age 62.2. The commonest reasons for study exclusion were follow-up less than 6 months and no physical activity measures. The majority of included interventions implement an arthritis self-management programme targeting coping skills and self-efficacy. Seven studies used self-report measures, the pooled effect of these studies was small with significant heterogeneity between studies (SMD 0.22 with 95% CI -0.11 to 0.56, z=1.30 (p=0.19) I(2) statistic of 85%). Subgroup analysis of 6-12 month outcome reduced heterogeneity and increased intervention effect compared to control (SMD 0.53, 95% CI 0.41 to 0.65, z=8.84 (p<0.00001) I(2) of 66%). CONCLUSIONS Arthritis self-management programmes achieve a small but significant improvement in physical activity in the short term. Effectiveness of intervention declines with extended follow-up beyond 12 months with no significant benefit compared to control. The small number of studies (11 RCTs) limited ability to define effective delivery methods. Investigation of behavioural lifestyle interventions for lower limb osteoarthritis populations would benefit from consensus on methodology and outcome reporting. This includes use of validated physical activity reporting tools and planning for long-term follow-up.
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Affiliation(s)
- Wilby Williamson
- Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Stefan Kluzek
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Information Specialist Department, Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Justin Richards
- School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Nigel Arden
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paul Leeson
- Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charlie Foster
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Oxford, UK
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29
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Bamman MM, Ferrando AA, Evans RP, Stec MJ, Kelly NA, Gruenwald JM, Corrick KL, Trump JR, Singh JA. Muscle inflammation susceptibility: a prognostic index of recovery potential after hip arthroplasty? Am J Physiol Endocrinol Metab 2015; 308:E670-9. [PMID: 25670829 PMCID: PMC4398830 DOI: 10.1152/ajpendo.00576.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/09/2014] [Accepted: 02/03/2015] [Indexed: 12/25/2022]
Abstract
While elective total hip arthroplasty (THA) for end-stage osteoarthritis (OA) improves pain, mobility function, and quality of life in most cases, a large proportion of patients suffer persistent muscle atrophy, pain, and mobility impairment. Extensive skeletal muscle damage is unavoidable in these surgical procedures, and it stands to reason that poor recovery and long-term mobility impairment among some individuals after THA is linked to failed muscle regeneration and regrowth following surgery and that local muscle inflammation susceptibility (MuIS) is a major contributing factor. Here we present results of two integrated studies. In study 1, we compared muscle inflammation and protein metabolism signaling in elective THA (n=15) vs. hip fracture/trauma (HFX; n=11) vs. nonsurgical controls (CON; n=19). In study 2, we compared two subgroups of THA patients dichotomized into MuIS⁺ (n=7) or MuIS⁻ (n=7) based on muscle expression of TNF-like weak inducer of apoptosis (TWEAK) receptor (Fn14). As expected, HFX demonstrated overt systemic and local muscle inflammation and hypermetabolism. By contrast, no systemic inflammation was detected in elective THA patients; however, local muscle inflammation in the perioperative limb was profound in MuIS⁺ and was accompanied by suppressed muscle protein synthesis compared with MuIS⁻. Muscle from the contralateral limb of MuIS⁺ was unaffected, providing evidence of a true inflammation susceptibility localized to the muscle surrounding the hip with end-stage OA. We suggest MuIS status assessed at the time of surgery may be a useful prognostic index for muscle recovery potential and could therefore provide the basis for a personalized approach to postsurgery rehabilitation.
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MESH Headings
- Arkansas
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/rehabilitation
- Biomarkers/metabolism
- Biopsy, Needle
- Cytokines/blood
- Disease Susceptibility
- Early Diagnosis
- Female
- Hospitals, University
- Humans
- Male
- Middle Aged
- Myositis/diagnosis
- Myositis/etiology
- Myositis/immunology
- Myositis/metabolism
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Outpatient Clinics, Hospital
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/immunology
- Postoperative Complications/metabolism
- Precision Medicine
- Predictive Value of Tests
- Prognosis
- Quadriceps Muscle/immunology
- Quadriceps Muscle/metabolism
- Quadriceps Muscle/pathology
- Receptors, Tumor Necrosis Factor/genetics
- Receptors, Tumor Necrosis Factor/metabolism
- Reoperation/adverse effects
- Reoperation/rehabilitation
- TWEAK Receptor
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Affiliation(s)
- Marcas M Bamman
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama; Univeristy of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Arthritis, Musculoskeletal, and Autoimmunity Center, University of Alabama at Birmingham, Birmingham, Alabama; Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama;
| | - Arny A Ferrando
- Department of Geriatrics and Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard P Evans
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael J Stec
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama; Univeristy of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neil A Kelly
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama; Univeristy of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Johannes M Gruenwald
- Department of Trauma Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Katie L Corrick
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jesse R Trump
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Univeristy of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Arthritis, Musculoskeletal, and Autoimmunity Center, University of Alabama at Birmingham, Birmingham, Alabama; Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; and Research Collaborator, Mayo Clinic College of Medicine, Rochester, Minnesota
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30
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Denys K, Denys P, Macander M, Zboralski K. [Quality of life, acceptance of illness and a sense of health control in patients with chronic musculoskeletal disorders during the rehabilitation process]. Pol Merkur Lekarski 2015; 38:155-158. [PMID: 25815616] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED In medical science it is accepted that in order to determine the state of physical, mental as well as the progress of treatment, the concept of quality of life is applicable. However, the most popular use of the term is in the case of chronic diseases and particularly in the lives of those who are sick. Examples of such diseases are diseases of the musculoskeletal system and especially osteoarthritis of the knee and hip. The level of quality of life in chronic disease are also affected by psychological factors that can significantly help people in the healing process as well as acceptance of existing disease. AIM The aim of study was to evaluate the association between quality of life, acceptance of illness and sense of control over own health in patients with chronic motor disability during the rehabilitation course. MATERIALS AND METHODS The study included 105 patients (76 women and 29 men) with osteoarthritis of the hip and knee, undergoing rehabilitation at the Municipal Clinic "Lecznica" in Lodz. The study used a questionnaire in the development of their own - specifying the basic socio-demographic data subjects, the SF-36 questionnaire - evaluating the quality of life of patients, Acceptance of Illness Scale (AIS BJ Felton, TA Revenson, Hinrichsen GA) in the adaptation of the Z. Juczyński and Multidimensional Scale Health Locus of Control MHLC (KA wallstone, BS wallstone, R. DeVellis) in adaptation of Z. Juczyński. RESULTS The distribution of respondents by type of disease is as follows: diseases of the knee -63.81%, hip - 23.81% and knee and hip disorders - 12.38%. A similar breakdown occurs in women and men. The average level of quality of life in this population of patients was 88.63, which is not too high. Evaluation of the results of health locus of control scale laid the equal distribution of respondents, taking into account all the studied rocks. Thanks to the use of Pearson's correlation coefficient allowed the conclusion that the level of quality of life correlates positively with the acceptance of the disease and internal locus of control pain in patients. CONCLUSIONS Quality of life of the patients in the general dimension is in significant correlation with the acceptance of the disease and with a sense of control over their own health internally. Patients who have a high sense of control health by others or by accident is characterized by a lower level of acceptance of his illness. Acceptance of the disease and a sense of control over their own health may be important factors for health behaviors.
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Affiliation(s)
- Katarzyna Denys
- Medical University of Łódź, Poland, Department of Adult Psychiatry
| | - Paweł Denys
- Medical University of Łódź, Poland, Department of Adult Psychiatry
| | - Marian Macander
- Medical University of Łódź, Poland, Department of Adult Psychiatry
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French HP, Huang X, Cummiskey A, Meldrum D, Malone A. Normalisation method can affect gluteus medius electromyography results during weight bearing exercises in people with hip osteoarthritis (OA): a case control study. Gait Posture 2015; 41:470-5. [PMID: 25600175 DOI: 10.1016/j.gaitpost.2014.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/10/2014] [Revised: 11/06/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the involved side (p=0.02-0.001) and most of the Step exercises on the uninvolved side (p=0.03-0.04), but not the Squat (p>0.05), compared to controls. Using PDM normalisation, significant between-group differences occurred only for Ascending Squat (p=0.03) on the involved side. MVIC normalisation demonstrated higher inter-trial relative reliability (ICCs=0.78-0.99) than PDM (ICCs=0.37-0.84), but poorer absolute reliability using Standard Error of Measurement. Normalisation method can significantly affect interpretation of EMG amplitudes. Although MVIC-normalised amplitudes were more sensitive to differences between groups, there was greater variability using this method, which raises concerns regarding validity. Interpretation of EMG data is strongly influenced by the normalisation method used, and this should be considered when applying EMG results to clinical populations.
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Affiliation(s)
- Helen P French
- Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Xiaoli Huang
- First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | | | - Dara Meldrum
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ailish Malone
- Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Abstract
Total hip replacement is a common and succesful treatment of the osteoarthritis of the hip. According to the demographical trends in Switzerland in the coming decades, there will be a significant increase in the demand for total hip replacement surgery. The 20-year survival of a total hip prosthesis is approximately 85%. New prosthesis designs aim to improve the hip biomechanics, sacrifice less bone stock and facilitate "minimal-invasive"' approaches to the hip joint. Severe complications in total hip replacement comprise dislocation, aseptic loosening, infection, periprosthetic fracture and limping. The painful total hip replacement requires thourough and systematic work up of extrinsic and intrinsic causes. A referral to the orthopaedic specialist should be considered early.
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Affiliation(s)
- Marc Attinger
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Universitätsspital Bern, Inselspital, Bern
| | - Klaus Siebenrock
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Universitätsspital Bern, Inselspital, Bern
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Affiliation(s)
- Kim Bennell
- University of Melbourne, Parkville, Victoria, Australia
| | - Fiona Dobson
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
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Krauß I, Steinhilber B, Haupt G, Miller R, Martus P, Janßen P. Exercise therapy in hip osteoarthritis--a randomized controlled trial. Dtsch Arztebl Int 2014; 111:592-9. [PMID: 25249361 PMCID: PMC4174683 DOI: 10.3238/arztebl.2014.0592] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/03/2014] [Accepted: 07/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Roughly one in ten persons in the industrialized world suffers from hip osteoarthritis, a disease for which there is no cure. The goal of conservative therapy is to relieve symptoms, preferably with methods that let patients assume responsibility for their own treatment, e.g., physical training. METHOD In a randomized controlled trial, we studied the effectiveness of twelve weeks of exercise therapy in patients with hip osteoarthritis (THüKo), compared to no treatment (control group) and placebo ultrasound treatment of the hip (placebo ultrasound group). The primary endpoint was a comparison of the pain scores of the intervention versus control groups on the generic SF-36 health questionnaire. Secondary endpoints included comparisons across all three study groups of scores on the 7 other scales of the SF-36 and on the pain, physical function, and stiffness scales of the osteoarthritis-specific WOMAC Index. The statistical analysis was performed with ANCOVA, with baseline values as a covariate. Between-group effects were subsequently tested pairwise (two-tailed t-tests, alpha = 0.05). RESULTS As for the primary endpoint, pain reduction was significantly greater in the intervention than in the control group (mean difference 5.7 points, 95% confidence interval [CI] 0.4-11.1 points, p = 0.034). The comparisons across all three study groups (i.e., secondary endpoints, with 71 subjects in the intervention group, 68 in the control group, and 70 in the placebo group) revealed no significant between-group effects with respect to the SF-36. On the WOMAC Index, however, statistically significant differences were found for pain reduction between the intervention and control group (mean difference 7.4 points, 95% CI 3.0-11.8, p = 0.001) and between the intervention and placebo group (mean difference 5.1 points, 95% CI 0.7-9.4, p = 0.024). Comparable mean differences were also found for functional improvement. CONCLUSION Twelve weeks of exercise therapy in hip osteoarthritis patients of normal vitality reduced pain and improved physical function. No significant improvement was found in these patients' general health-related quality of life.
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Affiliation(s)
- Inga Krauß
- Department of Sports Medicine, University Hospital, Faculty of Medicine Tübingen
| | - Benjamin Steinhilber
- Department of Sports Medicine, University Hospital, Faculty of Medicine Tübingen
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Faculty of Medicine Tübingen
| | - Georg Haupt
- Department of Sports Medicine, University Hospital, Faculty of Medicine Tübingen
| | - Regina Miller
- Department of Sports Medicine, University Hospital, Faculty of Medicine Tübingen
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital, Faculty of Medicine Tübingen
| | - Pia Janßen
- Department of Sports Medicine, University Hospital, Faculty of Medicine Tübingen
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35
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Steurer J. [Physical therapy of hip arthrosis, compared with placebo therapy, is ineffective]. Praxis (Bern 1994) 2014; 103:1033-1034. [PMID: 25146950 DOI: 10.1024/1661-8157/a001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Johann Steurer
- Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer; Universitätsspital Zürich
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36
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Skou ST, Simonsen ME, Odgaard A, Roos EM. Predictors of long-term effect from education and exercise in patients with knee and hip pain. Dan Med J 2014; 61:A4867. [PMID: 25123117] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Education and exercise are poorly implemented in osteoarthritis care. The purpose of the present study was to identify predictors of effectiveness at one year from education and exercise in patients with knee or hip pain in clinical practice. MATERIAL AND METHODS Good Life with Arthritis in Denmark is an implementation initiative consisting of education and 12 sessions of neuromuscular exercise delivered by trained physiotherapists. Pain (visual analogue scale 0-100) and quality of life (EQ-5D) were assessed at baseline and after three and 12 months. Changes in outcome from baseline to one year were dependent variables in regression analyses, while changes from baseline to 3 months and absolute results at three months in physical performance (30-second chair stand test) and self-efficacy were predictor variables. RESULTS A total of 79/82 patients completed the one-year follow-up. Improvements in pain and EQ-5D at three months were maintained at one year (p < 0.006). Change in self-efficacy from baseline to three months (Beta = -0.369) and 30-second chair stand test (Beta = -0.251) and self-efficacy at three months (Beta = -0.492) were predictors of one-year improvement in pain (p < 0.05). Furthermore, self-efficacy at three months (Beta = 0.304) was a predictor of one-year improvement in EQ-5D (p = 0.01). CONCLUSION The identified predictors highlight the importance of combining education and exercise. This study indicates that good long-term treatment results are achievable in clinical practice.
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Affiliation(s)
- Søren Thorgaard Skou
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Research and Innovation Center, 15 Soendre Skovvej, 9000 Aalborg, Denmark.
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Dowsey MM, Castle DJ, Knowles SR, Monshat K, Salzberg MR, Choong PFM. The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: study protocol for a randomised controlled trial. Trials 2014; 15:208. [PMID: 24899242 PMCID: PMC4059073 DOI: 10.1186/1745-6215-15-208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/20/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Osteoarthritis is a leading cause of disability in developed nations. In Australia it afflicts 16.5% of the adult population. Total joint arthroplasty is considered the treatment of choice for end stage osteoarthritis. The number of total joint arthroplasties undertaken in Australia has doubled over the last decade (more than 80,000 procedures in 2011). The incidence of pre-operative psychological distress in this group of patients is reported between 30% and 60% and pre-operative psychological distress is associated with poorer pain and functional outcomes after surgery. This study will use a mindfulness-based psychological intervention to enhance outcomes in people undergoing total joint arthroplasty and, in addition, will test hypotheses about coping with chronic illness in an aged population. This study is the first of its kind and will provide a greater understanding of the role of a mental health enhancement program on the physical recovery of total joint arthroplasty patients. METHODS/DESIGN One hundred and fifty people with end-stage arthritis on the waiting list for total hip or knee arthroplasty will be recruited and randomly allocated to one of two groups using computer-generated block randomisation. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of a mindfulness training program (weekly group-based classes in mindfulness practice, 2 ½ hours, for 8 weeks plus a 7-hour Saturday session in Week 6) prior to total joint arthroplasty, compared to a "standard care" group who will undergo routine total joint arthroplasty. Primary outcomes will be evaluated by a blinded examiner at baseline, 3 and 12 months post-surgery, using a validated self-reported pain and physical function scale. Secondary outcomes will include i) a range of validated measures of psychological wellbeing and ii) health economic analysis. All analyses will be conducted on an intention to treat basis using linear regression models. Health economic modelling will be applied to estimate the potential cost-effectiveness of mindfulness training and total joint arthroplasty. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTRN12611001184965). Date of registration; 15th November 2011.
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MESH Headings
- Arthralgia/prevention & control
- Arthralgia/psychology
- Arthralgia/therapy
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Humans
- Mindfulness/methods
- Motor Activity
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Knee/rehabilitation
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/prevention & control
- Pain, Postoperative/psychology
- Pain, Postoperative/therapy
- Preoperative Care/methods
- Research Design
- Self Efficacy
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Affiliation(s)
- Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, 35 Victoria parade, Fitzroy 3065, Victoria, Australia
| | - David J Castle
- Department of Psychiatry, St Vincent’s Mental Health, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Simon R Knowles
- Faculty of Life and Social Sciences, Swinburne University of Technology, Burwood Road, Hawthorn, Victoria 3122, Australia
| | - Kaveh Monshat
- Department of Psychiatry, St Vincent’s Mental Health, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Michael R Salzberg
- Department of Psychiatry, St Vincent’s Mental Health, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Peter F M Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, 35 Victoria parade, Fitzroy 3065, Victoria, Australia
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38
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Eitzen I, Fernandes L, Nordsletten L, Snyder-Mackler L, Risberg MA. Weight-bearing asymmetries during Sit-To-Stand in patients with mild-to-moderate hip osteoarthritis. Gait Posture 2014; 39:683-8. [PMID: 24238750 DOI: 10.1016/j.gaitpost.2013.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 05/28/2013] [Revised: 07/31/2013] [Accepted: 09/15/2013] [Indexed: 02/02/2023]
Abstract
The Sit-To-Stand (STS) transition is a mechanically demanding task that may pose particular challenges for individuals with lower limb osteoarthritis (OA). Biomechanical features of STS have been investigated in patients with OA, but not in patients with early stage hip OA. The purpose of this study was to explore inter-limb weight-bearing asymmetries (WBA) and selected kinematic and kinetic variables during STS in patients with mild-to-moderate hip OA compared with healthy controls. Twenty-one hip OA patients and 23 controls were included in the study. Sagittal and frontal plane kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. There were no distinctive biomechanical alterations in sagittal or frontal plane kinematics or kinetics, movement time, or time to reach peak ground reaction force (GRF) in hip OA patients compared with controls. However, the hip OA patients revealed a distinct pattern of WBA compared with the controls, in unloading their involved limb by 18.4% at peak GRF. These findings indicate that patients with early stage hip OA are not yet forced into a stereotypical movement strategy for STS; however, the observed pattern of WBA requires clinical attention.
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Affiliation(s)
- Ingrid Eitzen
- Norwegian Research Centre for Active Rehabilitation, Oslo, Norway; Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
| | - Linda Fernandes
- Norwegian Research Centre for Active Rehabilitation, Oslo, Norway; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
| | - Lars Nordsletten
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
| | | | - May Arna Risberg
- Norwegian Research Centre for Active Rehabilitation, Oslo, Norway; Norwegian School of Sport Sciences, Oslo, Norway.
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39
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Kotela I, Kawik Ł, Bednarenko M, Lorkowski J, Kotela A. [Influence on the results of surgical treatment of osteoarthritis of the hip using anatomical stem ABG]. Przegl Lek 2014; 71:86-90. [PMID: 25016782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to evaluate the clinical and radiological results of treatment and quality of life, and impact of surgical approach in patients after arthroplasty using anatomical stem ABG II in the Department of Orthopaedics and Trauma Regional Hospital. St. Luke in Tarnów of years 2008-2011. The material consisted of 68 patients operated using a Proxima stem (surgical approaches; anterolateral--34 cases, posterior lateral---34 cases similarly). The average age was 62.2 years. Patients stayed in the hospital an average of 8 days. Term follow-up was determined after 6 weeks, 3 months and then once a year. Postoperative results were evaluated using the scale: Harris and WOMAC NRS. X-rays were evaluated for setting and migration of the prosthesis components. In assessing patients with HHS to scale achieved 73.5% of very good and good. Compared to the pre-operative assessment resulted in a significant improvement in mobility of the hip after arthroplasty. According to the standardized WOMAC extended the average score of treatment was 77.0 points. During the study showed significant reduction in pain intensity after surgery. Average NRS score before surgery was 6.4 points and 1.4 points after surgery. In the material appropriate settings were 51 and 17 axial axis of the prosthesis. No effect on clinical outcomes set in the HHS and WOMAC scales. There was no effect on the results of surgical treatment.
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40
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Di Monaco M, Castiglioni C. Which type of exercise therapy is effective after hip arthroplasty? A systematic review of randomized controlled trials. Eur J Phys Rehabil Med 2013; 49:893-923. [PMID: 24172644] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Early multidisciplinary rehabilitation can improve the recovery after total hip arthroplasty (THA). However, optimal exercise therapy has not been defined. We aimed to answer the question: "Which type and/or timing of exercise therapy is effective following THA?" DESIGN Systematic review. METHODS We searched four databases: MEDLINE, PEDro, Cochrane Library, and Cinahl since January 2008 till December 2012. Literature before 2008 was not searched for, because it was previously analyzed by two systematic reviews. Eligible criteria for studies were: Randomized Controlled Trials (RCTs); English language; interventions on type and/or timing of physical exercise initiating after THA; outcome measures including at least one among impairment, activity, participation, quality of life, or length of stay in hospital. RESULTS Eleven papers on nine RCTs were identified. Trial quality was mixed. PEDro scores ranged from four to eight. Exercise therapy varied greatly in type and timing. Each of the nine RCTs addressed a specific issue and overall the results were sparse. In the early postoperative phase favorable outcomes were due to ergometer cycling and maximal strength training. Inconclusive results were reported for aquatic exercises, bed exercises without external resistance or without its progressive increase according to the overload principle, and timing. In the late postoperative phase (> 8 weeks postoperatively) advantages were due to weight-bearing exercises. CONCLUSION Insufficient evidence exists to build up a detailed evidence-based exercise protocol after THA. Sparse results from few RCTs support specific exercise types which should be added to the usual mobility training in THA patients.
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Affiliation(s)
- M Di Monaco
- Division of Physical Medicine and Rehabilitation and Osteoporosis Research Center Presidio Sanitario San Camillo, Turin, Italy -
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41
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Peter WF, van der Wees PJ, Hendriks EJM, de Bie RA, Verhoef J, de Jong Z, van Bodegom-Vos L, Hilberdink WKHA, Vliet Vlieland TPM. Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties. Musculoskeletal Care 2013; 11:193-202. [PMID: 23280718 DOI: 10.1002/msc.1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). METHODS Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups. RESULTS Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89. CONCLUSION The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined.
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Affiliation(s)
- W F Peter
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; Reade, Centre of Rehabilitation and Rheumatology (formerly Jan van Breemen Institute), Amsterdam, the Netherlands
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42
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Pollard B, Dixon D, Johnston M. Does the impact of osteoarthritis vary by age, gender and social deprivation? A community study using the International Classification of Functioning, Disability and Health. Disabil Rehabil 2013; 36:1445-51. [PMID: 24164585 PMCID: PMC4196505 DOI: 10.3109/09638288.2013.847123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 06/18/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 11/14/2022]
Abstract
UNLABELLED Abstract Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically. METHOD The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation. RESULTS Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age. CONCLUSIONS The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation. Implications of Rehabilitation The ICF model appears to vary with respect to gender and social deprivation for people with osteoarthritis. The ICF model did not appear to vary with respect to age for people with osteoarthritis. Different treatments and interventions for osteoarthritis may need to be targeted for specific gender and social deprivation groups.
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Affiliation(s)
- Beth Pollard
- Aberdeen Health Psychology Group, University of AberdeenAberdeenUK
| | - Diane Dixon
- School of Psychological Sciences and Health, University of StrathclydeGlasgowUK
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of AberdeenAberdeenUK
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43
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Sankar A, Davis AM, Palaganas MP, Beaton DE, Badley EM, Gignac MA. Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthritis Cartilage 2013; 21:1485-93. [PMID: 23774473 DOI: 10.1016/j.joca.2013.06.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [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: 01/14/2013] [Revised: 04/30/2013] [Accepted: 06/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. METHODS 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). RESULTS 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. CONCLUSIONS The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.
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Affiliation(s)
- A Sankar
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada
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44
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Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, Foster NE. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347:f5555. [PMID: 24055922 PMCID: PMC3779121 DOI: 10.1136/bmj.f5555] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. DATA SOURCES Nine electronic databases searched from inception to March 2012. STUDY SELECTION Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis. DATA EXTRACTION Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness. RESULTS 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference -0.63, 95% credible interval -1.16 to -0.10). CONCLUSIONS As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis. PROTOCOL REGISTRATION PROSPERO (www.crd.york.ac.uk/prospero/) No CRD42012002267.
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Affiliation(s)
- Olalekan A Uthman
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK
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45
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Affiliation(s)
- Kim Bennell
- Department of Physiotherapy, The University of Melbourne, Australia.
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46
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Macovei L, Brujbu I, Murariu RV. Coxarthrosis--disease of multifactorial etiology methods of prevention and treatment. The role of kinesitherapy in coxarthrosis. Rev Med Chir Soc Med Nat Iasi 2013; 117:351-357. [PMID: 24340516] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Coxarthrosis is a disorder of the physiological balance between the strength of the articular cartilage and articular bone, and between the pressures exerted on the joint. It is a disease with a slow progressive and long course. Its insidious onset and progression, marked by variable periods of stagnation lasting months or even years make it difficult to establish the time of onset. MATERIAL AND METHODS The study was conducted between January 2012 and December 2012, on a series of 27 coxarthrosis patients, diagnosed at the Rheumatology Clinic of the lasi Rehabilitation Hospital. RESULTS AND DISCUSSION Of the 27 patients, 11 (40.74%) had primary bilateral coxarthrosis, 8 (29.63%) early coxarthrosis. right, 6 (22.22%) coxarthrosis, left, secondary to aseptic femoral head osteonecrosis, and 2 (7.41%) patients had bilateral coxarthrosis secondary to acetabular insufficiency. Kinesitherapy proved to be highly effective in the rehabilitation of coxarthrosis patients by alleviating pain, mechanical protection of the hip joint, walking rehabilitation in total hip arthroplasty, and social and professional integration of the patients. The massage besides its analgesic effect also acted as a muscle relaxant. Once the objectives have been met, the kinesiology program becomes global and functional rather than analytical, as it aims at reintegrating the coxofemoral joint into normal movement patterns. CONCLUSIONS Kinesitherapy has been shown to be a physical treatment that can not be replaced by other rehabilitation methods and is crucial in the recovery of lost functions.
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Affiliation(s)
- Luana Macovei
- Discipline of Reumatology-Balneophysiotherapy, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa" - Iaşi
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47
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Holsgaard-Larsen A, Roos EM. Objectively measured physical activity in patients with end stage knee or hip osteoarthritis. Eur J Phys Rehabil Med 2012; 48:577-585. [PMID: 22641252] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients with lower extremity osteoarthritis (OA) have increased all cause and disease specific mortality compared to the general population and epidemiological data suggests that OA management should include increased physical activity. AIM To measure physical activity assessed as daily energy expenditure and accumulated steps day-1 in patients with severe OA of the hip or knee and compare with healthy controls. Furthermore, to investigate if gender, age, BMI and affected joint influence measures of physical activity. DESIGN Cross sectional study. SETTING Community. POPULATION Fifty-one patients (49% women, age: 68±5 years, BMI: 28.4±4.6) with severe knee (N.=25) or hip (N.=26) OA scheduled for total joint replacement and 15 healthy population-based controls (53 % women, age: 68±5 years, BMI: 26.9±4.3). METHODS Subjects wore an accelerometer (SenseWear™ Pro2 Armband) on 5 consecutive days. Time on body, total energy expenditure, average intensity (METS), time being sedentary, time above 3 METS and numbers of steps day(-1) were calculated. RESULTS Patients had similar daily energy expenditure to controls (2632 vs. 2633 calories per day) but walked on average 29.3% fewer steps day(-1) (6632 vs. 8576 P=0.033). Gender and affected joint (hip or knee) did not influence the results. Age and BMI explained 15.4%-32.7% of the variation in total energy expenditure, average METS, time being sedentary, and steps day(-1). CONCLUSION The present data indicate a need for interventions improving walking ability in patients with severe hip and knee OA. This need is independent regarding gender and affected joint but higher for older and heavier patients. Simultaneously assessed measures of physical activity gave different results, raising concern about validity of physical activity measures in patients with lower extremity OA and indicating caution when comparing results from studies applying different measures. CLINICAL REHABILITATION IMPACT It is of potential interest for patients and practitioners that a relative high physical activity is possible for end-stage OA patients since this may reduce the increased all cause and disease specific mortality.
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Affiliation(s)
- A Holsgaard-Larsen
- Orthopedic Research Unit, Department of Orthopedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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48
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Wei X, Wang Z, Yang C, Wu B, Liu X, Yi H, Chen Z, Wang F, Bai Y, Li J, Zhu X, Li M. Development of a simplified Chinese version of the Hip Disability and Osteoarthritis Outcome Score (HOOS): cross-cultural adaptation and psychometric evaluation. Osteoarthritis Cartilage 2012; 20:1563-7. [PMID: 22944526 DOI: 10.1016/j.joca.2012.08.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 07/27/2012] [Accepted: 08/22/2012] [Indexed: 02/02/2023]
Affiliation(s)
- X Wei
- Orthopaedic Department of Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
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49
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Pogorzała AM, Stryła W, Nowakowski A. Functional activity in patients after total hip replacement. Pol Orthop Traumatol 2012; 77:121-125. [PMID: 23306299] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Osteoarthritis of hip joints is one of the most common diseases limiting social functioning of patients. Pain and mobility disorders are major problems associated with the disease. The goal of the study was to compare the efficacy of surgical treatment in a selected group of patients using a modified Harris Hip Score questionnaire including questions regarding the pain, the type of gait disorders and the functional activity. Surgical treatment helped to reduce the pain and improve the gait quality and parameters as well as functional activities associated with putting on socks and shoes, climbing stairs, sitting and using public transportation. Following conclusions were drawn after the study: Surgical treatment leads to significant reduction in hip pain. Mobility improvement was observed in most analyzed patients in early post-operative period as a consequence of hip contracture and pain being eliminated. The walking speed and distance improved significantly during the first 3 months after the surgery. All patients were satisfied with the treatment.
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Affiliation(s)
- Adam M Pogorzała
- Department and Clinic of Rehabilitation, Poznań University of Medical Sciences, Poznań, Poland
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50
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Su EP, Su SL. 5 points on hip resurfacing. Am J Orthop (Belle Mead NJ) 2012; 41:446-449. [PMID: 23376986] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hip resurfacing has enjoyed a resurgence in popularity as an alternative to total hip replacement (THR) for the treatment of end-stage arthritis in younger, active patients. However, technical difficulties in implant positioning have been realized, as the procedure has been introduced amongst surgeons new to the concept. Furthermore, as the follow-up interval increases beyond the short-term, it is evident that certain issues with the metal-on-metal bearing surface may lead to complications. These 5 points on hip resurfacing are selected to highlight the factors that will help ensure an optimal outcome.
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Affiliation(s)
- Edwin P Su
- Associate Professor of Clinical Orthopaedics, Weill Cornell University Medical College, and Orthopaedic Surgeon, Hospital for Special Surgery, New York, New York.
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