scholarly journals Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049476
Author(s):  
Kristin Gustafsson ◽  
Joanna Kvist ◽  
Marit Eriksson ◽  
Andrea Dell'Isola ◽  
Caddie Zhou ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
General Population ◽  
Knee Osteoarthritis ◽  
Age Groups ◽  
First Line ◽  
Swedish Population ◽  
Knee Oa ◽  
Intervention Patient ◽  
Comorbidity Index ◽  
Reference Cohort

ObjectivesTo describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities.DesignRegister-based study.SettingPrimary healthcare, Sweden.ParticipantsIndividuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population.Outcome measuresComorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status.ResultsIn this OA population, 85% had ≥1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, ≥3 comorbidities, aged ≤45 years OR; 1.74 (95% CI 1.52 to 1.98), ≥81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates.ConclusionComorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status.Trial registration numberNCT03438630.

scholarly journals Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons

2021 ◽  
Vol 2 ◽  
Author(s):  
Lea Ettlin ◽  
Irina Nast ◽  
Erika O. Huber ◽  
Karin Niedermann
Keyword(s):  
Knee Osteoarthritis ◽  
General Practitioners ◽  
Treatment Options ◽  
Barriers And Facilitators ◽  
First Line ◽  
Pharmacological Management ◽  
Physically Active ◽  
Knee Oa ◽  
Diagnostic Measures ◽  
Active Patient

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.

scholarly journals Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population—a descriptive observational study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristin Gustafsson ◽  
Joanna Kvist ◽  
Marit Eriksson ◽  
Leif E. Dahlberg ◽  
Ola Rolfson
Keyword(s):  
Educational Level ◽  
Reference Group ◽  
Management Program ◽  
Self Management ◽  
Line Treatment ◽  
First Line ◽  
Swedish Population ◽  
Knee Oa ◽  
General Swedish Population ◽  
First Line Treatment

Abstract Background First-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population. Methods This is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed. Results The BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with ≥10 years of education), and with knee OA (77% vs 72% with ≥10 years of education). Their average disposable income was higher (median [IQR] in Euro (€), for hip €17,442 [10,478] vs €15,998 [10,659], for knee €17,794 [10,574] vs €16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%). Conclusions The consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.

scholarly journals Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053194
Author(s):  
Simone Battista ◽  
Andrea Dell'Isola ◽  
Mattia Manoni ◽  
Martin Englund ◽  
Alvisa Palese ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Knee Osteoarthritis ◽  
Primary Outcome Measure ◽  
Structured Interviews ◽  
First Line ◽  
Knee Oa ◽  
Social Sphere ◽  
Medical Visits ◽  
Purposeful Sampling ◽  
The Social

ObjectiveTo examine the experience of the COVID-19 pandemic as lived by people with hip and knee osteoarthritis (OA), in Italy.DesignA qualitative study based on semi-structured interviews.SettingUrban and suburban areas in northern Italy.ParticipantsA total of 11 people with OA were enrolled through a purposeful sampling and completed the study.Primary outcome measureThe experience of Italian people with OA during the COVID-19 pandemic.ResultsFour themes were brought to the forefront from the analysis of the interviews. (1) Being Stressed for the Limited Social Interactions and for the Family Members at High Risk of Infection, as the interviewees were frustrated because they could not see their loved ones or felt a sense of apprehension for their relatives. (2) Recurring Strategies to Cope with the Pandemic such as an active acceptance towards the situation. (3) Being Limited in the Possibility of Undergoing OA Complementary Treatments and Other Routine Medical Visits. (4) Being Unaware of the Importance of Physical Activity as First-Line Interventions which was an attitude already present before the pandemic.ConclusionThe COVID-19 pandemic and related restrictions impacted the quality of life and the care of individuals with hip and knee OA. The social sphere seemed to be the most hindered. However, the interviewees developed a good level of acceptance to deal with the pandemic. When it came to their care, they faced a delay of routine medical visits not related to OA and of other complementary treatments (eg, physical therapies) to manage OA. Finally, a controversial result that emerged from these interviews was that first-line interventions for OA (ie, therapeutic exercise) was not sought by the interviewees, regardless of the restrictions dictated by the pandemic. Policy-making strategies are thus necessary to support the awareness of the importance of such interventions.

scholarly journals Evaluation of the efficacy and safety of bioactive concentrate from small sea fish in elderly patients with knee osteoarthritis

2021 ◽  
Vol 15 (1) ◽  
pp. 60-65
Author(s):  
E. V. Usova ◽  
Yu. V. Averkieva ◽  
M. V. Letaeva ◽  
O. S. Malyshenko ◽  
M. V. Koroleva ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
The Elderly ◽  
Efficacy And Safety ◽  
Standard Regimen ◽  
Knee Oa ◽  
American College Of Rheumatology ◽  
Significant Efficacy ◽  
Comorbidity Index ◽  
High Level ◽  
Sea Fish

Objective: to evaluate the efficacy and safety of Alflutop (the bioactive concentrate from small sea fish) in patients aged 75 years and older with knee osteoarthritis (OA). Patients and methods. The investigation enrolled 38 patients aged 75 years and older with knee OA (according to the American College of Rheumatology (ACR) criteria, 1986), Kellgren–Lawrence grades II–III, ≥40 mm pain visual analogue scale (VAS), who required continuous non-steroidal anti-inflammatory drug (NSAID) use. All the patients received Alflutop in the standard regimen: a 1-ml intramuscular injection daily for 20 days. The dynamics of pain during movement was assessed using the VAS scale, the WOMAC, and the EQ-5D questionnaire. Comorbidity was determined according to the Charlson comorbidity index, polypharmacy, and the safety of therapy in all the patients. The investigation duration was 8 weeks.Results and discussion. On day 21 of Alflutop therapy, there was a statistically significant reduction in pain, stiffness, and functional insufficiency according to the WOMAC index (p< 0.001) and improvements in quality of life as shown by the EQ-5D questionnaire (p< 0.001); on day 56, the number of NSAID intake days decreased (p=0.005). The findings suggest that there is a high level of comorbidity in the majority (94.7%) of patients. The mean number of drugs taken was 5.0±1.5, which indicates the presence of polypharmacy. No serious or severe adverse events were recorded.Conclusion. The results of the investigation showed the statistically significant efficacy and safety of Alflutop in patients with knee OA in the elderly group.

scholarly journals Conservative non-pharmacological management of knee osteoarthritis in Switzerland: a survey among medical specialists

2020 ◽  
Author(s):  
Lea Ettlin ◽  
Irina Nast ◽  
Erika O. Huber ◽  
Karin Niedermann
Keyword(s):  
Knee Osteoarthritis ◽  
Treatment Options ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
First Line ◽  
Pharmacological Management ◽  
Physically Active ◽  
Knee Oa ◽  
Diagnostic Measures ◽  
Active Patient

Abstract Background: International Guidelines recommend self-management, exercise and weight management if appropriate as first line conservative treatment for patients with knee osteoarthritis (OA). The objective of this study was to survey the conservative non-pharmacological management of patients with knee OA in Switzerland and to explore perceived barriers and facilitators for the application of guideline recommendations. Methods: Based on the results of semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons, a survey was performed across their scientific societies. Questions addressed diagnostic measures, treatment options, reasons for referral to exercise as well as barriers and facilitators. Results: In total, 234 members responded. They indicated that usually patients presented due to pain (n=222, 98.2%) and functional limitations of the knee (n=151, 66.8%). Additionally to clinical assessment X-ray (n=214, 95.5%) and MRI (n=70, 31.3%) were used as diagnostic measures. The referral to exercise, was driven by the patients’ expectation/high level of suffering (n=73, 37.1%), as well as by their own clinical experience (n=49, 24.9%). They estimated to refer 54% of their patients to exercise. Further, the specialists rated as the most important barriers for the referral to exercise ‘disinterest of patient’ (n=88, 46.3%) and ‘physically active patient’ (n=59, 31.1%). As most important facilitators, they rated ‘priority to mention exercise during short time of consultation’ (n=170, 89.4%) and ‘insufficiently physically active patient’ (n=165, 86.9%). Conclusion: A substantial evidence-performance gap in the management of patients with knee OA seems to be present. To successfully support systematic referral to exercise as first line intervention, it may be important to not simply suggest exercise in general, but a specific best-practice exercise and education programme for knee OA.

COVID - 19 AND THE PROBLEM OF PERSONALITY

2020 ◽  
pp. 31-35
Author(s):  
Mazaeva N.A. ◽  
Golovina A.G.
Keyword(s):  
General Population ◽  
Age Groups ◽  
Personal Transformation ◽  
Personality Changes ◽  
Age Dependent

In order to determine possible trends in the dynamics and characterological structure of personality in the General population caused by the COVID-19 pandemic, which is a long-term strong stressful effect and clinically and psychopathologically comparable to chronic personality changes after experiencing a disaster, the conditions predisposing to personal transformation, including clinical and prognostic patterns, are analyzed. The age-dependent nature of these changes is shown, and a number of features identified for different age groups are discussed.

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

2020 ◽  
Vol 5 (1) ◽  
pp. 29
Author(s):  
Nelson Sudiyono
Keyword(s):  
Knee Osteoarthritis ◽  
Cross Sectional Study ◽  
Functional Mobility ◽  
Cross Sectional ◽  
Knee Oa ◽  
Walking Aids ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Contralateral Hand ◽  
Painful Knee

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral. Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

scholarly journals AB0587 ASSESSING THE CHARACTERISTICS AND MANAGEMENT OF KNEE OSTEOARTHRITIS PATIENTS WITH HYPERTENSION BY CLINICIAN SPECIALITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1330.2-1331
Author(s):  
D. Baldock ◽  
E. Baynton ◽  
C. F. Ng
Keyword(s):  
Knee Osteoarthritis ◽  
Sports Medicine ◽  
Primary Care Physicians ◽  
Bone Erosion ◽  
Holistic Treatment ◽  
Knee Oa ◽  
Patient Demographics ◽  
Medical Chart Review ◽  
Complex Patients ◽  
Minimum Number

Background:Though the pathogenesis of knee osteoarthritis (OA) is complex, patients with OA frequently have other comorbidities, including hypertension, which eludes to other considerations needed when deciding appropriate treatment management.Objectives:This study aims to examine the profiles of knee OA patients with hypertension vs. those without any comorbidities, and to elucidate key differences between these patient groups as potential areas of consideration.Methods:A multi-center, online medical chart review study of patients with OA was conducted between May – July 2020 among US rheumatologists (rheums), orthopedic surgeons (orthos), primary care physicians with a focus in sports medicine (SM PCPs), and pain specialists. Physicians recruited were screened for duration of practice in their specialty (3-50 years) and caseload (>=35 knee OA patients personally managed, at least 10 being moderate-severe). Patient charts were recorded for the next 5 eligible patients seen during the screening period. Respondents abstracted patient demographics and treatments used. Descriptive statistics were used to analyse the data.Results:260 physicians were recruited and collectively reported 796 knee OA patients; 559 were reported to experience hypertension whilst 237 were reported as not experiencing any comorbidities.Reported hypertension patients were significantly older (mean 67 vs 59 years old, respectively; p≤0.01) and weighed more (mean 82kg vs 77kg, respectively; p≤0.01) than patients without comorbidities; they were also significantly more likely to be previous smokers compared to those without comorbidities (23% vs 8%, respectively; p≤0.01). With regards to current knee OA severity, both orthos and SM PCPs reported a significantly higher proportion of hypertension patients that were deemed ‘severe’ (physician opinion) vs patients without comorbidities (orthos: 50% vs 32%, respectively; SM PCPs: 42% vs 23%, respectively; p≤0.01).Rheums and pain specialists reported greater mild opioid usage amongst hypertension patients compared to those without comorbidities (rheums: 28% vs 10%, respectively (p≤0.05); pain specialists: 40% vs 9%, respectively; (p≤0.01)); orthos and SM PCPs stated significantly greater use of corticosteroid injections amongst their reported hypertension patients vs those without comorbidities (orthos: 60% vs 41%, respectively; SM PCPs: 40% vs 19%, respectively; p≤0.01). Hypertension patients reported by orthos and SM PCPs are more likely to be considered for total knee replacement (TKR) surgery compared to those without comorbidities (orthos: 59% vs 32%, respectively; SM PCPs: 37% vs 19%, respectively; p≤0.01). Conversely, hypertension patients reported by rheums are less likely to be considered for TKR vs those without comorbidities (41% vs 18%, respectively; p≤0.05).Reported hypertension patients had a significantly higher mean Visual Analogue Scale for Pain (VAS) score than patients without comorbidities (6.6 vs 5.9, respectively; p≤0.01). A significantly higher proportion of patients with hypertension demonstrate radiographic evidence of bone erosion compared to those without comorbidities (69% vs 56%, respectively; p≤0.01).Conclusion:From the sample surveyed, knee OA patients with hypertension may require a more specific and holistic treatment approach that takes into account their CV status and managing physician specialty. Further investigation using comparator cohort is warranted.References:[1]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.[2]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.Disclosure of Interests:None declared.

scholarly journals Influence of sex and gender on the management of late-stage knee osteoarthritis

2021 ◽  
Author(s):  
B. Moretti ◽  
A. Spinarelli ◽  
G. Varrassi ◽  
L. Massari ◽  
A. Gigante ◽  
...  
Keyword(s):  
Gender Differences ◽  
Knee Osteoarthritis ◽  
Healthcare Professionals ◽  
Pain Tolerance ◽  
Exact Nature ◽  
Sex And Gender ◽  
Physician Practices ◽  
Knee Oa ◽  
And Gender ◽  
Sex And Gender Differences

Abstract Purpose The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA presentation, care, and outcomes after TKA. Methods The survey questions were elaborated by a multidisciplinary scientific board composed of 1 pain specialist, 4 orthopedic specialists, 2 physiatrists, and 1 expert in gender medicine. The survey included 5 demographic questions and 20 topic questions. Eligible physician respondents were those who treat patients during all phases of care (pain specialists, orthopedic specialists, and physiatrists). All survey responses were anonymized and handled via remote dispersed geographic participation. Results Fifty-six physicians (71% male) accepted the invitation to complete the survey. In general, healthcare professionals expressed that women presented worse symptomology, higher pain intensity, and lower pain tolerance and necessitated a different pharmacological approach compared to men. Pain and orthopedic specialists were more likely to indicate sex and gender differences in knee OA than physiatrists. Physicians expressed that the absence of sex and gender-specific instruments and indications is an important limitation on available studies. Conclusions Healthcare professionals perceive multiple sex and gender-related differences in patients with knee OA, especially in the pre- and perioperative phases of TKA. Sex and gender bias sensitivity training for physicians can potentially improve the objectivity of care for knee OA among TKA candidates.

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