Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial

2020 ◽  
pp. 026921552094693
Author(s):  
Aishwarya Nigam ◽  
Kiran H Satpute ◽  
Toby M Hall
Keyword(s):  
Patient Satisfaction ◽  
Confidence Interval ◽  
Knee Osteoarthritis ◽  
Usual Care ◽  
Primary Outcome ◽  
Mean Difference ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Objectives: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis Design: A randomised controlled trial. Setting: A general hospital Subjects: Forty adults with knee osteoarthritis (grade 1–3 Kellgren–Lawrence scale). Interventions: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. Main Measures: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. Results: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. Conclusion: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

scholarly journals An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Indiana Cooper ◽  
Peter Brukner ◽  
Brooke L. Devlin ◽  
Anjana J. Reddy ◽  
Melanie Fulton ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Confidence Interval ◽  
Knee Osteoarthritis ◽  
Drop Out ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Anti Inflammatory ◽  
Dietary Education

Abstract Background Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis. Methods This 9-week single-arm feasibility study recruited participants aged 40–85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval. Results Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m−2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection. Conclusion This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis. Trial registration ACTRN12620000229976 prospectively on 25/2/2020.

scholarly journals Long-term Results of Hemiarthroplasty for Osteoarthritis of the First Metatarsophalangeal Joint

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Stefan Beekhuizen ◽  
Ron Onstenk
Keyword(s):  
Patient Satisfaction ◽  
Scale Score ◽  
Operative Treatment ◽  
Primary Outcome ◽  
Metatarsophalangeal Joint ◽  
Long Term Results ◽  
First Metatarsophalangeal Joint ◽  
Satisfaction Rates

Category: Big toe, MTP-1 joint osteoarthritis Introduction/Purpose: Osteoarthritis of the first metatarsophalangeal joint is the second most common disorder affecting the hallux. If non-operative treatment is not efficacious, operative treatment should be considered. Arthrodesis is considered standard care for grade III and IV osteoarthritis of the first metatarsophalangeal joint. If preservation of joint mobility is preferred, implant arthroplasty could be considered. Total arthroplasty is less recommendable because of high failure rates. However, recent studies showed similar short term results after arthrodesis and hemi joint replacement with greater satisfaction rates, as well as low postoperative pain, after hemiarthroplasty. In our study we mainly focussed on long-term subjective results like patient satisfaction as well as patient recommendation for the performed procedure including our primary outcome; the postoperative AOFAS HMI score. Methods: We therefore evaluated primary arthrodesis and hemiarthroplasty as treatment for arthritis of the first metatarsophalangeal joint. All 102 patients operated between January 2005 and December 2011 were asked to participate in our study, sixty-seven patients responded and were included. Forty-seven arthrodesis were performed in 40 patients using different fixation techniques and thirty-one hemiarthroplasties were performed in 27 patients using the BiopPro® First MPJ implant. Both procedures performed for stage 3 or 4 osteoarthritis and patients had been followed for at least five years, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale score was measured as primary outcome. Secondary outcomes addressed satisfaction rates, recommendation of the performed procedure, number of unplanned surgical repeat procedures, return to daily activities (work as well as sports), and influence of smoking and diabetes mellitus on postoperative results. Finally, financial costs for both procedures were calculated. Results: The 47 primary arthrodeses and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean follow-up of 8.3 years (range 5-11.8) the mean AOFAS-HMI scale score after arthrodesis and after hemiarthroplasty were 72.8±14.5 and 89.7±6.6 respectively (p =.001). Patients were significantly more pleased after hemiarthroplasty (p<.001) and this procedure was better recommended (p<.001). The number of unplanned repeat surgical procedures did not differ between the two groups. No differences were found in postoperative work resumption, but patients returned to sports significantly sooner after hemiarthroplasty (p=.002). No association was found between smoking and the total AOFAS-HMI score. Overall costs, the sum of procedure costs as wel as additional costs, were quite similar for both procedures. Conclusion: Higher postoperative AOFAS HMI scores after a long-term follow-up (mean 8.3 years, range 5-11.8 years) were found after hemiarthroplasty compared to arthrodesis of the MTP-1 joint. Also greater patient satisfaction and better recommendation is seen after hemiarthroplasty. However return to work showed no differences, a significantly faster return to sports was seen after hemiarthoplasty. Based on these long-term results we could recommend hemiarthroplasty in future patient with osteoarthritis of the MTP-1 joint, with modest preference for the younger, more active patients.

scholarly journals Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Regina WS Sit ◽  
Vincent CH Chung ◽  
Kenneth D. Reeves ◽  
David Rabago ◽  
Keith KW Chan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Knee Oa ◽  
Composite Scale ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Pain Subscale ◽  
Hypertonic Dextrose

Abstract Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi–randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.

Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study

2013 ◽  
Vol 73 (7) ◽  
pp. 1369-1375 ◽  
Author(s):  
Jasmijn F M Holla ◽  
Marike van der Leeden ◽  
Martijn W Heymans ◽  
Leo D Roorda ◽  
Sita M A Bierma-Zeinstra ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Activity Limitations ◽  
Follow Up Study ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

scholarly journals Role of Diabetes Mellitus in Acute Coronary Syndrome Patients with Heart Failure With Mid-Range Ejection Fraction Underwent Percutaneous Coronary Intervention: A 3-Year Case Series Follow-Up Retrospective Study

2020 ◽  
Author(s):  
Lieyou Li ◽  
Ganyang Li ◽  
Huang Chen ◽  
Zhihai Feng ◽  
Yifan Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Confidence Interval ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patients With Heart Failure

Abstract Backgroud Data are limited about the effect of diabetes mellitus (DM) on prognosis of acute coronary syndrome (ACS) patients with heart failure with mid-range ejection fraction (HFmrEF) underwent percutaneous coronary intervention (PCI). This study aimed to investigate the relationship between type 2 diabetes mellitus(T2DM) and the 3-year outcomes in such population.Methods 377 ACS patients with HFmrEF (left ventricular EF 40–49%) underwent PCI (132 diabetic and 245 nondiabetic patients) were included into analysis. The primary outcome was a composite endpoint of all-cause death or HF rehospitalization. Cox proportional-hazards regression analysis and Kaplan–Meier test were used to assess the effect of diabetes on the primary outcome. Sensitivity analysis was conducted with propensity score-matching analysis.Results During a follow-up of three years, diabetic patients had a higher incidence rate of the primary outcome than nondiabetic patients (96.1 vs. 44.6 per 1000 patient-years, incidence rate ratio 2.301, 95% confidence interval 1.334–3.969; P=0.002). Multivariate analysis showed that diabetes mellitus was associated with a significant increase in the composite outcome of all-cause death or HF rehospitalization (adjusted hazard ratio 2.080, 95% confidence interval 1.115–3.878, P=0.021). Sensitivity analysis further confirmed that diabetes mellitus was an independent prognostic factor of long-term adverse outcome for ACS patients with HFmrHF who underwent PCI (adjusted hazard ratio 3.792, 95% confidence interval 1.802-7.980, P＜0.001).Conclusions Among ACS patients with HFmrEF underwent PCI, complicating with T2DM was significantly associated with worse long-term outcomes.

scholarly journals Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola Veronese ◽  
Sinisa Stefanac ◽  
Ai Koyanagi ◽  
Nasser M. Al-Daghri ◽  
Shaun Sabico ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Muscle Mass ◽  
Lower Limbs ◽  
American People ◽  
Knee Oa ◽  
Skeletal Mass ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Significant Difference

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p&lt;0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.

scholarly journals Intramuscular Clodronate in Long-Term Treatment of Symptomatic Knee Osteoarthritis: A Randomized Controlled Study

Drugs in R&D ◽  
2020 ◽  
Vol 20 (1) ◽  
pp. 39-45
Author(s):  
Bruno Frediani ◽  
Carmela Toscano ◽  
Paolo Falsetti ◽  
Antonella Nicosia ◽  
Serena Pierguidi ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Term Treatment ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Long Term Treatment

Magna Ease versus Trifecta Early Hemodynamics

2018 ◽  
Vol 13 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Bobby Yanagawa ◽  
Derrick Y. Tam ◽  
Kathryn Hong ◽  
Amine Mazine ◽  
Akshay Bagai ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Mean Difference ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Jude Medical ◽  
Long Term Follow Up

Objective This meta-analysis compares the early echocardiographic outcomes of aortic valve replacement using the two most commonly implanted stented bioprostheses. Methods We searched MEDLINE and EMBASE databases until 2017 for studies comparing Magna or Magna Ease (Edwards Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul, MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was performed for the primary outcome of mean gradient on echocardiography and secondary outcomes of effective orifice area, indexed effective orifice area, and in-hospital mortality. Results There were two randomized controlled trial, three matched, and six unmatched retrospective observational studies with 2119 patients [median reported follow-up = 6 months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was associated with higher early mean gradient (mean difference = 4.09, 95% confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective orifice area (mean difference = 0.30, 95% confidence interval = −0.38 to −0.22, P < 0.0001). There were no differences in 30-day mortality between Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence interval = 0.41 to 2.50, P = 1.0). Conclusions Trifecta may offer a small hemodynamic advantage compared with the Magna/Magna Ease valve with no differences in early mortality. Long-term follow-up is required to determine whether these differences persist and translate into differences in clinical outcomes.

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