Objective The prevalence of symptomatic knee osteoarthritis (OA) has been increasing over the past several decades in the United States concurrent with an aging population and the growing obesity epidemic. We quantify the impact of these factors on the number of persons with symptomatic knee OA in the first decades of 21st century. Methods We calculated prevalence of clinically diagnosed symptomatic knee OA from the National Health Interview Survey 2007–08 and derived the proportion with advanced disease (Kellgren-Lawrence grades 3–4) using the Osteoarthritis Policy Model, a validated simulation model of knee OA. Incorporating contemporary obesity rates and population estimates, we calculated the number of persons living with symptomatic knee OA. Results We estimate that about fourteen million persons had symptomatic knee OA, with advanced OA comprising over half of those cases. This includes over three million African American, Hispanic, and other racial/ethnic minorities. Adults under 45 years of age represented nearly two million cases of symptomatic knee OA and individuals between 45 and 65 years of age six million more. Conclusion Over half of all persons with symptomatic knee OA are younger than 65 years of age. As many of these younger persons will live for three decades or more, there is substantially more time for greater disability to occur and policymakers should anticipate healthcare utilization for knee OA to increase further in upcoming decades. These data emphasize the need for the deployment of innovative prevention and treatment strategies for knee OA, especially among younger persons.
A dual THC + FI intervention led to substantial improvements in step count and physical activity following TKR.
Objective Summarize the comparative effectiveness of oral non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in reducing knee osteoarthritis (OA) pain. Methods Two reviewers independently screened reports of randomized controlled trials, published in English between 1982 and 2015, evaluating oral NSAIDs or opioids for knee OA. Included studies were at least eight weeks duration, conducted in Western Europe, the Americas, New Zealand, or Australia, and reported baseline and follow-up pain using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain subscale (0–100, 100-worst). Effectiveness was evaluated as reduction in pain, accounting for study dropout and heterogeneity. Results 27 treatment arms (9 celecoxib, 4 non-selective NSAIDs [diclofenac, naproxen, piroxicam], 11 less potent opioids [tramadol], and 3 potent opioids [hydromorphone, oxycodone]) from 17 studies were included. NSAID and opioid studies reported similar baseline demographics and efficacy withdrawal rates; NSAID studies reported lower baseline pain and toxicity withdrawal rates. Accounting for efficacy-related withdrawals, all drug classes were associated with similar pain reductions (NSAIDs: −18; less potent opioids: −18; potent opioids: −19). Meta-regression did not reveal differential effectiveness by drug class but found that study cohorts with a higher proportion of male subjects and worse mean baseline pain had greater pain reduction. Similarly, results of the network meta-analysis did not find a significant difference in WOMAC Pain reduction for the three analgesic classes. Conclusion NSAIDs and opioids offer similar pain relief in OA patients. These data could help clinicians and patients discuss likely benefits of alternative analgesics.
BackgroundWe designed and implemented the Brigham and Women’s Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees.MethodsWe enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently.ResultsB-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently.ConclusionsOur data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial.Trial registrationClinicaltrials.gov, NCT02850094. Registered July 27, 2016 [retrospectively registered].
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