Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346.

obesity is one of the most important risk factors of knee osteoarthritis (KoA), but its impact on clinical and functional consequences is less clear. the main objective of this cross-sectional study was to describe the relation between body mass index (BMi) and clinical expression of KoA. participants with BMi ≥ 25 kg/m 2 and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m 2), stage I obesity (BMI 30-35 kg/m 2) and stage II/III obesity (BMI ≥ 35 kg/m 2). the groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMi and contributes to preventing the clinical consequences of KoA.

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BackgroundOsteoarthritis (OA) is not limited to joint pain and stiffness, which can lead to disability; it is also linked to comorbidities such as overweight, obesity and fears and beliefs related to the pathology. The knee OA population appears more affected by these risk factors and has a lower physical activity (PA) level than the general population. The key challenge for OA treatment is increasing the PA level to decrease the risk factors.MethodsWe aim to perform a prospective, multicentric, quasi-randomized controlled trial with an alternate-month design (1-month periods). People aged 50–75 years old with symptomatic knee OA (stage I-IV Kellgren and Lawrence scale) with low and moderate PA level will be included in 3 spa therapy resorts. The experimental arm will receive 5 self-management exercise sessions (1.5 h each; education, aerobics, strength training, range of motion) + an information booklet + 18 sessions (1 h each) of spa therapy treatment (STT). The active comparator arm will receive an information booklet + 18 sessions of STT. The primary outcome will be a change at 3 months in PA level (International Physical Activity Questionnaire short form score). Secondary outcomes will be function (WOMAC) pain (numerical scale), anxiety/depression (HAD), fears and beliefs about OA (KOFBeQ) and arthritis self-efficacy (ASES). The barriers to and facilitators of regular PA practice will be assessed by using specific items specifically designed for the study because of lack of any reference scale.DiscussionThe study could demonstrate the impact of a self-management exercise program associated with spa therapy in the medium term by increasing PA level in people with OA. A benefit for ameliorating fears and beliefs and anxiety/depression and improving self-efficacy will also be analysed. The findings could offer new prospects while establishing best clinical practice guidelines for this population.Trial registrationClinicalTrials.gov NCT02598804 (November 5, 2015).Electronic supplementary materialThe online version of this article (10.1186/s12906-018-2339-x) contains supplementary material, which is available to authorized users.

ObjectivesTo model and analyse conceptions of determinants of health and cancer that are expressed and perceived by school children aged 6–11 based on a multiphase qualitative protocol.MethodologyThis is a multicentric, qualitative study of human and social sciences conducted among school children aged 6–11 years old. Two different tools were used, e.Photoexpression and Photonarration, in four French schools. This innovative and exploratory method addresses global health during the first phase (e.Photoexpression) and the theme of cancer during the second phase (Photonarration). The children express themselves through photography and narration.Results1498 qualitative productions were made by 381 children aged 6–11 years old. The analysis of these productions of expression and narration through images allowed modelling of determinants of health and cancer as perceived by children through 7 fields and 28 categories. The conceptions of determinants of health and child cancer refer to rationalities that are centred on individual determinants (76%), minimise environmental determinants (20%) and conceal the parameters of access to healthcare and social services (3%).DiscussionThese findings provide new data to the international literature on children’s perceptions of determinants of health and cancer. These research findings, which can be applied to interventions and current practices, will enable prevention workers to act more effectively, closer to children’s perceptions and needs.

To identify the determinants of global health in the literature as perceived and expressed by children and adolescents in order to adapt prevention actions to this young audience. To also question the pertinence of a qualitative approach when interviewing children. Method: Systematic review of the literature from PubMed, Google Scholar, CINAHL, PsycINFO databases. The studies selected used qualitative methods alone for investigating the views of health determinants in children and adolescents. Results: 185 articles were read to reach a final selection of 13 articles on global health, excluding studies with children who were ill, studies using quantitative, mixed, or retrospective methodologies, and those dealing exclusively with themes of health. Collecting information from children and adolescents showed the pertinence and effectiveness of qualitative methods. It also appears necessary to explore new paths: improving and adapting the tools and methodological supports used and combining them to enrich repositories. Conclusion: The small amount of qualitative data available with the views of children and adolescents on health determinants requires that new studies with better adapted collection methodologies be set up. To increase pertinence and effectiveness among a young audience, it is necessary, considering the methodologies identified during this literature review, to turn toward a multi-phase method that combines these methods. A methodology in several phases allows each one to use a different approach with young people and to obtain richer and more varied information. A corpus of images appeared as a powerful tool for collection: it facilitates children's capacity for oral expression and places the researcher in a position of listening.

Objective: To validate the Arthritis Self-Efficacy Scale—French version (ASES-F) of the ASES questionnaire designed to evaluate self-efficacy in arthritis population and to confirm its psychometric properties. Design: The translation/back-translation procedure was done in line with cross-cultural adaptation international guidelines. Prospective multicenter validation was performed on 168 patients with osteoarthritis who filled out the ASES-F. Function subscale of the Western Ontario and McMaster Universities Arthritis Index, Hospital Anxiety and Depression (HAD), Knee Osteoarthritis Fears and Beliefs Questionnaire, and pain on visual analog scale were collected. Acceptability, internal consistency, reproducibility, internal and external structure validity, and sensitivity following a self-management program focused on physical activity were analyzed. The retest was performed 15 days later. Results: A culturally adapted version was obtained following the validation procedure. The final translated questionnaire is available within the full article. Cronbach’s alpha coefficient was at 0.95 for the overall ASES-F. Regarding the test–retest reproducibility, Lin’s concordance coefficient was at 0.84. The internal and external validity was also explored with correlations at −0.50 between ASES-F and (WOMAC), and significant correlations between ASES-F and HAD. Sensitivity shown significant improvement at three months for the subscale function only (+2.65, P < 0.01). Conclusion: The ASES-F, French version of the ASES, available in supplemental data, was validated in knee osteoarthritis patients and could be used in clinical practice and research for French-speaking patients. Sensitivity needs to be more explored.