Conclusions:Evidence-based non-surgical OA treatment, at least delivered digitally, may reduce the need for surgery and should therefore be offered as the first-line treatment option to patients with hip and knee OA. Several patients reconsidered their options and had changed their attitude to TJR after participation in the program. These results highlight the importance of providing patients with adequate information about non-surgical management options to facilitate shared decision-making, and possibly reduce the need for surgery and improve the identification of those seemingly in need of TJR.
2011). Data were extracted on subgroup analyses (methods and potential moderators), outcome measure data (pain and function) and subgroup findings (associated statistics and tests of potential moderator*intervention effects). Findings were analysed for each potential moderator using narrative synthesis summarising: a) the amount of evidence (number of RCTs and participants); b) the direction, strength, and statistical significance of subgroup (moderation) effects; c) consistency of results across trials and outcome domains, and; (iv) level of evidence for the moderator (based on risk of bias and moderation analysis quality). Results: 142 full text RCTs of exercise for hip or knee OA were identified, of which 14 explored 25 potential moderators (n¼2,145 participants, published in 15 articles). Only one RCT focused on hip OA (n¼203). Potential moderators investigated were: overweight or obese BMI (n¼5 RCTs); anxiety/depression (n¼4); quadriceps strength, pain in other joints, radiographic OA severity (all n¼3); cardiac problems, diabetes, respiratory conditions, number of comorbidities, age, subchondral bone
BackgroundOsteoarthritis (OA) related joint pain and mental health problems are common and often co-exist in patients with other long term conditions (LTCs), but are under-detected and sub-optimally managed in primary care. The ENHANCE study aims to develop and test the feasibility and acceptability of a practice nurse-led “enhanced” review for identifying, assessing and supporting management of joint pain, anxiety and/or depression in patients attending routine LTC reviews. We report on the development of the new complex intervention.ObjectivesTo use a theoretically informed approach to co-design an intervention for case-finding and initial management of OA related joint pain and anxiety and/or depression in routine consultations for LTCs in primary care.MethodsAn implementation of change model was used in three parts. (1) A “concrete proposal” for the intervention was co-produced using an evidence synthesis and a community of practice (CoP) (patient and practice nurse advisory groups and 3 stakeholder workshops). (2) A target group analysis was undertaken using a focus group with practice nurses (n=6) to identify current practice and potential determinants of behaviour change required to deliver the new intervention. Data were analysed thematically and then mapped to the Theoretical Domains Framework. (3) Training needs and techniques to address determinants of nurse behaviour highlighted in part 2 were identified and integrated into the trial training programme.Results(1) Through collaborative working an algorithm for the enhanced review consultation was produced. This includes tools for case-finding and initial assessment, evidence based treatment options (e.g. based on NICE guidelines), and signposting options to other services including the third sector. (2) In the focus group, practice nurses understood the new complex intervention but highlighted potential treatment burden for patients. Issues related to capabilities and professional roles were evident as they talked of a lack of knowledge, confidence and skills to undertake OA case-finding, joint assessments and initial management. Practice nurses were more confident in asking about anxiety and depression but disclosed avoidance of this activity in practice. (3) In addition to knowledge, confidence and skills for dealing with OA, training needs in detecting non-verbal cues which might suggest anxiety and/or depression were highlighted, as were strategies for providing reassurance about their own decisions (and consequences) and emotional support or supervision during the intervention period.ConclusionsAn implementation of change model has been applied using an evidence synthesis, community of practice and focus group with practice nurses. This approach has enabled co-design of a new complex intervention for integrating joint pain and anxiety and/or depression into LTC reviews in primary care consultations, and identification of training needs. A feasibility stepped wedge trial will now commence.AcknowledgementsIndependent research funded by the National I...
Background Physical activity (PA) is recommended as a core treatment for osteoarthritis (OA). Previous research evaluating the measurement properties of PA instruments in OA populations has focused solely on knee and hip OA (Terwee et al. 2011). To date there is still no consensus on which instrument is the most suitable for OA and joint pain research. Objectives To identify the most suitable self-report PA instruments for OA and joint pain research. Methods Systematic searches were conducted to identify PA instruments in OA and joint pain research. Appraisal of measurement properties (reliability, measurement error, validity, responsiveness and interpretability) in populations with OA or joint pain or older adults (aged 45 years and over) was then conducted. Searches were made in Embase, Medline and Web of Science databases. Data on each instrument’s measurement properties were extracted using the QAPAQ (Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires) checklist. Study methodology was then assessed for quality using a modified COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) checklist. At least two reviewers independently reviewed selection criteria, completed data extraction and methodology quality assessments. Results Twenty different validated PA instruments were obtained from 51 studies. Twenty-five (49%) studies using non-validated instruments were excluded. Measurement properties were identified 37 studies; with 6 (16%) studies in a population with OA or joint pain and 31 (84%) additional studies in older adults. In older adults the International Physical Activity Questionnaire (IPAQ), Physical Activity Scales for the Elderly (PASE), Active Australia Survey (AAS) and Short Telephone Activity Rating (STAR) questionnaire were shown to be reliable (ICC=>0.7). Criterion validity was evaluated in the PASE (r=0.68) and modified Baecke (r=0.54). Correlations with objective measures of PA and measures of physical function were found in the IPAQ, PASE and STAR (r=0.3-0.5). In OA and joint pain populations the IPAQ, PASE, University California in Los Angeles (UCLA) scale, Tegner and Activity Rating Scale (ARS) were shown to be reliable (ICC=>0.7). The PASE was also found to correlate with objective measures (r=0.3). The UCLA, Tegner and ARS scales all showed correlations with physical function (r=0.26-0.5). Conclusions A large number of validated instruments are available to assess PA levels in adults with OA and joint pain. The IPAQ and PASE appear to be most suitable for measuring self-reported PA in OA and joint pain research; however 23% of studies evaluating the IPAQ and PASE had small sample sizes (n=<50). There is a need for well conducted validation studies on the IPAQ and PASE in joint pain and OA populations. References Terwee, C.B., Bouwmeester, W., van Elsland, S.L., de Vet, H.C. & Dekker, J. 2011, “Instruments to assess physical activity in patients with osteoarthritis of the hip or knee: a systematic review of measur...
Background Current research and guidelines are often focused on single joint osteoarthritis (OA). The National Institute for Health and Clinical Excellence OA guidelines recommended that future research should consider the impact of multisite joint pain (NICE, 2008). Objectives To describe the prevalence and pattern of multisite joint pain (pain in two or more joint sites; hip, knee, hand, foot) and the impact on quality of life (QoL) and general health in a community dwelling population. Methods A cross-sectional population survey was mailed to adults aged 45 years and over (n=28,443) registered with 8 general practices in the North West Midlands, UK as part of the MOSAICS study. Participants provided information on demographic characteristics, general health, QoL and joint pain in the hand, hip, knee or foot in the last year. Participants were divided into mutually exclusive subgroups based on 16 combinations of multisite joint pain. These subgroups were collapsed into five groups based on the number of pain sites: 0,1,2,3 and 4. Linear regression analysis was used to investigate the association of multisite joint pain with general health (SF12, PCS & MCS) and QoL (EQ5D) after adjusting for age, gender, BMI, and social deprivation. Results Of those mailed the survey, it was completed by 15,083 (53.0%). Average age of responders was 63.9 years (11.2 sd) and approximately half were female. 11,928 (42.0%) had joint pain, 8206 (28.8%) had multisite joint pain. Knee pain was the most prevalent single site pain (n=1492, 5.2%). Knee and hand was the most prevalent combination of 2 sites of joint pain (n=857, 3.0%) and knee, hand and foot was the most prevalent of 3 sites of joint pain (n=712, 2.5%). The prevalence of pain in all four sites was n=1953 (6.9%). After adjusting for covariates the linear regression showed a statistically significant association between multisite joint pain and the EQ5D and SF12. Each additional joint site demonstrated an increasing negative impact on QoL and general health (see table 1.) Table 1. The impact of multisite joint pain on the EQ5D and SF12 Conclusions Self-reported multisite peripheral joint pain has a significant negative impact on general health and QoL in the community. Multisite joint pain also shows a greater impact with each additional affected joint site. These findings suggest that the impact of multisite joint pain should be assessed in consultations with health care professionals. References NICE (2008) Osteoarthritis. The care and management of osteoarthritis in adults. National practice guideline no 59. London: NICE. Disclosure of Interest None Declared
BackgroundOsteoarthritis (OA) is one of the diseases with the highest prevalence of comorbidity. Clinical guidelines recommend physical activity (PA) for people with OA irrespective of comorbidity. Research investigating the effectiveness of PA interventions in OA and comorbidity is needed. Objective: To synthesise existing evidence investigating the effectiveness of PA interventions in adults with OA and obesity.MethodsA systematic review with meta-analysis was conducted (PROSPERO Registration: CRD42017055582). Six electronic databases; MEDLINE, EMBASE, AMED, CINAHL, SportDiscus and CENTRAL were searched for studies from their inception to 29.03.17. Inclusion criteria were: randomised controlled trials (RCTs) comparing the effectiveness of any PA intervention to non-PA control group; including adults aged 45 years old and over with clinical or radiographic OA at any site; at least one of the comorbidities of interest (COPD, depression, diabetes, hypertension, obesity, T2DM); and measuring pain, physical function, quality of life, global health post intervention and adverse events. Included study risk of bias (ROB) was assessed using the Cochrane risk of bias tool. Two reviewers screened titles, abstracts and full text articles, checked data extraction, and carried out ROB assessment. Random-effects model meta-analysis pooled outcomes from sufficiently homogeneous studies to calculate effect sizes (Standardized Mean Difference (SMD) with 95% confidence interval (CI)). Meta-analysis findings of the OA and obesity subgroup are reported.ResultsThe literature search retrieved 8171 citations of which 14 studies (n=4224 participants) were included in the full review, with 9 (n=1382 participants) analysed in the OA and obesity subgroup. PA interventions included: aquatic, aerobic, strengthening and functional activity; of 1–18 months in duration.Four studies of OA and obesity measuring either Western Ontario Osteoarthritis Index (WOMAC) pain, WOMAC function or Six Minute Walking Test (6 MWT) and were included in three meta-analyses. Best estimates showed PA to improve WOMAC pain (n=3 studies; n=547 participants; SMD=-0.09 (95% CI) −0.65, 0.47), improve WOMAC function (n=3 studies, n=415 participants; SMD=-0.35 (95% CI) −0.89, 0.18) and the 6 MWT (n=4 studies, n=573 participants; SMD=-0.93 (95% CI) −0.49, 2.35). However, results were not statistically significant. There was substantial between-trial outcome heterogeneity (I²=89.4% (p=0.000); 77.5% (p=0.012); 97.8% (p=0.000); respectively); results should be interpreted with caution. ROB domain judgements were generally either low or unclear. A small minority of judgements were at high risk of bias.ConclusionBest estimates suggest small beneficial effects of physical activity on WOMAC pain, WOMAC function and the 6 MWT. Mixed effectiveness among individual RCTs was likely due to heterogeneous intervention types, intensity and duration.
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