Standardized mean differences (SMDs; Hedges' g) were calculated from means and standard deviations (mean difference/pooled SD) of muscle strength data using Review Manager software (Version 5.2; The Cochrane Collaboration, London, UK). The SMDs of 0.2, 0.5, and 0.8 were considered small, moderate, and large, respectively. 9 The percentage difference in strength was also calculated to provide a further indication of the relative difference in strength between OA and control participants [(OA strength -control strength)/control strength × 100]. Results were grouped according to the type of strength measurement (eg, isometric or isokinetic) or hip action performed (eg, hip flexion or extension). Data were pooled for multiple studies in a meta-analysis within each group using a random-effects model. When studies reported on multiple grades of OA classification (eg, Kellgren-Lawrence grade 2 or 3) without reporting on muscle strength of the whole sample combined, only the more established OA grading was used in the meta-analysis, to avoid repeated assessment of control-group data. When studies measured isokinetic strength at multiple speeds, the slower speed was used, as slower speeds are considered more reliable.35,41 When a study reported results of left and right knees of participants with bilateral knee OA, only the side with the most conservative SMD was presented, to avoid repeated inclusion of control-group data.10 Statistical heterogeneity across pooled studies was assessed using the I 2 statistic, in which a value of 25%, 50%, or 75% was considered a low, moderate, or high level of heterogeneity, respectively. 23 Assessment of Quality of Body of EvidenceA modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence in each meta-analysis. 20,35,43 The GRADE tool has been modified to apply to observational, nonexperimental data. 35,43 Each meta-analysis was graded using the following predefined criteria: (1) inconsistency (downgraded if I 2 was 50% or greater), (2) Screened by title and abstract, n = 1737Screened by title and abstract, n = 1737Full-text articles assessed for eligibility, n = 102Full-text articles assessed for eligibility, n = 102Hip strength in knee OA compared to control, n = 5Hip strength in knee OA compared to control, n = 5Hip strength as a risk factor for knee OA development, n = 0Hip strength as a risk factor for knee OA development, n = 0
ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.
Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population‐based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into “0 to 3 months” and “3 months and above.” Meta‐analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.
Groupwork has proved to be a key choice in methods of intervention with children and young people in recent years and it is greatly implemented by the social workers in the agency where I have been placed for my work experience. This paper will examine the use of groupwork as a method of intervention for the children from a disadvantaged community, focusing on the a number of theories that are incorporated to assist and inform the social workers in their endeavour to alleviate the many problems faced by the children who attend this agency. This paper will furthermore acknowledge my role and observations in the group setting and discuss how groupwork participation has provided me with the opportunity to engage with children in a formal and informal structure in the workplace.
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