Objective. To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty. Methods. A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6-week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery. Results. Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P ‫؍‬ 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P ‫؍‬ 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074 -0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively. Conclusion. A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.

The pedi-IKDC demonstrated overall acceptable psychometric performance for outcome assessment of children and adolescents with various disorders of the knee.

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Background and purpose The Knee Injury and Osteoarthritis Outcome Score (KOOS) is distinguished from other knee-specific measures by the inclusion of separate scales for evaluation of activities of daily living, sports and recreation function, and knee-related quality of life, with presentation of separate subscale scores as a profile. However, its applicability in children has not been established. In this study, we examined how well the KOOS could be understood in a cohort of children with knee injury, with a view to preparing a pediatric version (KOOS-Child).Material and methods A trained researcher conducted cognitive interviews with 34 Swedish children who had symptomatic knee injuries (either primary or repeated). They were 10–16 years of age, and were selected to allow for equal group representation of age and sex. All the interviews were recorded. 4 researchers analyzed the data and modified the original KOOS questionnaire.Results Many children (n =14) had difficulty in tracking items based on the time frame and an equivalent number of children had trouble in understanding several terms. Mapping errors resulted from misinterpretation of items and from design issues related to the item such as double-barreled format. Most children understood how to use the 5-point Likert response scale. Many children found the instructions confusing from both a lexical and a formatting point of view. Overall, most children found that several items were irrelevant.Interpretation The original KOOS is not well understood by children. Modifications related to comprehension, mapping of responses, and jargon in the KOOS were made based on qualitative feedback from the children.

Self-management interventions (SMIs) are patient-centered and designed to foster active participation of patients in order to promote well-being and to manage symptoms. Over the past two decades the role of self-management in chronic diseases has gained momentum. Selfmanagement programs are now acknowledged as a key element of quality care. New modes of delivery allow greater access to information and are tailored to address patient needs. This systematic review presents data from clinical studies of self-management over the past decade, summarizes the evidence for program effectiveness and suggests future research directions. 3

The final KOOS-Child demonstrates good psychometric properties and supports the use of the KOOS-Child when evaluating children with knee disorders.

The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form is a knee-specific measure developed for adults. Its usefulness in children is not established. This study describes how children interpret IKDC items, identifies sources of response errors, and provides suggestions for modification. Cognitive interviews were conducted in 30 children with a primary knee injury, purposefully sampled based on age and gender. Most children could not recall their injury date or symptoms 4 weeks after injury. All reported problems interpreting directions; half noted item timeframes were unclear and did not realize all questions pertained to their injured knee. Seventy percent read only the first half of a question, missing subtle differences between items. Children had difficulty comprehending the following concepts: strenuous/moderate activity, pivoting, locking, giving way, significant pain/swelling, and knee catching. Examples to describe activity levels either did not apply (e.g. housework) or were ranked differently by children. Younger children had difficulty using five-point responses. The two most difficult items were assessment of current and prior function. Children found the IKDC Subjective Knee Evaluation Form difficult to comprehend and to answer. Modifications to directions, item formatting, and definitions are needed to ensure comprehensibility and validity.

Background Multiple studies demonstrate poor adherence to medications prescribed for chronic illnesses, including osteoporosis, but few interventions have been proven to enhance adherence. We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve medication adherence for osteoporosis. Methods We conducted a one year randomized controlled clinical trial. Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries. All potentially eligible individuals had been newly prescribed a medication for osteoporosis. Consenting persons were randomized to either a program of telephone-based counseling (n = 1,046) using a motivational interviewing framework or a control group (n = 1,041) that received mailed educational materials. Medication adherence was the primary outcome compared across treatment arms and was measured as the median (interquartile range, IQR) medication possession ratio (MPR), calculated as the ratio of days with filled prescriptions to total days of follow-up. Results The groups were balanced at baseline, with a mean age of 78 years; 94% were female. In an intention-to-treat analysis, median adherence was 49% (IQR 7, 88) in the intervention arm and 41% (1.5, 86.0) in the control arm (P = 0.074 by Kruskal-Wallis test). There were no differences in self-reported fractures. Conclusions In this randomized controlled trial, we did not find a statistically significant improvement in osteoporosis medication adherence using a telephonic motivational interviewing intervention.