Supplemental Digital Content is Available in the Text. This feasibility study of contemporary pain science education to increase activity levels in people with painful knee osteoarthritis supports progression to a larger trial.
Objective. Emerging research supports the role of chronic stress in chronic disease development. The objective was to perform a scoping review mapping the field of research exploring relationships between chronic stress and the development of arthritis in adult populations.Methods. Five electronic databases were systematically searched without publication limits based on 3 key concepts: stress, arthritis, and adults. Eligible qualitative studies investigated individuals' perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by 2 independent reviewers, and data were narratively synthesized.Results. Of 1,819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods, and 45 used quantitative methods. The frequency of studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorized as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self-reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development.Conclusion. Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease etiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiologic framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions.
Purpose: Elbow tendinopathies are common conditions that typically last 6 to 24 months. There is no clear consensus in the literature regarding the most effective management. Platelet-rich plasma (PRP) is an autologous blood product used for elbow tendinopathies with the aim of enhancing tissue regeneration. The aim of this systematic review was to evaluate the available evidence on the effectiveness and safety of PRP for reducing pain and physical function in elbow tendinopathies. Methods: Electronic databases were searched for relevant studies and data were extracted regarding the design, sample characteristics, interventions, and outcome measures. Each study was critically appraised for methodological quality using a modified tool for quantitative studies and presented in a narrative summary. Results: The search strategy identified 299 hits related to platelet-rich plasma and/or elbow tendinopathies. Five studies met the inclusion criteria; all were randomized controlled trials except one cohort study. All five studies showed improvements from baseline in pain and physical function with a PRP intervention. One study and its follow-up study showed significant improvements in pain and function with PRP compared to corticosteroid at 26, 52, and 104 weeks. Two studies compared PRP to whole blood, which did not find sufficient evidence to suggest one is more effective than the other. A cohort study found PRP was more effective than placebo at 4 and 8 weeks. Three studies reported on the safety of PRP and found no significant adverse effects. Conclusions: The current literature has some limitations and is insufficient to provide strong recommendations regarding the use of PRP in elbow tendinopathies over other modalities; however, these studies suggest that PRP may be more efficacious than corticosteroid injections, but that whole blood injections may be as effective as PRP.
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