Dietary weight loss and exercise for obese adults with knee osteoarthritis: modest weight loss targets, mild exercise, modest effects.
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Adult↗
Biomedical subjects
Marlene Fransen
Publications and source records attributed to Marlene Fransen.
When is physiotherapy appropriate?
The main goal of physiotherapy is to reduce pain and restore (or maintain) optimal physical functioning. A wide range of non-pharmacological treatment modalities can be accessed by physiotherapists, including manual therapies, electrophysical agents, thermotherapy, hydrotherapy and graded exercise. The aim of this chapter is to summarise the evidence to date for the effectiveness of various physiotherapy treatment modalities for patients with chronic musculoskeletal conditions, specifically ankylosing spondylitis, rheumatoid arthritis and osteoarthritis involving the peripheral joints. Some important issues for consideration by the rheumatologist before referral of a patient to physiotherapy are also outlined.
Humans↗
Preventing chronic ectopic bone-related pain and disability after hip replacement surgery with perioperative ibuprofen. A multicenter, randomized, double-blind, placebo-controlled trial (HIPAID).
Postoperative ectopic bone formation affects about 40% of people undergoing elective hip replacement surgery. Despite clear evidence that a short course of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) can substantially reduce the occurrence of ectopic bone, the use of NSAID-based prophylactic therapy is uncommon in Australia or New Zealand. In part, this reflects surgeons' uncertainty about the importance of ectopic bone as a cause of impaired long-term outcome, and in part, concerns about possible increased risk for gastrointestinal complications and excess wound bleeding in patients undergoing orthopedic surgery. To address this uncertainty, a multicenter randomized controlled clinical trial is being conducted amongst 1000 patients undergoing elective total hip replacement (or revision) surgery. Patients are randomly allocated to 14 days of treatment with either 1200 mg ibuprofen (a commonly used NSAID) or matching placebo commencing within 24 h of surgery. Treatment outcomes will be assessed 6-12 months later. The primary outcome will be self-reported pain and physical function. Secondary outcomes include quality of life and physical performance measures. Patient recruitment has commenced in more than 20 orthopedic centers throughout Australia and New Zealand and will be complete by the end of October 2003. The prevention of chronic ectopic bone-related pain and disability after hip replacement surgery with anti-inflammatory drugs study (HIPAID) has been designed to provide precise and reliable information about the overall balance of risks and benefits associated with a short 14-day perioperative course of ibuprofen among individuals undergoing elective total hip replacement surgery.
Anti-Inflammatory Agents, Non-Steroidal↗
Isometric muscle force measurement for clinicians treating patients with osteoarthritis of the knee.
OBJECTIVE: To evaluate the discriminant validity and, for clinicians, the test-retest reliability of isometric force in patients with knee osteoarthritis (OA). METHODS: Mean isometric muscle strength data collected for 113 patients with knee OA were compared with published normative data for 131 asymptomatic subjects. RESULTS: Patients with knee OA, ages 60-79 years, could attain only 40-53% of the knee extensor force and 35-46% of the knee flexor force generated by their age- and sex-matched peers. One-week test-retest intraclass correlations ranged from 0.79 to 0.95. Random measurement error demonstrated a favorable "signal-to-noise" ratio. CONCLUSION: The similar decrease in knee extensor and knee flexor strength demonstrated by patients with knee OA compared with their age- and sex-matched asymptomatic peers suggests that strategies should be directed at both muscle groups to optimally limit joint damage. Isometric muscle force measurement can be a useful assessment tool for clinicians.
Aged↗
Risk factors associated with the transition from acute to chronic occupational back pain.
STUDY DESIGN: A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later. OBJECTIVE: To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain. SUMMARY OF BACKGROUND DATA: Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage. METHODS: At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants' computerized records. RESULTS: The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1-4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05). CONCLUSIONS: Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.
Acute Disease↗
Excess mortality or institutionalization after hip fracture: men are at greater risk than women.
OBJECTIVES: To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over. DESIGN: Cohort study. SETTING: Auckland, New Zealand, from July 1991 to February 1996. PARTICIPANTS: Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases. MEASUREMENTS: Two-year mortality or institutionalization status. RESULTS: Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women. CONCLUSIONS: For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.
Activities of Daily Living↗
Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review.
OBJECTIVE: To determine whether land based therapeutic exercise is beneficial for people with osteoarthritis (OA) of the hip or knee in terms of reduced joint pain, improved physical function, and/or the patient's global assessment of therapeutic effectiveness. METHODS: Five databases were searched for randomized clinical trials. Standardized mean differences (SMD) with their 95% confidence intervals (CI) were calculated for each study and then combined using a fixed effects model. RESULTS: Only 2 studies, totaling about 100 participants, could potentially provide data on people with hip OA. Fourteen studies provided data on 1633 participants with knee OA. Nine of these studies were considered of high methodological quality. For pain, combining the results revealed a mean moderate beneficial effect (SMD 0.46, 95% Cl 0.35, 0.57), while for self-reported physical function a mean small beneficial effect (SMD 0.33, 95% CI 0.23, 0.43) was found. These results appeared to be sensitive to blinding of outcome assessor and choice of control group. CONCLUSION: Land based therapeutic exercise was shown to reduce pain and improve physical function for people with OA of the knee.
Databases, Bibliographic↗