Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis.

Obesity is one of the most important risk factors of knee osteoarthritis (KOA), but its impact on clinical and functional consequences is less clear. The main objective of this cross-sectional study was to describe the relation between body mass index (BMI) and clinical expression of KOA. Participants with BMI ≥ 25 kg/m2 and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m2), stage I obesity (BMI 30-35 kg/m2) and stage II/III obesity (BMI ≥ 35 kg/m2). The groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMI and contributes to preventing the clinical consequences of KOA.

Measurement properties of the Star Excursion Balance Test in patients with ACL deficiency.

OBJECTIVES: To assess intrarater reliability, agreement and construct validity of the Star Excursion Balance Test (SEBT) in individuals with anterior cruciate ligament (ACL) deficiency and the ability of the SEBT to distinguish between healthy and ACL-deficient individuals. METHODS: Patients with ACL deficiency and healthy matched controls performed the SEBT and the One Leg Hop for Distance test (OLHD). Three consecutive trials were analyzed. Also evaluated were isokinetic thigh muscle strength and self-reported function. RESULTS: We included 33 patients and 33 matched controls. Intrarater reliability of the SEBT was good to excellent (ICC: 0.88-0.96). Agreement was estimated by the minimal detectable change (5.93-8.36 cm). Posteromedial and posterolateral direction and composite score of the SEBT were correlated with OLHD performance (r: 0.34-0.53, p < 0.05) and thigh muscle strength (r: 0.35-0.45, p < 0.05). Posteromedial and posterolateral direction and composite scores of the SEBT were significantly lower bilaterally for patients with ACL deficiency than controls (p < 0.05). CONCLUSION: The SEBT can be used in patients with ACL deficiency with good to excellent intrarater reliability. Construct validity of the SEBT versus the OLHD test and isokinetic thigh muscle strength can be confirmed. Furthermore, posteromedial and posterolateral performance of the SEBT can detect bilateral neuromuscular control deficits.

French validation of the Arthritis Self-Efficacy Scale and further psychometric properties exploration among 168 people with osteoarthritis.

OBJECTIVE:: To validate the Arthritis Self-Efficacy Scale-French version (ASES-F) of the ASES questionnaire designed to evaluate self-efficacy in arthritis population and to confirm its psychometric properties. DESIGN:: The translation/back-translation procedure was done in line with cross-cultural adaptation international guidelines. Prospective multicenter validation was performed on 168 patients with osteoarthritis who filled out the ASES-F. Function subscale of the Western Ontario and McMaster Universities Arthritis Index, Hospital Anxiety and Depression (HAD), Knee Osteoarthritis Fears and Beliefs Questionnaire, and pain on visual analog scale were collected. Acceptability, internal consistency, reproducibility, internal and external structure validity, and sensitivity following a self-management program focused on physical activity were analyzed. The retest was performed 15 days later. RESULTS:: A culturally adapted version was obtained following the validation procedure. The final translated questionnaire is available within the full article. Cronbach's alpha coefficient was at 0.95 for the overall ASES-F. Regarding the test-retest reproducibility, Lin's concordance coefficient was at 0.84. The internal and external validity was also explored with correlations at -0.50 between ASES-F and (WOMAC), and significant correlations between ASES-F and HAD. Sensitivity shown significant improvement at three months for the subscale function only (+2.65, P < 0.01). CONCLUSION:: The ASES-F, French version of the ASES, available in supplemental data, was validated in knee osteoarthritis patients and could be used in clinical practice and research for French-speaking patients. Sensitivity needs to be more explored.

Short-term pain evolution in chronic low back pain with Modic type 1 changes treated by a lumbar rigid brace: A retrospective study.

BACKGROUND: Blocking the lumbar or lumbosacral spine with a custom-made rigid lumbar brace, based on the mechanical origin of active discopathy, is a therapeutic option for low back pain, but no study has yet defined its applicability in low back pain. OBJECTIVE: To assess the pain evolution of individuals with non-specific chronic low back pain associated with Modic type 1 changes treated with custom-made rigid lumbar brace. METHODS: This was a retrospective observational study conducted in the Physical Medicine and Rehabilitation unit at Clermont-Ferrand University Hospital, France, between January 2014 and December 2016. Inclusion criteria were adults with non-specific chronic low back pain associated with Modic type 1 changes on the lumbar or lumbosacral spine confirmed by MRI. Patients had 4 consultations with the physician (baseline, 5 weeks, 3 months, and 5 months). The brace was progressively withdrawn at 3 months. The main outcome was pain improvement of at least 30% at 3 months (visual pain scale). The secondary outcome was an improvement of at least 50%. We also studied the association between pain improvement at the 2 thresholds (30 and 50%) and clinical data, level of Modic type 1 changes, and pain recurrence after withdrawal of the brace. RESULTS: Among the 174 patients who wore the brace, 62 were included in the study; 49/62 (79%) showed improvement of at least 30% at 3 months. Two months after brace withdrawal, pain recurred for 30/46 patients (16 missing data). No sociodemographic, clinical or radiographic criteria were associated with pain evolution. CONCLUSION: In the present study, a rigid lumbar brace worn for 3 months was associated with a 30% reduction in pain for 79% of patients with chronic low back pain and active discopathy. However, the retrospective open and uncontrolled design of our study limits our interpretation about a specific treatment effect. A prospective randomized controlled trial is needed to clarify the effect of a rigid lumbar brace in this condition.

Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial.

Evidence is still inconclusive for the benefits of bracing in patients with knee osteoarthritis. To assess the effect of REBEL RELIEVER unloading knee brace in conservative treatment of knee osteoarthritis, a randomized controlled trial was conducted in 67 patients with symptomatic medial knee osteoarthritis, who randomly received 6-week treatment with either REBEL RELIVER unloading knee brace + usual care (Brace group, N = 32) or usual care alone (Control group, N = 35). Primary outcome was the global last 24h-pain relief (100-mm visual analogic scale [VAS]) at 6 weeks. Secondary endpoints included pain on motion (100-mm VAS), function (Lequesne index), safety and observance. At 6 weeks, mean [SD] last 24h-pain decreased significantly more in Brace group versus Control group (-41.35 [3.37] vs -15.37 [3.23], difference -25.98, 95% CI -41.64 to -10.33, P < 0.0001). Higher mean [SD] pain on motion decrease (-51.91 [3.49] vs -19.91 [3.34], difference -32.01, 95% CI -48.21 to -15.80, P < 0.0001) and better improvement of Lequesne index score (-5.8 [0.5] vs -2.3 [0.5], difference -3.5, 95% CI -5.0 to -2.0, P < 0.0001) were observed in Brace group. Safety and observance to the brace were excellent. The additive clinical benefit of wearing REBEL RELIEVER unloading knee brace was demonstrated in knee osteoarthritis patients.

Motivators for and barriers to physical activity in people with knee osteoarthritis: A qualitative study.

OBJECTIVES: We aimed to explore the motivators for and barriers to regular physical activity in people with knee osteoarthritis. METHODS: We performed a cross-sectional, monocentric qualitative study based on 20 semi-structured individual interviews and two focus groups. People with knee osteoarthritis according to American College of Rheumatology criteria were recruited from spa therapy resorts (Royat, France). Data were collected by interviews, which were then transcribed and coded. The analysis was performed according to the researcher triangulation method. RESULTS: Among the 27 participants (17 women), the mean age was 67years (SD 7.8) and mean body mass index 29.2kg/m2 (SD 8.2). The motivators for physical activity were physical (well-being, decreased pain, self-perception), personal (lifestyle, psychological well-being), societal (relationships, others' views), and environmental (living). The motivators differed by gender, with the concept of performance predominant for men and others' views for women. The barriers were psychological (fear of pain, lack of motivation) and physical (knee pain, asthenia) and were also potentially related to life events (depression, hospitalization). CONCLUSIONS: The study population had an overall positive idea of the value of physical activity for knee osteoarthritis. The participants expressed beliefs and knowledge generally in line with current recommendations. Compliance with these recommendations remains moderate. An educational support for progressive adapted physical activity and identification of barriers and motivators could help improve adherence.

Efficacy of two injection-site localisation techniques for botulinum toxin injections: a single-blind, crossover, randomised trial protocol among adults with hemiplegia due to stroke.

INTRODUCTION: Botulinum toxin injections are an effective treatment for limb spasticity following stroke. Different tracking techniques are used for this purpose: palpation, electrostimulation, electromyography and ultrasound. Yet very few studies have compared these different techniques, and none has successfully proved the superior efficacy of ultrasound-guided injections compared to another tracking method. The primary objective of our study was therefore to compare the efficacy of botulinum toxin injections depending on the tracking technique used: ultrasound versus electrostimulation. METHODS AND ANALYSIS: This is a clinical, single-centre, prospective, interventional, single-blind, crossover, randomised trial. In total, 30 patients aged between 18 and 80 years presenting with triceps surae spasticity (evaluated >1 on the modified Ashworth scale) associated with hemiplegia sequelae due to stroke will be included. The patients will be selected among those who attend for consultation the Physical Medicine and Rehabilitation Department of the Clermont-Ferrand University Hospital. One group will receive the abobotulinumtoxinA (BoNT-A) injection guided by electrostimulation then ultrasound, and the second group's botulinum toxin injections will be guided by ultrasound then electrostimulation. For each patient, the duration of study participation is 5 months. The primary end point is variation in passive ankle dorsiflexion range of motion at slow and high speeds (Tardieu scale) with the knee straight. ETHICS AND DISSEMINATION: This study received ethics approval form the CPP of Rhônes-Alpes region. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT01935544; pre-results.