Osteoarthritis year in review 2022: rehabilitation.

This year in review presents key highlights from research relating to osteoarthritis (OA) rehabilitation published from the 1st April 2021 to the 18th March 2022. To identify studies for inclusion in the review, an electronic database search was carried out in Medline, Embase and CINAHLplus. Following screening, included studies were grouped according to their predominant topic area, including core OA rehabilitation treatments (education, exercise, weight loss), adjunctive treatments, novel and emerging treatments or research methods, and translation of rehabilitation evidence into practice. Studies of perceived high clinical importance, quality, or controversy in the field were selected for inclusion in the review. Headline findings include: the positive role of technology to support remote delivery of core OA rehabilitation treatments, the importance of delivering educational interventions alongside exercise, the clinical and cost-effectiveness of a stepped approach to exercise, controversy around the potential mechanisms of action of exercise, mixed findings regarding the use of splinting for thumb base OA, increasing research on blood flow restriction training as a potential new intervention for OA, and evidence that the beneficial effects from core OA treatments seen in randomised controlled trials can be seen when implemented in clinical practice. A consistent finding across several recently published systematic reviews is that randomised controlled trials testing OA rehabilitation interventions are often small, with some risk of bias. Whilst future research is warranted, it needs to be large scale and robust, to enable definitive answers to important remaining questions in the field of OA rehabilitation.

Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness.

BACKGROUND: It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. METHODS: We used citation searches of Web of Science (date of 'parent publication' for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). RESULTS: Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. CONCLUSIONS: In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions.

Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis.

A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE: To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS: Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS: 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION: Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO: CRD42018116478.

Osteoarthritis year in review 2021: epidemiology & therapy.

This "Year in review" presents a selection of research themes and individual studies from the clinical osteoarthritis (OA) field (epidemiology and therapy) and includes noteworthy descriptive, analytical-observational, and intervention studies. The electronic database search for the review was conducted in Medline, Embase and medRxiv (15th April 2020 to 1st April 2021). Following study screening, the following OA-related themes emerged: COVID-19; disease burden; occupational risk; prediction models; cartilage loss and pain; stem cell treatments; novel pharmacotherapy trials; therapy for less well researched OA phenotypes; benefits and challenges of Individual Participant Data (IPD) meta-analyses; patient choice-balancing benefits and harms; OA and comorbidity; and inequalities in OA. Headline study findings included: a longitudinal cohort study demonstrating no evidence for a harmful effect of non-steroidal anti-inflammatory drugs (NSAIDs) in terms of COVID-19 related deaths; a Global Burden of Disease study reporting a 102% increase in crude incidence rate of OA in 2017 compared to 1990; a longitudinal study reporting cartilage thickness loss was associated with only a very small degree of worsening in pain over 2 years; an exploratory analysis of a non-OA randomised controlled trial (RCT) finding reduced risk of total joint replacement with an Interleukin -1ß inhibitor (canakinumab); a significant relationship between cumulative disadvantage and clinical outcomes of pain and depression mediated by perceived discrimination in a secondary analysis from a RCT; worsening socioeconomic circumstances were associated with future arthritis diagnosis in an innovative natural experiment (with implications for unique research possibilities arising from the COVID-19 pandemic context).

Delegation by Allied Health Professionals to Allied Health Assistants: a mixed methods systematic review.

BACKGROUND: Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored. OBJECTIVES: The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs', AHAs' and patients' attitudes and beliefs towards delegation. DATA SOURCES: MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions. STUDY SELECTION: Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs', AHAs' and patients' attitudes and beliefs about delegation. DATA EXTRACTION & SYNTHESIS: Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted. RESULTS: Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients' attitudes and preferences. Further research is needed to facilitate the standardisation of delegation. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019119557.

Towards prevention of post-traumatic osteoarthritis: report from an international expert working group on considerations for the design and conduct of interventional studies following acute knee injury.

OBJECTIVE: There are few guidelines for clinical trials of interventions for prevention of post-traumatic osteoarthritis (PTOA), reflecting challenges in this area. An international multi-disciplinary expert group including patients was convened to generate points to consider for the design and conduct of interventional studies following acute knee injury. DESIGN: An evidence review on acute knee injury interventional studies to prevent PTOA was presented to the group, alongside overviews of challenges in this area, including potential targets, biomarkers and imaging. Working groups considered pre-identified key areas: eligibility criteria and outcomes, biomarkers, injury definition and intervention timing including multi-modality interventions. Consensus agreement within the group on points to consider was generated and is reported here after iterative review by all contributors. RESULTS: The evidence review identified 37 studies. Study duration and outcomes varied widely and 70% examined surgical interventions. Considerations were grouped into three areas: justification of inclusion criteria including the classification of injury and participant age (as people over 35 may have pre-existing OA); careful consideration in the selection and timing of outcomes or biomarkers; definition of the intervention(s)/comparator(s) and the appropriate time-window for intervention (considerations may be particular to intervention type). Areas for further research included demonstrating the utility of patient-reported outcomes, biomarkers and imaging outcomes from ancillary/cohort studies in this area, and development of surrogate clinical trial endpoints that shorten the duration of clinical trials and are acceptable to regulatory agencies. CONCLUSIONS: These considerations represent the first international consensus on the conduct of interventional studies following acute knee joint trauma.

Manual dexterity in the gorilla: bimanual and digit role differentiation in a natural task.

The manipulative actions of mountain gorillas Gorilla g. beringei were examined in the context of foraging on hard-to-process plant foods in the field, in particular those used in tackling thistle Carduus nyassanus. A repertoire of 72 functionally distinct manipulative actions was recorded. Many of these actions were used in several variants of grip, finger(s) and movement path, both by different individuals and by the same individual at different times. The repertoire appears somewhat greater than that observed in comparable studies of monkeys, but a far more striking difference is found in the use of differentiated actions in concert. Mountain gorillas routinely and frequently deal with problems that involve: (1) bimanual role differentiation, with the two hands taking different roles but synchronized in time and space, and (2) digit role differentiation, with independent control of parts of the same hand used for separate purposes at the same time. The independent control that allows these abilities, so crucial to human manual constructional ability, is apparently general in African great apes. Role differentiation, between and within the hand, is evidently a primitive characteristic in the human arsenal of skills.

Apparent absorption efficiency and gut morphometry of wood mice, Apodemus sylvaticus, from two distinct populations with different diets.

Interpopulation variation in the diet of the wood mouse, Apodemus sylvaticus, is well documented. In this study, we examined the gut morphology and apparent absorption efficiencies of two populations of wood mice whose diet in the field was known to differ. One population inhabited sand dunes, where food availability was relatively low and the diet was dominated by invertebrates. The other population lived in deciduous woodland, with greater food availability and a diet consisting primarily of seeds. Wood mice from the woodland had longer small intestines and total digestive tract lengths than mice from the sand dunes. However, these differences had no effect on the apparent absorption efficiencies of dry mass or energy when the mice were fed mealworms, wheat grain, or All-Bran diets (apparent energy absorption efficiencies of 88%, 89%, and 65%, respectively). The population differences in gut morphometry may be linked to different resource availabilities at the two field sites.

Seasonal variation in the resting metabolic rate of male wood mice Apodemus sylvaticus from two contrasting habitats 15 km apart.

Diurnal and nocturnal resting metabolic rates of winter- and summer-acclimatized adult male wood mice Apodemus sylvaticus from two adjacent populations, 15 km apart, were measured. One population lived in deciduous woodland, and experienced a narrower daily range of temperatures than the second population, which inhabited maritime sand-dunes. Ambient temperature and body mass had significant effects on the resting metabolism of mice, excluding winter-acclimatized sand-dune animals where only temperature explained significant amounts of the observed variation. Only in this latter group could a thermoneutral zone be determined, with a lower critical temperature of ca. 25 degrees C and resting metabolism of 0.155 W. Nocturnal resting metabolic rates were significantly greater than diurnal levels. Winter acclimatization was associated with reductions in thermal conductance and resting metabolism, thus minimizing energy expenditure at rest. Site differences in thermoregulatory strategies were only found in winter, thermal conductances remained similar but mice from the sand-dunes had significantly lower metabolic rates than those from the woodland. Winter acclimatization in wood mice was influenced by factors in addition to photoperiod. Intra-specific and individual variations in resting metabolism, as shown in this study, potentially have a pronounced effect on the daily energy expenditure of a free-living animal.

Ranging behaviour and time budgets of male wood mice Apodemus sylvaticus in different habitats and seasons.

Radiotelemetry was used to measure the range areas, activity patterns and time budgets of 21 adult male wood mice (Apodemus sylvaticus) between May 1991 and August 1992. The study investigated variation in range, total distance travelled, speed of movement and time budgets between wood mice in the nonbreeding and breeding seasons in a deciduous woodland (n = 8 and 6 respectively). We also examined habitat differences by estimating these same parameters for wood mice inhabiting maritime sand-dunes in the breeding season (n = 7). Insufficient males of an appropriate mass for radiotracking were captured to study the sand-dune mice in the nonbreeding season. Significant variation was found across both season and site. In the breeding season, in woodland, range areas were 5 times larger than during the nonbreeding season. Wood mice on the sand-dunes exploited ranges 28 times greater than their woodland counterparts. The pattern of variation in range area was parallelled by significant differences in total distances and average speeds travelled per night. Diurnal activity, c. 60 min day-1, was frequently recorded, at both sites, but only, in the breeding season, which was attributed to the need to forage in order to maintain energy balance. The comparatively lower availability of food on the sand-dunes was considered the main factor explaining the greater range area, total distance moved, speed travelled and level of activity of animals at this site.

Accumulation of heavy metals from polluted soils by the earthworm, Lumbricus rubellus: can laboratory exposure of 'control' worms reduce biomonitoring problems?

This paper compares the patterns of metal (Pb, Zn, Cd, Cu) accumulation in nine populations of the epigeic earthworm, Lumbricus rubellus, native on metalliferous soils, with the patterns of metal accumulation in batches of L. rubellus sampled from an uncontaminated site and maintained on the nine contaminated soils for 31 days under laboratory conditions. The primary findings were: (1) the Pb, Zn and Cd concentrations in the 'native' worms were significantly higher in most cases than in the 'introduced' worms; (2) multiple regression analyses indicated that the relationships between tissue and soil metal concentrations were similar for 'native' and 'introduced' worms; (3) high soil organic matter content reduced the bioavailability of Pb, but low pH increased Pb bioavailability. It was concluded that, although no phenotypic evidence of metal-tolerant ecotypes was obtained, the exposure of earthworms from uncontaminated soils to contaminated soils under laboratory conditions can provide meaningful integrative data concerning metal bioavailability in soils which, for biomonitoring purposes, often present formidable sampling problems.