Experiences of living with hip osteoarthritis and of receiving advice, education and ultrasound-guided intra-articular hip injection in the hip injection trial. A qualitative study.

OBJECTIVES: The Hip Injection Trial (HIT) compared the effectiveness of adding a single ultrasound-guided intra-articular injection of either corticosteroid and local anaesthetic or local anaesthetic alone to advice and education among people with hip osteoarthritis (OA). This nested qualitative study explored participants' experiences of living with hip OA and of the trial treatment they received. METHOD: Semi-structured telephone interviews were undertaken with a purposeful sample of trial participants after a 2-month trial follow-up. Interviewers were blinded to which injection participants had received. Thematic analysis using constant comparison was undertaken prior to knowing the trial results. RESULTS: 34 trial participants were interviewed across all arms. OA causes pain, physical limitations, difficulties at work, lowered mood, and disrupted sleep. Those who received advice and education alone felt that they had not received 'treatment' and described little/no benefit. Participants in both injection groups described marked improvements in pain, physical function, and other aspects of life (e.g., sleep, confidence). The perceived magnitude of benefit appeared greater among those who received the corticosteroid injection; however, the length of benefit varied in both injection groups. There was uncertainty about the longer-term benefits of injection and repeated injections. CONCLUSION: Hip OA is highly burdensome. Participants perceived little/no benefit from advice and education alone but reported marked improvements when combined with either injection. However, the magnitude of benefit was greater among those who received corticosteroid. The varying duration of response to injection and uncertainty regarding longer-term benefits of injection and repeated injections suggests that these areas are important for future research. TRIAL REGISTRATION: EudraCT 2014-003412-37; ISRCTN50550256.

Exercise Interventions for Preventing and Treating Low Bone Mass in the Forearm: A Systematic Review and Meta-analysis.

OBJECTIVE: To examine the effectiveness of exercises for improving forearm bone mass. DATA SOURCES: MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and Cochrane CENTRAL were searched from their inception until December 2018. STUDY SELECTION: Eligibility included adults undertaking upper limb exercise interventions (≥12wk) to improve bone mass. DATA EXTRACTION: Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using Cochrane risk of bias tool. DATA SYNTHESIS: Exercise interventions were classified into "resistance training" of high or low intensity (HIRT/LIRT, respectively) or "impact." Random-effects meta-analysis of the percentage change in forearm bone mass from baseline was conducted. Twenty-six studies were included in the review, of which 21 provided suitable data for meta-analysis. Methodological quality ranged from "low" to "unclear" risk of bias. Exercise generally led to increases (moderate-quality evidence) in forearm bone mass (standard mean difference [SMD], 1.27; 95% CI, 0.66-1.88; overall effect Z value=4.10; P<.001). HIRT (SMD, 1.00; 95% CI, 0.37-1.62; Z value=3.11; P=.002), and LIRT (SMD, 2.36; 95% CI, 0.37-4.36; Z value=2.33; P<.001) led to moderate increases in forearm bone mass. Improvements resulting from impact exercises (SMD, 1.12; 95% CI, -1.27 to 3.50; Z value=0.92; P=.36) were not statistically significant (low-quality evidence). CONCLUSIONS: There is moderate-quality evidence that exercise is effective for improving forearm bone mass. There is moderate-quality evidence that upper body resistance exercise (HIRT/LIRT) promotes forearm bone mass but low-quality evidence for impact exercise. Current evidence is equivocal regarding which exercise is most effective for improving forearm bone mass.