Association of tibial acceleration during walking to pain and impact loading in adults with knee osteoarthritis.

BACKGROUND: Higher impact loading during walking is implicated in the pathogenesis of knee osteoarthritis. Accelerometry enables the measurement of peak tibial acceleration outside the laboratory. We characterized the relations of peak tibial acceleration to knee pain and impact loading during walking in adults with knee osteoarthritis. METHODS: Adults with knee osteoarthritis reported knee pain then walked at a self-selected speed on an instrumented treadmill for 3 min with an ankle-worn inertial measurement unit. Ground reaction forces and tibial acceleration data were sampled for 1 min. Vertical impact peaks, and average and peak instantaneous load rates were determined and averaged across 10 steps. Peak tibial acceleration was extracted for all steps and averaged. Pearson's correlations and multiple linear regression analyses assessed the relation of peak tibial acceleration to pain and impact loading metrics, independently and after controlling for gait speed and pain. FINDINGS: Higher peak tibial acceleration was associated with worse knee pain (r = 0.39; p = 0.01), and higher vertical average (r = 0.40; p = 0.01) and instantaneous (r = 0.46; p = 0.004) load rates. After adjusting for gait speed and pain, peak tibial acceleration was a significant predictor of vertical average (R2 = 0.33; p = 0.003) and instantaneous (R2 = 0.28; p = 0.02) load rates, but not strongly associated with vertical impact peak. INTERPRETATIONS: Peak tibial acceleration during walking is associated with knee pain and vertical load rates in those with knee osteoarthritis. Clinicians can easily access measures of peak tibial acceleration with wearable sensors equipped with accelerometers. Future work should determine the feasibility of improving patient outcomes by using peak tibial acceleration to inform clinical management.

Reporting of Adverse Events in Randomized Controlled Trials of Therapeutic Exercise for Hip Osteoarthritis: A Systematic Review.

OBJECTIVE: The purpose of this study was to describe adverse events (AEs) and dropouts (DOs) in randomized controlled trials of therapeutic exercise for hip osteoarthritis (HOA) and to identify whether Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed. METHODS: The Cochrane Library, Embase, PubMed, and CINAHL databases were searched. Randomized controlled trials of therapeutic exercise for HOA published in English from January 1, 1980 to August 1, 2020 were included. Studies were excluded if other interventions were provided, if participants had previous hip arthroplasty, or if AEs and DOs for HOA participants were not reported separately. The internal validity of each study (Physiotherapy Evidence Database [PEDro] scoring) was assessed, participant and intervention characteristics were extracted, and the existence of a clear statement and reasons for AEs and DOs was reported. Descriptive statistics characterized results. Data heterogeneity prohibited the use of meta-analysis. RESULTS: Fourteen studies (mean PEDro score = 7.4; range = 6-10) from 10 countries were included, with 707 participants exercising. Exercise intensity was unspecified in 72.2% of exercise arms. Six studies (42.9%) included a statement of AEs, and 32 AEs were reported. All studies had a DO statement, but 29.0% of DOs occurred for unknown reasons. Six studies (42.9%) gave reasons for DOs that could be classified as AEs in 9 participants; 41 participants (5.8%) experienced exercise-related AEs. CONCLUSION: Reports of AEs were inconsistent, some DOs were potentially misclassified, and primary components of exercise interventions were frequently unreported. Despite these limitations, the overall low number of nonserious AEs suggests that the exercise-related risk of harm is minimal for individuals with HOA. IMPACT: Understanding the risk of harm associated with exercise for HOA can better inform safe dosing of exercise, clinical implementation, and replicability. Informative, consistent reporting of AEs, DOs, and exercise is needed. Greater use of the CONSORT harms-reporting checklist is warranted.

The quality of intervention reporting in trials of therapeutic exercise for hip osteoarthritis: a secondary analysis of a systematic review.

BACKGROUND: Therapeutic exercise is recommended as a core treatment for hip osteoarthritis (HOA). Whilst it is widely accepted that exercise can improve pain and disability, optimal type and dose of exercise are yet to be agreed upon. This may, in part, be attributed to the wide variation and inadequate reporting of interventions within the literature. This study evaluates the quality of intervention reporting among trials of therapeutic exercise in HOA. METHODS: Randomised controlled trials (RCTs) were sourced in a systematic review, completed in August 2020. Two raters independently used the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT) to evaluate intervention reporting. Correlations between quality assessment scores and CERT and TIDieR scores evaluated the relationship between internal validity and external applicability. The year of publication was compared to the quality of reporting scores. RESULTS: Fourteen RCTs were included in the analysis. On average, studies were awarded 9.43 ± 1.95 out of 12 points for the TIDieR checklist (range 4-12) and 13.57 ± 4.01 out of 19 points for the CERT (range 5-19). Pearson's correlation coefficient suggested that the quality of reporting had improved over time and that there was a fair, positive relationship between internal validity and external applicability. DISCUSSION: Whilst the quality of intervention reporting is improving, many RCTs of therapeutic exercise in HOA lack the detail necessary to allow accurate evaluation and replication. Researchers are encouraged to utilise the standardised reporting guidelines to increase the translation of effective interventions into clinical practice.

Reducing knee pain and loading with a gait retraining program for individuals with knee osteoarthritis: Protocol for a randomized feasibility trial.

Objective: This study aims to 1) determine the feasibility of conducting a full-scale randomized controlled trial (RCT) evaluating the efficacy of a gait retraining program on decreasing knee pain and impact loading in people with knee osteoarthritis, and 2) provide an estimate of treatment effects for a gait retraining program compared to a traditional walking program. Methods: Forty individuals with knee osteoarthritis will be enrolled in this randomized, double-blind, feasibility trial with two parallel groups. Participants will be randomly allocated to a gait retraining program aimed to decrease peak axial acceleration of the lower leg (i.e., tibia) by 20% or a traditional walking program. Both programs involve 8 sessions of walking on a treadmill. Feasibility will be assessed with recruitment, enrollment, and retention rates, and number of adverse events and unanticipated problems. Treatment effects will be estimated with measures of knee pain and impact loading collected at baseline, follow-up (<1 week post-intervention), and retention (≥1 month post-intervention) visits. Knee pain will be evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index and impact loading will be measured during walking with three-dimensional motion analysis. Conclusion: Findings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of a gait retraining program for people with knee osteoarthritis. Trial registration: (NCT04148807).

Yoga, as a transitional platform to more active lifestyle: a 6-month pilot study in the USA.

A 6-month pilot study explored the effects of a yoga program on the physical activity (PA) level of overweight or obese sedentary adults. Fourteen community-dwelling overweight or obese sedentary adults participated in a 6-month program (2-month yoga program and 4-month follow-up) delivered by two types of instruction [the direct guidance of an instructor (face-to-face group) vs. the self-learning method of using a DVD (DVD group)]. Measurements included program adherence (class attendance and home practice; min/week) and level of PA [metabolic equivalent (MET)-hour/week] at baseline, 2, 4 and 6 months. Descriptive statistics and nonparametric tests were used to describe the sample and examine differences by group and time. There were no significant differences in demographic variables by group assigned. Participants showed significant PA changes from baseline to each measurement point. The direct guidance of an instructor was preferred over the self-learning method. At each time interval, the DVD group showed higher levels of PA than the face-to-face group; the only difference that achieved statistical significance occurred at 4 months. The PA level significantly changed over 6 months in the DVD group, but not in the face-to-face group. The results indicate that a yoga program may be utilized as a 'stepping-stone' toward regular exercise among overweight sedentary adults. Research with a larger sample is needed to further evaluate the effects of the program on the level of PA among this population.

Body mass index self-perception and weight management behaviors during late adolescence.

BACKGROUND: This study examined the relationship between actual body weight and self-perceived weight, and how perception of one's weight affects weight management behaviors among US adolescents. METHODS: Adolescents ages 16-19 years with objectively-measured weight and height and self-reported perception of weight, weight-loss efforts, and health-related behaviors (N = 642) from the 2009-2010 National Health and Nutritional Examination Survey (NHANES) were included. Sociodemographic variables, body mass index percentile, weight perception, weight-loss efforts, and health-related behaviors were examined using Wald chi-square, Student's t test, analysis of variance, and logistic regression. RESULTS: Approximately 15% were overweight, and 20% were obese; 26% inaccurately perceived their weight. Ethnic minority groups displayed higher rates of overweight and obesity. Overweight adolescents had a higher rate of inaccurate weight perception than obese adolescents. More girls correctly perceived their weight status than boys. Nearly 25% had tried to lose weight during the past year. Among overweight and obese adolescents, accurate weight perception was significantly and positively related to weight-loss efforts after controlling for sociodemographic variables and actual weight. CONCLUSIONS: Accurate body weight perception is a significant factor in adolescents' weight-loss efforts. Targeting counseling for body weight perception and weight management toward boys and overweight adolescents may impact obesity in this age group.