Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version-KOPS Brazilian version.

BACKGROUND: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. OBJECTIVE: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. METHODS: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. RESULTS: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. CONCLUSION: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

The effectiveness of a randomised clinical trial of PLE2 NO self-management and exercise programme for knee osteoarthritis to improve self-efficacy.

OBJECTIVE: This study aims to assess the effectiveness of a 12-weeks self-management and exercise intervention to improve self-efficacy in older individuals with knee osteoarthritis (KOA) DESIGN: Randomised Controlled Trial. SETTING: Four different community settings. SUBJECTS: Eighty individuals aged 60 years or over with clinical and radiographic knee osteoarthritis. INTERVENTION: The subjects were randomly assigned to (1) a combined self-management and exercise programme (treatment group) and (2) an educational programme (control group). MAIN MEASURES: The primary outcome was self-efficacy and secondary outcomes were physical activity, health-related quality of life and skill-related physical fitness measures. RESULTS: Sixty-seven participants, mean age 69.1 (5.8) years, completed the study: 32 in the control group and 35 in the treatment group. A significant group effect favourable to the treatment group was observed in the following variables: self-efficacy (F[2,64] = 9.2, p = 0.003), physical activity (F[2,64] = 43.6, p < 0.001) and balance for most painful knee (F(2,64) = 4.87, p = 0.031) and less painful knee (F[2,64] = 6.94, p = 0.010). No improvements regarding health-related quality of life, gait speed and agility were found. This study supports the importance of a combined self-management and exercise intervention to improve self-efficacy and physical activity in KOA individuals.

Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version—KOPS Brazilian version

Abstract Background: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. Objective: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. Methods: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. Results: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. Conclusion: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

Translation, cultural adaptation and validation of the self-efficacy to manage chronic disease 6-item scale for european Portuguese.

OBJECTIVES: Self-efficacy is an important factor in the acquisition of self-management skills in patients with chronic diseases. The present study provides a translation and cultural adaptation for the Portuguese population, as well as psychometric properties, of the Self-Efficacy for Managing Chronic Disease 6-Item Scale. MATERIALS AND METHODS: This is a cross-sectional study. As a first stage, a translation and cultural adaptation were conducted. After preparation, a final version was applied initially to a sample of 30 participants with chronic disease in two phases, with a one-week gap between phases, to assess teste retest reliability. Subsequently, a sample of 217 participants with chronic disease, mean age 42.8 (10.7) years, participated in the study. Participants were supposed to be over the age of 18 and with at least one clinically diagnosed chronic disease. The questionnaire was applied electronically. RESULTS: The results showed a good test retest reliability (ICC of 0.83, 95% CI: 0.65 - 0.92). Internal consistency met the criterion for a reliable measure (global Cronbach's alpha of 0.95). Item-total correlations of all items were above 0.30. A correlation matrix was considered favorable (KMO = 0.90; Bartlett's sphericity test = 1399.090, p < 0.01). The results confirmed the permanence of the 6 items, as in the original scale. CONCLUSIONS: A Self-Efficacy for Managing Chronic Disease 6-Item Scale is a reliable and valid instrument to assess the patients' self-efficacy for managing chronic diseases in Portuguese, enabling its use in clinical practice and in future studies.

Predictors of walking capacity in obese adults with knee osteoarthritis.

INTRODUCTION: Knee osteoarthritis(KOA) has a considerable prevalence in obese individuals and recommendations of weight loss for KOA management are gaining greater importance. Exercise is recommended to interrupt the cycle obesity-KOA-pain-inactivity, where walking is the most common exercise pattern recommended for obese individuals who initiate a weight loss exercise program. Thus this study aimed to analyse the factors which can affect the walking capacity in obese adults with symptomatic KOA. METHODS: 48 obese adults (age=55±7years; BMI=35±5 Kg/m2) with clinical and radiological KOA completed self-reported questionnaires (Knee Injury and Osteoarthritis Outcome Score, Brief Pain Inventory and Beck Depression Inventory), physical function tests (Six Minutes Walking Test-6MWT, chair sit and reach-CSRT, five repetition sit-to-stand test-FRSTST, handgrip strength-HST, isokinetic knee strength) and body composition was determined. RESULTS: The best model (F= 41.485; p<.001) explained 73% of the 6MWT's variance, where fat mass of the most painful limb, knee pain severity and lower limb strength were the strongest predictors of the 6MWT. CONCLUSION: Despite the importance of lower limb fat mass and strength, pain was the only variable that appeared as a predictor of 6MWT in the three tested models. The existence of knee pain affects the capacity to walk or to perform weight bearing exercises and consequently the exercise's adherence, compromising the objective of body composition improvement. Thus, authors suggest that, additionally to the lower limb strengthening, knee pain should be screened, controlled and acknowledged for exercise prescription. This study is inserted in the PICO Project (Clinical trial: NCT01832545).

A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program.

OBJECTIVE: To assess the effectiveness of a 12-week self-management and exercise intervention (the PLE2NO program) in elderly individuals with knee osteoarthritis. DESIGN: Randomized controlled trial. SETTING: Four different community settings. SUBJECTS: Eighty individuals aged 60 years or older with clinical and radiographic knee osteoarthritis enrolled in the study. INTERVENTION: A combined self-management and exercise intervention (treatment group) and an educational intervention (control group). MAIN MEASURES: The primary outcomes were pain and other knee osteoarthritis symptoms (swelling, crackling, limitation on movement, and stiffness), self-management behaviors (communication with physician and cognitive symptom management), and functional lower limb strength. Secondary outcomes were knee osteoarthritis-specific health-related quality of life, self-perceived health, aerobic capacity, lower and upper limb flexibility, and handgrip strength. RESULTS: In all, 67 participants, mean age 69.1 ± 5.8 years, completed the study: 32 in the Educational Group and 35 in the Self-Management and Exercise Group. A significant group effect favorable to the Self-Management and Exercise Group was observed in the following variables: communication with the physicians ( P = .048), aerobic capacity ( P = .035), and functional lower limb strength ( P = .015). Although no significant group effect was detected, clinical improvements in pain (31%) and knee osteoarthritis symptoms (29%) were observed in the experimental group. No improvements regarding cognitive symptom management, self-perceived health, lower limb flexibility, and handgrip strength were found. CONCLUSION: This study supports the importance of a combined self-management and exercise intervention to improve functional lower limb strength and aerobic capacity in a Portuguese sample. Additionally, pain and other symptoms have improved clinically.

The PLE(2)NO self-management and exercise program for knee osteoarthritis: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: International recommendations suggest exercise and self-management programs, including non-pharmacological treatments, for knee osteoarthritis (KOA) because they can benefit pain relief and improve function and exercise adherence. The implementation of a combined self-management and exercise program termed PLE(2)NO may be a good method for controlling KOA symptoms because it encourages the development of self-efficacy to manage the pathology. This study will assess the effects of a self-management and exercise program in comparison to an educational intervention (control program) on symptoms, physical fitness, health-related quality of life, self-management behaviors, self-efficacy, physical activity level and coping strategies. METHODS/DESIGN: This PLE(2)NO study is a single-blinded, randomized controlled trial of elderly (aged above 60 yrs old) patients with clinical and radiographic KOA. The patients will be allocated into either an educational group (control) or a self-management and exercise group (experimental). All participants will receive a supplement of chondroitin and glucosamine sulfates. This paper describes the protocol that will be used in the PLE(2)NO program. DISCUSSION: This program has several strengths. First, it involves a combination of self-management and exercise approaches, is available in close proximity to the patients and occurs over a short period of time. The latter two characteristics are crucial for maintaining participant adherence. Exercise components will be implemented using low-cost resources that permit their widespread application. Moreover, the program will provide guidance regarding the effectiveness of using a self-management and exercise program to control KOA symptoms and improve self-efficacy and health-related quality of life. TRIAL REGISTRATION: NCT02562833 (09/23/2015).

Determinant factors of pain intensity in overweight and obese adults with knee osteoarthritis.

Osteoarthritis is one of the most disabling diseases, the main symptom being pain, which is associated with a low level of physical activity. The incidence and progression of knee osteoarthritis are directly related with risk factors such as obesity, age and mechanical factors. OBJECTIVE: The aim of this study was to identify which variables (physical activity, anthropometry and body composition of the lower limb) best predict pain intensity in obese individuals with knee osteoarthritis. METHODS: The sample consisted of 44 individuals of both genders (mean age 56.6 ± 6.6 yrs). Anthropometric measures of body mass, stature, mid-thigh, patellar and calf circumferences, and foot breadth were obtained. The body composition of the most painful lower limb was obtained by dual-energy X-ray absorptiometry in different regions: mid-thigh; patella; calf and foot. For each of these regions, fat mass percentage, the amount of fat and fat-free mass, bone mass and bone mineral density were evaluated. Physical activity was assessed by the International Physical Activity Questionnaire (short version) and pain intensity with the numeric rating scale. Data analysis was done using the multifactorial logistic regression (backward conditional method). RESULTS: The multifactorial analysis showed that gender (Odds Ratio of 7.448 for a 95% Confidence Interval of [1.032 - 53.747]) and foot breadth (Odds Ratio of 3.730 for a 95% Confidence Interval of [1.006 - 13.827]) are important factors to explain the risk of pain. CONCLUSIONS: These results seem to indicate that the assessment of foot morphology must be considered in knee osteoarthritis studies, since foot breadth is a predictor of knee pain. Further research is required to investigate the influence of foot morphology as well as of the use of insoles, splints or adapting shoes, on obese individuals with knee osteoarthritis.

Development of the Knee OA Pre-Screening Questionnaire.

AIM: Self-report questionnaires are still considered to be a useful instrument for disease screening and for epidemiological studies. Few questionnaires have been developed for the purpose of screening for knee osteoarthritis (KOA). The aim of this study was to develop a KOA screening tool that is useful for health and exercise professionals who do not have access to advanced and costly diagnostic instruments. METHODS: This study comprised five steps: content validity, reliability, criterion validity, construct validity and responsiveness. Internal consistency was verified using Cronbach's alpha and the intraclass correlation coefficient (ICC). Reproducibility was analyzed using the ICC (1 week). Criterion validity was assessed by comparing the Knee OA Pre-Screening Questionnaire (KOPS) score with the Short Form (SF)-12, the Knee Injury and Osteoarthritis Outcome Scores questionnaire and the 6 min walk test. Construct validity was verified using the receiver operating characteristic (ROC) curve (American College of Rheumatology clinical criteria and X-ray). Responsiveness was analyzed over 3 months of an aquatic exercise program using the pooled effect size. RESULTS: The overall KOPS score yielded a Cronbach's alpha of 0.747 and an ICC of 0.646. KOPS was considered reproducible (ICC: 0.895-0.992; Cronbach's alpha: 0.894-0.979). The ROC curve revealed a sensitivity of 86.96 and a specificity of 75.82. The KOPS demonstrated medium responsiveness in terms of the total score and the pain and symptoms components. CONCLUSION: The KOPS questionnaire is valid for the purposes for which it was created, and its translation into English should be considered.

Perception and reality - Portuguese adults' awareness of active lifestyle.

This study aims to assess awareness of physical activity levels among adults and to investigate the variables associated with different types of awareness. The participants were 1042 men and 1316 women aged 31-60 years old (43.3 ± 6.1). Data were collected on physical activity behaviour, physical activity awareness, perceptions and psychological factors. Awareness was assessed by comparing self-rated physical activity with achieving physical activity guidelines. Chi-square and logistic regression analyses were applied to the results. About 32.4% were considered active. Moreover, 61% accurately reported their physical activity (38.3% realistic inactive and 22.7% realistic active), 29.2% overestimated their physical activity (overestimators) and 9.7% incorrectly described themselves as inactive (underestimators). Perception of an excellent health status (odds ratio, OR = 4.07, 95% confidence interval, CI: 2.07-8.00, p < 0.001) was the strongest positive association with being realistic active, followed by having a high socio-economic status (SES) (OR = 1.53, 95% CI: 1.10-2.12, p < 0.05). Overestimator participants were more likely to have an excellent perception of health (OR = 2.58, 95% CI: 1.47-4.52, p < 0.01) and had a good experience in physical education (OR = 1.46, 95% CI:1.03-2.08, p < 0.05). Almost half of these participants erroneously perceived themselves as physically active. Gender, body mass index (BMI) and the quality of physical education at school were associated with those who misperceived their physical activity.

The correlates of meeting physical activity recommendations: a population-based cross-sectional study.

The aim of this study was to identify correlated factors which explain the recommended level of leisure time physical activity (LTPA) among Portuguese adults. Subjects aged 31-60 years (972 males, 1195 females) were categorized, based on LTPA data obtained using a questionnaire, into two groups according to the PA recommendation for PA: ≥ 10 or < 10 MET · hr · wk(-1). Chi-square and logistic regression analyses were applied to the results. For men, the perception of an active lifestyle [odds ratio (OR) = 4.61, 95% CI:3.13-6.81, p <0.001], having an excellent perception of health (OR = 3.14, 95% CI:1.28-7.71, p =0.013), perception of being sufficiently active (OR = 2.16, 95% CI:1.53-3.05, p <0.001), and having a high socio-economic status (SES) (OR = 1.86, 95% CI:1.22-2.81, p =0.004) were associated with attaining the recommended level of PA. For women, the perception of an active lifestyle (OR = 3.68, 95% CI:2.63-5.15, p <0.001), and middle SES (OR = 1.50, 95% CI:1.07-2.11, p =0.018) were positive and associated with meeting PA recommendations. Unlike men, women with body mass index (BMI) 25-29.9 kg/m(2) were more likely to attain the recommended level of PA than those with BMI <25 kg/m(2). The incidence of adults that met the recommended amount of PA is low. Men and women had different patterns of psychological and socio-demographic correlates. An intervention designed to improve the levels of PA among Portuguese adults may take these correlates into account.

The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals.

BACKGROUND: Aquatic exercise is recommended by the Osteoarthritis Research Society (OARSI), by the American College of Rheumatology (ACR) and by the European League Against Rheumatism (EULAR) as a nonpharmacological method of controlling the knee osteoarthritis (KOA) symptoms. Moreover, given that weight loss results in a reduction of the load that is exerted upon the knee during daily activities, obesity is also considered to be a modifiable risk factor for the development and or exacerbation of KOA. The implementation of an exercise based weight loss program may, however, itself be limited by the symptoms of KOA. The aquatic program against osteoarthritis (termed "PICO" in Portuguese) prioritizes the control of symptoms and the recovery of functionality, with an attendant increase in the patient's physical activity level and, consequently, metabolic rate. Our laboratory is assessing the effectiveness of 3 months of PICO on the symptoms of KOA, on physical function, on quality of life and on gait. In addition, PICO shall examine the effects of said exercise intervention on inflammatory biomarkers, psychological health, life style and body composition. METHODS/DESIGN: The trial is a prospective, single-blinded, randomized controlled trial, and involves 50 overweight and obese adults (BMI = 28-43.5 kg/m²; age 40-65 yrs) with radiographic KOA. The participants are randomly allocated into either an educational attention (control) group or an aquatic (exercise program) group. This paper describes the experimental protocol that is used in the PICO project. DISCUSSION: The PICO program shall provide insight into the effectiveness of an aquatic exercise program in the control of KOA symptoms and in the improvement of the quality of life. As such, they are likely to prove a useful reference to health professionals who intend to implement any kind of therapeutic intervention based around aquatic exercise. TRIAL REGISTRATION: NCT01832545.

The cadence and water temperature effect on physiological responses during water cycling.

The aim of the study was to compare the maximal physiological responses during three protocols: maximal test on land cycle ergometer, maximal test on water cycling in an indoor pool at 27 °C (WC27) and at 31 °C (WC31). Moreover, the submaximal physiological responses were compared according cycling cadences and water temperatures during the water protocols. Ten young men were included and performed the protocols in separate days. Blood lactate (BL) concentration, heart rate (HR), oxygen uptake (VO2), ventilation (VE) and thermal comfort (TC) were collected during the exercise. The maximal HR and VO2 showed no significant differences between the protocols: HRmax: 189 ± 7 (Land), 188 ± 14 (WC27), 185 ± 9 bpm (WC31) and VO2max: 4.2 ± 0.4 (Land), 4.1 ± 0.5 (WC27) and 4.3 ± 0.5 l min(-1) (WC31). However, the maximal BL demonstrated significant lower values during the water protocols compared to the land protocol (p=0.018). All the submaximal physiological responses showed significant differences between the cadences (60, 70, 80 and 90 rpm). The effect of water temperature was significant for TC response (p=0.001) showing higher values at 31 °C than 27 °C (TCW27: 7 ± 1 and TCW31:9 ± 1). In conclusion, higher physiological responses were showed by increasing the cadence by 10 rpm and the subjects were more comfortable when cycling in the lower water temperature.