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.

Fisioterapia y osteoartritis: una revisión histórica de las técnicas utilizadas en el pasado y su relevancia actual / Physiotherapy and osteoarthritis: a historical review of techniques used in the past and their current relevance

Objetivo principal: El propósito de esta revisión ha sido proveer una visión histórica de las técnicas de fisioterapia empleadas en el pasado y su relevancia actual en el tratamiento de la Osteoartritis (OA). Metodología: Se realizó una búsqueda exhaustiva en bases de datos y análisis de la literatura. Se incluyeron artículos que abordaran el tratamiento de la OA en fisioterapia desde la Historia Antigua hasta la actualidad. Resultados principales: Se seleccionaron 34 publicaciones que abordaron el tratamiento de la OA en diferentes períodos históricos. Las técnicas identificadas fueron desde tratamientos a base de ungüentos hasta enfoques actuales como la hidroterapia y la electroterapia. Conclusión principal: El abordaje fisioterapéutico de la OA ha evolucionado a lo largo de la historia con el empleo de diversas técnicas y agentes físicos. Desde el siglo XIX las técnicas empleadas lograron un avance científico y terapéutico valioso para esta afección (AU)

Objective: The purpose of this review has been to provide a historical perspective on the physiotherapy techniques used in the past and their current relevance in the treatment of Osteoarthritis (OA). Methods: A comprehensive search of databases and literature analysis was conducted. Articles addressing the treatment of OA in physiotherapy from Ancient History to the present were included. Results: 34 publications addressing the treatment of OA in different historical periods were selected. The identified techniques ranged from ointment-based treatments to current approaches such as hydrotherapy and electrotherapy. Conclusions: The physiotherapeutic approach to OA has evolved throughout history, utilizing various techniques and physical agents. Since the 19th century, the employed techniques have achieved valuable scientific and therapeutic advancements for this condition (AU)

Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies.

STUDY DESIGN: Invited review. BACKGROUND: Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE: The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS: A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS: This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS: The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.

Qualitative Exploration of Dyadic Influence on Physical Activity Between Latina Patients With Osteoarthritis and a Supporter of Their Physical Activity.

OBJECTIVE: Research indicates that social support may promote physical activity; however, most Latina individuals with osteoarthritis (OA) are not sufficiently active. The purpose of this qualitative dyadic study was to explore how Latina patients with OA and a self-selected physical activity "supporter" motivate each other to be more active. Furthermore, perceptions of how OA symptoms impact support and physical activity were examined. METHODS: Semistructured dyadic interviews were conducted with Latina patients with OA and a member of their social network age ≥16 years who supports their physical activity (n = 14 dyads). We used framework analysis to reduce qualitative data to themes and subthemes. RESULTS: Daughters (n = 5), spouses (n = 4), sons (n = 2), a granddaughter (n = 1), a nephew (n = 1), and a friend (n = 1) provided support for the target behavior. In many cases, members of dyads said the motivation to engage in physical activity was reciprocated rather than focused solely on Latina patients with OA. Support was often reciprocated by engaging in physical activity together, using pressure, talking about being active, modeling physical activity, and helping with household responsibilities. Although participants agreed that physical activity was beneficial and Latina patients desired additional support when experiencing OA symptoms, there was concern about the safety of activity in the presence of symptoms. Several adult daughters indicated that their mothers' OA symptoms motivated their own physical activity. CONCLUSION: Dyadic strategies for promoting physical activity among Latina patients with OA and how support may be reciprocated were identified.

Practice patterns following carpometacarpal (CMC) arthroplasty.

STUDY DESIGN: Descriptive Survey. INTRODUCTION: Therapy following thumb carpometacarpal (CMC) arthroplasty is a complex issue as there are multiple surgical procedures and postoperative rehabilitative programs. PURPOSE OF THE STUDY: To gather information from therapy practitioners on practice patterns following thumb carpometacarpal (CMC) joint arthroplasty. METHODS: A web-based survey was sent to 3221 occupational and physical therapists in a single stage via online technology. RESULTS: Six-hundred and one (601) therapists responded to the survey. Key findings included: Most therapists (45.5%) indicated that the therapy program they use was developed in collaboration with the referring surgeon. In addition, most patients received a plaster splint or long thumb spica orthosis following surgery, but time frames for use varied widely. Fifty-five percent of respondents waited until after 22 days postsurgery to initiate active flexion/extension of the wrist, while 19.5% initiated wrist flexion/extension between eight and 14 days postsurgery. Ten percent of respondents initiated active thumb flexion/extension within the first postoperative week, while 55% of respondents did not initiate thumb motion until 22 or more days following surgery. Few respondents (5.7%) indicated that they used a published evidence-based treatment program to guide therapy following thumb CMC arthroplasty surgery. CONCLUSION: This study demonstrates that multiple therapy programs exist and rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise.

Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation: A Review.

Background and Purpose: Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options. Methods: Narrative review using a comprehensive literature search of PubMed, osteoarthritis, and stroke guidelines. Outcomes related to co-occurrence prevalence, osteoarthritis as a stroke risk-factor, osteoarthritis-related imaging and treatment were extracted and summarized descriptively. Overall quality of the evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. Results: We identified 23 studies and guidelines related to our objective. Overall quality of the evidence was very low. Conclusions: Few trials have investigated the relationship between osteoarthritis and stroke, nor osteoarthritis-specific pain and function management for stroke survivors. High-quality research evaluating the impact of osteoarthritis on stroke rehabilitation is needed.

Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis: a randomised trial.

OBJECTIVE: To evaluate the efficacy of carbon-fibre shoe-stiffening inserts in individuals with first metatarsophalangeal joint osteoarthritis. DESIGN: This was a randomised, sham-controlled, participant- and assessor-blinded trial. One hundred participants with first metatarsophalangeal joint osteoarthritis received rehabilitation therapy and were randomised to receive either carbon fibre shoe-stiffening inserts (n = 49) or sham inserts (n = 51). The primary outcome measure was the Foot Health Status Questionnaire (FHSQ) pain domain assessed at 12 weeks. RESULTS: All 100 randomised participants (mean age 57.5 (SD 10.3) years; 55 (55%) women) were included in the analysis of the primary outcome. At the 12 week primary endpoint, there were 13 drop-outs (7 in the sham insert group and 6 in the shoe-stiffening insert group), giving completion rates of 86 and 88%, respectively. Both groups demonstrated improvements in the FHSQ pain domain score at each follow-up period, and there was a significant between-group difference in favour of the shoe-stiffening insert group (adjusted mean difference of 6.66 points, 95% CI 0.65 to 12.67, P = 0.030). There were no between-group differences for the secondary outcomes, although global improvement was more common in the shoe-stiffening insert group compared to the sham insert group (61 vs 34%, RR 1.73, 95% CI 1.05 to 2.88, P = 0.033; number needed to treat 4, 95% CI 2 to 16). CONCLUSION: Carbon-fibre shoe-stiffening inserts were more effective at reducing foot pain than sham inserts at 12 weeks. These results support the use of shoe-stiffening inserts for the management of this condition, although due to the uncertainty around the effect on the primary outcome, some individuals may not experience a clinically worthwhile improvement.

The effect of thermal mineral waters on pain relief, physical function and quality of life in patients with osteoarthritis: A systematic review and meta-analysis.

BACKGROUND: To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA). METHODS: Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included. RESULTS: Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P  < .05). There is no evidence that thermal mineral waters is unsafe for treating OA. CONCLUSION: Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA.

Physical function after dietary weight loss in overweight and obese adults with osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: Osteoarthritis (OA) is associated with functional limitations that can impair mobility and reduce quality of life in affected individuals. Excess body weight in OA can exacerbate impaired physical function, highlighting the importance of weight management in this population. The aim of this systematic review was to compare the effects of different dietary interventions for weight loss on physical function in overweight and obese individuals with OA. DESIGN: A comprehensive search of five databases was conducted to identify relevant articles for inclusion. Studies were included that examined the effect of dietary weight loss interventions, with or without exercise, on physical function in adults with OA who were overweight or obese. Quality and risk of bias were assessed using the Quality Criteria Checklist for primary research. Primary and secondary outcomes were extracted, including change in weight and physical function which included performance-based and self-report measures. RESULTS: Nineteen relevant studies were included, which incorporated lifestyle interventions (n 8), diet in combination with meal replacements (DMR; n 5) and very low-energy diets (VLED; n 6) using meal replacements only. Pooled data for eight RCT indicated a mean difference in Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function of 12·4 and 12·5 % following DMR or VLED interventions, respectively; however, no statistically significant change was detected for lifestyle interventions. CONCLUSIONS: Our findings suggest that partial use of meal replacements is as effective as their sole use in the more restrictive VLED. Both dietary interventions are more effective than lifestyle programmes to induce significant weight loss and improvements in physical function.

Osteoarthritis year in review 2020: rehabilitation and outcomes.

OBJECTIVE: Systematically review and synthesize guidelines, systematic reviews, or randomized controlled trials (RCTs) published between April 1, 2019 and April 30, 2020 which evaluated or made recommendations for rehabilitation of persons with osteoarthritis. DESIGN: Five electronic databases (Medline, EMBASE, Cochrane CENTRAL, CINHAL, Web of Science) were searched with a comprehensive search strategy. Guidelines for rehabilitation of persons with osteoarthritis, and systematic reviews and RCTs evaluating osteoarthritis rehabilitation that included at least one patient-reported outcome measure and/or clinical test of function were included. Two authors independently screened records and assessed methodological quality using the AGREE-II (guidelines), AMSTAR-2 (systematic reviews) or PEDro scale (RCTs). Data were extracted to summarize included records and a narrative synthesis of findings related to core recommended osteoarthritis rehabilitation treatments performed. RESULTS: Of 2,479 potential records, 253 records were reviewed. Two guidelines, 18 systematic reviews and 38 RCTs were included. 84% (n = 49) of included records related to knee osteoarthritis, 13% (n = 8) to hip, 10% (n = 6) to hand, 3% (n = 2) to mixed, and 1% (n = 1) to foot osteoarthritis. Exercise-therapy, methods to deliver exercise-therapy remotely, and approaches to facilitate exercise-therapy behaviour change were the most commonly evaluated interventions (n = 27). 94% of systematic reviews and 63% of RCTs rated high-quality. CONCLUSIONS: Osteoarthritis rehabilitation research continues to focus on knee osteoarthritis and exercise-based interventions. Emerging topics include rehabilitation of comorbid populations, exercise behaviour change and technology supports. A better understanding of rehabilitation of osteoarthritis in joints other than the knee, and methods to determine and promote ideal exercise-therapy prescription are needed.

Osteoartrosis de ATM: recuperar la función / TMJ Osteoarthrosis: recover function

Objetivo: evaluar la rehabilitación funcional de la ATM en pacientes con osteoartrosis, con abordaje neuromuscular. La osteoartrosis se caracteriza por la degeneración del cartílago articular y la cortical ósea, que conduce a dolor e inmovilidad. Se incluyó a 8 mujeres entre 20 y 42 años de edad con dolor en la región orofacial, signos de oclusión disfuncional e imágenes compatibles con trastornos degenerativos en ATM. Clínicamente se evaluó el dolor y la oclusión y, mediante tecnología electrónica, se obtuvieron datos objetivos de los movimientos de apertura-cierre y lateralidades, la velocidad de apertura-cierre mandibulares y de los ruidos articulares. Las mediciones fueron realizadas al inicio y al finalizar el tratamiento de estabilización mandibular con una ortosis neuromuscular. Para determinar la significación estadística se utilizaron el Student`s test de comparaciones múltiples y el análisis de varianza, ANOVA, de un factor. Las diferencias entre medias se consideraron significativas con p <0.05. Los resultados demostraron ausencia de dolor en el 100% de los casos al primer mes de tratamiento. Se incrementaron la apertura bucal (6,73 mm promedio), ambas lateralidades (P=0.0023), velocidad en apertura y en cierre (no estadísticamente significativo). Después de estabilizar la mandíbula se redujo la frecuencia de los ruidos. En conclusión, la oclusión dental disfuncional es el principal factor etiológico de la artrosis de la ATM. El establecimiento de una oclusión fisiológica produce la descompresión de la ATM, aumenta el rango de los movimientos mandibulares y disminuye significativamente el dolor (AU)

Objective: to evaluate the functional rehabilitation of the TMJ in patients with osteoarthritis, with a neuromuscular approach. Osteoarthrosis is characterized by degeneration of articular cartilage and bone cortex, which leads to pain and immobility. Eight women between 20 and 42 years of age with pain in the orofacial region, signs of dysfunctional occlusion, and images consistent with degenerative TMJ disorders were included. Clinically, pain and occlusion were evaluated and, using electronic technology, objective data were obtained on the opening-closing movements and lateralities, the opening-closing speed of the jaws and joint noises. Measurements were made before and at the end of the mandibular stabilization treatment with a neuromuscular orthosis. To determine the statistical significance, the Student`s multiple comparisons test and the analysis of variance, ANOVA, of one factor were used. The differences between means were considered significant with p <0.05. The results showed absence of pain pain in 100% of cases in the first month of treatment. Mouth opening (6.73 mm average), both lateralities (P = 0.0023), opening and closing speed (not statistically significant) were increased. After stabilizing the jaw the noise frequency value was reduced. In conclusion, dysfunctional dental occlusion is the main etiologic factor of TMJ osteoarthritis. Establishing a physiological occlusion causes TMJ decompression, increases the range of mandibular movements, and significantly decreases pain (AU)

Clinical outcomes of a combined arthroscopic and mini-open Outerbridge-Kashiwagi procedure for elbow osteoarthritis.

BACKGROUND: To evaluate the short-term clinical outcomes of a modified Outerbridge-Kashiwagi (O-K) procedure in the treatment of elbow osteoarthritis. METHODS: Between January 2012 and December 2016, 27 patients with elbow osteoarthritis were treated with a modified O-K procedure combining mini-open and arthroscopic technique in our institution. All patients with primary osteoarthritis and post-traumatic degenerative osteoarthritis of the elbow were included in the study if they had undergone the modified O-K procedure. Clinical outcomes were assessed using the visual analog scale (VAS), degree of flexion, extension loss, arc of motion, Mayo Elbow Performance Score (MEPS), and radiographs. RESULTS: Twenty-five patients with a mean age of 47.2 years (range, 21-69 years) at surgery were followed up for a mean of 54.5 months (range, 27-86 months). The VAS improved from 8.0 ± 1.4 (range, 6-10) preoperatively to 1.3 ± 1.1 (range, 0-3) at the final follow-up (P < .001), degree of flexion from 115.2° ± 12.0° (range, 90°-135°) to 130.6° ± 6.3° (range, 120°-140°) (P < .001), extension loss from 31.2° ± 15.0° (range, 10°-60°) to 10.2° ± 7.7° (range, 0°-30°) (P < .001), arc of motion from 84.0° ± 18.8° (range, 55°-120°) to 120.4° ± 9.3° (range, 105°-135°) (P < .001), and MEPS from 55.8 ± 8.1 (range, 40-70) to 88.4 ± 7.2 (range, 70-100) (P < .001). Radiographs at the final follow-up showed that 9 patients (36%) had significant recurrence of bone formation within the fenestration of the olecranon fossa. One patient developed delayed-onset ulnar neuropathy, with only slight numbness in the ulnar nerve distribution 6 months after surgery. CONCLUSIONS: The modified O-K procedure is safe and effective in pain relief and function restoration in patients with elbow osteoarthritis.

Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation.

Osteoarthritis (OA) is a complex musculoskeletal disease and a leading cause of pain and disability worldwide. Hip and knee OA alone are major contributors to global disability, having notable effects on individual well-being, increasing the reliance of individuals on health-care services and contributing to a rise in the socioeconomic burden. Consistent, coordinated and tailored approaches are important for providing appropriate care to all people with OA, but despite the scale of the challenge many individuals are still not offered the safe, best-evidence treatments recommended for OA care. This Review discusses the core priority treatments for OA, including exercise and physical activity, weight-loss, education and support for self-management. Additional physical or psychological evidence-based adjunctive therapies and combined therapies that can be used to tailor individual programmes are also discussed. These options include cognitive behavioural therapy, heat therapy, walking aids and splints, manual therapies and transcutaneous electrical nerve stimulation. International examples of OA treatment options, models of care and resources available are also given. Many challenges still need to be addressed to advance the uptake of these conditions, including further discussion around the risks and costs involved with all treatments.

Cross-cultural adaptation and validation of the Arabic version of the functional index for hand osteoarthritis.

BACKGROUND: The Functional Index of Hand Osteoarthritis (FIHOA) is a clinically and methodologically validated score used to assess functional impact in patients with hand osteoarthritis (OA). The aim of the study was to translate the FIHOA into classical Arabic, and to validate the psychometric properties of the translated version. METHODS: The FIHOA was translated into Arabic (FIHOA-AR) according to cross-cultural adaptation guidelines. The FIHOA-AR was administrated to patients diagnosed with hand OA according to the criteria of the American College of Rheumatology (ACR). A 5-day test-retest reliability and internal consistency study was performed using the intra-class correlation coefficient (ICC) and the Cronbach's alpha coefficient. External validity was measured by correlations between FIHOA-AR, hand pain visual analog scale (VAS) and the Health Assessment Questionnaire (HAQ). RESULTS: The sample consisted of 101 patients with hand OA. The obtained ICC > 0.9 and Cronbach's alpha of 0.93 indicated excellent reliability and internal consistency respectively. The evaluation of external validity showed strong correlation with hand pain VAS (r = 0.88, p < 0.001), and strong correlation with HAQ score (r = 0.86, p < 0.001). CONCLUSION: The FIHOA-AR is a reliable and valid score to assess functional disability in Arabic- speaking patients with hand OA.

Assessment of the Level of Pain Intensity and the Level of Anxiety Treated as State and Trait in Patients with Osteoarthritis of the Limbs.

Introduction: Osteoarthritis of the musculoskeletal system is accompanied with chronic pain which is the main factor in mood lowering, causing anxiety. Rehabilitation conducted in the framework of spa therapy and outpatient care aims at eliminating or reducing pain and improving physical fitness. Pain relief is an expected phenomenon because it improves the quality of life. Aim of the study. The aim of the study was to evaluate the effect of rehabilitation in the spa and in outpatient clinic on the level of pain and anxiety in patients with degenerative joints and disc disease. Material and methods. The study included a comprehensive treatment conducted in the spa and in outpatient clinic. Observation included 120 persons with disorders of the musculoskeletal system treated in the spa Przerzeczyn-Zdrój. The second group of patients was treated in the rehabilitation clinic. The examinations were performed before and after treatment. The scope of the observations included self-evaluation of anxiety treated as a state and a trait, the level of intensity of pain, medical history, and sociodemographic background interview. In the observations, there were VAS scale and State Trait Anxiety Inventory STAI used. Result: As a result of the spa therapy and therapy performed in an outpatient clinic, there was an improvement in lowering the level of pain and anxiety noted. Conclusions: 1. Spa therapy and treatment performed in an outpatient clinic reduce the level of pain and anxiety in patients with degenerative disease of the musculoskeletal system. 2. It was found that the therapy conducted in the spa was more effective in lowering the level of pain and anxiety. This trial is registered with NCT03405350.

Mobility Limitation After Surgery for Degenerative Pathology of the Ankle, Hindfoot, and Midfoot vs Total Hip Arthroplasty.

BACKGROUND: Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients' mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. METHODS: Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. RESULTS: Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant (P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) (P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores (P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation (P = .065). CONCLUSION: Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Management of first metatarsophalangeal joint osteoarthritis by physical therapists and podiatrists in Australia and the United Kingdom: a cross-sectional survey of current clinical practice.

BACKGROUND: First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability. There is limited research on assessment and treatment options, and the efficacy of current management strategies is unknown. The aim of this study was to determine how podiatrists and physical therapists in Australia and the United Kingdom (UK) manage people with first MTP joint OA. METHODS: A survey of podiatrists and physiotherapists was conducted. Potential respondents were recruited through professional representative organisations in Australia and the UK. Participants completed a bespoke online survey regarding the assessment and treatment approaches they most commonly use for patients with first MTP joint OA. Descriptive statistics were calculated and differences between professions compared using chi-square. RESULTS: Two hundred respondents (n = 113 (57%) podiatrists and n = 140 (70%) from Australia) completed the survey. Assessment tests were similar between professions and included x-ray (n = 151/164; 92%), range of motion (n = 127/141; 90%), and a pain scale (n = 78/99; 79%). Podiatrists were more likely than physical therapists to discuss over-the-counter medication (42% vs 17%; p < 0.001), prescribe orthoses (97% vs 66%; p < 0.001), particularly custom orthoses (78% vs 42%; p < 0.001), and provide advice on footwear (92% vs 78%; p < 0.01) when treating first MTP joint OA. In contrast, physical therapists used more exercise-based approaches to treatment, including exercise therapy (91% vs 34%; p < 0.001), increasing general activity (70% vs 49%; p < 0.01), and advice to pace activities (83% vs 48%; p < 0.001). CONCLUSION: Podiatrists and physical therapists use an array of assessment and treatment approaches for people with first MTP joint OA, albeit there is limited evidence to support their clinical utility. Treatment strategies differ between professions, particularly with respect to medication, orthoses and exercise. It is unclear whether these commonly-used strategies improve symptoms associated with first MTP joint OA.

A bio-psycho-social approach in elderly population: outcome of adapted physical activity in patients with osteoarthritis.

BACKGROUND: The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. OBJECTIVE: The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. METHODS: The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). RESULTS: A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. CONCLUSIONS: These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.