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1.
Orv Hetil ; 161(33): 1373-1381, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32749234

RESUMO

INTRODUCTION: Osteoarthritis (OA) as the most common joint disease is a major public health concern. AIM: To investigate the effect of multimorbidity on functional and quality of life outcomes in women with generalized osteoathritis (hand and knee arthritis, GOA). METHOD: In this cross-sectional study, patients according to the American College of Rheumatology (ACR) criteria for OA were invited. The control group consisted of subjects without any musculoskeletal symptoms, osteoarthritis or inflammatory rheumatic disease. Comorbidity count was calculated from the investigated comorbidities. In the GOA group, the function was assessed by Western Ontario and McMaster Universities Arthritis Index (WOMAC), Cochin Hand Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Health Assessment Questionnaire (HAQ), while quality of life was measured in both groups with the EuroQol-5D Scale. Interaction between summarized comorbidity count, age, body mass index (BMI) and scores were analysed. Descriptive statistics, two-sample t-test and Pearson's correlation test were used for data analysis. RESULTS: The study groups included 200-200 participants with a similar age spread. Significant correlation was demonstrated in both study groups between higher comorbidity count and older age (0.37, p<0.001, and 0.24, p<0.001 in the GOA and the control group, respectively) and higher BMI (0.18, p: 0.01, and 0.45, p<0.001 in the GOA and the control group, respectively). In GOA, the increasing comorbidity number had a negative effect on the measured outcomes. CONCLUSIONS: Age and BMI showed strong correlation with multimorbidity in both groups. The lower correlation between BMI and comorbidity count in the GOA group requires further investigation and may suggest different interactions. Orv Hetil. 2020; 161(32): 1332-1340.


Assuntos
Atividades Cotidianas , Osteoartrite do Joelho/psicologia , Qualidade de Vida , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Humanos , Multimorbidade , Dor/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-32858791

RESUMO

BACKGROUND: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. METHODS: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. RESULTS: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI -1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. CONCLUSION: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Medição da Dor/métodos , Dor/psicologia , Psicoterapia de Grupo/métodos , Atividades Cotidianas , Adulto , Idoso , Cognição , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/epidemiologia , Dor/epidemiologia , Resultado do Tratamento
3.
PLoS One ; 15(7): e0236865, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730319

RESUMO

BACKGROUND: There is currently no standardized method for measuring functional status in knee osteoarthritis (OA) patients, despite that it is one of the top priorities when determining eligibility for total knee arthroplasty (TKA). The purpose of the current investigation was to identify factors associated with discordance between individual self-report and performance-based measures of function for obese and non-obese men and women with knee OA. METHODS: In a cohort of 727 knee OA patients scheduled for TKA, physical function prior to surgery was assessed with the self-reported physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-pf), and the performance-based Timed Up and Go (TUG). Data on sociodemographic characteristics, health status, knee pain intensity, symptomatic joint site count, and pain catastrophizing were collected via questionnaire. The primary outcome was the difference in rescaled score between a participant's self-report and performance-based measures of function. Multivariable linear regression stratified by sex and obesity status was used to identify factors associated with discordance. RESULTS: The mean age of participants was 65.5 years and 55% were women. With younger age, self-reported scores indicated increasingly worse function compared to performance-based scores, regardless of sex or obesity status. Among non-obese individuals, greater knee pain intensity was associated with a participant's self-report score indicating increasingly worse function compared to their performance-based score. For obese women, pain catastrophizing, and number of symptomatic joints were also associated with discordance as was reporting fewer comorbidities. CONCLUSIONS: Physical function may be differentially represented by self-reported and performance-based measures depending on a variety of patient factors. Our findings add to the evidence which suggests both measures should be used when assessing functional status prior to TKA.


Assuntos
Obesidade/fisiopatologia , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/cirurgia , Avaliação de Resultados em Cuidados de Saúde/métodos , Desempenho Físico Funcional , Qualidade de Vida , Autorrelato , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Medição da Dor , Prognóstico , Estudos Prospectivos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários
4.
Phys Ther ; 100(10): 1771-1781, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32589713

RESUMO

OBJECTIVE: This study explored the association of patients' demographics, health status, symptom severity, previous osteoarthritis (OA) care, and psychological status with the change in pain severity following a first-line intervention including education and exercise for OA provided nationwide in Swedish primary care. METHODS: This register-based cohort study included 23,309 people with knee or hip OA from the Better Management of Patients with OA register. Linear regression models were used to assess the association of independent variables with the change in pain from baseline to 3 and 12 months. All the analyses were stratified based on the affected joint (hip vs knee). RESULTS: In people with hip and people with knee OA, high levels of baseline pain were associated with decreased pain at both follow-ups (3 months: knee B = -.67; hip B = -.64; 12 months: knee B = -.70; hip B = -.66), whereas being older, overweight, or female had a weak or no association. Finally, at both follow-ups, bilateral OA was associated with increased pain only in people with knee OA, whereas comorbidities and the willingness to undergo surgery were associated with increased pain regardless of the affected joint. CONCLUSIONS: Baseline pain showed the strongest association among the analyzed variables, whereas sex, age, and body mass index appear to be weakly associated with the pain change after a first-line intervention. Comorbidities and willingness to undergo surgery showed a potentially important association and may have a negative impact on the pain change following a first-line intervention. IMPACT: In people with hip or knee OA, age, sex, body mass index, and previous surgery are only weakly associated with the change in pain after a first-line intervention supporting the evidence recommending exercise and education as a foundation for all OA therapy. Having comorbidities and being willing to undergo surgery is associated with a worse outcome from a first-line intervention, including exercise and education. Individualized treatments addressing the disease perception and the specific comorbidity profile may improve the outcomes.


Assuntos
Avaliação da Deficiência , Nível de Saúde , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Índice de Gravidade de Doença , Idoso , Índice de Massa Corporal , Estudos de Coortes , Terapia por Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Qualidade de Vida , Sistema de Registros
5.
Zhongguo Zhen Jiu ; 40(6): 657-63, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32538020

RESUMO

OBJECTIVE: To systematically review the effect of acupuncture on emotional disorder in the patients with migraine and knee osteoarthritis and its effect time limit. METHODS: The randomized controlled trials of acupuncture for migraine or knee osteoarthritis were retrieved from the databases, starting from the time of establishment through to December, 2018, i.e. the Cochrane Library, PubMed, EMbase, CNKI, SinoMed, VIP and Wanfang. The bias risk assessment tool of Cochrane Review Manual 5.1.0 was adopted to evaluate the quality of trials in methodology. RevMan 5.3 software was used for the Meta-analysis. RESULTS: A total of 12 articles were included, with 2450 cases. Regarding the immediate effect, the score of the emotional function subscale of migraine-specific quality-of-life questionnaire (MSQ) in the acupuncture group was higher than the control group (6.38[2.78,9.98], I 2=25%). In view of the emotional function subscale of the short-form of health survey (SF-36/SF-12), and the scores of the mental function and negative mode scale in Spain's index of quality of life (PQLC), there were no significant differences in the scores between the acupuncture group and the control group. In 3 months of treatment, the score of the emotional function subscale of MSQ in the acupuncture group was higher than the control group (9.66 [3.06,16.25], I 2=44%). The difference in the score of the mental health subscale of SF-36 and SF-12 was not significant between the acupuncture group and the control group. In 3 to 6 months of treatment, as well as in over 6 months of treatment, the score of every scale was not different statistically between the acupuncture group and the control group. CONCLUSION: Acupuncture effectively maintains the healthy emotion in the patients with migraine and the effect is sustainable for 3 months after treatment. But the improvement of acupuncture is not remarkable in emotional disorder induced by knee osteoarthritis.


Assuntos
Terapia por Acupuntura , Dor Crônica/psicologia , Dor Crônica/terapia , Emoções , Humanos , Transtornos de Enxaqueca/psicologia , Transtornos de Enxaqueca/terapia , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/terapia , Qualidade de Vida , Resultado do Tratamento
6.
Health Qual Life Outcomes ; 18(1): 184, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539838

RESUMO

BACKGROUND: The EQ-5D-5 L is a quality-of-life questionnaire based on individuals' preferences that is widely employed for cost-effectiveness analysis. Given the current demand for mapping algorithms to directly assign "utilities", this study aimed to generate different mapping models for predicting EQ-5D-5 L utility values based on scores of the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires provided by patients suffering from hip and knee osteoarthritis (OA), respectively, and to assess the predictive capability of these functions. METHODS: This was a prospective, observational study. Following the criteria of the American Rheumatism Association, 361 patients with hip OA and 397 with knee OA from three regions in Spain were included. Health-related quality of life (HRQoL) was assessed through the EQ-5D-5 L general questionnaire and the OHS and OKS specifically for lower limb OA. Based on the scores on the OHS and OKS questionnaires, EQ-5D-5 L utilities were estimated using 4 models: ordinary least squares (OLS), Tobit, generalized linear model (GLM), and beta regression (Breg). The models were validated on the same patients after 6 months: the mean absolute error (MAE) and mean squared error (MSE) with their 95% confidence intervals (CI), mean values of standard errors (SE), intraclass correlation coefficients (ICC), and Bland-Altman plots were obtained. RESULTS: The lowest MAEs were obtained using GLM and Breg models, with values of 0.1103 (0.0993-0.1214) and 0.1229 (0.1102-0.1335) for hip OA, and values of 0.1127 (0.1014-0.1239) and 0.1141 (0.1031-0.1251) for knee OA. MSE values were also lower using GLM and Breg. ICCs between predicted and observed values were around or over the 0.8 cut-off point. Bland-Altman plots showed an acceptable correlation, but precision was lower for subjects with worse HRQoL, which was also evident when comparing MAEs of the bottom and top halves of the utilities scale. Predictive equations for utilities based on OHS/OKS scores were proposed. CONCLUSIONS: The OHS and OKS scores allow for estimating EQ-5D-5 L utility indexes for patients with hip and knee OA, respectively, with adequate validity and precision. GLM and Breg produce the best predictions. The predictive power of proposed equations is more consistent for subjects in better health condition.


Assuntos
Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos Prospectivos , Espanha
7.
Health Qual Life Outcomes ; 18(1): 121, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370751

RESUMO

BACKGROUND: The Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one's health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA. METHODS: Item response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes. RESULTS: Two-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores. CONCLUSIONS: This study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.


Assuntos
Osteoartrite do Joelho/psicologia , Participação do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Inquéritos e Questionários/normas , Atividades Cotidianas , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Reprodutibilidade dos Testes , Autogestão
8.
Medicine (Baltimore) ; 99(20): e20242, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443360

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a disabling joint disease with an increasingly prevalence among the older individuals. Tai Chi, one of the ancient meditative movements, has been recognized to have clinical benefits for KOA. We aim to evaluate the efficacy and safety of Tai Chi for patients with KOA through this systematic review. METHODS: Five English databases (Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, and CINAHL), 4 Chinese databases (CBM, CNKI, CQVIP, and Wanfang), and 5 clinical trial registration databases (ClinicalTrials.gov, ANZCTR, EU-CTR, ChiCTR, and ICTRP) will be searched from establishment of the database until November 31, 2019. Grey literature will be searched in SIGLE, Grey Net, Microsoft Academic, Google Scholar, Open Aire, World Wide Science.org, and WorldCat. There will be no restrictions on language. The randomized controlled trials of Tai Chi training for patients with KOA will be included. The primary outcome will be assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Meta-analysis will be conducted with the use of RevMan 5.3. The specific process will refer to the Cochrane Handbook 5.1 for Systematic Review. RESULTS: High-quality synthesis of current evidence on the efficacy and safety of Tai Chi training for KOA will be provided in this study. CONCLUSION: This systematic review aims to present evidence for whether Tai Chi training is an effective intervention which can improve both physical condition and life quality in patients suffering KOA.


Assuntos
Osteoartrite do Joelho/terapia , Tai Ji/normas , Idoso , Protocolos Clínicos , Humanos , Metanálise como Assunto , Pessoa de Meia-Idade , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Tai Ji/métodos , Tai Ji/psicologia
9.
Medicine (Baltimore) ; 99(17): e19761, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332614

RESUMO

The objective of this review is to systematically evaluate the short-term efficacy of mud therapy in the treatment of knee osteoarthritis (KOA).Randomized controlled trials, in which treatment of KOA is mud therapy, were included by systematically searching the PubMed, Embase, and the Cochrane Library databases.According to inclusion criteria and searching method, 11 articles, containing a total of 1106 patients, were included in the study. Our results showed significant differences in visual analog scale pain score and Western Ontario and McMaster Universities Osteoarthritis Index (pain, stiffness, function). In addition, the heterogeneity of study included is lower (I < 25%).According to the results of this meta-analysis, mud therapy can effectively alleviate the pain and improve joint function for KOA.


Assuntos
Terapia por Lama/normas , Osteoartrite do Joelho/terapia , Fatores de Tempo , Humanos , Terapia por Lama/métodos , Osteoartrite do Joelho/psicologia , Resultado do Tratamento
10.
Qual Life Res ; 29(9): 2395-2402, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32314125

RESUMO

PURPOSE: To evaluate the health-related quality of life (HRQoL) of knee osteoarthritis (KOA) patients in China, compare their HRQoL with norm population, and examine the associations between the potential influencing factors and HRQoL. METHODS: A cross-sectional study was conducted in 912 KOA patients from 4 provinces between March and November 2017. All participants were diagnosed according to the National Institute for Health and Care Excellence (NICE)'s criterion or the Chinese Medical Association (CMA)'s criterion. Recruited patients were surveyed for HRQoL using the 12-item Short Form (SF-12) and sociodemographic, disease-related factors. We assessed the associations between potential influencing factors and HRQoL using multiple linear regression models. RESULTS: Among the KOA patients, the mean physical component summary (PCS) of HRQoL was 40.91 ± 11.62, lower than norm (P < 0.001). And the mean mental component summary (MCS) was 50.25 ± 11.99, similar to the norm. Patients who were older (ß = - 0.155, P = 0.001), women (ß = - 4.589, P < 0.001), had ever been treated (ß = - 2.426, P = 0.006), had longer course of KOA (ß = - 0.164, P = 0.012), and were in early stage (ß = - 2.968, P = 0.001) or progressive/late stage (ß = - 7.636, P < 0.001) showed lower scores of PCS. Patients who lived in Hunan (ß = 4.988, P < 0.001) and had education levels of junior high school (ß = 3.134, P = 0.012) or senior high school and above (ß = 3.050, P = 0.010) had better mental status. Those suffered from non-knee pains (ß = - 2.308, P = 0.027) and with progressive or late KOA (ß = - 4.690, P = 0.016) had lower MCS scores. CONCLUSION: KOA patients had worse physical condition. The mental and physical health of patients were affected by different factors. Targeted management measures should be taken to improve their HRQoL.


Assuntos
Nível de Saúde , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , China , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/patologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Joelho/patologia , Inquéritos e Questionários
11.
Value Health ; 23(3): 379-387, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197734

RESUMO

OBJECTIVES: To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA). METHODS: A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R2, mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient. RESULTS: The preferred models were a GLM with Pain2+Pain3+Function+Pain·Function as covariates and a beta model with Pain3+Function+Function2+Function3 as covariates. The adjusted R2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death. CONCLUSION: To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available.


Assuntos
Artralgia/diagnóstico , Avaliação da Deficiência , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores de Tempo
12.
Pain Physician ; 23(2): 209-218, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214303

RESUMO

BACKGROUND: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients' response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. OBJECTIVES: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. STUDY DESIGN: This research used a prospective, cohort, observational study design. SETTING: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. METHODS: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression Inventory-II (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. RESULTS: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. LIMITATIONS: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. CONCLUSIONS: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. KEY WORDS: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.


Assuntos
Catastrofização/psicologia , Depressão/psicologia , Osteoartrite do Joelho/psicologia , Manejo da Dor/psicologia , Dor/psicologia , Modalidades de Fisioterapia/psicologia , Adulto , Idoso , Catastrofização/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/terapia , Dor/epidemiologia , Manejo da Dor/métodos , Medição da Dor/métodos , Medição da Dor/psicologia , Estudos Prospectivos , Resultado do Tratamento , Turquia/epidemiologia
13.
Geriatr Gerontol Int ; 20(4): 379-383, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32037727

RESUMO

AIM: To investigate the relationship between knee osteoarthritis, mental health and health-related quality of life (QoL). METHODS: This study included 6343 men and women aged ≥50 years from the Korean National Health and Nutrition Examination Survey. Osteoarthritis was defined as Kellgren-Lawrence grade ≥2 in the knee on radiographic images with knee pain. Mental health and health-related QoL were assessed according to three dimensions (depressive mood, psychological distress and suicidal ideation) and five domains (impaired mobility, impaired self-care, impaired usual activities, pain/discomfort and anxiety/depression). The odds ratios and 95% confidence intervals (CI) for mental health and health-related QoL were calculated using multiple logistic regression analyses. RESULTS: Compared with the control group, the odds ratios for depressive mood, psychological distress and suicidal ideation in the osteoarthritis group were 2.80 (95% CI 1.31-3.31), 1.92 (95% CI 1.21-3.05) and 1.97 (95% CI 1.31-2.94) in men, and 1.51 (95% CI 1.16-1.95), 1.36 (95% CI 1.07-1.72) and 1.92 (95% CI 1.49-2.46) in women after adjusting for potential confounding variables. Similarly, the odds ratios for impaired mobility, impaired self-care, impaired usual activities, pain/discomfort and anxiety/depression in the osteoarthritis group were 12.37 (95% CI 8.17-18.72), 3.02 (95% CI 1.84-4.94), 7.33 (95% CI 4.89-10.98), 8.92 (95% CI 5.92-13.45) and 2.56 (95% CI 1.52-4.29) in men, and 8.29 (95% CI 6.41-10.73), 2.53 (95% CI 1.74-3.69), 4.40 (95% CI 3.33-5.80), 4.79 (95% CI 3.72-6.17) and 1.85 (1.44-2.37) in women after adjusting for the same covariables. CONCLUSIONS: Knee osteoarthritis was significantly associated with deteriorated mental health and health-related QoL in middle-aged and older men and women. Geriatr Gerontol Int 2020; 20: 379-383.


Assuntos
Depressão/epidemiologia , Osteoartrite do Joelho/epidemiologia , Angústia Psicológica , Qualidade de Vida/psicologia , Ideação Suicida , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoartrite do Joelho/psicologia , República da Coreia/epidemiologia
14.
Clin Rehabil ; 34(3): 404-415, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31965830

RESUMO

OBJECTIVE: To identify predictors of long-term pain and disability in knee osteoarthritis. DESIGN: A longitudinal cohort study of five years. SETTING: Primary care providers. SUBJECTS: In all, 108 patients (mean age = 63.6 years, standard deviation (SD) = 7.2 years) with knee pain (⩾40 mm on a 100 mm visual analogue scale in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index pain scale) and radiographic grading (Kellgren-Lawrence: 2-4) of knee osteoarthritis who participated in a randomized controlled trial. MAIN MEASURES: Disease-specific pain and functioning were assessed using the corresponding WOMAC subscales. Generic functioning was assessed by the RAND-36 subscales for function and physical and mental component summary scores. Possible baseline predictors for these outcomes were (1) demographic and disease-related variables and (2) psychological variables of mood (anxiety, depression), pain-related cognitions (pain self-efficacy, pain catastrophizing, kinesiophobia), and positive resource factors (life satisfaction, sense of coherence). RESULTS: Multivariate linear mixed model analyses revealed that minimal anxiety at baseline predicted significantly better results for pain (WOMAC, P = 0.019) and function (WOMAC, P = 0.001, RAND-36 function P = 0.001). High pain self-efficacy predicted significantly better scores in RAND-36 function (P = 0.006), physical (P = 0.004) and mental (P = 0.001) component summaries. Pain catastrophizing predicted higher pain (P = 0.015), whereas fear of movement predicted poorer functioning in RAND-36 physical (P = 0.016) and mental (P = 0.009) component summaries. Those satisfied with life reported higher scores in RAND-36 function (P = 0.002) and mental component summary (P = 0.041). A low number of comorbidities predicted significantly better results in pain (WOMAC P = 0.019) and function (WOMAC P = 0.033, RAND-36 P = 0.009). CONCLUSION: Anxiety, pain-related cognitions, and psychological resources predict symptoms in knee osteoarthritis in the long term.


Assuntos
Avaliação da Deficiência , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Ansiedade/psicologia , Catastrofização , Comorbidade , Medo/psicologia , Feminino , Finlândia , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Movimento , Medição da Dor , Satisfação Pessoal , Estudos Prospectivos , Autoeficácia
15.
PLoS One ; 15(1): e0228398, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978194

RESUMO

OBJECTIVE: Osteoarthritis of the lower limb (OALL) worsens health-related quality of life (HRQL), but this impact has not been quantified with standardized measures. We intend to evaluate the impact of OALL on HRQL through measures based on individual preferences in comparison to the general population. METHODS: A cross-sectional study was designed. A total of 6234 subjects aged 50 years or older without OALL were selected from the Spanish general population (National Health Survey 2011-12). An opportunistic sample of patients aged 50 years or older diagnosed with hip (n = 331) or knee osteoarthritis (n = 393), using the American Rheumatism Association criteria, was recruited from six hospitals and 21 primary care centers in Vizcaya, Madrid and Tenerife between January and December 2015. HRQL was measured with the EQ-5D-5L, and the results were transformed into utility scores. Sociodemographic variables (age, sex, social group, cohabitation), number of chronic diseases, and body mass index were considered. The clinical stage of OALL was collected using the Western Ontario and McMaster Universities Osteoarthritis Index and the Oxford hip score and Oxford knee score. Generalized linear models were constructed using the utility index as the dependent variable. RESULTS: HRQL expressed by OALL patients was significantly worse than this of the general population. After adjustment for sociodemographic and clinical characteristics, the mean utility loss was -0.347 (95% CI: -0.390, -0.303) for osteoarthritis of the hip and -0.295 (95% CI: -0.336, -0.255) for osteoarthritis of the knee. OALL patients who were treated at a hospital had an additional utility loss of -0.112 (95% CI: -0.158, -0.065). CONCLUSION: OALL has a great impact on HRQL. People with OALL perceive a utility loss of approximately 0.3 points compared to the general population without osteoarthritis, which is very high in relation to the utility loss reported for other chronic diseases and for arthritis in general.


Assuntos
Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e Questionários
16.
Phys Ther ; 100(1): 127-135, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31596479

RESUMO

BACKGROUND AND PURPOSE: Existing osteoarthritis (OA) care models often fall short in addressing the many biological, psychological, social, and behavioral characteristics that contribute to disability. As US health care shifts towards value-based payment, there is an increasing need to develop and test scalable, cost-effective, and multi-modal OA care models. This administrative case report will describe the development and pilot of a new, value-based comprehensive care model for OA. CASE DESCRIPTION: The Joint Health Program (JHP) is a physical therapist-led conservative care model for individuals with hip and knee OA. In the JHP, physical therapists with specialized training in cognitive behavioral-theory based strategy function as the central care provider (ie, the primary osteoarthritis provider) who delivers evidence-based, psychologically informed interventions and coordinates care within a multi-disciplinary network of dietitians, behavioral health specialists, and orthopedic providers. The JHP is focused on enhancing patient engagement, shared decision making, self-management and multi-modal patient interaction, and long-term follow-up. OUTCOMES: A value-based, comprehensive care program for OA led by physical therapists demonstrated feasibility and acceptability within a large, academic health care system, which has led to its early growth. Barriers to development and integration of the program were addressed through effective collaboration among health care providers, program and health system administrators, and executive leadership. DISCUSSION: The JHP serves as a model for future physical therapist-led, value-based care models that could be developed in other health care systems for OA and other chronic conditions. Future work will identify characteristics that predict program response and compare the effectiveness of this program to existing models of care.


Assuntos
Tratamento Conservador/métodos , Osteoartrite do Quadril/reabilitação , Osteoartrite do Joelho/reabilitação , Fisioterapeutas , Desenvolvimento de Programas , Terapia Cognitivo-Comportamental , Tomada de Decisão Compartilhada , Estudos de Viabilidade , Humanos , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Equipe de Assistência ao Paciente , Exame Físico , Projetos Piloto , Medicina de Precisão/métodos , Atenção Primária à Saúde , Encaminhamento e Consulta , Autogestão , Estados Unidos
17.
Arthritis Care Res (Hoboken) ; 72(5): 652-660, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-30927509

RESUMO

OBJECTIVE: To explore therapeutic alliance between physical therapists and patients with knee osteoarthritis during telephone consultations. Specifically, to describe and compare physical therapist and patient ratings, to determine whether alliance changes over time, and to evaluate whether individual characteristics are associated with alliance. METHODS: We performed a secondary analysis of 84 patients in the intervention arm of a randomized controlled trial who completed 5-10 consultations with 1 of 8 physical therapists via telephone over 26 weeks, involving education, advice, and prescription of a strengthening and physical activity program. Therapeutic alliance was measured after the second (week 4) and final consultations (week 26), using the Working Alliance Inventory-Short Form. RESULTS: Patient and physical therapist ratings of the alliance were high. At week 4, patients rated the overall alliance, and all 3 subscales, higher than therapists. At 26 weeks, patients rated the Task subscale higher than therapists. Patient ratings for the Goal subscale decreased over time, while physical therapist ratings for total alliance and the Bond subscale increased. For patients, the variables of living with others, consulting with a therapist with no previous experience delivering care remotely, having more telephone consultations, and having a higher self-efficacy were associated with greater alliance ratings. Therapists were more likely to perceive a stronger alliance if they had less clinical experience and when treating patients who were younger and had higher self-efficacy. CONCLUSION: Physical therapist perceptions of the therapeutic alliance tended to be lower than those of patients early in treatment, but differences were small and of unclear clinical significance. Some subgroups of patients rated the alliance more strongly than others.


Assuntos
Atitude do Pessoal de Saúde , Terapia por Exercício , Conhecimentos, Atitudes e Prática em Saúde , Osteoartrite do Joelho/terapia , Participação do Paciente , Fisioterapeutas/psicologia , Relações Profissional-Paciente , Consulta Remota , Telefone , Aliança Terapêutica , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Autoeficácia , Fatores de Tempo , Resultado do Tratamento
18.
Arthritis Care Res (Hoboken) ; 72(5): 669-678, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-30951261

RESUMO

OBJECTIVE: The present study was undertaken to identify depression subtypes in individuals with or at risk for symptomatic knee osteoarthritis (OA) and to evaluate differences in pain and disability trajectories between groups. METHODS: Participants (n = 4,486) were enrolled in the Osteoarthritis Initiative. Latent class analysis was applied to the 20-item Center for Epidemiologic Studies Depression Scale measured at baseline to identify groups with similar patterns of depressive symptoms, and subtypes were assigned using posterior probability estimates. The relationships between depression subtypes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and disability subscales were modeled over 4 years and stratified by baseline knee OA status (symptomatic [n = 1,626] or at risk [n = 2,860]). RESULTS: Four subtypes were identified: asymptomatic (80.6%), catatonic (5.3%), anhedonic (10.6%), and melancholic (3.5%). Catatonic and anhedonic subtypes were differentiated by symptoms corresponding to psychomotor agitation and the inability to experience pleasure, respectively. The melancholic subtype expressed symptoms related to reduced energy and movement, anhedonia, and other somatic symptoms. Detectable mean differences in pain and disability compared to the asymptomatic group were observed for the anhedonic (1.5-2.3 WOMAC units) and melancholic (4.8-6.6 WOMAC units) subtypes, and associations were generally larger in individuals with symptomatic knee OA relative to those at risk. CONCLUSION: Among individuals with or at risk for symptomatic knee OA, there is evidence of depression subtypes characterized by distinct clusters of depressive symptoms that have differential effects on reports of pain and disability over time. Our findings thus imply that depression interventions could be optimized by targeting the specific symptomology that these subtypes exhibit.


Assuntos
Afeto , Artralgia/complicações , Depressão/etiologia , Saúde Mental , Osteoartrite do Joelho/complicações , Idoso , Artralgia/diagnóstico , Artralgia/psicologia , Depressão/diagnóstico , Depressão/fisiopatologia , Depressão/psicologia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Medição da Dor , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos
19.
Arthritis Care Res (Hoboken) ; 72(8): 1096-1103, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173484

RESUMO

OBJECTIVE: Pain catastrophizing and widespread pain are predictors of pain chronicity/severity. Gaps remain in our understanding of the extent to which each is a stable (trait) or dynamic (state) variable. We undertook this study to assess the stability of each variable from before to after total knee replacement (TKR) and whether changes are explained by pain improvements. METHODS: We used data from a prospective study of TKR recipients ages ≥40 years. Questionnaires included body pain diagrams assessing widespread pain, the Pain Catastrophizing Scale (PCS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. We divided subjects into widespread pain groups (0 versus 1-2 versus ≥3 pain regions) and into low and high PCS score groups (<16 versus ≥16). We assessed changes in group membership from pre-TKR to 12 months post-TKR, then compared these changes between subjects with most and least WOMAC pain improvement. RESULTS: A total of 176 subjects completed scales at both time points; 64% were female, the mean age was 66 years, and baseline median WOMAC pain score was 40. In all, 71% of subjects in the high PCS score group improved to join the low PCS score group at follow-up. While 73 subjects (41%) changed widespread pain group, they were similarly likely to worsen and to improve. We found a statistically significant positive association of improvement in WOMAC pain score with improvement in PCS score (r = 0.31), but not widespread pain (r = -0.004). CONCLUSION: The PCS score reflects state-like aspects of catastrophizing that diminish along with pain. In contrast, widespread pain scores worsened and improved equally often, regardless of knee pain relief. The findings urge caution in interpreting PCS score and widespread pain as trait measures in musculoskeletal research.


Assuntos
Artroplastia do Joelho/psicologia , Catastrofização/psicologia , Osteoartrite do Joelho/psicologia , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medição da Dor/psicologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
20.
Arthritis Care Res (Hoboken) ; 72(8): 1074-1080, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31199582

RESUMO

OBJECTIVE: The influence of sex on post-total knee arthroplasty (TKA) outcomes has been variable in the literature. Though sex is often reported as an averaged effect, we undertook this study to investigate whether sex modified the influence of presurgery characteristics on post-TKA knee pain. METHODS: This was a prospective study with data derived from 477 TKA osteoarthritis patients (279 women, 198 men). Questionnaires were completed presurgery and at 3 months postsurgery. The association between 3-month post-TKA knee pain and presurgery covariates (body mass index, comorbidity count, symptomatic joint count, low back pain, knee pain, and depressive symptoms) was assessed by linear regression. Sex-specific effects were evaluated using interactions. RESULTS: Women had significantly worse presurgery knee pain, joint count, and depressive symptoms, and worse postsurgery knee pain, than men. With simple covariate adjustment, no sex effect on pain was found. However, sex was found to moderate the effects of comorbidities (worse for women [P = 0.013]), presence of low back pain (worse for men [P = 0.003]), and depressive symptoms (worse for men [P < 0.001]) on postsurgery pain. Worse presurgery pain was associated with worse postsurgery pain similarly for women and men. CONCLUSION: The influence of some patient factors on early post-TKA pain cannot be assumed to be the same for women and men; average effects may mask underlying associations. Results suggest a need to consider sex differences in understanding TKA outcomes, which may have important implications for prognostic tool development in TKA.


Assuntos
Artroplastia do Joelho/psicologia , Depressão/complicações , Dor Lombar/psicologia , Osteoartrite do Joelho/psicologia , Dor Pós-Operatória/psicologia , Fatores Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medição da Dor , Período Pré-Operatório , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento
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