Factors related to the indecision of older adults with knee osteoarthritis about receiving physician-recommended total knee arthroplasty

Purpose: To explore factors related to the indecision of older adults with knee osteoarthritis (OA) about receiving physician-recommended total knee arthroplasty (TKA) and their needs during the decision-making process.

Method: Older outpatients with knee OA and undecided about physician-recommended TKA (N?=?26) were recruited by convenience from two medical centers and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by thematic analysis.

Results: Participants’ indecision about receiving physician-recommended TKA was due to four major concerns: treatment-related concerns, physical condition-related concerns, surgery-related concerns, and postsurgical care concerns. The few participants (n?=?6) who expressed needs during the decision-making process wanted more information about preparing for surgery, postsurgical care, rehabilitation, and medicines.

Conclusions: Healthcare providers are challenged to respect the decision-making process of older adults with OA regarding recommended TKA while maintaining their quality of life. These adults need appropriate information not only about the relationship between OA suffering and quality of life, but also TKA. While these patients are deciding whether to undergo physician-recommended TKA, they also need information about preparations for surgery, postsurgical care, rehabilitation, and medicines.

• Implications for Rehabilitation

• Total knee arthroplasty (TKA) can significantly relieve pain and improve function for older adults with knee osteoarthritis (OA), but many are unwilling to receive the surgery.

• Our older adult participants with knee OA ascribed their indecision about receiving physician-recommended TKA to treatment-related, physical condition-related, surgery-related, and postsurgical care-related concerns.

• Healthcare providers need to provide appropriate information to older adults with knee OA not only about the relationship between OA suffering and quality of life, but also about TKA.

• Healthcare providers should also provide these patients information about preparing for surgery, postsurgical care, rehabilitation, and medicines while they are deciding whether to undergo TKA.

     

Changes in self-reported disability after performance-based tests in obese and non-obese individuals diagnosed with osteoarthritis of the knee

Abstract

Purpose: The purposes of this study are three-fold: (1) To examine whether the WOMAC questionnaire should be obtained before or after performance-based tests. (2) To assess whether self-reported disability scores before and after performance-based tests differ between obese and non-obese individuals. (3) To observe whether physical activity and BMI predict self-reported disability before and after performance based tests. Methods: A longitudinal study included thirty one participants diagnosed with knee osteoarthritis (OA) using the Kellgren-Lawrence Scale by an orthopedic surgeon. Results: All WOMAC scores were significantly higher after as compared to before the completion of performance-based tests. This pattern of results suggested that the WOMAC questionnaire should be administered to individuals with OA after performance-based tests. The obese OA was significantly different compared to the non-obese OA group on all WOMAC scores. Physical activity and BMI explained a significant proportion of variance of self-reported disability. Conclusion: Obese individuals with knee OA may over-estimate their ability to perform physical activities, and may under-estimate their level of disability compared to non-obese individuals with knee OA. In addition, self-reported physical activity seems to be a strong indicator of disability in individuals with knee OA, particularly for individuals with a sedentary life style.

• Implications for Rehabilitation

• Osteoarthritis is a progressive joint disabling condition that restricts physical function and participation in daily activities, particularity in elderly individuals.

• Obesity is a comorbidity commonly associated with osteoarthritis and it appears to increase self-reported disability in those diagnosed with osteoarthritis of the knee.

• In a relatively small sample, this study recommends that rehabilitation professionals obtain self-report questionnaires of disability after performance-based tests in obese individuals with osteoarthritis of the knee as they are more likely to give an accurate representation of their level of ability at this time.

     

The effect of orthotic devices on knee adduction moment,pain and function in medial compartment knee osteoarthritis: a literature review

Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function.

• Implications for Rehabilitation

• Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA).

• Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA.

• The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

     

Determinants of pain,disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty

Abstract

Purpose: In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance.

Material and methods: Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations.

Results: Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p?<?0.05) and explained 12%–35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p?<?0.05) and explained 41%–59% of the variances of the different physical tests results.

Conclusions: Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well.

• Implications for rehabilitation

• Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs.

• Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA.

• Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.

     

Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase

Purpose: The aim of this study was to understand the living experiences of middle-aged Taiwanese adults with early knee osteoarthritis (OA). Methods: A qualitative research design was used in this study. Participants (n?=?17) were recruited by purposive sampling from orthopedic clinics at two medical centers in northern Taiwan. Data were collected through in-depth interviews from July to December 2010. The data were transcribed verbatim and summarized by content analysis. Results: The results indicated that the lived experiences could be grouped into 4 main themes: awareness; surmise of causes; acquisition of strategies; and the search for confirmative diagnosis. Conclusions: This study found that patients’ knowledge is insufficient for recognition of the presence of early OA. There is a need for clinicians to integrate knowledge of OA into the health education system and to develop interventions for early knee osteoarthritic patients. Patients’ disease cognition must be promoted so that their ability to process early symptoms of this disease will improve.

Implications for Rehabilitation

• Awareness, surmise of causes, and acquisition of strategies are repetitive circles. Patients pursue the true cause for their knee joint disease and seek confirmative diagnosis when the symptoms do not improve or when they became worse.

• The information patients have is insufficient to know the presence of degenerative osteoarthritis disease.

• There is a need for clinical practitioners to integrate knowledge of osteoarthritis into the health education system to increase awareness and to develop appropriate interventions for patients with early knee OA.

     

The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain

Purpose: The aims of this study were to translate the numeric rating scale (NRS) into Arabic and to evaluate the test–retest reliability and convergent validity of an Arabic Numeric Pain Rating Scale (ANPRS) for measuring pain in osteoarthritis (OA) of the knee.

Methods: The English version of the NRS was translated into Arabic as per the translation process guidelines for patient-rated outcome scales. One hundred twenty-one consecutive patients with OA of the knee who had experienced pain for more than 6 months were asked to report their pain levels on the ANPRS, visual analogue scale (VAS), and verbal rating scale (VRS). A second assessment was performed 48 h after the first to assess test–retest reliability. The test–retest reliability was calculated using the intraclass correlation coefficient (ICC_2,1). The convergent validity was assessed using Spearman rank correlation coefficient. In addition, the minimum detectable change (MDC) and standard error of measurement (SEM) were also assessed.

Results: The repeatability of ANPRS was good to excellent (ICC 0.89). The SEM and MDC were 0.71 and 1.96, respectively. Significant correlations were found with the VAS and VRS scores (p?<0.01).

Conclusions: The Arabic numeric pain rating scale is a valid and reliable scale for measuring pain levels in OA of the knee.

• Implications for Rehabilitation

• The Arabic Numeric Pain Rating Scale (ANPRS) is a reliable and valid instrument for measuring pain in osteoarthritis (OA) of the knee, with psychometric properties in agreement with other widely used scales.

• The ANPRS is well correlated with the VAS and NRS scores in patients with OA of the knee.

• The ANPRS appears to measure pain intensity similar to the VAS, NRS, and VRS and may provide additional advantages to Arab populations, as Arabic numbers are easily understood by this population.

     

Cross-cultural adaptation,reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis

Purpose: We adapted the reduced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for the Arabic language and tested its metric properties in patients with knee osteoarthritis (OA). Methods: One hundred and twenty-one consecutive patients who were referred for physiotherapy to the outpatient department were asked to answer the Arabic version of the reduced WOMAC index (ArWOMAC). After the completion of the ArWOMAC, the intensity of knee pain and general health status were assessed using the visual analog scale (VAS) and the 12-item short form health survey (SF-12), respectively. A second assessment was performed at least 48?h after the first session to assess test–retest reliability. The test–retest reliability was quantified using the intra-class correlation coefficient (ICC), and Cronbach’s alpha was calculated to assess the internal consistency of the Arabic questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. Results: The total ArWOMAC scale and pain and function subscales were internally consistent with Cronbach’s coefficient alpha of 0.91, 0.89 and 0.90, respectively. Test–retest reliability was good to excellent with ICC of 0.91, 0.89 and 0.90, respectively. SF-12 and VAS score significantly correlated with ArWOMAC index (p?Conclusions: The ArWOMAC index is a reliable and valid instrument for evaluating the severity of knee OA, with metric properties in agreement with the original version.

• Implications for Rehabilitation

• Although, the reduced WOMAC index has been clinically utilized within the Saudi population, the Arabic version of this instrument is not validated for an Arab population to measure lower limb functional disability caused by OA.

• The Arabic version of reduced WOMAC (ArWOMAC) index is a reliable and valid scale to measure lower limb functional disability in patients with knee OA.

• The ArWOMAC index could be suitable in Saudi Arabia and other Arab countries where the language, culture and the life style are similar.

     

Exercise in knee osteoarthritis: do treatment outcomes relate to bone marrow lesions? A randomized trial

Purpose: Exercise is effective for reducing knee osteoarthritis (OA) pain but effect sizes vary widely. Moreover, not all knee OA patients perceive beneficial effects. Tailoring specific exercises to subgroups of knee OA patients may increase effectivity. Bone marrow lesions (BMLs) have been suggested as a criterion to define such subgroups.

This study aimed to investigate whether BMLs’ presence/absence is related to treatment outcomes in a group of knee OA patients who exercised for 18 weeks.

Methods: Subjects with symptomatic knee OA started a strength or walking exercise program. BMLs’ presence at baseline was assessed. Pain was assessed before and after the intervention with the intermittent and constant osteoarthritis pain (ICOAP) questionnaire. Also the global perceived effect (GPE) on the patient’s complaints was rated.

Results: Thirty-five patients (strength (N?=?17) and walking (N?=?18)) were analyzed for BMLs. BMLs were present in 25 (71%) knees. Five (14%) patients dropped out and 19 (54%) improved (GPE ≥5). All dropouts had BMLs, but no difference was seen between dropouts and retainers (p?>?0.05). Pain scores did not differ between intervention groups (p?>?0.05) or between patients with BMLs and without BMLs (p?>?0.05).

Conclusions: Pain scores and GPE was not different between knee OA patients with and without baseline BMLs in this sample.

• Implications for Rehabilitation

• Both walking and strengthening exercises are effective means of improving pain in patients with knee osteoarthritis.

• In a relatively small sample, this study shows that the presence or absence of subchondral bone marrow lesions, as seen on magnetic resonance images, is not related to treatment outcomes.

     

Reliability and responsiveness of measures of pain in people with osteoarthritis of the knee: a psychometric evaluation

Purpose: To examine the fit between data from the Short Form McGill Pain Questionnaire (SF-MPQ-2) and the Rasch model, and to explore the reliability and internal responsiveness of measures of pain in people with knee osteoarthritis. Methods: Participants with knee osteoarthritis completed the SF-MPQ-2, Intermittent and Constant Osteoarthritis Pain questionnaire (ICOAP) and painDETECT. Participants were sent the same questionnaires 3 and 6 months later. Results: Fit to the Rasch model was not achieved for the SF-MPQ-2 Total scale. The Continuous subscale yielded adequate fit statistics after splitting item 10 on uniform DIF for gender, and removing item 9. The Intermittent subscale fit the Rasch model after rescoring items. The Neuropathic subscale had relatively good fit to the model. Test–retest reliability was satisfactory for most scales using both original and Rasch scoring ranging from fair to substantial. Effect sizes ranged from 0.13 to 1.79 indicating good internal responsiveness for most scales. Conclusions: These findings support the use of ICOAP subscales as reliable and responsive measure of pain in people with knee osteoarthritis. The MPQ-SF-2 subscales found to be acceptable alternatives.

• Implications for Rehabilitation

• The McGill Pain Questionnaire short version 2 is not a unidimensional scale in people with knee osteoarthritis, whereas three of the subscales are unidimensional.

• The McGill Pain Questionnaire short version 2 Affective subscale does not have good measurement properties for people with knee osteoarthritis.

• The McGill Pain Questionnaire short version 2 and the Intermittent and Constant Osteoarthritis Pain scales can be used to assess change over time.

• The painDETECT performs better as a screening measure than as an outcome measure.

     

The immediate and long-term effects of a walking-skill program compared to usual physiotherapy care in patients who have undergone total knee arthroplasty (TKA): a randomized controlled trial

Abstract

Purpose: To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function, pain and perceived self-efficacy in patients after total knee arthroplasty (TKA). Method: A single blind randomized controlled trial design was applied. Fifty-seven patients with primary TKA, mean age of 69 years (SD?±?9), were randomly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy. Outcomes were assessed before the interventions started at 6 weeks postoperatively (T1), directly after the interventions at 12–14 weeks (T2) and 9 months after the interventions (T3). Walking was the primary outcome, assessed by the 6?min walk test (6MWT). The secondary outcomes were timed stair climbing, timed stands, Figure-of-eight test, Index of muscle function, active knee range of motion, Knee Injury and Osteoarthritis Outcome Score and self-efficacy score. Results: From T1 to T2, a better 6MWT score was found in favor of the walking-skill program of 39?m (2–76), p?=?0.04. The difference between the groups in 6MWT persisted at T3, 44?m (8–80), p?=?0.02. No differences in other outcome measures were found. Conclusion: The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated.

• Implications for Rehabilitation

• Weight-bearing exercises are tolerated by the patients in the early stage after TKA.

• Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.

     

Preoperative factors related to the ambulatory status at 1 year after total knee arthroplasty

Purpose: The purpose of this study is to investigate whether preoperative factors can predict the ambulatory status at 1?year after primary total knee arthroplasty (TKA).

Methods: The subjects were 115 patients who had undergone TKA. Isometric lower limb muscle strength was measured and the Timed Up and Go (TUG) test and the 2011 knee society scoring were conducted preoperatively. Then, the patients were divided into two groups after surgery: a cane-assisted walking group (n?=?42) and independent walking group (n?=?73). Unpaired t-test, chi-square test, Mann–Whitney U-test, logistic regression analysis and the receiver-operating characteristic curve analysis were used in this study.

Results: A multiple logistic regression analysis selected age, TUG test and functional activities as significant variables estimating the use of a cane after surgery. Receiver-operating characteristic curve analyses revealed that the cut-off score for TUG test was 10.8?s (sensitivity?=?69%, specificity?=?67%, area under curve?=?0.81) and the cut-off score for functional activities was 39 points (sensitivity?=?83%, specificity?=?63%, area under curve?=?0.83) in predicting the ambulatory status.

Conclusions: Preoperative TUG test with a cut-off score of 10.8?s and functional activities with a cut-off score of 39 points are reliable assessment tools for predicting the use of walking aid following TKA.

• Implications for Rehabilitation

• An accurate prediction of the ambulatory status after total knee arthroplasty can aid patients in understanding their own goals of the activities of daily living.

• Preoperative timed up and go test of <10.8?s and a preoperative functional activities functional activities score in the 2011 knee society scoring >39 points are useful for predicting the ambulatory status after total knee arthroplasty.

     

The measurement of psychological constructs in people with osteoarthritis of the knee: a psychometric evaluation

Purpose To examine the measurement properties of measures of psychological constructs in people with knee osteoarthritis. Method Participants with osteoarthritis of the knee completed the beck depression inventory (BDI-II), state-trait anxiety inventory (STAI), arthritis helplessness index (AHI), fatigue severity scale (FSS), coping strategies questionnaire (CSQ), beliefs about pain control questionnaire (BPCQ), illness perceptions questionnaire-revised (IPQ-R), pain self-efficacy questionnaire (PSEQ) at home as part of a set of measures covering different aspects of osteoarthritis pain. The questionnaires were returned by pre-paid envelope. Rasch analysis was used to check the psychometric properties of the scales in people with osteoarthritis. Results The STAI-SF was an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue, with removal of items 1 and 2. The BDI subscales were acceptable for measuring negative thoughts and behaviours related to depressive symptomatology with some modifications to the scale. The helplessness scale of the AHI was acceptable as a measure of helplessness. The PSEQ was an acceptable measure of self-efficacy and the CSQ as a measure of cognitive coping strategies. The BPCQ and IPQ-R did not fit the Rasch model. Conclusions These findings indicate that questionnaires need to be checked for their ability to measure psychological constructs in the clinical groups to which they will be applied.

• Implications for Rehabilitation

• For people with osteoarthritis, the STAI-SF is an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue with removal of items 1 and 2.

• The BDI subscales, but not the total score, are acceptable for measuring depressive symptomatology with some modifications to the scoring of the scale. And helplessness can be measured using the Helplessness subscale of the AHI.

• The PSEQ was an acceptable measure of self-efficacy and cognitive coping strategies can be measured with the CSQ.

• Rasch analysis highlighted lack of unidimensionality, disordered response thresholds and poor targeting in some measures commonly used for people with osteoarthritis

     

Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit. They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p < 0.0001). Patients experienced only moderate knee pain during the strength training exercises, but knee pain at rest and knee joint effusion (p < 0.0001) were unchanged or decreased over the six training sessions. Isometric knee-extension strength and maximal walking speed increased by 147 and 112%, respectively. Conclusion: Progressive strength training initiated immediately after TKA seems feasible, and increases knee-extension strength and functional performance without increasing knee joint effusion or knee pain.

Implications for Rehabilitation

• Rehabilitation with progressive strength training initiated early after total knee arthroplasty (TKA) seems feasible.

• Rehabilitation with progressive strength training increases knee-extension strength and maximal walking speed without increasing knee joint effusion and knee pain during the first 2 weeks after TKA.

• During the progressive strength training exercises, patients with TKA may experience moderate knee pain, which seems to decrease over time. Resting knee pain before and after each training session is none to mild.

• The results of this pilot study are encouraging, but a larger randomized controlled trial, which compares rehabilitation with or without progressive strength training, is needed to confirm our findings.

     

Cross-cultural adaptation and validation of the Arabic version of the knee outcome survey-activities for daily living scale

Purpose: The purpose of this study is to cross-culturally adapt the Knee Outcome Survey-Activities of Daily Living Scale into Arabic and to assess its psychometric properties (internal consistency, reliability, validity, and responsiveness) in patients with knee disorders.

Methods: The cross-cultural adaptation process for the Knee Outcome Survey-Activities of Daily Living Scale into Arabic was performed consistent with the published guidelines. The psychometric properties of this Arabic version were then evaluated. Participants completed this version three times: at baseline, 2–4 days later, and 4?weeks later. Correlations between the Arabic version of Knee Outcome Survey-Activities of Daily Living Scale and the Arabic version of the Short Form-36 Health Survey, Get Up and Go, and Ascending/Descending stairs tests were evaluated.

Results: Linguistic and cultural issues were addressed. The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale demonstrated excellent internal consistency (Cronbach’s alpha?=?0.97) and excellent test–retest reliability (intraclass correlation coefficient?=?0.97). Construct validity of the Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale with the Arabic version of Short Form-36 Health Survey subscales ranged from r?=?0.28 to 0.53, p?r?=??0.47 to ?0.60, p?Conclusions: The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale is a reliable, valid and responsive measure for assessing knee-related symptoms and functional limitations

• Implications for rehabilitation

• The Knee Outcome Survey-Activities of Daily Living Scale-Arabic is a reliable, valid and responsive measure for assessing knee-related functional limitations.

• This Arabic version can be used in clinical practice and for research purposes to assess symptoms and functional limitations in Arabic-speaking patients with knee disorders.

• This scale is responsive to track therapeutic outcome of Arabic-speaking patients with knee disorders.

     

Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial

Objectives: The aim was to evaluate an Acceptance commitment therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. Methods: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomization. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. Results: Of 87 people assessed for eligibility, 31 (36%) were randomized. The main reason for non-randomization was that participants received surgery. Of the 16 participants randomized to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with seven participants suggested the intervention was acceptable. Conclusions: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible.

• Implications for Rehabilitation

• Acceptance commitment therapy (ACT) is an effective treatment for many pain conditions andcould be a useful intervention for people with osteoarthritis who have high levels of pain.

• Rasch analysis is a measurement technique that may enable greater precision in detectingmeaningful treatment effects in routine clinical outcomes.

• The ACT intervention was successful in reducing pain and sleep difficulties and there werenotable differences in effects between standard and Rasch-transformed scales.

• In a relatively small trial, ACT may to be an acceptable intervention for people with osteoarthritisand progress to a definitive trial is warranted.

     

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study

Purpose: To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers.

Methods: Seventy-two patients (60–87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63–82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy.

Results: The symptomatic extremity in patients was significantly (p?t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8–17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p?Conclusions: Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis.

• Implications for Rehabilitation

• Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present.

• Between-leg differences in leg extensor power (force?×?velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry.

• Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity.

• Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.

     

Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty

Purpose: We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty.

Materials and methods: Twenty patients with knee osteoarthritis aged 40–79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis.

Results: Interviews were completed with 11 pre-operative (67.1?±?7.6?years, 45.5% female, BMI 31.2?±?6.3) and nine post-operative patients (61.7?±?11.7 years, 44.4% female, BMI 30.2?±?4.7?kg/m²). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels.

Conclusion: Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients.

• Implications for rehabilitation

• This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery.

• Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes, having a personal commitment to activity and tracking activity levels.

• Barriers that may interfere with healthy eating behaviors and knee arthroplasty rehabilitation include the desire for high-fat/high-calorie foods, overeating and mood; whereas planning and portion control may help to facilitate healthy eating.

• Understanding barriers and facilitators to healthy eating and physical activity can help guide rehabilitation professionals with their discussions on weight management with patients who had or are contemplating knee arthroplasty.

     

Effects of elastic-band exercise on lower-extremity function among female patients with osteoarthritis of the knee

Objective: To investigate a new style of resistance exercise using elastic bands and explore its therapeutic effect on the lower-extremity function of female patients with osteoarthritis (OA) of the knee. Design: A randomized, controlled clinical trial. Setting: University-affiliated medical center. Participants: Forty-one women with mild-to-moderate knee OA were randomly assigned to one of two groups, an exercise group (n?=?24; age: 65.0?±?8.4 years), and a control group (n?=?17; age: 70.8?±?8.4 years). Interventions: The exercise group performed supervised exercise with elastic bands in addition to conventional modality treatments two to three times a week for 8 weeks. The control group received only the conventional modality treatments over the same period. Main outcome measures: The distance of the functional forward-reach, 30 s chair stand repetitions, walking function (time of a 10 m walk, timed up-and-go, and going up-and-down 13-stair tests), and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores. Results: Statistically significant improvements in all measures were observed in the exercise group after 8 weeks (p?<?0.001). Except for the outcomes on the functional forward-reach (p?=?0.108) and going up-and-down 13-stair test (p?=?0.278), there were significant differences in the extent of improvement between the two groups. Positive changes in the 30 s chair stand test, 10 m walk test, and timed up-and-go test were 2.5?±?1.4 repetitions, 1.4?±?1.2 s, and 1.6?±?1.1 s in the exercise group, which were significant better than those in the control group (0.6?±?0.9 repetitions, 0.5?±?1.1 s, and 0.3?±?1.1 s, respectively) (p?≤?0.001). The lower scores of all three subscales of the WOMAC index were significant after 8 weeks (p?≤?0.05), especially for pain (?2.3?±?1.3) and physical function (?10.7?±?5.9) (both p?≤?0.01), and the improvements were all significant better than those of the control group (p?≤?0.05). Conclusions: A new style of resistance exercise using elastic bands with four color combinations (yellow-red, red-red, red-green, and green-green) over a period of 8 weeks can significantly improve lower-extremity function among females with mild-to-moderate knee OA.

Implications for Rehabilitation

• Resistance exercise is an effective means of improving the lower extremity function for people with knee osteoarthritis (OA).

• A new model for using elastic bands combinations based on leg-press exercise and the principles of progressive resistance training leads to improved lower extremity function in female patients with knee OA after an 8-week period.