OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial Effects of Impairment-Based Exercise on Performance of Specific Self-Reported Functional Tasks in Individuals With Knee Osteoarthritis Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol Agility and Perturbation Training Techniques in Exercise Therapy for Reducing Pain and Improving Function in People With Knee Osteoarthritis: A Randomized Clinical Trial The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis Occupational physical loading tasks and knee osteoarthritis: a review of the evidence. Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Does Transcutaneous Electrical Nerve Stimulation Improve the Physical Performance of People With Knee Osteoarthritis? Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Determinants of self-report outcome measures in people with knee osteoarthritis. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement.
OBJECTIVES To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis ( OA ) or following joint replacement . METHODS An international , multidisciplinary expert advisory group was established to guide the study . Potential tests for consideration in the recommended set were identified via a survey of selected experts and through a systematic review of the measurement properties for performance-based tests . A multi-phase , consensus-based approach was used to prioritize and select performance-based tests by applying decision analysis methodology ( 1000Minds software ) via online decision surveys . The recommended tests were chosen based on available measurement-property evidence , feasibility of the tests , scoring methods and expert consensus . RESULTS Consensus incorporated the opinions of 138 experienced clinicians and research ers from 16 countries . The five tests recommended by the advisory group and endorsed by Osteoarthritis Research Society International ( OARSI ) were the  30-s chair-st and test , 40 m fast-paced walk test , a stair-climb test , timed up- and -go test and 6-min walk test . The first three were recommended as the minimal core set of performance-based tests for hip or knee OA . CONCLUSION The OARSI recommended set of performance-based tests of physical function represents the tests of typical activities relevant to individuals diagnosed with hip or knee OA and following joint replacements . These tests are complementary to patient-reported measures and are recommended as prospect i ve outcome measures in future OA research and to assist decision-making in clinical practice . Further research should be directed to exp and ing the measurement-property evidence of the recommended tests OBJECTIVE To develop clinical practice guidelines for the use of foot orthotics ( FO ) in the treatment of knee and hip osteoarthritis . METHOD The SOFMER ( French Physical Medicine and Rehabilitation Society ) methodology , associating a systematic review of the literature , input from every day clinical practice and external review by a multidisciplinary expert committee , was used . The selected analysis criteria were  pain , disability , medications used and X-ray evolution of osteoarthritis .  The recommendations are classified according to the level of proof in Grade A , B or C according to the French National Agency for Health Accreditation and Evaluation ( NAHAE ) . RESULTS In medial knee osteoarthritis , foot pronation orthotics -- when there are no contraindications -- can be proposed for their symptomatic impact , especially in the decrease of NSAIDs consumption ( Grade B ) . To this day , there is no evidence of a structural or functional impact on osteoarthritis ( Grade B ) . Outside of this specific clinical framework , there is no vali date d indication for prescribing foot orthotics in the treatment of knee or hip OA ( Grade C ) . CONCLUSION It is necessary to have further r and omized controlled trials to better define the indication of Foot orthotics ( severity of knee OA , genu varum ) , test the efficacy of other orthoses such as cushioning FO . The long-term side effects , mainly on the external femorotibial compartment could also be assessed . A medical and economical assessment of FO prescriptions is also quite necessary Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis ( OA ) . Strengthening the hip abductor and adductor muscles may influence joint loading and /or OA-related symptoms , but no study has evaluated these hypotheses directly . The aim of this r and omised , single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA . Methods / Design 88 participants with painful , radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and r and omly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity . The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks . They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance . The control group will be requested to continue with their usual care . Blinded follow up assessment will be conducted at 12 weeks after r and omisation . The primary outcome measure is the change in the peak external knee adduction moment measured during walking . Question naires will assess changes in pain and physical function as well as overall perceived rating of change . An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics . Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA . If shown to reduce the knee adduction moment , hip strengthening has the potential to slow disease progression . Trial Registration Australia New Zeal and Clinical Trials Registry OBJECTIVES To examine the objective physical function of the lower extremities , to measure the properties of quadriceps femoris muscle ( QFM ) , and to assess subjective disabilities in men with knee osteoarthritis ( OA ) and to compare the results with those obtained from age- and sex-matched control subjects . DESIGN Cross-sectional study . SETTING Rehabilitation clinic in a university hospital . PARTICIPANTS Male volunteers ( n=54 ) ( age range , 50 - 69y ) with knee OA and r and omly selected healthy , age- and sex-matched control subjects ( n=53 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Physical function evaluated with a test battery including the QFM composition measurement , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the R AND 36-Item Short-Form Health Survey , version 1.0 .  RESULTS Knee OA patients had 13 % to 26 % poorer ( P range , .050-.001 ) physical function and muscle strength compared with the controls . There were also significant differences in QFM composition . WOMAC ( P range , .050-.001 ) and muscle strength ( P<.001 ) associated with physical function tests , but subjective pain correlated with neither physical function nor muscle strength in knee OA patients . The radiographic knee OA grade did not have any significant effect on physical function , but passive knee motion , knee extension strength , and WOMAC were related to the severity of the disease ( P<.05 ) . CONCLUSIONS The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls . The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease . The results highlight the effect of QFM strength on physical function as well as the importance of patient 's subjective and objective physical function when deciding on knee OA treatment policy Objective : To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis ( OA ) . Design : A quasi-experimental design consisting of an exercise group and an age-matched control group . Setting : Public community swimming pool in Sheffield , UK . Subjects : One hundred and six community-dwelling sedentary older people , with confirmed knee-hip osteoarthritis , enrolled in an experimental controlled trial for 12 months . Sixty-six subjects in the exercise group were offered a water-exercise programme .  Forty age-matched , nonexercising , ‘ control ’ subjects received monthly education material and quarterly telephone calls . Interventions : Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors . Main measures : Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) . Secondary outcomes included a battery of performance-based physical function tests . Results : Adherence to exercise averaged 70 % ( ±14 % ) over the year : 77 % of the exercising subjects and 89 % control subjects completed both pre- and post- outcome measures . After one year , participants in the exercise group experienced a significant improvement in physical function ( 4.0 ± 9.1 versus -0.4 ± 7.3 units ; 95 % confidence interval ( CI ) 0.96–7.96 , p < 0.05 ) and reduction in the perception of pain ( 1.3 ± 3.7 versus 0.2 ± 2.5 units ; 95 % CI -0.19 - 2.52 , p < 0.05 ) compared with the control group , as measured by the WOMAC Osteoarthritis Index . In addition , the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05 ) , had significantly greater improvements in knee range of movement ( p < 0.01 ) and hip range of movements ( p < 0.005 ) . There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being ( Arthritis Impact Measurement Scales 2 question naire ) . Conclusions : Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function , pain , general mobility and flexibility after participating in 12 months of community-based water exercise Introduction Management of osteoarthritis ( OA ) includes the use of non-pharmacological and pharmacological therapies . Although walking is commonly recommended for reducing pain and increasing physical function in people with OA , glucosamine sulphate has also been used to alleviate pain and slow the progression of OA . This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA . Methods Thirty-six low active participants ( aged 42 to 73 years ) were provided with 1500 mg glucosamine sulphate per day for 6 weeks , after which they began a 12-week progressive walking program , while continuing to take glucosamine . They were r and omized to walk 3 or 5 days per week and given a pedometer to monitor step counts . For both groups , step level of walking was gradually increased to 3000 steps/day during the first 6 weeks of walking , and to 6000 steps/day for the next 6 weeks . Primary outcomes included physical activity levels , physical function ( self-paced step test ) , and the WOMAC Osteoarthritis Index for pain , stiffness and physical function . Assessment s were conducted at baseline and at 6- , 12- , 18- , and 24-week follow-ups . The Mann Whitney Test was used to examine differences in outcome measures between groups at each assessment , and the Wilcoxon Signed Ranks Test was used to examine differences in outcome measures between assessment s. Results During the first 6 weeks of the study ( glucosamine supplementation only ) , physical activity levels , physical function , and total WOMAC scores improved ( P < 0.05 ) . Between the start of the walking program ( Week 6 ) and the final follow-up ( Week 24 ) , further improvements were seen in these outcomes ( P < 0.05 ) although most improvements were seen between Weeks 6 and 12 . No significant differences were found between walking groups . Conclusions In people with hip or knee OA , walking a minimum of 3000 steps ( ~30 minutes ) , at least 3 days/week , in combination with glucosamine sulphate , may reduce OA symptoms . A more robust study with a larger sample is needed to support these preliminary findings .Trial Registration Australian Clinical Trials Registry ACTRN012607000159459 Background Little is known regarding how impairment-based exercises may improve performance of specific functional tasks in people with knee osteoarthritis ( OA ) . Objective The purpose of this study was to compare the probability that participation in an impairment-based exercise program or the same impairment-based program supplemented with agility and perturbation training will improve patient-reported function on specific functional tasks . Design This study was a secondary analysis of data from a r and omized clinical trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise . Measurements Specific functional items were taken from the physical function subscale of the Western Ontario and McMasters Universities Osteoarthritis Index , the Lower Extremity Function Scale , and the Activities of Daily Living Scale of the Knee Outcome Survey . Results The probability of self-reported improvement in a variety of specific functional tasks was low following participation in either of the exercise programs . When only participants with moderate to severe difficulty performing specific functional tasks were considered in the analysis , the probability of success improved but was still limited . Limitations The results are generalizable only to self-reported assessment of performance of specific functional tasks . Conclusions Impairment-based exercise may not be enough to make substantial improvement in performance of specific functional tasks .  Task-specific exercise approaches need to be explored for people with knee OA Background Osteoarthritis ( OA ) of the hip and knee are among the most common chronic conditions , result ing in substantial pain and functional limitations . Adequate management of OA requires a combination of medical and behavioral strategies . However , some recommended therapies are under-utilized in clinical setting s , and the majority of patients with hip and knee OA are overweight and physically inactive . Consequently , interventions at the provider-level and patient-level both have potential for improving outcomes . This manuscript describes two ongoing r and omized clinical trials being conducted in two different health care systems , examining patient-based and provider-based interventions for managing hip and knee OA in primary care . Methods / Design One study is being conducted within the Department of Veterans Affairs ( VA ) health care system and will compare a Combined Patient and Provider intervention relative to usual care  among n = 300 patients ( 10 from each of 30 primary care providers ) . Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only , Provider Only , and Combined ( Patient + Provider ) interventions relative to usual care  among n = 560 patients across 10 clinics . Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis , are overweight , and do not meet current physical activity guidelines . The 12-month , telephone-based patient intervention focuses on physical activity , weight management , and cognitive behavioral pain management . The provider intervention involves provision of patient-specific recommendations for care ( e.g. , referral to physical therapy , knee brace , joint injection ) , based on evidence -based guidelines . Outcomes are collected at baseline , 6-months , and 12-months . The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index ( self-reported pain , stiffness , and function ) , and secondary outcomes are the Short Physical Performance Test Protocol ( objective physical function ) and the Patient Health Question naire-8 ( depressive symptoms ) . Cost effectiveness of the interventions will also be assessed . Discussion Results of these two studies will further our underst and ing of the most effective strategies for improving hip and knee OA outcomes in primary care setting s . Trial registration NCT01130740 ( VA ) ; NCT 01435109 ( NIH Abstract Osteoarthritis ( OA ) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation . Behavioral self-management for OA symptomatology is commonly recommended ; but these interventions are underutilized , unst and ardized in application , and at times , unavailable in the context of clinical care . For people with chronic pain , rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms . Activity pacing is widely used in combination with other pharmacological and behavioral interventions but has not been studied as a singular behavioral intervention for people with OA . The purpose of this study was to evaluate the effectiveness of an occupational therapist-delivered , time-based activity pacing program for treatment of pain , fatigue , and physical function in people with symptomatic knee or hip OA . A 3-arm r and omized controlled trial was conducted in which 193 people were r and omized into tailored activity pacing , general activity pacing , or usual care arms . Assessment s were done at 10 weeks and 6 months after baseline . Using linear mixed models , Western Ontario and McMaster Universities Osteoarthritis Index pain scores changed over time , decreasing the most in the general and usual care groups ; only the usual care group had decreased pain over 6 months . The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks , but pacing was not sustained at 6 months . This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA OBJECTIVE To determine if behavioral grade d activity ( BGA ) results in better long-term effectiveness ( 5 years after inclusion ) than usual exercise therapy ( UC ; usual care ) in patients with osteoarthritis ( OA ) of the hip or knee . METHOD Long-term follow-up study of a single blind cluster r and omized trial comparing BGA and UC .  One hundred and forty-nine patients out of the 200 included were followed until 60 months ' follow-up . Primary outcome measures were pain , physical function , and patient global assessment . Furthermore , patient-oriented physical function , physical performance , health care utilization and the number of joint replacement surgeries were assessed . Assessment s took place at 3 , 9 , 15 and 60 months ' follow-up . Data were analyzed according to intent-to-treat principle . RESULTS Both treatments showed beneficial within-groups effects in the long-term . In patients with knee OA no differences between treatments were found on the short- , mid-long and long-term . In patients with hip OA significant differences in favor of BGA were found at 3 months ' ( pain and physical performance ) and 9 months ' follow-up ( pain , physical function , patients global assessment and patient-oriented physical function ) . Furthermore , UC result ed in patients with hip OA in more joint replacement surgeries compared to BGA ( hazard ratio [ HR ] , 2.87 ; 95 % confidence interval [ CI ] , 1.1 ; 7.3 ) . CONCLUSION No differences between treatment groups were found in the long-term on the primary outcome measures . Although more research is needed to confirm the study findings , the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA , which probably can be explained by better outcome in favor of BGA in the short- and mid-long-term Background Knee osteoarthritis ( OA ) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability . Many people with knee OA also experience co-morbidities that further add to the OA burden . Uptake of and adherence to physical activity recommendations is suboptimal in this patient population , leading to poorer OA outcomes and greater impact of associated co-morbidities . This pragmatic r and omised controlled trial will investigate the clinical - and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA . Methods / Design 168 people with clinical ly diagnosed knee OA will be recruited from the community in metropolitan and regional areas and r and omly allocated to physiotherapy only , or physiotherapy plus nurse-delivered telephone coaching . Physiotherapy involves five treatment sessions over 6 months , incorporating a home exercise program of 4–6 exercises ( targeting knee extensor and hip abductor strength ) and advice to increase daily physical activity . Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia ( HCA ) Model of Health Change to provide behaviour change support . The telephone coaching intervention aims to maximise adherence to the physiotherapy program , as well as facilitate increased levels of participation in general physical activity . The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months . Secondary outcomes include physical activity levels , quality -of-life , and potential moderators and mediators of outcomes including self-efficacy , pain coping and depression . Relative cost-effectiveness will be determined from health service usage and outcome data . Follow-up assessment s will also occur at 12 and 18 months . Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis ( OA ) . It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function . Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to st and ard exercise therapy compared with the st and ard exercise program alone for people with knee OA . Design This was a single-blinded r and omized controlled trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise program . Measurements The outcome measures were self-reported knee pain and function , self-reported knee instability , a performance-based measure of function , and global rating of change . Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2- , 6- , and 12-month follow-up periods , there were no differences between groups on these outcomes . There was no reduction in knee pain or improvement in performance-based function in either group . Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach . Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change . Our results , however , did not support an additive effect of agility and perturbation training with st and ard exercise therapy in our sample of individuals with knee OA . Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach Background A large proportion of patients with knee and /or hip osteoarthritis ( OA ) do not meet the recommended levels of physical activity ( PA ) . Therefore , we developed a web-based intervention that provides a tailored PA program for patients with knee and /or hip OA , entitled Join2move . The intervention incorporates core principles of the behaviour grade d activity theory ( BGA ) . The aim of this study was to investigate the preliminary effectiveness , feasibility and acceptability of Join2move in patients with knee and /or hip OA . Methods A non-r and omized pilot study was performed among patients with knee and /or hip OA . Primary outcomes were PA ( SQUASH Question naire ) , physical function ( HOOS and KOOS question naires ) and self-perceived effect ( 7-point Likert scale ) . Baseline , 6 and 12 week follow-up data were collected via online question naires . To assess feasibility and acceptability , program usage ( modules completed ) and user satisfaction ( SUS question naire ) were measured as secondary outcomes . Participants from the pilot study were invited to be interviewed . The interviews focused on users ’ experiences with Join2move . Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move . In the first usability test , software experts evaluated the website from a list of usability concepts . In the second test , users were asked to verbalize thoughts during the execution of multiple tasks . Results Twenty OA patients with knee and /or hip OA between 50 and 80 years of age participated in the pilot study . After six weeks , pain scores increased from 5.3 to 6.6 ( p=0.04 ) . After 12 weeks this difference disappeared ( p=0.5 ) . Overall , users were enthusiastic about Join2move . In particular , performing exercise at one 's own pace without time or travel restrictions was cited as convenient . However , some minor flaws were observed . Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying . Conclusions This paper outlines the preliminary effectiveness , feasibility and acceptability of a web-based PA intervention . Preliminary results from the pilot study revealed that PA scores increased , although differences were not statistically significant . Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and /or hip OA . The intervention was easy to use and the satisfaction with the program was high . Trial registration The Netherl and s National Trial Register . Trial number : UNLABELLED Purpose : To perform a systematic review with best evidence synthesis examining the literature on the relationship between occupational loading tasks and  knee osteoarthritis ( OA ) . METHODS Two data bases were search ed to identify articles published between 1946 and April , 2011 . Eligible studies were those that ( 1 ) included adults reporting on their employment history ; ( 2 ) measured individuals ' exposure to work-related activities with heavy loading in the knee joint ; and ( 3 ) identified presence of knee OA ( determined by X-ray ) , cartilage defects associated with knee OA ( identified by magnetic resonance imaging ) , or joint replacement surgery . RESULTS A total of 32 articles from 31 studies met the inclusion criteria . We found moderate evidence that combined heavy lifting and kneeling is a risk factor for knee OA , with odds ratios ( OR ) varying from 1.8 to 7.9 , and limited evidence for heavy lifting ( OR=1.4 - 7.3 ) , kneeling ( OR=1.5 - 6.9 ) , stair climbing ( OR=1.6 - 5.1 ) , and occupational groups ( OR=1.4 - 4.7 ) as risk factors . When examined by sex , moderate level evidence of knee OA was found in men ; however , the evidence in women was limited . CONCLUSIONS Further high- quality prospect i ve studies are warranted to provide further evidence on the role of occupational loading tasks in knee OA , particularly in women OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance Background : According to a recent meta analysis study , there is strong evidence to support the view that transcutaneous electrical nerve stimulation ( TENS ) is an effective treatment for managing osteoarthritis ( OA ) knee pain . However , there is limited evidence showing its effectiveness in improving physical function . This study examined whether TENS alone can improve physical function in terms of range of knee motion and the Timed-Up- and -Go Test . Methods : Subjects were r and omly allocated into 2 groups receiving TENS at 100 Hz or a placebo TENS . Outcome measures included : 1 ) visual analog scale for measuring the intensity of the present pain , 2 ) Timed-Up- and -Go Test , and 3 ) range of knee motion ( ROM ) . Repeated- measures analysis of variance and Pearson correlation were used for data analyses . Results : By day 10 , TENS produced a significantly greater increase in maximum knee ROM than the placebo group ( P = 0.033 ) . TENS also significantly increased the pain-limited knee ROM across sessions , but the between-group difference was short of significance ( P = 0.067 ) . The decrease in time in performing the Timed-Up- and -Go Test was also not significantly different between the 2 groups . A moderate correlation was observed between the reduction in pain scores and the improvement in the Timed-Up- and -Go Test . Conclusions : Our findings suggested that TENS did improve some of the physical parameters but over 10 days was unable to produce significant improvement in functional performance among people with knee OA . A larger-scale study with the assessment of other functional outcomes may be required to clarify if TENS could improve function in people with knee OA . Also , exercise can be considered to be an important adjunct treatment to TENS to improve function significantly Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response OBJECTIVE To determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment . METHODS In a r and omised controlled trial , 89 participants were r and omly allocated to a hip strengthening group or to a control group with no intervention . The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks . The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor . Secondary outcomes included a pain numeric rating scale , Western Ontario and McMaster Universities Osteoarthritis Index , step test , stair climb test , maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change . Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics . RESULTS The trial was completed by 76/89 participants ( 85 % ) . There was no significant between-group difference in change in the knee adduction moment [ mean difference ( 95 % confidence interval ( CI ) ) 0.134 ( -0.069 to 0.337 ) Nm/BW x HT% ] . All pain , physical function and muscle strength measures showed significantly greater improvement in the strengthening group ( all P<0.05 ) . The relative risk ( 95 % CI ) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 ( 6.21 - 64.47 ) . CONCLUSIONS Although strengthening the hip muscles improved symptoms and function in this patient group , it did not affect medial knee load as measured by the knee adduction moment . Thus it is unlikely that hip muscle strengthening influences structural disease progression . TRIAL REGISTRATION ACTR12607000001493 OBJECTIVE To determine the effectiveness of a behavioral grade d activity program ( BGA ) compared with usual care ( UC ; exercise therapy and advice ) according to the Dutch guidelines for physiotherapy in patients with osteoarthritis ( OA ) of the hip and /or knee . The BGA intervention is intended to increase activity in the long term and consists of an exercise program with booster sessions , using operant treatment principles . METHODS We conducted a cluster r and omized trial involving 200 patients with hip and /or knee OA . Primary outcome measures were pain ( visual analog scale [ VAS ] and Western Ontario and McMaster Universities Osteoarthritis Index [ WOMAC ] ) , physical function ( WOMAC ) , and patient global assessment , assessed at weeks 0 , 13 , 39 , and 65 . Secondary outcome measures comprised tiredness ( VAS ) , patient-oriented physical function ( McMaster Toronto Arthritis Patient Preference Disability Question naire [ MACTAR ] ) , 5-meter walking time , muscle strength , and range of motion . Data were analyzed according to intent-to-treat principle . RESULTS Both treatments showed short-term and long-term beneficial within-group effects . The mean differences between the 2 groups for pain and functional status were not statistically significant . Significant differences in favor of BGA were found for the MACTAR functional scale and 5-meter walking test at week 65 . CONCLUSION Because both interventions result ed in beneficial long-term effects , the superiority of BGA over UC has not been demonstrated . Therefore , BGA seems to be an acceptable method to treat patients with hip and /or knee OA , with equivalent results compared with UC Background Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes . However , some people experience long-term pain . Objectives To review published studies in representative population s with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity . Data sources MEDLINE and EMBASE data bases search ed to January 2011 with no language restrictions . Citations of key articles in ISI Web of Science and reference lists were checked . Study eligibility criteria , participants and interventions Prospect i ve studies of consecutive , unselected osteoarthritis patients representative of the primary total hip or knee replacement population , with intensities of patient-centred pain measured after 3 months to 5-year follow-up . Study appraisal and synthesis methods Two authors screened titles and abstract s. Data extracted by one author were checked independently against original articles by a second . For each study , the authors summarised the proportions of people with different severities of pain in the operated joint . Results Search es identified 1308 articles of which 115 reported patient-centred pain outcomes .  Fourteen articles describing 17 cohorts ( 6 with hip and 11 with knee replacement ) presented appropriate data on pain intensity . The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7 % to 23 % after hip and 10 % to 34 % after knee replacement . In the best quality studies , an unfavourable pain outcome was reported in 9 % or more of patients after hip and about 20 % of patients after knee replacement . Limitations Other studies reported mean values of pain outcomes . These and routine clinical studies are potential sources of relevant data . Conclusions and implication s of key findings After hip and knee replacement , a significant proportion of people have painful joints . There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes OBJECTIVE To determine whether Tai Chi or hydrotherapy classes for individuals with chronic symptomatic hip or knee osteoarthritis ( OA ) result in measurable clinical benefits . METHODS A r and omized controlled trial was conducted among 152 older persons with chronic symptomatic hip or knee OA . Participants were r and omly allocated for 12 weeks to hydrotherapy classes ( n = 55 ) , Tai Chi classes ( n = 56 ) , or a waiting list control group ( n = 41 ) . Outcomes were assessed 12 and 24 weeks after r and omization and included pain and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index ) , general health status ( Medical Outcomes Study Short Form 12 Health Survey [ SF-12 ] , version 2 ) , psychological well-being , and physical performance ( Up and Go test , 50-foot walk time , timed stair climb ) . RESULTS At 12 weeks , compared with controls , participants allocated to hydrotherapy classes demonstrated mean improvements ( 95 % confidence interval ) of 6.5 ( 0.4 , 12.7 ) and 10.5 ( 3.6 , 14.5 ) for pain and physical function scores ( range 0 - 100 ) , respectively , whereas participants allocated to Tai Chi classes demonstrated improvements of 5.2 ( -0.8 , 11.1 ) and 9.7 ( 2.8 , 16.7 ) , respectively . Both class allocations achieved significant improvements in the SF-12 physical component summary score , but only allocation to hydrotherapy achieved significant improvements in the physical performance measures . All significant improvements were sustained at 24 weeks . In this almost exclusively white sample , class attendance was higher for hydrotherapy , with 81 % attending at least half of the available 24 classes , compared with 61 % for Tai Chi . CONCLUSION Access to either hydrotherapy or Tai Chi classes can provide large and sustained improvements in physical function for many older , sedentary individuals with chronic hip or knee OA OBJECTIVES To identify the determinants of self-report mobility measures in people with knee osteoarthritis ( OA ) and to compare self-report measures with physical performance . DESIGN Cross-sectional , prospect i ve . SETTING Motor performance laboratory and human mobility research center . PARTICIPANTS A convenient sample of 54 participants with medial compartment knee OA ( 32 women , 22 men ; age 68.3+/-8.7y ; range , 50 - 87y ) . Three participants were excluded because of the presence of lateral knee OA on radiographs . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Self-reports were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) and the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) . Performance measures included the  six-minute walk test ( 6MWT ) , Timed Up & Go ( TUG ) test , and a st and ardized stair-climbing task ( STR ) . RESULTS Stepwise linear regression analysis identified models that included pain , quadriceps and hamstrings strength , and depression to explain 62 % to 73 % of the variance in scores on the physical functioning subscale of the WOMAC and the SF-36 . These self-report measures had a moderate relation ( r range , .46-.64 ) with performance measures ( 6MWT , TUG , STR ) . CONCLUSIONS Self-report measures were strongly related to pain ; physical performance measures were strongly related to self-efficacy . Regression models showed that self-report scores reflect pain , knee strength , and depression . The relation between self-report and performance measures was moderate , suggesting that these examine different aspects of mobility BACKGROUND In clinical trials , at the group level , results are usually reported as mean and st and ard deviation of the change in score , which is not meaningful for most readers . OBJECTIVE To determine the minimal clinical ly important improvement ( MCII ) of pain , patient 's global assessment of disease activity , and functional impairment in patients with knee and hip osteoarthritis ( OA ) . METHODS A prospect i ve multicentre 4 week cohort study involving 1362 out patients with knee or hip OA was carried out . Data on assessment of pain and patient 's global assessment , measured on visual analogue scales , and functional impairment , measured on the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) function subscale , were collected at baseline and final visits . Patients assessed their response to treatment on a five point Likert scale at the final visit . An anchoring method based on the patient 's opinion was used . The MCII was estimated in a subgroup of 814 patients ( 603 with knee OA , 211 with hip OA ) . RESULTS For knee and hip OA , MCII for absolute ( and relative ) changes were , respectively , ( a ) -19.9 mm ( -40.8 % ) and -15.3 mm ( -32.0 % ) for pain ; ( b ) -18.3 mm ( -39.0 % ) and -15.2 mm ( -32.6 % ) for patient 's global assessment ; ( c ) -9.1 ( -26.0 % ) and -7.9 ( -21.1 % ) for WOMAC function subscale score . The MCII is affected by the initial degree of severity of the symptoms but not by age , disease duration , or sex . CONCLUSION Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients
On balance of the limited evidence , the 40 m self-paced test was the best rated walk test , the 30 s-chair st and test and timed up and go test were the best rated sit to st and tests , and the Stratford battery , Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures .
OBJECTIVES To systematic ally review the measurement properties of performance-based measures to assess physical function in people with hip and /or knee osteoarthritis ( OA ) .