Activity Increase Despite Arthritis (AÏDA): phase II randomised controlled trial of an active management booklet for hip and knee osteoarthritis in primary care. 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 [Psychological mechanisms in the transition from acute to chronic pain: over- or underrated?]. Impact of chronic musculoskeletal pathology on older adults: a study of differences between knee OA and low back pain. Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. The factor subdimensions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) help to specify hip and knee osteoarthritis. a prospective evaluation and validation study. Activity Increase Despite Arthritis (AÏDA): design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis [ISRCTN24554946] Occupational physical loading tasks and knee osteoarthritis: a review of the evidence. The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis The Cost Utility of Autologous Chondrocytes Implantation Using ChondroCelect® in Symptomatic Knee Cartilage Lesions in Belgium Optimism Moderates the Influence of Pain Catastrophizing on Shoulder Pain Outcome: A Longitudinal Analysis Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study The effectiveness of self‐management educational interventions for osteoarthritis of the knee Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. The Visual Analogue WOMAC 3.0 scale - internal validity and responsiveness of the VAS version Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol Testing a Positive Psychological Intervention for Osteoarthritis OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial.
BACKGROUND The Hip & Knee Book : Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis . AIM To assess the feasibility of conducting a definitive r and omised controlled trial ( RCT ) of this evidence -based booklet in people with hip or knee osteoarthritis . DESIGN Phase II feasibility r and omised controlled trial ( RCT ) . METHOD Computerised search es of patients ' record data bases identified people with osteoarthritis of the hip or knee , who were invited to participate in the RCT comparing the new booklet with a control booklet . Outcomes were measured at baseline , 1 month , and 3 months , and included : beliefs about hip and knee pain , exercise , and fear avoidance ; level of physical activity ; and health service use . RESULTS The trial methods were feasible in terms of recruitment , r and omisation , and follow-up , but most participants recruited had longst and ing established symptoms . After one and 3 months , there was a small relative improvement in illness , exercise , and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group ( n = 59 ) compared with the control group ( n = 60 ) , which provides some proof of principle for using these outcomes in future trials . CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT 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 INTRODUCTION During the last 20 years a great number of studies have emphasized the potential role of psychological factors as relevant predictors for the first onset of back pain as well as for the development of chronic pain . The formulation of a biopsychosocial perspective of the etiology and chronicity of back pain was a natural consequence . Actual questions concern the relative impact of psychological risk factors in the process of chronicity of back pain compared to biomedical , social and occupational factors . METHODS Whereas several review articles regarding the role of psychological risk factors are available up to now , a recently published review conducted by Steven Linton was the first systematic analysis of well controlled prospect i ve studies published since 1967 . Using a grading system similar to that recommended for guidelines the author defined a level A evidence when at least two good- quality prospect i ve studies supported the prospect i ve power of a variable . Level B evidence had support from one prospect i ve study . Level C represented inconclusive data and level D indicated that no studies met the criteria . Based on a literature search of more than 900 studies , 37 good- quality prospect i ve studies were analysed in detail . RESULTS The results indicated level A evidence for the following interrelations : ( 1 ) Psychosocial variables , especially chronic distress in daily life , depression and work dissatisfaction were clearly associated with the onset of back and neck pain ( 2 ) . Psychological variables , especially chronic stress in daily life , work dissatisfaction , depression and pain-related cognitions and coping behaviour were clearly linked to the transition from acute to chronic pain and disability ( 3 ) . Psychological variables generally had more prospect i ve power than biomedical , social or objective occupational variables . Among the pain-related cognitions , catastrophizing and fear-avoidance-beliefs yielded the most empirical support . Among coping behaviour passive coping stretegies such as avoiding behaviour was most important . At least level B evidence has been shown for the counterpart of an extreme suppressive coping behaviour . Patients who tended to suppress or ignore pain in order to finish all activities they started , who were unable to integrate phases of passive relaxation into the daily routine displayed a high risk of chronicity of pain 6 months after an acute phase of pain . One international and two German good- quality prospect i ve studies have shown the predictive power of a maladaptive suppressive behaviour pattern . Based on the avoidance-endurance-model of pain chronification , both extreme and one-sided passive pain coping as well as one-sided suppressive coping modes were conceptualized as maladaptive due to the process of chronicity . We assume that extreme passive behaviour will lead to immobility and muscular atrophy . Neurophysiological processes of sensitization will further lead to the development of chronic pain . On the other h and , extreme suppressive behaviour will lead to an overuse of muscles and joints with a repetitive combination of muscular hyperactivity and pain . These repetitive pain experiences will also elicit neurophysiological processes of sensitization . ( 4 ) Psychosocial variables displayed more predictive power than biomedical or biomechanical factors . ( 5 ) Psychosocial factors may be used as predictors of the risk for developing long-term pain and disability . Mixed empirical evidence has been shown for the role of personality factors ( level C evidence ) and no support has been found for the idea of a " pain prone " personality disorder or for the role of sexual and physical abuse . DISCUSSION 20 years of research , several qualitative review s and a recently published systematic review of 37 good- quality prospect i ve studies regarding the role of psychological , biomedical , social and objective occupational factors in the process of chronicity of back pain revealed that psychological factors are significantly related to the onset of back pain as well as to the development of chronic pain . Furthermore , the psychological factors displayed more predictive power than biomedical or biomechanical variables . As a consequence for clinical practice , these psychological risk factors have to be considered as " yellow flags " if a back pain problem wo n't respond to medical treatment for more than four weeks . As a further consequence , special risk factor - based psychosocial interventions should be offered in addition to the medical treatment to patients with high psychological risk factors for the development of chronic pain . The efficacy of such an interdisciplinary care in the very early phases of back pain in order to prevent chronicity of pain and disability has been published recently by our group OBJECTIVES The study aim ed to compare the psychological and physical characteristics of older adults with knee osteoarthritis ( OA ) vs those of adults with chronic low back pain ( CLBP ) and to identify psychological and physical predictors of function as measured by gait speed . DESIGN Secondary data analysis . METHOD AND PATIENTS Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate r and omized controlled trials were selected for this study . MEASURES Inclusion criteria for both trials included age > or = 65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months .  Psychological constructs ( catastrophizing , fear avoidance , self-efficacy , depression , affective distress ) and physical measures ( comorbid medical conditions , pain duration , pain severity , pain related interference , self-rated health ) were obtained . RESULTS Subjects with CLBP had slower gait ( 0.88 m/s vs 0.96 m/s , P = 0.002 ) and more comorbid conditions than subjects with knee pain ( mean 3.36 vs 1.97 , P < 0.001 ) . All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory-Affective Distress score . Self-efficacy , pain severity , and medical comorbidity burden were associated with slower gait regardless of the location of the pain . CONCLUSIONS Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed . These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans 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 OBJECTIVE To determine whether it is possible to specify different score patterns for hip and knee osteoarthritis ( OA ) , and to identify the degree of responsiveness and the validity of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) factors , which are alternative health dimensions obtained by factor analysis of the WOMAC items . METHODS  WOMAC scales and WOMAC factors  were compared in a prospect i ve setting examining patients with hip and knee OA before and after rehabilitative inpatient intervention ( n = 317 ) . In a partial sample ( n = 103 ) , the validity of the WOMAC factors was determined by a global rating of their activities . RESULTS The WOMAC factor " ascending/descending " was significantly different for hip and knee OA in the health state before therapy ( score in hip 5.09 , in knee 6.59 ; p < 0.001 ) ; this was also true of the effect size after therapy ( hip 0.39 , knee 0.65 ; p = 0.012 ) . The WOMAC scales did not differ for the 2 conditions . The WOMAC factor " ascending/descending " was the most responsive dimension in knee OA ( effect size 0.65 ) , but in hip OA the WOMAC pain scale was most responsive ( effect size 0.55 ) . Most of the WOMAC factors correlated moderately ( r = 0.52 - 0.69 ) with the patient 's self-rating on the validation question naire . CONCLUSION The WOMAC factors are valid measures . Analyzing the WOMAC by the WOMAC factors facilitates and improves the differential relevance and accuracy of the WOMAC for specific conditions such as hip and knee OA Background Hip and knee osteoarthritis is a common cause of pain and disability , which can be improved by exercise interventions . However , regular exercise is uncommon in this group because the low physical activity level in the general population is probably reduced even further by pain related fear of movement . The best method of encouraging increased activity in this patient group is not known . A booklet has been developed for patients with hip or knee osteoarthritis . It focuses on changing disadvantageous beliefs and encouraging increased physical activity . Methods / Design This paper describes the design of a Phase II r and omised controlled trial ( RCT ) to test the effectiveness of this new booklet for patients with hip and knee osteoarthritis in influencing illness and treatment beliefs , and to assess the feasibility of conducting a larger definitive RCT in terms of health status and exercise behaviour . A computerised search of four general medical practice patients ' record data bases will identify patients older than 50 years of age who have consulted with hip or knee pain in the previous twelve months . A r and om sample of 120 will be invited to participate in the RCT comparing the new booklet  with a control booklet , and we expect 100 to return final question naires . This trial will assess the feasibility of recruitment and r and omisation , the suitability of the control intervention and outcome measurement tools , and will provide an estimate of effect size . Outcomes will include beliefs about hip and knee pain , beliefs about exercise , fear avoidance , level of physical activity , health status and health service costs . They will be measured at baseline , one month and three months . Discussion We discuss the merits of testing effectiveness in a phase II trial , in terms of intermediate outcome measures , whilst testing the processes for a larger definitive trial . We also discuss the advantages and disadvantages of testing the psychometric properties of the primary outcome measures concurrently with the trial . Trial registration Current Controlled Trials IS RCT 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 There is limited underst and ing of how comorbid health conditions affect osteoarthritis (OA)-related outcomes . This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes ( PROs ) among patients with hip and knee OA . Data were from patients ( N = 300 , 9 % female , mean age = 61.1 ; SD = 9.2 ) enrolled in a r and omized control trial at the Durham Veterans Affairs Medical Center . Separate multivariable regression models , adjusted for demographic and clinical characteristics , examined the association of each comorbidity measure with baseline PROs : pain , physical function , depressive symptoms , fatigue , and insomnia . Comorbidity measures included the Self-Administered Comorbidity Question naire ( SACQ ) , conditions reported as activity-limiting ( SACQ-AL ) , and indicators of depression , diabetes , hypertension , and back pain . Mean ( SD ) numbers of comorbid conditions and activity-limiting conditions were 3.4 ( 1.8 ) and 1.6 ( 1.4 ) , respectively . Comorbidity scores  ( SACQ overall and SACQ-AL ) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors . Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain , depressive symptoms , fatigue , and insomnia ( p values < 0.01 ) . Additionally , increasing SACQ-AL scores were associated with worse mean scores for function ( p < 0.01 ) . Depression was associated with worse pain ( p = 0.03 ) , fatigue , and insomnia ( p values < 0.01 ) . Diabetes was associated with worse fatigue ( p = 0.01 ) , depressive symptoms ( p = 0.02 ) , and insomnia ( p = 0.03 ) . Back pain was associated with worse pain scores ( p = 0.02 ) . Results provide evidence that comorbidity burden , particularly activity-limiting conditions , is associated with worse OA-related PROs . Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes Abstract Background : Knee cartilage lesions increase the risk of developing osteoarthritis ( OA ) , and may eventually result in a total knee replacement ( TKR ) . There is currently no consensus on the optimal treatment of cartilage lesions . ChondroCelect ® ( CC ) is a cell-based therapy approved for use in autologous chondrocytes implantation ( ACI ) to treat symptomatic cartilage defects of the femoral condyle . Its capacity to safely restore good- quality cartilage was demonstrated in a r and omized controlled trial ( RCT ) versus the surgical procedure microfracture ( MFX ) . Objective : This study investigated the cost utility of CC used in ACI compared with MFX to treat symptomatic knee cartilage lesions in Belgium . Methods : A decision tree model comparing CC with MFX over a 40-year horizon was developed in TreeAge Pro ™ . The key timepoints of the model were ( i ) clinical assessment 5 years after initial intervention ( success or no success , with or without re-operation ) ; ( ii ) development of OA at 15 years ( yes/no ) ; ( iii ) need for TKR at 20 years ( yes/no ) ; and ( iv ) need for prosthesis revision at 35 years ( yes/no ) . Clinical data provided by the RCT of CC versus MFX were the clinical success ( response ) rate based on the Knee injury and Osteoarthritis Outcome Score ( KOOS ) at 36 months ( 82.9 % vs 62.0 % ; p = 0.048 ) and the proportion of good structural repair/presence of hyaline cartilage based on International Cartilage Repair Society ( ICRS II ) visual item at 12 months ( 44.9 % vs 23.2 % ; p= 0.023 ) . Utility scores by surgery outcome were derived from the SF-36 question naire responses collected in the RCT . Conservative assumptions related to the incidences of OA , TKR and prosthesis revision relied on a literature search . A patient chart review ( n = 82 ) provided follow-up costs by surgery outcome . National tariffs were applied to direct medical re sources used ( healthcare payer perspective , year 2008 costs ) . Annual discounting was applied to costs ( 3 % ) and effects ( 1.5 % ) as recommended by the Belgian pharmacoeconomic guidelines . Results : The incremental cost per QALY gained for CC compared with MFX was € 16 229 , with a difference in costs of € 20 802 and 1.282 QALYs gained . Sensitivity analyses indicated that the key model drivers were the proportion of patients with hyaline cartilage and the correlation between hyaline cartilage formation and later avoidance of OA . Probabilistic sensitivity analyses showed robustness of the results , with 80 % of the simulations below the usual UK National Institute for Health and Clinical Excellence ( NICE ) threshold of € 22 000 per QALY . Conclusions : Assuming a good correlation between high- quality cartilage repair and avoidance of OA at a later stage , the benefits of the cell therapy CC over MFX in terms of QALYs gained and OA-related costs avoided appear real . Further research is required to explore long-term effects of cartilage repair and reduce uncertainty on quality of life of patients with OA before and after joint replacement • STUDY DESIGN : Secondary analysis of prospect ively collected data . • BACKGROUND : An abundance of evidence has highlighted the influence of pain catastrophizing and fear avoidance on clinical outcomes . Less is known about the interaction of positive psychological re sources with these pain‐associated distress factors . • OBJECTIVE : To assess whether optimism moderates the influence of pain catastrophizing and fear avoidance on 3‐month clinical outcomes in patients with shoulder pain . • METHODS : Data from 63 individuals with shoulder pain ( mean ± SD age , 38.8 ± 14.9 years ; 30 female ) were examined . Demographic , psychological , and clinical characteristics were obtained at baseline . Vali date d measures were used to assess optimism ( Life Orientation Test‐Revised ) , pain catastrophizing ( Pain Catastrophizing Scale ) , fear avoidance ( Fear‐Avoidance Beliefs Question naire physical activity subscale ) , shoulder pain intensity ( Brief Pain Inventory ) , and shoulder function ( Pennsylvania Shoulder Score function subscale ) . Shoulder pain and function were reassessed at 3 months . Regression models assessed the influence of ( 1 ) pain catastrophizing and optimism and ( 2 ) fear avoidance and optimism . The final multivariable models controlled for factors of age , sex , education , and baseline scores , and included 3‐month pain intensity and function as separate dependent variables . • RESULTS : Shoulder pain ( mean difference , ‐1.6 ; 95 % confidence interval [ CI ] : ‐2.1 , ‐1.2 ) and function ( mean difference , 2.4 ; 95 % CI : 0.3 , 4.4 ) improved over 3 months . In multivariable analyses , there was an interaction between pain catastrophizing and optimism ( & bgr ; = 0.19 ; 95 % CI : 0.02 , 0.35 ) for predicting 3‐month shoulder function ( F = 16.8 , R2 = 0.69 , P<.001 ) , but not pain ( P = .213 ) . Further examination of the interaction with the Johnson‐Neyman technique showed that higher levels of optimism lessened the influence of pain catastrophizing on function . There was no evidence of significant moderation of fear‐avoidance beliefs for 3‐month shoulder pain ( P = .090 ) or function ( P = .092 ) . • CONCLUSION : Optimism decreased the negative influence of pain catastrophizing on shoulder function , but not pain intensity . Optimism did not alter the influence of fear‐avoidance beliefs on these outcomes . • LEVEL OF EVIDENCE : Prognosis , level 2b This paper aims to compare the results of single-joint knee vs hip hyaluronic acid ( HA ) injections in patients with osteoarthritis ( OA ) involving both the knee and hip joints . Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled . Patients were divided into two groups to receive HA injection three times at 1-week intervals either to the hip or knee joints . Pain level during activities and rest was measured by using visual analog scale ( VAS ) . Western Ontario and McMaster University Osteoarthritis Index ( WOMAC 5-point Likert 3.0 ) was also used prior to the injections and 1 month after the 3rd injection . In the knee injection group , the intragroup analysis revealed significant improvements in VAS activity pain , VAS rest pain , and WOMAC pain values following injection when compared with preinjection values , while no significant difference was detected in WOMAC stiffness , WOMAC physical function , and WOMAC total values . In the hip injection group , VAS activity pain , VAS rest pain , WOMAC pain , WOMAC stiffness , WOMAC physical function , and WOMAC total values showed significant improvement after the injection when compared with preinjection values . Although statistically not significant ( p > 0.05 ) , the comparison of the differences ( preinjection – postinjection ) between the groups demonstrated higher values in the hip injection group . We imply that intra-articular single-joint HA injections either to the knee or hip joints in OA patients with involvement of both of these joints are effective with regard to pain and functional status Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes Background Osteoarthritis ( OA ) is a degenerative disease that can lead to painful and dysfunctional joints . Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint . Intra-articular injections are controversial because of the introduction of needles into the articular capsule . Objectives To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA . Study design R and omized double-blind controlled clinical trial . Setting Single center , university hospital ( Imam Hossein Hospital , Tehran , Iran ) . Methods A total of 104 patients with chronic knee OA were enrolled . In the intra-articular group , 8 mL of 10 % dextrose and 2 mL of 2 % lidocaine were injected . Injections were repeated at 1 and 2 weeks after the first injection . In the periarticular group , 5 mL of 20 % dextrose and 5 mL of 1 % lidocaine were injected subcutaneously at 4 points in the periarticular area . Pain and disability , as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , were recorded at each follow-up visit at 1 , 2 , 3 , 4 , and 5 months post-injection . Results The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2- , 3- , 4- , and 5-month visits but not at 1 month . Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups . Pain , joint locking , and limitation scores were all improved in both groups . Difficulty in walking on flat surfaces or climbing stairs , and sitting and st and ing pain , were all improved in both groups from 1 to 5 months after treatment . Limitations WOMAC scores are subjective and could be a limitation of the study . Conclusion Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections , while avoiding risks of complications OBJECTIVE To determine , in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis ( OA ) , whether mean body weight , quadriceps and hamstring strength , lower extremity muscle mass , depression scores , and perceptions of their general health status differed from those of subjects with symptomatic knee OA . METHODS Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination , and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed , on average , 31 months later . These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after r and om selection through r and om digit dialing of households in central Indiana . Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison . Lower extremity muscle strength was measured by isokinetic dynamometry , lean tissue ( i.e. , muscle ) mass in the lower extremities by dual x-ray absorptiometry , depression by Center for Epidemiology Depression ( CES-D ) scale . knee pain by Western Ontario McMaster University OA instrument , and perceived general health status by the Medical Outcome Survey Short Form-36 . RESULTS In contrast to those with symptomatic knee OA , those who had knee pain but no radiographic evidence of OA were less obese , had hamstring as well as quadriceps weakness , and had CES-D scores high enough to qualify for a diagnosis of clinical depression . CONCLUSION Among subjects with knee pain but no OA-- and among women in this subset , in particular -- knee pain may be a manifestation of depression . rather than of joint disease Background Many people suffer with Osteoarthritis ( OA ) and subsequent morbidity . Therefore , measuring outcome associated with OA is important . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) has been a widely used patient reported outcome in OA . However , there is relatively little evidence to support the use of the Visual Analogue Scale ( VAS ) version of the scale . We aim ed to explore the internal validity and responsiveness of this VAS version of the WOMAC . Methods Patients with chronic hip or knee pain of mechanical origin , waiting for a hip or knee joint replacement completed the WOMAC as part of a study to investigate the effects of acupuncture and placebo controls . Validity was tested using factor analysis and Rasch analysis , and responsiveness using st and ardised response means . Results Two hundred and twenty one patients ( mean age 66.8 , SD 8.29 , 58 % female ) were recruited . Factor and Rasch analysis confirmed unidimensional Pain and Physical Functioning scales , capable of transformation to interval scaling and invariant over time . Some Differential Item Functioning ( DIF ) was observed , but this cancelled out at the test level . The Stiffness scale fitted the Rasch model but adjustments for DIF could not be made due to the shortness of the scale . Using the interval transformed data , St and ardised Response Means were smaller than when using the raw , ordinal data . Conclusions The WOMAC Pain and Physical Functioning subscales satisfied unidimensionality and ordinal scaling tests , and the ability to transform to an interval scale . Some Differential Item Functioning was observed , but this cancelled out at the test level and , by doing so , at the same time removed the disturbance of unidimensionality . The scaling characteristics of sets of items which use VAS require further analysis , as it would appear that they can lead to spurious levels of responsiveness and scale compression because they exaggerate the distortion of the ordinal scale . Trial numberUKCRN study ID : 4881IS RCT Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 Objective Osteoarthritis is a leading cause of disability for which there is no cure . Psychosocial-oriented treatments are underexplored . We developed and tested an intervention to build positive psychological skills ( e.g. , gratitude ) to reduce osteoarthritis symptom severity , including pain and functioning , and to improve psychosocial well-being in patients with knee or hip osteoarthritis . Design Two-arm r and omized design with six-month follow-up . Setting An academic Veterans Affairs Medical Center . Subjects Patients aged 50 years or older with knee or hip osteoarthritis and pain ratings of 4 or higher . Methods Patients ( N = 42 ) were r and omized to a six-week program containing positive skill-building activities or neutral control activities tailored to the patient population . Adherence  was assessed by telephone each week . We assessed osteoarthritis symptom severity ( WOMAC Osteoarthritis Index ) and measures of well-being ( positive affect , negative affect , and life satisfaction ) at baseline and by telephone one , three , and six months after the program ended . We used linear mixed models to examine changes over time . Results The majority ( 64 % ) of patients completed more than 80 % of their weekly activities . Patients in the positive ( vs neutral ) program reported significantly more improvement over time in osteoarthritis symptom severity ( P = 0.02 , Cohen 's d = 0.86 ) , negative affect ( P = 0.03 , Cohen 's d = 0.50 ) , and life satisfaction ( P = 0.02 , Cohen 's d = 0.36 ) . Conclusions The study successfully engaged patients with knee or hip osteoarthritis in a six-week intervention to build positive psychological skills . Improving osteoarthritis symptom severity and measures of psychosocial well-being , the intervention shows promise as a tool for chronic pain management 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 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 Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in r and omized controlled trials ( RCTs ) . We report on an implementation study of two evidence -based exercise and health education programmes for older adults with osteoarthritis ( OA ) of the knee or hip . Three types of primary health-care providers ( n = 18 ) delivered the OA Knee programme ( n = 20 ) and the OA Hip programme ( n = 20 ) , supported by programme manuals and implementation guidelines , in four regions . The outcome measures were pain and mobility . The Knee programme had OA knowledge and self-efficacy as additional outcome measures . Differences in outcome measures and background variables of participants were assessed between the RCTs and the implementation study . Positive effects ( P < 0.05 ) were found for OA knowledge , pain and self-efficacy in the Knee programme ( n = 157 ) , and for pain in the Hip programme ( n = 132 ) . No effect was found for mobility . Effect sizes of the RCTs and the present study were comparable . Background variables did not explain the variance in the outcome measures . The outcomes of the previous RCTs and the implementation study were comparable , and indicated the ecological validity of the two programmes . The implication s for nationwide dissemination and implementation in The Netherl and s are discussed STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers OBJECTIVE To investigate whether an exercise program , initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only , in reducing activity limitations in patients with knee osteoarthritis ( OA ) and instability of the knee joint . DESIGN A single-blind , r and omized , controlled trial involving 159 knee OA patients with self-reported and /or biomechanically assessed knee instability , r and omly assigned to two treatment groups . Both groups received a supervised exercise program for 12 weeks , consisting of muscle strengthening exercises and training of daily activities , but only in the experimental group specific knee joint stabilization training was provided . Outcome measures included activity limitations ( Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function , primary outcome ) , pain , global perceived effect and knee stability . RESULTS Both treatment groups demonstrated large ( ∼20 - 40 % ) and clinical ly relevant reductions in activity limitations , pain and knee instability , which were sustained 6 months post-treatment . No differences in effectiveness between experimental and control treatment were found on WOMAC physical function ( B ( 95 % confidence interval - CI ) = -0.01 ( -2.58 to 2.57 ) ) or secondary outcome measures , except for a higher global perceived effect in the experimental group ( P = 0.04 ) . CONCLUSIONS Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee . In knee OA patients suffering from knee instability  , specific knee joint stabilization training , in addition to muscle strengthening and functional exercises , does not seem to have any additional value . Dutch Trial Register ( NTR ) registration number : NTR1475
In knee OA , strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness ( mediation by muscle weakness ) , strong evidence was found for an association between muscle weakness and activity limitations , and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance of activities ( mediation by avoidance ) .
In hip OA , weak evidence was found for mediation by muscle weakness ; and strong evidence was found for an association between muscle weakness and activity limitations .
The avoidance model in patients with knee and hip osteoarthritis ( OA ) hypothesizes that pain and psychological distress lead to avoidance of activities , and thereby to muscle weakness and activity limitations .
This paper systematic ally review s the scientific evidence for the validity of this avoidance model .