Does hand osteoarthritis predict future hip or knee osteoarthritis? 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. Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study Which patientswith osteoarthritis of hip and/or knee benefit most from behavioral graded activity? Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial Effectiveness of hip abductor strengthening on health status, strength, endurance and six minute walk test in participants with medial compartment symptomatic knee osteoarthritis. The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial. A phase III placebo- and oxycodone-controlled study of tanezumab in adults with osteoarthritis pain of the hip or knee Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community-based rheumatologists in the United States. OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group 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. Open pilot study of ultrasound-guided intra-articular injection of hylan G-F 20 (Synvisc) in the treatment of symptomatic hip osteoarthritis Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury--a prospective cohort study.
OBJECTIVE To evaluate the risk of future hip or knee osteoarthritis ( OA ) in subjects with h and OA at baseline and to evaluate whether the concurrent presence of h and OA , other risk factors for OA , or an OA biomarker ( type II collagen C-telopeptide degradation product [ CTX-II ] ) further increases the risk . METHODS Radiographs of the h and s ( baseline ) and the hips and knees ( baseline and 6.6 years later ) were obtained in a r and omly selected subset of participants in the Rotterdam Study who were ages 55 years and older . Radiographs were scored for the presence of OA using the Kellgren/Lawrence ( K/L ) system . A total of 1,235 subjects without OA of the hip/knee ( K/L score 0 - 1 ) at baseline were included in the study . CTX-II levels were measured at baseline . The independent risk of future hip/knee OA in subjects with h and OA at baseline was assessed by logistic regression , as stratified for age , sex , body mass index , family history of OA , and heavy workload . RESULTS Overall 12.1 % of the participants ( 19.7 % of those with h and OA versus 10.0 % of those without ) developed hip or knee OA ( odds ratio [ OR ] 2.1 [ 95 % confidence interval ( 95 % CI ) 1.3 - 3.1 ] ) . Subjects with h and OA had an increased risk of future hip OA ( OR 3.0 [ 95 % CI 1.6 - 5.4 ] ) , which was further increased in those with a family history of OA . Subjects with h and OA had an OR of 1.6 [ 95 % CI 1.0 - 2.8 ) for the future development of knee OA , which was further increased in those who were overweight . Concurrent h and OA and high levels of CTX-II further increased the risk of having hip or knee OA at followup ( OR 4.2 [ 95 % CI 2.3 - 7.8 ] ) . CONCLUSION The presence of h and OA at baseline showed an increased risk of future hip/knee OA ( higher for hip OA than for knee OA ) . The concurrent presence of h and OA and other OA risk factors or high CTX-II levels further increased the risk of future hip/knee OA 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 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 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 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 Our objective was to investigate whether behavioral grade d activity ( BGA ) has particular benefit in specific subgroups of osteoarthritis ( OA ) patients . Two hundred participants with OA of hip or knee , or both ( clinical American College of Rheumatology , ACR , criteria ) participated in a r and omized clinical trial on the efficacy of BGA compared to treatment according to the Dutch physiotherapy guideline ( usual care ; UC ) . Changes in pain ( Visual Analog Scale , VAS ) , physical functioning ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC , and McMaster Toronto Arthritis Question naire , MACTAR ) , and patient global assessment were compared for specific subgroups . Subgroups were assigned by the median split method and were analyzed using analysis of covariance . Beneficial effects of BGA were found for patients with a relatively low level of physical functioning ( p?0.03 ) . Furthermore , beneficial effects of BGA  in patients with a low level of internal locus of control were marginally significant ( p = .05 ) . Patients with a relatively low level of physical functioning  benefit more from BGA compared to UC . Compared to UC , BGA is the preferred treatment option in patients with a low level of physical functioning The prevalence of  osteoarthritis ( OA )  is greater in women then men . Weight , a factor strongly associated with osteoarthritis , is significantly increased over the menopausal transition . Despite the high prevalence of osteoarthritis , a disabling disease with limited treatment options , there is a paucity of studies in women . The longitudinal phase of the Melbourne Women 's Midlife Health Project , is a population -based prospect i ve study of 438 Australian born women who have been followed annually over 11 years . 257 ( 59 % ) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and h and s. In this study , X-rays were scored for evidence of osteoarthritis using a vali date d scale , by two investigators who were blinded to question naire results . Information on hormone therapy use , physical activity , smoking , BMI and age were obtained by both self-administered and face-to-face question naires . Results showed that one hundred and twenty-eight women ( 56 % ) had evidence of radiological OA . Forty-nine ( 21.6 % ) had evidence of radiological knee OA . One hundred and one ( 44.5 % ) had evidence of radiological h and OA . Compared to baseline , at 11th year of follow-up participants had put on weight ( 4 kg range -14 to 25 kg ) and a larger proportion ( 25 % vs. 40 % ) reported exercising frequently ( P = 0.005 ) . Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up . Smoking was associated with a lower prevalence of radiological knee OA . The prevalence was 61 % among never smokers compared to only 39 % among those who smoked ( P < 0.05 ) . Total OA was associated with never having used hormone therapy ( odds ratio 2.7 ; CI 1.1 - 6.9 ) . There was a trend for increasing level of physical activity at ages 20 - 29 to be associated with an increased risk of knee OA ( P value 0.03 for trend ) . In conclusion increasing age , BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA . In contrast , smoking appeared to be associated with less knee OA . Never having used hormone therapy was a risk factor for radiological h and and knee OA . Further work will be needed to determine whether modification of these factors can prevent the development of OA 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 AND OBJECTIVES Decreased activity of hip abductor musculature has been suggested as a contributing factor for the disease progression in participants with symptomatic knee osteoarthritis ( OA ) . In this study , the effectiveness of 6 weeks isolated hip abductor strengthening on WOMAC , 6 minute walk test and hip strength and endurance in participants with symptomatic medial compartment knee OA were studied . MATERIAL AND METHOD Thirty persons with medial compartment knee OA were r and omized to hip abductor strengthening group ( n = 15 )  and conventional group ( n = 15 ) . Both the groups received intervention for 5 times per week for 6 weeks . 6 minute walk test , health status ( WOMAC ) , hip strength ( by modified syphgmomanometer ) and hip endurance ( number of repetitions ) were assessed at baseline and post intervention . The dependent variables were analyzed using 2 × 2 ANOVA , with repeated measurement as second factor to determine the effects of the intervention on each outcome variable . RESULTS Significant group-by-time interactions were observed for each variable of interest . Post hoc testing revealed that all the outcome measures improved significantly in the hip abductor strengthening group following the 6-week intervention than the control group . CONCLUSION The incorporation of hip-strengthening exercises may be considered along with conventional exercises when design ing a rehabilitation program for persons with knee OA 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 : 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 : 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 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 OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis ( OA ) . DESIGN Prospect i ve cohort study of knee OA development and progression with 1-year follow-up . SETTING Community . PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA ( n=2274 ; age , 45 - 79y ) who participated in functional performance assessment s ( timed 20-m walk and chair st and test ) at baseline and 1-year follow-up . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE A good 1-year performance outcome ( separately defined for walk time and chair st and measures ) was improvement from baseline quintile or maintenance in the best quintile . RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year .  Physical activity  measured by the  Physical Activity Scale for the Elderly  ( PASE ) was significantly associated with good walk rate and chair st and outcomes ( odds ratio per 40 units PASE [ 95 % confidence interval]=1.13 [ 1.13 , 1.17 ] and 1.10 [ 1.05 , 1.15 ] , respectively ) , as were participation in sports/recreational activities ( 1.45 [ 1.23 , 1.71 ] and 1.29 [ 1.09 , 1.51 ] , respectively ) and lifestyle activities ( 1.11 [ 1.06 , 1.16 ] and 1.09 [ 1.04 , 1.14 ] , respectively ) . An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors . Older adults reported the least baseline physical activity and least frequent good 1-year outcomes . CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA .  Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants OBJECTIVE Physical activity improves function in adults with arthritis , but it is unknown if there is a grade d relationship between physical activity and functional benefit . This study was undertaken to examine the cross-sectional and longitudinal relationship between self-reported physical activity and observed functional performance in adults with knee osteoarthritis ( OA ) . METHODS The Osteoarthritis Initiative cohort included 2,589 patients with knee OA ( 2,301 with longitudinal followup data ) who were ages 45 - 79 years at baseline . Prospect i ve annual functional performance was assessed for 2 years using timed 20-meter walk tests .  We used linear regression to estimate differences across physical activity quartiles in subsequent function ( baseline and 1-year activity predicts 1-year and 2-year function , respectively ) adjusted for demographic factors ( age , sex , race/ethnicity , education level , and marital status ) and health factors ( OA severity , knee symptoms , knee pain , knee injury , body mass index , comorbidity , depression , smoking , alcohol use , and other joint pain ) . RESULTS Increasing physical activity levels had a significant grade d relationship to functional performance . Adults in physical activity quartile groups from least active to most active had an average gait speed of 4.0 , 4.2 , 4.3 , and 4.5 feet/second , respectively , at baseline ( P for trend<0.001 ) and 4.0 , 4.2 , 4.3 , and 4.5 feet/second , respectively , after 1 year ( P for trend<0.001 ) ; increasing trends remained significant after adjusting for covariates . Findings were similar within sex and age groups . CONCLUSION These prospect i ve data indicate a consistent grade d relationship between physical activity level and better performance in adults with knee OA . These findings support guidelines that encourage patients with arthritis who can not attain minimum recommended physical activity to be as active as possible 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 Summary Tanezumab is efficacious in a phase III clinical trial of patients with moderate to severe osteoarthritis pain of the hip or knee .  ABSTRACT Tanezumab is a humanized monoclonal antinerve growth factor antibody in development for treatment of chronic pain . In a phase III , placebo‐ and active‐controlled study , we investigated the efficacy and safety of tanezumab for osteoarthritis ( OA ) hip or knee pain . Patients ( N = 610 ) received up to 2 doses of intravenous tanezumab ( 5 or 10 mg in 8‐week intervals ) , controlled‐release oral oxycodone ( 10 to 40 mg every 12 hours ) , or placebo . The primary endpoint was mean change from baseline to week 8 in Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) Pain score  for tanezumab versus placebo and oxycodone . Secondary endpoints included change from baseline in WOMAC Physical Function and Stiffness scores , Patient 's Global Assessment ( PGA ) of OA , and patient response , defined as ≥30 % , ≥50 % , ≥70 % , and ≥90 % improvement from baseline in WOMAC Pain score . Tolerability and safety also were assessed . Both tanezumab groups demonstrated significant improvements in WOMAC Pain score  versus placebo ( P < .001 ) and oxycodone ( P ≤ .018 ) . Tanezumab also provided significant improvements versus placebo and oxycodone for WOMAC Physical Function and Stiffness scores and PGA of OA ( P ≤ .002 for all ) at week 8 . For all analyses , oxycodone did not differ from  placebo . Adverse event frequency was higher with oxycodone ( 63.3 % ) than tanezumab ( 40.7 % to 44.7 % ) or placebo ( 35.5 % ) ; serious adverse event frequency was similar among treatments . The adverse event profile for tanezumab was similar to previous tanezumab studies . Results indicate that tanezumab is efficacious in the treatment of OA pain ; no new safety signals were identified OBJECTIVE To determine rheumatologists ' preferences in the medical management of osteoarthritis ( OA ) of the hip and knee , and examine possible variations in these preferences . METHODS A stratified r and om sample of 1,001 rheumatologists in community-based practice in the United States was surveyed by mail . RESULTS Responses were obtained form 594 subjects ( 529 white , 499 male , mean + /- SD age 47.4 + /- 8.1 years ) . Over 80 % used acetaminophen or nonaspirin , nonsteroidal antiinflammatory drugs ( NSAIDs ) either always or frequently for the management of OA of the hip and knee . A majority used the following nonpharmacologic methods either always or frequently : weight loss , cane or crutch , physical and /or occupational therapy referral  , and  exercise .  Variation in practice preferences was noted by age ( < 47 versus > or = 47 years ) , sex , board certification in rheumatology , and number of patients seen per month . Respondents felt that severe pain and limitation of function were the most important factors in recommending total join arthroplasty for patients . CONCLUSION These data demonstrate that practicing rheumatologists most often use either acetaminophen and /or NSAIDs in combination with nonpharmacologic methods in the medical management of OA of the hip and knee . The existence of variation in practice preferences has policy implication Objective . To define pain and physical function cutpoints that would , coupled with structural severity , define a surrogate measure of “ need for joint replacement surgery , ” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis ( OA ) . Methods . New scores were developed for pain and physical function in knee and hip OA . A cross-sectional international study in 1909 patients was conducted to define data -driven cutpoints corresponding to the orthopedic surgeons ’ indication for joint replacement . A post hoc analysis of 8 r and omized clinical trials ( 1379 patients ) evaluated the prevalence and validity of cutpoints , among patients with symptomatic hip/knee OA . Results . In the international cross-sectional study , there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement ; indeed , it was not possible to determine cutpoints for pain and function defining this indication . The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression , high level of pain , and high degree of function impairment was low ( 2%–12 % ) . The most discriminatory cutpoint to define an indication for joint replacement was found to be [ pain ( 0–100 ) + physical function ( 0–100 ) > 80 ] . Conclusion . These results do not support a specific level of pain or function that defines an indication for joint replacement . However , a tentative cutpoint for pain and physical function levels is proposed for further evaluation . Potentially , this symptom level , coupled with radiographic progression , could be used to define “ nonresponders ” to disease-modifying drugs in OA clinical trials 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 Patients suffering from hip osteoarthritis ( OA ) are frequently symptomatic , and the disease can result in significant limitation of patients ’ activity and high social costs . Hip OA is generally managed with systemic treatments such as nonsteroidal anti-inflammatory drugs ( NSAIDs ) and /or symptomatic slow acting drugs . Viscosupplementation with hyaluronan ( HA ) or its derivatives , which aims to restore the physiological and rheological features of the synovial fluid to improve symptoms , is now a routinely prescribed treatment for OA of the knee . However , few data exist in the literature regarding the use of viscosupplementation in the treatment of hip OA . The objective of this prospect i ve , open , uncontrolled pilot study was to investigate the safety and effectiveness of intra-articular injection , under ultrasound control , of hylan G-F 20 for the treatment of OA of the hip . Twelve patients ( ≥40 years old ) with symptomatic hip OA were treated with one injection of 2 ml of hylan G-F 20 under ultrasound guidance . During the study , patients were evaluated for safety and efficacy using the Lequesne index , a visual analogue scale ( VAS ) measure of hip OA pain and analysis of NSAID consumption . Patients treated with hylan G-F 20 in this study showed clinical ly significant reductions in Lequesne and VAS scores and in the consumption of NSAIDs up to 3 months after the injection . In the 12 patients treated ( total of 14 injections ) , no systemic adverse events were observed . Three patients reported mild , local pain post-injection . This study demonstrates the potential of ultrasound-guided intra-articular injections of a viscosupplement into the hip joint and gives positive preliminary information about the safety and efficacy of hylan G-F 20 for the treatment of symptomatic hip OA OBJECTIVE Prevalence and clinical relevance of patellofemoral ( PF ) osteoarthritis ( OA ) after anterior cruciate ligament ( ACL ) injury . METHOD Prospect ively we studied 94 out of 100 consecutive patients 15 years after acute ACL injury .  ACL reconstructions were only performed late if recurrent " give way " persisted or a secondary meniscal injury suitable for repair occurred . The subjects , mean age 42 years , had knee radiographs including skyline PF view taken  , which were grade d according to the atlas of the Osteoarthritis Research Society International . Knee-related symptoms and function were assessed by question naires . RESULTS PF OA  was present in 12/75 knees ( 16 % ) . Of 94 patients 22 ( 23 % ) have had their ACL reconstructed during follow-up . Meniscal injury and ACL reconstruction had occurred more often in knees with PF OA than in knees without PF OA ( P=0.004 and P=0.002 , respectively ) . Seven of 15 ACL reconstructed knees showed radiographic PF OA at follow-up . Knees with PF OA had more extension and flexion deficit than knees without PF OA . Subjects with PF OA maintained a higher activity level from injury to follow-up , but did not differ significantly from those without PF OA regarding patient-relevant symptoms and knee function . However , there was a trend for worse outcome in subjects with PF OA . CONCLUSION We found a relatively low prevalence of mild PF OA after ACL injury treated non-operatively , and it had limited impact on knee symptoms and patient-relevant knee function . At follow-up PF OA was associated with higher activity level , meniscal injury , extension and flexion deficit , and ACL reconstruction
For patients with knee OA there is limited evidence that a lower level of physical function is associated with a lower level of physical activity .
There is also limited evidence that depression is not associated with the level of physical activity .
For patients with hip OA there is limited evidence that higher age , higher body mass index ( BMI ) and a low level of physical function is associated with a low level of physical activity .
CONCLUSION A high age ( hip OA ) , a high BMI ( hip OA ) and a low level of physical function ( both hip and knee OA ) are related to a low level of physical activity .
OBJECTIVE To give an overview of factors related to the level of physical activity  in patients with hip or knee osteoarthritis ( OA ) .