Allan Villadsen

Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial

Objective To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. Methods In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured on the activities of daily living (ADL) subscale in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires for patients with hip and knee OA, respectively. Primary endpoint was 3 months after surgery. Results 165 patients randomised to the two groups were on average 67±8 years, 84 (51%) had hip OA and 92 (56%) were women. 153 patients (93%) underwent planned surgery and were evaluated postoperatively. There was no statistically significant difference in effects between hip or knee patients (p=0.7370). Three months postoperatively, no difference was found between groups for ADL (4.4, 95% CI −0.8 to 9.5) or pain (4.5, 95% CI −0.8 to 9.9). However, there was a statistically significant difference indicating an effect of exercise over the entire period (baseline to 3-months postoperatively) (p=0.0029). Conclusions Eight weeks of supervised neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset of postoperative recovery. Trial registration ClinicalTrials NCT01003756.

Immediate Efficacy of Neuromuscular Exercise in Patients with Severe Osteoarthritis of the Hip or Knee: A Secondary Analysis from a Randomized Controlled Trial

Objective. Knowledge about the effects of exercise in severe and endstage osteoarthritis (OA) is limited. The aim was to evaluate the efficacy of a neuromuscular exercise program in patients with clinically severe hip or knee OA. Methods. This was a randomized controlled assessor-blinded trial. Patients received an educational package (care-as-usual) only, or care-as-usual plus an 8-week neuromuscular exercise intervention (NEMEX-TJR). NEMEX-TJR was supervised by a physiotherapist, twice weekly for 1 h. The primary outcome was Activities of Daily Living (ADL) subscale from the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The secondary outcomes were the HOOS/KOOS subscales Pain, Symptoms, Sport and Recreation, and Joint-related Quality of Life. Exploratory outcomes were functional performance measures and lower limb muscle power. Results. Included were 165 patients, 56% female, average age 67 years (SD ± 8), and a body mass index of 30 (SD ± 5), who were scheduled for primary hip or knee replacement. The postintervention difference between mean changes in ADL was 7.2 points (95% CI 3.5 to 10.9, p = 0.0002) in favor of NEMEX-TJR compared with control. Second, there were statistically significant differences between groups in favor of NEMEX-TJR on all self-reported outcomes and most functional performance tests (walk, chair stands, and 1-leg knee bends). Stratified analyses according to joint revealed moderate effect size for ADL for hip patients (0.63, 95% CI 0.26 to 1.00). Corresponding effect size for knee patients was small (0.23 95% CI −0.14 to 0.60). Conclusion. Feasibility of neuromuscular exercise was confirmed in patients about to have total joint replacement. Self-reported activities of daily living and objective performance were improved and pain reduced immediately following 8 weeks of neuromuscular exercise. While the effects were moderate in hip OA, they were only small in knee OA. ClinicalTrials.gov Identifier: NCT01003756.

Agreement and reliability of functional performance and muscle power in patients with advanced osteoarthritis of the hip or knee.

ObjectiveThe purpose of this study was to test the reproducibility and clinical feasibility of three functional performance measures and five single-joint or multijoint muscle power measures. DesignTwenty patients with a mean age of 68.7 ± 7.2 yrs with severe hip or knee osteoarthritis were assessed for test-retest reliability and agreement on two occasions 1 wk apart. The outcomes were maximal single-joint muscle power (hip extension/abduction and knee extension/flexion), maximal muscle power during multijoint leg extension press, and functional performance measures (20-m walk, five-time repeated chair stands, and repeated unilateral knee bending). ResultsFor single-joint and multijoint maximal peak power and functional performance measures, we demonstrated poor (CVws, approximately 25%, single-joint hip extension) and moderate (CVws, approximately 15%, multijoint leg extension press, single-joint knee extension, chair stands, and knee bending) to good (CVws, <10%, single-joint knee flexion, single-joint hip abduction, and 20-m walk) agreement and good (intraclass correlation coefficient, 0.61–0.80, single-joint hip extension, multijoint leg extension press, and knee bending) to excellent (intraclass correlation coefficient, >0.81, single-joint knee extension, knee flexion, hip abduction, 20-m walk, and chair stands) reliability. ConclusionsIsolated muscle power over the hip and knee can safely be evaluated with poor to good agreement and good to excellent reliability in patients with advanced hip or knee osteoarthritis. Functional performance and muscle power may be assessed concurrently.

Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study

Background Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors.

85 NEUROMUSCULAR EXERCISE IMPROVES FUNCTIONAL PERFORMANCE IN PATIENTS WITH SEVERE HIP OSTEOARTHRHIS

detected in chondrogenic pellets and secreted by the differentiating MSCs. Finally, high levels of IL16 were detected in osteoarthritic cartilage. Conclusions: We hypothesise that differentiation of MSCs initially involves hypermethylation to facilitate the rapid down regulatation of genes involved in self-renewal or alternative differentiation pathways. Epigenetic mechanisms also represent an important aspect of control to ensure the sequential and temporal expression of critical genes throughout the differentiation process. IL16, previously associated with synovial fibroblasts from rheumatoid joints was identified as a novel factor in chondrogenesis.