Paul O'Connell

Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial.

OBJECTIVES To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention. DESIGN Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up. SETTING Four academic teaching hospitals in Dublin, Ireland. PARTICIPANTS Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43). INTERVENTIONS Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65). MAIN OUTCOME MEASURES The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction. RESULTS There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group. CONCLUSIONS Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.

Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial

BackgroundOsteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy.Methods and designAn assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6–8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests.DiscussionThis RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA.Trial RegistrationNumber: NCT00709566

Hemiplegia and amputation rehabilitation in the dual disability

About 10% of all elderly dysvascular amputees have had cerebrovascular accidents at some time. This is an often overlooked but important fact which significantly impacts the outcomes of their rehabilitation, especially where prosthetic ambulation is attempted. This study reviews the rehabilitation outcomes of 46 patients with the dual disability of hemiplegia and amputation. The mean age of the patients was 63 years (range 49 to 84). Forty-one (89%) could participate in a trial of physical therapy, and 25 (54%) in a comprehensive rehabilitation program. Seventeen (37%) were fitted with a prosthesis, and 12 (26%) became independent ambulators. Eighteen (39%) achieved independence in their activities of daily living (ADL) and transfers. Patients were reviewed to establish those features predictive of a good outcome. The following factors were associated with regaining independent ambulation: the presence of a mild hemiparesis with residual hand function (p less than 0.001), a below-knee amputation (p less than 0.01), and a history of ambulation before the second disability (p = 0.05). The ADL independence was associated with a mild hemiparesis (p less than 0.001), and age less than 60 years (p less than 0.05). Incontinence of bowel or bladder was strongly predictive of failure to achieve independence in either ADL or ambulation (p less than 0.001). Of those patients who did achieve independent ambulation, 73% were still ambulating a mean of 16.5 months later. These findings should be considered when planning rehabilitation goals for patients with the dual disability of hemiplegia and amputation.

Brief Report: Genetic Variation of the α1-Antitrypsin Gene Is Associated With Increased Autoantibody Production in Rheumatoid Arthritis

To examine the prevalence of α1‐antitrypsin deficiency (AATD) in rheumatoid arthritis (RA), and to determine whether AATD is associated with higher levels of rheumatoid factor (RF), antinuclear antibodies (ANAs), and anti–citrullinated peptide autoantibodies (ACPAs).

Measuring patient satisfaction with exercise therapy for knee osteoarthritis: evaluating the utility of the physiotherapy outpatient survey

OBJECTIVES To assess patient satisfaction with exercise for knee osteoarthritis (OA). METHODS A convenience sample of 27 patients recruited to a randomized controlled trial (RCT) comparing open kinetic chain and closed kinetic chain exercises for knee OA were reassessed at nine months post-randomization. Clinical outcomes included self-report and physical performance measures of function and pain severity. Patients also completed the Physiotherapy Outpatient Survey (POPS), which is a multi-dimensional measure of patient satisfaction with physiotherapy. RESULTS There was no significant difference in satisfaction between the two intervention groups. Overall mean satisfaction for the entire cohort was 4.07 of a maximum score of 5 (standard deviation (SD) = 0.52). Lower levels of satisfaction with outcome (mean = 3.56, SD = 0.8) were reported compared with other domains of expectations, communication, organization and the therapist (mean = 3.79-4.49; SDs = 0.42-0.92). Both intervention groups improved from baseline on clinical outcomes of pain, self-report function and walking distance, with no significant differences between the two groups. CONCLUSIONS High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared with other aspects of care. The POPS questionnaire can be used to measure the multi-dimensional aspects of satisfaction with physiotherapy.

Genetic variation of the alpha-1-antitrypsin gene is associated with increased autoantibody production in rheumatoid arthritis

To examine the prevalence of α1‐antitrypsin deficiency (AATD) in rheumatoid arthritis (RA), and to determine whether AATD is associated with higher levels of rheumatoid factor (RF), antinuclear antibodies (ANAs), and anti–citrullinated peptide autoantibodies (ACPAs).

Clinical features of low back pain in people with hip osteoarthritis: A cross sectional study

BACKGROUND: Low back pain (LBP) is commonly reported in people with hip osteoarthritis (OA) and is a poor prognostic indicator of outcome in OA. This study aimed to identify the clinical features associated with LBP in people with hip OA attending orthopaedic and rheumatology clinics. METHODS: A cross-sectional study was undertaken. Twenty-four people with radiographically confirmed OA were recruited and completed self-report questionnaires for hip and LBP severity (Visual Analogue Scale), hip-related disability (Western Ontario and McMaster Universities Osteoarthritis Index) and back-related disability (Roland Morris Disability Questionnaire). Physical examination comprised spinal palpation, pelvic girdle pain provocation tests and hip and spinal range of motion tests. Between-group (presence/absence of LBP) differences in self-report and physical examination items were compared using Mann-Whitney U and Chi-squared tests. RESULTS: A total of 16/24 (66.7%) patients reported LBP. Those with LBP were younger, reported more pain locations and had higher self-report pain and disability. On physical examination, people with LBP and OA hip had reduced hip flexion, greater pain provocation with hip abduction, hip lateral rotation, spinal palpation and a greater number of painful pelvic girdle tests and spinal level palpation. CONCLUSIONS: Assessment of patients with hip OA should incorporate examination of the lumbar spine and pelvic regions. It appears from our study that LBP is a common co-morbidity in those with OA of the hip and may indicate greater severity of hip disease, although the small sample size limits interpretation of results. Further research should investigate the exact relationships between presence of LBP and hip OA.

Revalidatie Bij AIDS: een inventarisatie

Met de verspreiding van infectie met het hiv (human immunodeficiency virus) en aids (acquired immune deficiency syndrome) worden veel mensen in de revalidatie beroepsmatig geconfronteerd met nieuwe problemen. Dit verslag gaat over twee fundamentele problemen die steeds vaker voorkomen in de revalidatie: de begeleiding van de patient die lijdt aan lichamelijke handicaps tengevolge van infectie met het hiv of met aids en de begeleiding van de traditionele revalidatiepatient die gedurende hun behandelingsperiode infectie met het hiv oplopen.