Thorlene Egerton

Effect of Physical Therapy on Pain and Function in Patients With Hip Osteoarthritis: A Randomized Clinical Trial

IMPORTANCE There is limited evidence supporting use of physical therapy for hip osteoarthritis. OBJECTIVE To determine efficacy of physical therapy on pain and physical function in patients with hip osteoarthritis. DESIGN, SETTING, AND PARTICIPANTS Randomized, placebo-controlled, participant- and assessor-blinded trial involving 102 community volunteers with hip pain levels of 40 or higher on a visual analog scale of 100 mm (range, 0-100 mm; 100 indicates worst pain possible) and hip osteoarthritis confirmed by radiograph. Forty-nine patients in the active group and 53 in the sham group underwent 12 weeks of intervention and 24 weeks of follow-up (May 2010-February 2013) INTERVENTIONS: Participants attended 10 treatment sessions over 12 weeks. Active treatment included education and advice, manual therapy, home exercise, and gait aid if appropriate. Sham treatment included inactive ultrasound and inert gel. For 24 weeks after treatment, the active group continued unsupervised home exercise while the sham group self-applied gel 3 times weekly. MAIN OUTCOMES AND MEASURES Primary outcomes were average pain (0 mm, no pain; 100 mm, worst pain possible) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0 no difficulty to 68 extreme difficulty) at week 13. Secondary outcomes were these measures at week 36 and impairments, physical performance, global change, psychological status, and quality of life at weeks 13 and 36. RESULTS Ninety-six patients (94%) completed week 13 measurements and 83 (81%) completed week 36 measurements. The between-group differences for improvements in pain were not significant. For the active group, the baseline mean (SD) visual analog scale score was 58.8 mm (13.3) and the week-13 score was 40.1 mm (24.6); for the sham group, the baseline score was 58.0 mm (11.6) and the week-13 score was 35.2 mm (21.4). The mean difference was 6.9 mm favoring sham treatment (95% CI, -3.9 to 17.7). The function scores were not significantly different between groups. The baseline mean (SD) physical function score for the active group was 32.3 (9.2) and the week-13 score was 27.5 (12.9) units, whereas the baseline score for the sham treatment group was 32.4 (8.4) units and the week-13 score was 26.4 (11.3) units, for a mean difference of 1.4 units favoring sham (95% CI, -3.8 to 6.5) at week 13. There were no between-group differences in secondary outcomes (except greater week-13 improvement in the balance step test in the active group). Nineteen of 46 patients (41%) in the active group reported 26 mild adverse effects and 7 of 49 (14%) in the sham group reported 9 mild adverse events (P = .003). CONCLUSIONS AND RELEVANCE Among adults with painful hip osteoarthritis, physical therapy did not result in greater improvement in pain or function compared with sham treatment, raising questions about its value for these patients. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12610000439044.

Meta‐analysis of the relationship between breaks in sedentary behavior and cardiometabolic health

The concept of “breaks” in sedentary behavior has emerged as a potential modifier of detrimental effects on adiposity caused by sedentary behavior. The existing research investigating the relationship between breaks in sedentary behavior with adiposity and cardiometabolic health in adults was systematically reviewed and quantitatively synthesized by this study.

Neuromuscular Versus Quadriceps Strengthening Exercise in Patients With Medial Knee Osteoarthritis and Varus Malalignment: A Randomized Controlled Trial†

To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment.

Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial

Objective: To discover if the provision of additional inpatient physiotherapy after stroke speeds the recovery of mobility. Design: A multisite single-blind randomized controlled trial (RCT) comparing the effects of augmented physiotherapy input with normal input on the recovery of mobility after stroke. Setting: Three rehabilitation hospitals in North Glasgow, Scotland. Subjects: Patients admitted to hospital with a clinical diagnosis of stroke, who were able to tolerate and benefit from mobility rehabilitation. Intervention: We aimed to provide double the amount of physiotherapy to the augmented group. Main measures: Primary outcomes were mobility milestones (ability to stand, step and walk), Rivermead Mobility Index (RMI) and walking speed. Results: Seventy patients were recruited. The augmented therapy group received more direct contact with a physiotherapist (62 versus 35 minutes per weekday) and were more active (8.0% versus 4.8% time standing or walking) than normal therapy controls. The augmented group tended to achieve independent walking earlier (hazard ratio 1.48, 95% confidence interval 0.90–2.43; p=0.12) and had higher Rivermead Mobility Index scores at three months (mean difference 1.6; 0.1 to 3.3; p=0.068) but these differences did not reach statistical significance. There was no significant difference in any other outcome. Conclusions: A modest augmented physiotherapy programme resulted in patients having more direct physiotherapy time and being more active. The inability to show statistically significant changes in outcome measures could indicate either that this intervention is ineffective or that our study could not detect modest changes.

Central gait control mechanisms and the stride length – cadence relationship

The stride length - cadence relationship (SLCrel) was investigated to explore a theory of two alternate but inter-related pathways for gait control. Sixty-three healthy people in three age groups walked along a computerized walkway (GAITRite(®)) at five self-selected speeds from very slow to very fast, five cadences from 70 to 150 steps/min and five stride lengths from 0.8 to 1.6m. The data points from two walks in each level of each condition were examined for linear and quadratic relationships. In the self-selected speed condition 97% of participants had a positive linear or quadratic relationship of R(2)≥0.90. The quadratic relationships showed stride length decreased with very high cadences. When walks with cadences above 150 steps/min were removed, 95% of participants had a positive linear relationship of R(2)≥0.90. No age-related differences were found in slope or intercept of linear relationships or in maximum, minimum or range of stride length or cadence in the self-selected speed condition. In the cadence and stride length conditions, only 32% and 14% of positive linear or quadratic relationships were R(2)≥0.90. The near-invariant SLCrel, unaffected by ageing that exists for nearly all individuals when walking at self-selected speeds, indicates that the SLCrel may be used to simplify central control of automatic gait in healthy individuals. The current investigation also provides SLCrel data for healthy people which can be compared with patient populations.

Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.

To investigate whether a 12‐week physical therapist–delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA).

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol

BackgroundOsteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program.Methods/Design100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis), pain, and self-reported physical function measured at baseline and immediately following the program. Secondary outcomes include the external knee adduction moment angular impulse, electromyographic muscle activation patterns, knee and hip muscle strength, balance, functional ability, and quality-of-life.DiscussionThe findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load, pain and physical function in people with medial knee osteoarthritis and varus malalignment.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12610000660088

Effects of exercise on bone density and falls risk factors in post-menopausal women with osteopenia: a randomised controlled trial.

OBJECTIVES This study aimed to determine the efficacy of an exercise program for post-menopausal women with osteopenia undertaken in community exercise facilities. DESIGN Randomised, single-blind controlled trial. METHODS Thirty-nine community volunteers with hip osteopenia and not taking bone-enhancing medication were randomly allocated to an exercise (EX) or control (CON) group. EX participants attended an exercise facility in Melbourne, Australia, three times/week for 52 weeks (with a 2 week break) for partially supervised exercises targeting hip bone strength, muscle strength and balance. They also performed daily jumping exercises at home. CON participants continued with their usual care. All participants were given calcium supplementation. Assessment at baseline and 52 weeks measured bone mineral density (BMD) at the proximal femur and lumbar spine. Health-related quality of life (QOL) and objective measures of strength and balance were also collected. RESULTS ANCOVA adjusting for baseline values revealed a small benefit of exercise in mean total hip BMD (the primary outcome) with a significant mean difference in change between groups of -0.012 g/cm(2) (95% CI -0.022 to -0.002 g/cm(2)). EX participants improved 0.5% compared with a 0.9% loss for CON participants. The only other between-group differences were in QOL and a test of trunk and upper limb endurance, which both favoured the EX group. CONCLUSIONS This exercise program appears to have modest benefits for post-menopausal women with osteopenia who are not taking bone-enhancing medication. This mode of exercise delivery has adherence and progression limitations but may be appropriate to recommend for some people.

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

BackgroundHip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function.MethodsThe trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline.ConclusionsThe trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12610000439044

The immediate effect of physical activity on standing balance in healthy and balance-impaired older people.

Objective:  To determine if standing balance was affected by moderate levels of physical activity in healthy young, healthy older and balance‐impaired older adults.