Conservative Management Of Knee Osteoarthritis Research Articles

Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial.

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics. Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed. Significant between group differences were detected for the change in timed-up-and-go test, 40m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6months and trunk fat (%) at 3months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic. Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted. Clinicaltrials.gov/study/NCT04172688.

Clinically-accessible and laboratory-derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis

BackgroundLateral wedge insoles (both standalone and those incorporating individualized arch support) have been frequently studied for the effects on knee joint loading and pain in people with knee osteoarthritis. It has been shown that many people who use these insoles do not obtain the intended biomechanical effect, and thus may not experience a clinical benefit. The ability to identify biomechanical responders to lateral wedge insoles before research or clinical intervention is an important objective for efficient resource use and optimizing patient outcomes. The purpose of our exploratory, hypothesis-generating study was to provide an initial assessment of variables that are associated with the biomechanical response to lateral wedge insoles in people with knee osteoarthritis.MethodsWe collected a number of demographic (age, sex, body mass index, foot posture), clinical (knee pain, foot pain, radiographic disease severity), and walking-related (speed, knee alignment, frontal plane subtalar movement, and foot rotation) outcomes from 53 individuals with painful, radiographically-confirmed knee osteoarthritis. The walking-related outcomes were obtained using equipment both from the research laboratory and the clinical setting. We used logistic regression to generate predictive models to determine candidate variables associated with a reduction in the knee adduction moment during walking – a surrogate for tibiofemoral load distribution, and a known biomechanical risk factor for osteoarthritis progression – with the use of standalone and arch-supported lateral wedge insoles. Three different response thresholds (2%, 6%, and 10% reductions in the knee adduction moment) were used.ResultsIn general, biomechanical responders were those who walked faster, were female, had less varus alignment, and had less severe radiographic severity. Findings were similar between the standalone and arch-supported lateral wedge insoles, as well as between models using the laboratory-derived or clinically-available measures of walking performance.ConclusionsOur hypothesis-generating study provides valuable information that will inform future research into the efficient and effective use of lateral wedge insoles in the conservative management of knee osteoarthritis.

Evaluation of the strategy for implementing the GLA:D programme in Switzerland: protocol for an implementation-effectiveness hybrid type 3 design study with a mixed-method approach

IntroductionInternational guidelines recommend the use of exercise, education and weight reduction, when appropriate, as first-line treatment for the conservative management of knee osteoarthritis (OA). These guidelines have not been applied...

Intra-articular injection of Platelet rich plasma versus Hyaluronic acid for moderate knee osteoarthritis. A prospective, double-blind randomized controlled trial on 189 patients with follow-up for three years.

Platelet-rich plasma injections have been proposed as an option for Conservative management of knee Osteoarthritis to provide symptomatic relief and also to delay the need for surgical intervention. Although almost all the current literatures provide some evidence on the benefits of this technique compared with Visco- supplementation, no studies have been performed to compare their Clinical outcomes. The purpose is to compare the Clinical outcomes provided by intra- articular injection of either Platelet rich plasma or Hyaluronic acid to treat knee Osteoarthritis. Study Design: Randomized Controlled Trial 200 Patients with a history of Symptomatic knee Osteo- arthritis (Kellgren-Lawrence grade 2 or 3) were randomized to undergo 3 blinded intra-articular in- jections of either Platelet rich plasma or Hyaluronic acid. The Interval between successive injections was 2 weeks. Patients were evaluated prospectively before the injection and then at 2, 6, 12, 24, 30 and 36 months. Evaluation was based on International Knee Documentation Committee (IKDC), Visual analog scale, VOMAC Score and the re- injection rate; 189 patients reached the final evaluation. Both platelet rich plasma and Hyaluronic acid were effective in improving knee Symptoms and functional status over time and remained stable over time up to 18 months Post-injection (No re-injection has been performed to any patient incorporated in this study during the first 18 months). The performed re-injections have been significantly lower in the PRP group. Both platelet rich plasma and Hyaluronic acid were effective in improving knee Symptoms and functional status over time and remained stable over time up to 18 months Post-injection. The rate of the required re-injections has been significantly lower in platelet rich plasma group. platelet rich plasma provide longer duration of symptomatic relief, longer duration of functional status improvement and lesser number of needed re-injections than Hyaluronic acid when the patients have been followed through 36 months.

Applicability of Exercise and Education Programmes for Knee Osteoarthritis Management to Switzerland.

Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system. Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, "Reach, Effectiveness, Adoption, Implementation, and Maintenance," for rating the applicability of the programmes (on a scale of 1 = "least applicable" to 10 = "most applicable"). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating. Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction. Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.

Implementation of a community-based, physiotherapy-led, multidisciplinary model of care for the management of knee osteoarthritis: protocol for a feasibility study

IntroductionThere is a gap between the care people with knee osteoarthritis (OA) should receive according to evidence-based guidelines and the care they do receive. This feasibility study aims to test...

PMS27 CONCEPTUAL FRAMEWORK FOR ECONOMIC EVALUATION OF KNEE KINESIOGRAPHY FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS

Improved assessment of knee function would support the conservative management of knee osteoarthritis (OA). Knee kinesiography (KneeKG) is a new dynamic exam assessing biomechanical risk factors for OA progression. In a multi-arm cluster randomized clinical trial, significant improvements on clinical symptoms, pain, and daily activities in the Knee Injury and Osteoarthritis Outcome Score (KOOS) were reported in both KneeKG groups (all p<0.05) (Cagnin A. et al. 2019). The present study aimed to introduce a conceptual framework for assessing the economic value of the KneeKG in the management of knee OA in a primary care setting. Findings from the clinical trial and a targeted literature review were used to inform the KneeKG model framework conceptualisation. We compared three global care strategies (current medical management [CMM], CMM+KneeKG, and CMM+KneeKG+Education), as was done in the clinical trial. The expert panel consisted of Health Technology Assessment specialists and clinicians to guide key decisions in model design. The clinical and safety outcomes, health states, technical assumptions, economic endpoints, and costs were evaluated to identify the key value drivers to optimize the development of the proposed models. OA severity index was used to define the health states based on the clinical validation. The severity of knee OA was defined by the Kellgren and Lawrence grading system where grades 2, 3, and 4 are mild, moderate, and severe. The outcome was defined as global care strategies adherence, and the related costs. Costs were estimated for diagnostic tests, drugs, routine care, complications, adverse events, productivity costs, and mortality. The clinical effectiveness of the KneeKG exam in the conservative management of knee OA was previously reported. Based on clinical trial and targeted literature review, a health economic model was designed to evaluate the KneeKG.

Innovations in functional and rehabilitative knee bracing

New knee brace designs are available that have the potential to improve patient outcomes relative to traditional bracing. For the indications of post-knee injury/surgery recovery, conservative management of knee osteoarthritis (OA), total knee arthroplasty (TKA) pre-habilitation, and the treatment of post-surgical extension deficits/flexion contractures, innovative new bracing designs merit review and discussion. The researchers requested information from industry brace manufacturers, and from the information received, have selected those products considered significant improvements over traditional functional brace designs for review in this article. Clinical research supporting the benefits of the innovative products listed in the article have been cited when available. The authors are both Certified Orthotists with over 50 years of combined knee bracing experience.

Effects of an over-ground exoskeleton on external knee moments during stance phase of gait in healthy adults

BackgroundPhysical activity and exercise is central to conservative management of knee osteoarthritis (KOA), but is often difficult for patients with KOA to maintain over the decade or more prior to surgical management. Better approaches are needed for maintaining physical function and health in this population that can also address the patho-biomechanics of the osteoarthritic knee.The objective of the study is to quantify how a lower-extremity robotic exoskeleton (dermoskeleton) modifies the external knee moments during over-ground walking in a sample of healthy adults, and to evaluate these biomechanical modifications in the context of the osteoarthritic knee. MethodMotion analysis data was acquired for 13 participants walking with and without the dermoskeleton. Force plate data, external knee moment arms, and knee moments in the laboratory and tibia frames of reference were computed, as well as time–distance parameters of walking, and compared between the two conditions. ResultsAlthough gait speed was not different, users took shorter and wider steps when walking with the dermoskeleton. Ground reaction forces and early-stance knee moment increased due to the added mass of the dermoskeleton, but the knee adduction moment was significantly reduced in late stance phase of gait. There was no effect on the knee torsional moment when measured in the anatomical frame of reference, and the late-stance knee flexion moment was invariant. ConclusionsThe dermoskeleton demonstrated favorable biomechanical modifications at the knee in healthy adults while walking. Studies are warranted to explore this technology for enabling physical activity-based interventions in patients with KOA.

Tailoring implementation strategies for evidence-based recommendations using computerised clinical decision support systems: protocol for the development of the GUIDES tools.

BackgroundA computerised clinical decision support system (CCDSS) is a technology that uses patient-specific data to provide relevant medical knowledge at the point of care. It is considered to be an important quality improvement intervention, and the implementation of CCDSS is growing substantially. However, the significant investments do not consistently result in value for money due to content, context, system and implementation issues. The Guideline Implementation with Decision Support (GUIDES) project aims to improve the impact of CCDSS through optimised implementation based on high-quality evidence-based recommendations. To achieve this, we will develop tools that address the factors that determine successful CCDSS implementation.Methods/designWe will develop the GUIDES tools in four steps, using the methods and results of the Tailored Implementation for Chronic Diseases (TICD) project as a starting point: (1) a review of research evidence and frameworks on the determinants of implementing recommendations using CCDSS; (2) a synthesis of a comprehensive framework for the identified determinants; (3) the development of tools for use of the framework and (4) pilot testing the utility of the tools through the development of a tailored CCDSS intervention in Norway, Belgium and Finland. We selected the conservative management of knee osteoarthritis as a prototype condition for the pilot. During the process, the authors will collaborate with an international expert group to provide input and feedback on the tools.DiscussionThis project will provide guidance and tools on methods of identifying implementation determinants and selecting strategies to implement evidence-based recommendations through CCDSS. We will make the GUIDES tools available to CCDSS developers, implementers, researchers, funders, clinicians, managers, educators, and policymakers internationally. The tools and recommendations will be generic, which makes them scalable to a large spectrum of conditions. Ultimately, the better implementation of CCDSS may lead to better-informed decisions and improved care and patient outcomes for a wide range of conditions.Protocol registrationPROSPERO, CRD42016033738 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0393-7) contains supplementary material, which is available to authorized users.

Hip abductor strength in people with knee osteoarthritis: A cross-sectional study of reliability and association with function

BackgroundTo investigate the clinical importance of hip abductor (HA) strength in people with knee osteoarthritis (OA), the purposes of this study were to 1) compare the association of HA strength and physical function to that of knee extensor (KE) strength and physical function, and 2) determine the reliability of the assessment of HA strength using a hand-held dynamometer. MethodsThirty-five individuals [58 years standard deviation 10 years old] with knee osteoarthritis participated. Physical function was assessed with performance-based [Get-Up and Go (GUG), stair climb and descent (SC), and five times chair rise (CR)] and self-reported (WOMAC function) measures. The relationship between strength and function was assessed using bivariate correlation and hierarchical multiple regression models. Reliability across sessions was assessed in 25 subjects. ResultsIn the bivariate models, both KE and HA strength were both significantly associated with performance-based measures of function, but not WOMAC function. After controlling for anthropometric factors and KE strength in the hierarchical models, HA made significant independent contributions to the prediction of GUG and SC, but not CR or WOMAC function. The reliability of HA strength was excellent (ICC2, 3=0.94; 95% CI=0.86–0.97), while the minimum detectable change (MDC95) was 0.29Nm/kg (95% CI=0.23–0.41). ConclusionHA strength can be reliably measured and is closely associated with functional performance in people with knee OA. Clinical RelevanceThese results provide preliminary evidence suggesting that HA strength may be an important rehabilitation target for the conservative management of knee OA.

Associations between muscle perfusion and symptoms in knee osteoarthritis: a cross sectional study

To investigate the association between muscle perfusion in the peri-articular knee muscles assessed by dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and symptoms in patients with knee osteoarthritis (KOA). In a cross-sectional setting, muscle perfusion was quantified by DCE-MRI in KOA. Regions of interest (ROI) were drawn around the peri-articular muscles, summed and averaged into one single "Total Muscle Volume" volume of interest (VOI). Symptoms were assessed via the Knee injury and Osteoarthritis Outcome Score (KOOS) (0: worst; 100: best). DCE-MRI and clinical data were analyzed in 94 patients. The typical participant was a woman with a mean age of 65 years, and a body mass index (BMI) of 32 kg/m(2). Reduced multiple regression models analyzing the association between KOOS and DCE-MRI perfusion variables of Total Muscle Volume showed a statistically significant association between Nvoxel% and KOOS pain (0.41 (SE 0.14); P = 0.0048). Nvoxel% was defined as the proportion of highly perfused voxels; i.e., the voxels that show an early and rapid increase on the signal intensity vs time curves, reach a plateau state (plateau pattern) and then showing a relatively rapid decline (washout pattern) relative to the total number of voxels within the muscle VOI. More widespread perfusion in the peri-articular knee muscles was associated with less pain in patients with KOA. These results give rise to investigations of the effects of exercise on muscle perfusion and its possible mediating role in the causal pathway between exercise and pain improvements in the conservative management of KOA.

Physical Therapy Management of Knee Osteoarthritis in the Middle-aged Athlete

Osteoarthritis (OA) is prevalent in today's population, including the athletic and recreationally active "middle-aged" population. OA is a degenerative condition of the articular/hyaline cartilage of synovial joints and commonly affects the knee joint. In general, athletic participation does not specifically influence a higher incidence of knee OA in this population; however, traumatic injury to the knee joint poses a definitive risk in developing early-onset OA. The purpose of this article is to review evidence-based nonpharmacological interventions for the conservative management of knee OA. Manual therapy, therapeutic exercise, patient education, and weight management are strongly supported in the literature for conservative treatment of knee OA. Modalities [thermal, electrical stimulation (ES), and low-level laser therapy (LLLT)] and orthotic intervention are moderately supported in the literature as indicated management strategies for knee OA. While many strongly supported conservative interventions have been published, additional research is needed to determine the most effective approach in treating knee OA.

Efficacy of Knee Braces and Foot Orthoses in Conservative Management of Knee Osteoarthritis

A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.

The efficacy, accuracy and complications of corticosteroid injections of the knee joint

Corticosteroid knee injections are being increasingly used in the conservative management of knee osteoarthritis. The procedure is usually performed in secondary care by orthopaedic surgeons and rheumatologists, but as the role of general practitioners in chronic disease management expands, joint injections are now frequently being performed in primary care. It is commonly perceived amongst clinicians that the benefits of corticosteroid knee joint injections in treating symptomatic knee osteoarthritis significantly outweigh the risks of complications. The evidence in the literature for the benefits, accuracy, safety and complications of corticosteroid knee injections in osteoarthritis is reviewed. The perception that serious complications are rare is addressed, and the incidence of infectious complications is estimated. Short-term symptomatic relief is the only evidence-based benefit of corticosteroid injection of an osteoarthritic knee. Accurate intra-articular placement is not achieved in up to 20% of injections and varies considerably with the anatomical approach used. There is no evidence that a medial approach is more accurate. The incidence of serious infectious complications following knee joint injections ranges widely, and may be as high as 1 in 3,000 and potentially far higher in high-risk patients for whom specialist management is advised.