Improvement In WOMAC Scores Research Articles

Responsiveness of the electronic touch screen WOMAC 3.1 OA Index in a short term clinical trial with rofecoxib

The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index is a self-administered validated questionnaire for patients with osteoarthritis (OA) of the hip or knee. The electronic touch screen version of the WOMAC (e-WOMAC) has been previously shown to be highly correlated with the original paper format. However, whether the e-WOMAC would be suitable for monitoring the effects of drug treatment is unknown. To validate the longitudinal use of the e-WOMAC questionnaire and its ability to detect changes in WOMAC-scores induced by drug treatment in outpatient care. Fifty-three outpatients, men and women (mean age: 64 years; SD+/-9.5), with symptomatic osteoarthritis of hip or knee were included in an open label study with rofecoxib. At three visits over 3 weeks, responsiveness of the WOMAC 3.1 regarding the three subscales, pain, stiffness and function, were compared for the original paper format and the computer touch screen format (QUALITOUCH) using a Likert scale. WOMAC scores were transformed to the 0-100 scale. ANOVA for repeated measures was used for analysis and effect sizes by subscale were compared for both formats. Responsiveness for all three subscales was similar between formats. In both formats, pain and stiffness were significantly reduced with rofecoxib as early as 7 days, while functional ability was significantly increased (P<0.01 for all aggregate subscale scores) with continuing improvement until the end of study. The effect sizes by subscale between Day 1 and 21 were not statistically different between the paper and the electronic version of the questionnaire and showed similar clinically meaningful improvements in WOMAC scores over 3 weeks. In this longitudinal intervention study, the e-WOMAC OA Index 3.1 showed similar responsiveness in detecting clinically meaningful changes than the original paper format.

Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review

A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

Models of rheumatic disease occurring spontaneously in mice

Certain clinical or adverse intraoperative situations require the use of increased constraint in primary total knee arthroplasty (TKA). These include significant angular deformities causing incompetent collateral ligaments, or inadvertent intraoperative injury to collateral structures as well as the inability to achieve a balanced flexion and extension gap. Clinical success has been described with the use of constrained condylar knee arthroplasty in the primary setting in these situations. Traditionally, increasing constraint has been in conjunction with intramedullary stems, referred to as stemmed constrained condylar knees (SCCK); however, some devices provide an intermediary option by increasing constraint without the use of stems, herein referred to as nonstemmed constrained condylar knees (NSCCK). The aim of this study was to compare the clinical outcomes of both these devices in primary TKA in terms of revision rates and change in outcome measures over the follow-up period.Between 2007 and 2012, 85 SCCKs and 354 NSCCKs were identified in our institutional registry database performed in the primary TKA setting with minimum 2-year clinical outcome measure follow-up. Baseline demographic information, as well as Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Lower Extremity Activity Scale (LEAS) were collected preoperatively at 2-year follow-up. Revision data were also collected.Both groups showed substantial improvement in WOMAC scores (pain, stiffness, and function), and LEAS at 2 years postoperatively compared with baseline, although the changes in scores were not statistically significant. One of 85 SCCKs (1.17%) was revised for infection, whereas 9 of 354 NSCCKs (2.54%) were revised (6 for mechanical complications, eg, loosening, 2 for periprosthetic fracture, and 1 for infection).Both cohorts demonstrated improvement in clinical outcome measures at 2-year follow-up. None of the SCCKs performed in the primary setting were revised for a mechanical complication. Although both groups had overall low revision rates, there was trend toward a higher revision rate with NSCCKs. Many of these were revised for component loosening. In summary, when necessary, constrained options in the primary TKA setting provide excellent clinical outcome at short-term follow-up. However, constrained constructs with stemmed fixation may provide more rigid fixation and be less susceptible to mechanical failure.