Physical Function In Knee Osteoarthritis Research Articles

Commentary to 'Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis'.

Commentary to 'Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis'.

Evaluation of Dynamic Effects of Depressive Symptoms on Physical Function in Knee Osteoarthritis.

To assess how changes in depressive symptoms influence physical function over time among those with radiographic knee osteoarthritis (OA). Participants from the Osteoarthritis Initiative with radiographic knee OA (n=2,212) and complete data were identified at baseline. Depressive symptoms were assessed as a time-varying score at baseline and the first three annual follow-up visits using the Center for Epidemiological Studies Depression Scale (CES-D) Scale. Physical function was measured at the first four follow-up visits using 20-meter gait speed meters per second. The following two marginal structural models were fit: one assessing the main effect of depressive symptoms on gait speed and another assessing time-specific associations. Time-adjusted results indicated that higher CES-D scores were significantly associated with slower gait speed (-0.0048; 95% confidence interval -0.0082 to -0.0014), and time-specific associations of CES-D were largest during the first follow-up interval (-0.0082; 95% confidence interval -0.0128 to -0.0035). During subsequent follow-up time points, the influence of depressive symptoms on gait speed diminished. The negative effect of depressive symptoms on physical function may decrease over time as knee OA progresses.

Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis.

Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.

Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank

ObjectivesTo evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA).MethodsFor Subgrouping and TargetEd Exercise pRogrammes for knee and hip...

The associations of knee extensor muscle steadiness with maximal voluntary torque and physical function in patients with knee osteoarthritis

BackgroundMuscle weakness is characteristic of knee osteoarthritis. Muscle steadiness may be an important adjunct to knee muscle strength in improving physical function in knee osteoarthritis. However, the role of muscle steadiness is uncertain. AimsTo determine the associations of knee extensor muscle steadiness with maximal voluntary torque and physical function in patients with knee osteoarthritis. MethodsBaseline data from 177 patients in a randomized clinical trial were used. Isokinetic knee extension torque was processed into maximal voluntary torque [Nm]. Muscle steadiness was expressed as the coefficient of variance [%] and as peak power frequency [Hz]. Physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, the Get-Up-and-Go and Stair-climb tests. Associations were determined using regression analyses and adjusted for confounders. FindingsLower muscle steadiness (i.e., higher coefficient of variance and peak power frequency) was associated with lower maximal voluntary torque (B = − 7.38, [−10.8, −3.95], R2 = 0.10 and B = −14.71, [−28.29, −1.13], R2 = 0.03, respectively). Higher coefficient of variance was associated with lower self-reported physical function (B = 1.14, [0.11,2.17], R2 = 0.03) and remained significant after adjusting for potential confounders. Peak power frequency was not associated with physical function. InterpretationLow muscle steadiness was weakly associated with low muscle strength and poorer self-reported physical function. Muscle steadiness and muscle strength seem to be different attributes of muscle function. There is no convincing evidence that muscle steadiness is an important adjunct in studying physical function in patients with knee osteoarthritis.

Measurement properties of performance-based measures to assess physical function in knee osteoarthritis: A systematic review

Objective To systematically review the measurement properties of performance-based measures to assess physical function in people with knee osteoarthritis. Data sources PubMed, Web of Science, Embase, Scopus, CINAHL, and PsycINFO were searched in May 2022. Methods This study was conducted in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Clinical trials on the psychometric properties of performance-based tools for measuring physical function in people with knee osteoarthritis were included. Two reviewers independently rated measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). “Best evidence synthesis” was made using COnsensus-based Standards for the selection of health Measurement INstruments outcomes and the quality of findings. Results Thirty-six out of 3425 publications were eligible for inclusion. Thirty-two performance-based measures were evaluated including 26 single-activity measures and 6 multi-activity measures. Measurement properties evaluated included internal consistency (2 measures), reliability (23 measures), measurement error (20 measures), hypotheses testing for construct validity (22 measures), and responsiveness (23 measures). On balance of the limited evidence, the walk 40 m fast-paced test and 6-minute walking test were the best rated walking tests. The 30-second chair stand test and timed up and go test were the best rated sit-to-stand tests. The Performance Tests Measures and Physical Activity Restrictions may be the suitable multi-activity measures for knee osteoarthritis. Conclusions Further good quality research investigating the measurement properties, and in particular, the measurement error of performance-based measures in patients with knee osteoarthritis is needed.

GaitSmart motion analysis compared to commonly used function outcome measures in the IMI-APPROACH knee osteoarthritis cohort.

BackgroundThere are multiple measures for assessment of physical function in knee osteoarthritis (OA), but each has its strengths and limitations. The GaitSmart® system, which uses inertial measurement units (IMUs), might be a user-friendly and objective method to assess function. This study evaluates the validity and responsiveness of GaitSmart® motion analysis as a function measurement in knee OA and compares this to Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form 36 Health Survey (SF-36), 30s chair stand test, and 40m self-paced walk test.MethodsThe 2-year Innovative Medicines Initiative—Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) knee OA cohort was conducted between January 2018 and April 2021. For this study, available baseline and 6 months follow-up data (n = 262) was used. Principal component analysis was used to investigate whether above mentioned function instruments could represent one or more function domains. Subsequently, linear regression was used to explore the association between GaitSmart® parameters and those function domains. In addition, standardized response means, effect sizes and t-tests were calculated to evaluate the ability of GaitSmart® to differentiate between good and poor general health (based on SF-36). Lastly, the responsiveness of GaitSmart® to detect changes in function was determined.ResultsKOOS, SF-36, 30s chair test and 40m self-paced walk test were first combined into one function domain (total function). Thereafter, two function domains were substracted related to either performance based (objective function) or self-reported (subjective function) function. Linear regression resulted in the highest R2 for the total function domain: 0.314 (R2 for objective and subjective function were 0.252 and 0.142, respectively.). Furthermore, GaitSmart® was able to distinguish a difference in general health status, and is responsive to changes in the different aspects of objective function (Standardized response mean (SRMs) up to 0.74).ConclusionGaitSmart® analysis can reflect performance based and self-reported function and may be of value in the evaluation of function in knee OA. Future studies are warranted to validate whether GaitSmart® can be used as clinical outcome measure in OA research and clinical practice.

Relative Effect of Extracorporeal Shockwave Therapy Alone or in Combination with Noninjective Treatments on Pain and Physical Function in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials.

Extracorporeal shockwave therapy (ESWT) has been recommended for managing pain in patients with knee osteoarthritis (KOA). The difference in therapeutic effects between radial shockwave characteristics (RaSW) and focused shockwave characteristics (FoSW) with different energy levels for KOA remains controversial. The purpose of this network meta-analysis (NMA) was to identify the effects relative to the different ESWT regime and combination treatments on pain and functional outcomes in individuals with KOA. The randomized controlled trials (RCTs) which investigated the efficacy of RaSW, FoSW, and combination treatments in patients with KOA were identified by searches of electronic databases. The included RCTs were analyzed through NMA and risk-of-bias assessment. We analyzed 69 RCTs with a total of 21 treatment arms in the NMA. Medium-energy FoSW plus physical therapy, medium-energy acupoint RaSW plus Chinese medicine, and high-energy FoSW alone were the most effective treatments for reducing pain [standard mean difference (SMD) = −4.51], restoring function (SMD = 4.97), and decreasing joint inflammation (SMD = −5.01). Population area and study quality influenced the treatment outcomes, particularly pain. Our findings indicate that medium-energy ESWT combined with physical therapy or Chinese medicine is beneficial for treating pain and increasing function in adults with KOA.

Efficacy of Open versus Closed Kinetic Chain Exercises on Dynamic Balance and Health Status in Individuals with Osteoarthritis of Knee Joint: A Quasi-experimental Study

Introduction: Osteoarthritis is an inflammatory disorder characterised by changes in the biomechanics, biochemistry and genetic background of joint cartilage and subchondral bone. When distal parts move freely throughout exercises in a weight-bearing position, the phrase open kinetic exercises is employed. Closed kinetic exercises are employed in a weight-bearing position when the body travels through a hard and quick distal phase. Aim: To compare the efficacy of Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercises on dynamic balance and health status in individuals with osteoarthritis of knee joint. Materials and Method: A single-blinded experimental study was conducted from April 2020 to May 2021 at Dr D.Y. Patil college of Physiotherapy, Pimpri-Chinchwad area, Pune, Maharashtra, India. A sample of 30 subjects with unilateral osteoarthritis of knee joint, between the age of 40-60 years of both genders, were recruited. They were divided into open kinetic group (Group A) and closed kinetic group (Group B) using convenient sampling method. Y-balance and Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) (Pune CRD version) were used as outcome measures-preintervention, post two weeks and post four weeks of intervention. Data normality was tested by Shapiro-wilk test. Significance was tested using paired t-test within the groups for WOMAC and Y-balance test. Unpaired t-test was used between the groups. Results: Among 30 subjects, 17 were males and 13 females. There was a significant improvement in dynamic balance (p-value=0.001) and WOMAC (p-value=0.001) in both the groups. In group A, preintervention mean values for WOMAC was 41.2±10.53, and post four weeks of intervention it was 34.53±10.12 (p-value=0.001). Preintervention mean for Y-balance test was 0.554±14.6 and after four weeks of intervention mean was 0.586±13.8 (p-value <0.001). In group B, preintervention mean for WOMAC was 40.87±8.33, and after four weeks of intervention, mean was 30.47±7.22 (p-value=0.001); while preintervention mean for Y-balance test was 0.583±7.8 and after four weeks of intervention, mean was 0.645±7.0 (p-value=0.001). Between groups, analysis showed p-value=0.051 for both groups post four weeks of intervention. Conclusion: The study concluded that CKC exercises are more effective than OKC exercises in improving dynamic balance and decrease in pain, stiffness, and improving physical function in knee osteoarthritis.

The effect of intra-articular ozone injection on pain and physical function in knee osteoarthritis: A prospective study

Introduction: This study aims to evaluate the effect of intra-articular ozone treatment on pain and physical functionality by measuring Numerical Pain Rating Scale (NRS), WOMAC Osteoarthritis Index (WOMAC-OI), and Active Joint Range of Motion (AROM) in patients diagnosed with osteoarthritis. Material and methods: A total of 30 patients diagnosed with stage 2-3 osteoarthritis according to the Kellgren-Lawrence Classification System (K-L) were included in the study. Ozone gas was administered (10 ml of 10 mcg/ml per session) twice weekly for a total of four sessions. AROM examination was performed at pre-treatment baseline (BL), post-treatment (PT), and two weeks after treatment (PT2). During these periods, NRS was assessed and WOMAC-OI questionnaire was administered. Results: Significant improvement in NRS and WOMAC-OI total index scores were observed at PT and PT2 periods compared to BL (6.9±1.2; 2.1±1.3; 3.3±1.1; WOMAC-OI total index: 48.1±10.1; 25.5±10.4; 29.1±11.1 respectively; p˂0.001 for all). However, in both of these evaluation methods, the recovery at PT2 had decreased compared to the PT period (NRS p˂0.001; WOMAC-OI p˂0.05). Significant improvement was observed in the AROM values measured during the PT and PT2 periods, compared to baseline (105.6 ± 10.4°; 118.8 ± 8.1°; 117.5 ± 9.2°, respectively) (p˂0.001). There was no difference between the PT and PT2 periods in terms of AROM measurements (p˃0.05). Conclusion: Our study demonstrates that intra-articular ozone injection treatment provides improvement in pain and physical functionality in osteoarthritis patients. In our two-month follow-up assessment, although evaluation methods indicated that there was regression in recovery, AROM measurements showed that there was no regression in function. Therefore, we believe that future studies may include AROM as an objective measurement among evaluation methods.

Comparative matched-pair cohort analysis of the short-term clinical outcomes of mesenchymal stem cells versus hyaluronic acid treatments through intra-articular injections for knee osteoarthritis

PurposeIntra-articular injection of hyaluronic acid (HA) has shown promises in reducing pain and improving physical function in knee osteoarthritis (OA). Recently, cell-based therapies using mesenchymal stem cells (MSCs) have emerged as potential treatments. However, few studies have compared the treatment outcomes between MSCs and HA. This study aimed to compare the clinical and radiological outcomes of intra-articular injections of MSCs versus HA in patients with knee OA.MethodsA cohort of 209 patients with knee OA were retrospectively screened for those who underwent intra-articular injections using MSCs or HA. Thirty MSC-treated patients (MSC group) were pair-matched with thirty HA-treated patients (HA group) based on gender and age. Clinical outcomes were evaluated using the visual analog scale (VAS), International Knee Documentation Committee (IKDC) rating system, and Lysholm scoring system. Radiological evaluation was assessed using the Kellgren-Lawrence (K-L) grading system.ResultsMSC treatment yielded consistent significant improvements in VAS, IKDC and Lysholm scores. In the HA group, VAS scores significantly decreased at 1 month, slightly increased at 3 months, and increased significantly from 3 months to 1 year after injection. The IKDC and Lysholm scores improved significantly until 3 months, but gradually worsened thereafter. Significantly greater improvements in VAS (P = 0.041), IKDC (P = 0.014), and Lysholm (P = 0.020) scores were observed in the MSC group compared to those in the HA group at 1-year post-treatment. The K-L grade worsened in a few patients, especially those in the HA group, albeit no significant difference.ConclusionsMSC group showed better VAS, IKDC, and Lysholm scores at 1-year post-treatment, compared to the HA group, although earlier clinical improvements were superior in the HA group for the initial 3 months.Level of EvidenceTherapeutic study, Level III.

Muscle Function Tests as Supportive Outcome Measures for Performance-Based and Self-Reported Physical Function in Patients With Knee Osteoarthritis: Exploratory Analysis of Baseline Data From a Randomized Trial.

Holm, PM, Kemnitz, J, Bandholm, T, Wernbom, M, Schrøder, HM, and Skou, ST. Muscle function tests as supportive outcome measures for performance-based and self-reported physical function in patients with knee osteoarthritis: Exploratory analysis of baseline data from a randomized trial. J Strength Cond Res 36(9): 2635-2642, 2022-Uncertainty on the role of muscle function in relation to physical function in knee osteoarthritis (KOA) persists. This study aimed to assess the associations between muscle function and performance-based and self-reported physical function in patients with KOA. Physical function in 80 subjects with symptomatic and radiographic KOA was assessed using 40-m fast-paced walk, 30-second chair stand, 9-step stair climb tests, and the subscale activities of daily living from the Knee injury and Osteoarthritis Outcome Score (KOOS-ADL). Measurements of muscle function included leg extension (LE) power, knee extension (KE) torque, and estimated leg press one repetition maximum (LP RM). Associations were investigated using multivariable hierarchical linear regressions adjusted for age, sex, body mass index, self-reported physical activity, and thigh muscle lean area. Leg extension power was significantly associated with 40-m walk, stair climb, and 30-second chair stand, explaining 18, 8, and 3% of additional variance, respectively. Knee extension torque explained 13, 7, 17, and 7% of additional variance in the 40-m walk, stair climb, 30-second chair stand, and KOOS-ADL, respectively. Leg press one repetition maximum explained 11% of additional variance in the 30-second chair stand. In conclusion, LE power was the best explanatory variable for performance on the 40-m walk and stair climb tests, whereas KE torque best explained chair stand performance. Only KE torque was associated with KOOS-ADL. Our results highlight the importance of selecting supportive muscle function tests based on the specific physical function and suggest that other factors may be more important for certain physical function outcomes. Level of significance p < 0.05. Trial identifier: NCT03215602.

Effects of extracorporeal shock wave therapy in patients with knee osteoarthritis: A cohort study protocol.

Background:Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis.Methods:This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance.Results:The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms.Trial registration:This study protocol was registered in Research Registry (researchregistry5801).

Decreased Serum Adiponectin Reflects Low Vitamin D, High Interleukin 6, and Poor Physical Performance in Knee Osteoarthritis.

Obesity is a major contributor to deterioration of physical function toward sarcopenia in knee osteoarthritis (OA) due to its effect mediated through adipokines-derived molecules that have pro-/anti-inflammatory properties. This study aimed to investigate relationships of serum adiponectin, 25-hydroxyvitamin D (25(OH)D), interleukin (IL)-6, and physical performance in knee OA patients. A total of 175 knee OA patients and 52 healthy controls were recruited. Serum adiponectin, 25(OH)D, IL-6, biochemical markers, knee pain and functional scores, muscle strength, physical performance, metabolic parameters, and body composition were evaluated. Serum adiponectin levels were significantly higher in knee OA patients than thatin controls, while its serum levels were significantly decreased in obese patients, especially those with sarcopenia. Furthermore, there were independent relationships of serum adiponectin with body composition parameters, knee pain scores, physical function tests, and metabolic parameters in knee OA patients. Besides, serum adiponectin levels were positively associated with 25(OH)D levels, and negatively correlated with C-reactive protein and IL-6 levels in knee OA. Additionally, low serum adiponectin could be used to distinguish knee OA patients with sarcopenic obesity from those without sarcopenic obesity. Circulating adiponectin levels may serve as a possible surrogate biomarker for exacerbated physical function in knee OA patients-particularly sarcopenic obesity.

Effects of radial extracorporeal shock wave therapy on clinical variables and isokinetic performance in patients with knee osteoarthritis: a prospective, randomized, single-blind and controlled trial.

This study aims to compare the efficacy of r-ESWT treatment with sham-ESWT on pain, walking speed, physical function, and isokinetic muscle strength in knee osteoarthritis. The study included 104 patients (mean age 61.0 ± 6.2years; range 50 to 70years) who were admitted to our outpatient clinic with newly diagnosed with knee osteoarthritis. Patients were randomly assigned to two groups. Both groups received transcutaneous electrical nerve stimulation for 30minutes, hot pack for 40minutes, and home-based exercise program of around the knee strengthening for 30minutes in a day for three weeks (5days in a week). Also, one group was treated with r-ESWT, while the other group was treated with sham-ESWT. For r-ESWT, patients received 2000 pulses of shockwave at 2.0 to 3.0bar weekly for three weeks. All patients were evaluated with visual analog scale (VAS), active knee range of motion (ROM), 20-metre walk test, Western Ontario and McMaster Osteoarthritis Index (WOMAC), Lequesne's disability index, and isokinetic muscle performance before treatment, at the end of treatment, at one month and three months after treatment. When groups were compared, group 1 scores were significantly better than the group 2 in all outcome parameters except WOMAC-stiffness at the end of treatment, at onemonth and threemonth follow-up (all p< 0.05). The VAS-resting, VAS-movement, knee ROM, 20-m walk test, WOMAC, and Lequesne's disability scores and peak torque values of knee extension improved in both groups with the highest improvement in the r-ESWT group. A comparison of difference of the two group scores showed statistically significant superior improvement in group 1 in all parameters at both one month and three months. Our findings revealed that r-ESWT combined with conventional electrotherapy is an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms up to three months. NCT04243135.

Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections.

Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections.

Reliability and Validity of the Osteoarthritis Research Society International Minimal Core Set of Recommended Performance-Based Tests of Physical Function in Knee Osteoarthritis in Community-Dwelling Adults.

BackgroundThe proper reliability analysis for specific type of data and limit study of various types of construct validity are crucial for performance-based tests for the knee osteoarthritis (OA) population. The purpose of this study was to evaluate relative and absolute reliability and construct validity of the Osteoarthritis Research Society International (OARSI) recommended minimal core set of performance-based tests in knee OA in community-dwelling adults.MethodsFifty-five primary knee OA (median age 69.0, interquartile range [IQR] 11.0) participated in the cross-sectional study. Three performance-based tests were performed in two sessions with a 1-week interval; 30-s chair stand test, 40-m fast-paced walk test and 9-step stair climb test. Relative reliability included intra-class correlation and Spearman’s correlation coefficient (SPC). Absolute reliability included standard error of measurement, minimum detectable change, coefficient of variance, limit of agreement (LOA) and ratio LOA. Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), knee extensor strength and pain scale were analysed for convergent validity using Pearson’s correlation coefficient and SPC. Analysis of Covariance was utilised for known-groups validity.ResultsRelative and absolute reliability were all acceptable. LOA showed small systematic bias. Acceptable construct validity was only found with knee extensor strength. All tests demonstrated known-groups validity with medium to large effect size.ConclusionThe OARSI minimum core set of performance-based tests demonstrated acceptable relative and absolute reliability and good known-groups validity but poor convergent validity.

The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review

Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis. To determine whether resistance training affects pain and physical function in individuals with knee osteoarthritis, and whether a dose-response relationship exists. Second, we will investigate whether the effects are influenced by Kellgren-Lawrence grade or location of osteoarthritis. A search for randomized controlled trials was conducted in MEDLINE, Embase, and CINAHL, from their inception dates, between November 1, 2018, and January 15, 2019. Keywords included knee osteoarthritis, knee joint, resistance training, strength training, and weight lifting. Inclusion criteria were randomized controlled trials reporting changes in pain and physical function on humans with knee osteoarthritis comparing resistance training interventions with no intervention. Two reviewers screened 471 abstracts; 12 of the 13 studies assessed were included. Systematic review. Level 2. Mean baseline and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and standard deviations were extracted to calculate the standard mean difference. Articles were assessed for methodological quality using the CONSORT (Consolidated Standards of Reporting Trials) 2010 scale and Cochrane Collaboration tool for assessing risk of bias. The 12 included studies had high methodological quality. Of these, 11 studies revealed that resistance training improved pain and/or physical function. The most common regimen was a 30- to 60-minute session of 2 to 3 sets of 8 to 12 repetitions with an initial resistance of 50% to 60% of maximum resistance that progressed over 3 sessions per week for 24 weeks. Seven studies reported Kellgren-Lawrence grade, and 4 studies included osteoarthritis location. Resistance training improves pain and physical function in knee osteoarthritis. Large effect sizes were associated with 24 total sessions and 8- to 12-week duration. No optimal number of repetitions, maximum strength, or frequency of sets or repetitions was found. No trends were identified between outcomes and location or Kellgren-Lawrence grade of osteoarthritis.

Efficacy and tolerability of duloxetine in patients with knee osteoarthritis: a meta-analysis of randomised controlled trials.

Knee osteoarthritis (OA) is one of the most common joint diseases, and pharmacotherapy is necessary to control its symptoms. To evaluate efficacy and tolerability of duloxetine in patients with knee OA. PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov were searched to identify randomised controlled trials comparing duloxetine with placebo for knee OA. Data including pain, stiffness, physical function, and adverse events were extracted for meta-analysis. The protocol was prospectively registered in PROSPERO (CRD42018097110). Data from six randomised controlled trials including 2059 participants were pooled. Duloxetine achieved significant reductions in primary outcomes including Brief Pain Inventory 24-h average pain score (weighted mean difference (WMD) = -0.74, 95% confidence interval (CI) = -0.92 to -0.57), weekly mean of the 24-h average pain score (WMD = -0.76, 95% CI = -0.96 to -0.56), WOMAC stiffness score (WMD = -0.47, 95% CI = -0.60 to -0.34) and WOMAC physical function score (WMD = -4.44, 95% CI = -5.24 to -3.64). Furthermore, duloxetine demonstrated a higher number of treatment-emergent adverse events (risk ratio (RR) = 1.31, 95% CI = 1.20-1.44) and discontinuations (RR = 2.26, 95% CI = 1.63-3.12); however, no difference in serious adverse events (RR = 0.92, 95% CI = 0.40-2.11) was observed. Duloxetine is effective in the management of chronic pain and loss of physical function in knee OA with acceptable adverse events despite having no advantage in treating joint stiffness. Future trials should focus on determining the optimal treatment regimen.

The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials

Objective: To investigate the effectiveness of cryotherapy on pain and physical function in knee osteoarthritis. Data sources: An electronic search was performed up to February 2019 on PubMed/MEDLINE, EMBASE, CINAHL, Lilacs, Cochrane, Web of Science, Ibecs, and Scielo databases with keywords knee osteoarthritis and cryotherapy. Methods: Two authors independently performed the study selection. All languages and publication dates were considered. The PEDro scale was used to assess the methodological quality of the studies, and the body of evidence was analyzed and synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The clinical relevance of the included studies was evaluated using the criteria proposed in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Of the five studies, 202 subjects were included. All studies included participants with established knee osteoarthritis. The mean PEDro score was 4.20/10, and meta-analysis was not possible due to heterogeneity among the studies. The mean clinical relevance was 3/5. Only two studies were considered for analysis based on the GRADE approach, and low level of evidence was synthesized regarding the effectiveness of cryotherapy for pain management, knee stiffness, knee range of motion, and physical function. Application techniques, frequency, and duration did not affect outcomes. Conclusions: There were insufficient primary studies to draw any conclusions about the effectiveness of cryotherapy on pain and physical function on individuals with knee osteoarthritis.