Self-reported Knee Pain Research Articles

Effectiveness and cost-effectiveness of a combined lifestyle intervention compared with usual care for patients with early-stage knee osteoarthritis who are overweight (LITE): protocol for a randomised controlled trial

IntroductionObesity is the most important modifiable risk factor for knee osteoarthritis (KOA). Especially in an early stage of the disease, weight loss is important to prevent further clinical and structural...

The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10–14-year-old adolescents with patellofemoral pain

ObjectiveTo test 1) if the 45-second Anterior Knee Pain Provocation Test (AKPP-test) could differentiate between adolescents with patellofemoral pain (PFP) and pain-free controls and; 2) whether improvements in the AKPP-test over 12 weeks were associated with improvements in self-reported knee function and pain. DesignProspective cohort. Patients151 with PFP and 50 pain-free controls (age 10–14 years). OutcomesThe AKPP-test was performed at baseline, 4- and 12-week follow-up. Pain and function were collected using Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsAt baseline, the AKPP-test provoked pain to a median of 5 points (IQR: 3–7) on the 0–10 Numeric Pain Rating Scale in adolescents with PFP, compared to 0 (IQR 0-0) in controls. Higher pain during the AKPP-test was associated with worse KOOS-Sport/Rec (r = −0.33, P < 0.001), worse KOOS-Pain (r = −0.47, P < 0.001), and pain intensity (worst pain last 24 hours) (r = −0.39, P < 0.001) at baseline. Improvements in the AKPP-test over 12 weeks were associated with improvements in KOOS Pain (r = 0.48, P < 0.001) and KOOS Sport/Rec (r = 0.40, P < 0.001). ConclusionsImprovements in the AKPP-test were associated with improvements in self-report knee pain and limitations in sports, suggesting the AKPP-test may be a clinically responsive test of knee pain and sporting function in adolescents with PFP.

Association between Chronic Knee Pain and Psychological Stress in Those over 50 Years of Age: A Nationwide Cross-Sectional Study Based on the Sixth Korea National Health and Nutrition Examination Survey (KNHANES 2013-2015).

Chronic knee pain (CKP) can degrade the quality of life and cause dysfunction, resulting in the loss of independence. Psychological stress not only affects physical and mental health but is also a risk factor for CKP. In this cross-sectional study, we analyzed data from the sixth Korea National Health and Nutrition Examination Survey (2013–2015), and investigated the association between CKP and psychological stress of the Korean general population. The CKP status was determined based on survey responses of self-reported knee pain lasting for more than 30 days during the last 3 months. Psychological stress was classified as none, mild, moderate, or severe. The association between CKP and psychological stress was analyzed using multiple logistic regression analysis considering co-variables and demographic data. Logistic regression analysis adjusting for co-variables indicated that the risk of CKP increased with an increasing degree of stress, from mild (OR = 1.65, 95% CI 1.35–2.03, p < 0.001) to moderate (OR = 2.00, 95% CI 1.56–2.57, p < 0.001) and severe (OR = 3.02, 95% CI 2.08–4.37, p < 0.001). A significant association between the risk of CKP and psychological stress was identified. Therefore, when evaluating patients with CKP, it may be helpful for clinicians to check the degree of stress.

Lower urinary tract symptoms are associated with musculoskeletal pain among older men: Preliminary evidence for central sensitization as a mechanism?

Features of central sensitization (CS) are present in almost all chronic pain conditions, including painful urinary conditions and back pain. Recently CS was proposed as a mechanism of nonpainful lower urinary tract symptoms (LUTS). Using musculoskeletal pain as an indicator of CS, we investigated whether the prevalence of musculoskeletal pain is greater among community-dwelling men with moderate or severe LUTS compared to those with mild LUTS. We conducted a cross-sectional study of 5966 men ≥65 years who attended the Osteoporotic Fractures in Men Study baseline visit. LUTS were assessed with the American Urological Association Symptom Index (AUA-SI) and categorized as none/mild (0-7), moderate (8-19), or severe (≥20). Self-reported back, neck, hip, or knee pain within the 12 months before baseline was categorized as any pain and multilocation pain. We tested our hypothesis using odds ratios (OR) and 95% confidence intervals (CI) estimated from multivariable logistic regression models. The adjusted odds of any pain were higher among men with moderate (OR 1.49, 95% CI: 1.29-1.72) and severe LUTS (OR 1.76, 95% CI: 1.28-2.40) compared to those with no/mild LUTS. The adjusted odds of pain at ≥ 2 locations were 69% higher among men with moderate (OR 1.69, 95% CI: 1.45-196) and more than double among men with severe LUTS (OR 2.24, 95% CI: 1.62-3.10) compared to men with no/mild LUTS. Musculoskeletal pain, especially at multiple locations, is associated with greater LUTS severity among older men. CS may represent a novel shared mechanism of pain and LUTS.

Strength training in addition to neuromuscular exercise and education in individuals with knee osteoarthritis-the effects on pain and sensitization.

There is a lack of evidence of the relative effects of different exercise modes on pain sensitization and pain intensity in individuals with knee osteoarthritis (KOA). Ninety individuals with radiographic and symptomatic KOA, ineligible for knee replacement surgery, were randomized to 12weeks of twice-weekly strength training in addition to neuromuscular exercise and education (ST+NEMEX-EDU) or neuromuscular exercise and education alone (NEMEX-EDU). Outcomes were bilateral, lower-leg, cuff pressure pain- and tolerance thresholds (PPT, PTT), temporal summation (TS), conditioned pain modulation (CPM), self-reported knee pain intensity and number of painful body sites. After 12weeks of exercise, we found significant differences in increases in PPT (-5.01kPa (-8.29 to -1.73, p=.0028)) and PTT (-8.02kPa (-12.22 to -3.82, p=.0002)) in the KOA leg in favour of ST+NEMEX-EDU. We found no difference in effects between groups on TS, CPM or number of painful body sites. In contrast, there were significantly greater pain-relieving effects on VAS mean knee pain during the last week (-8.4mm (-16.2 to -0.5, p=.0364) and during function (-16.0mm (-24.8 to -7.3, p=.0004)) in favour of NEMEX-EDU after 12weeks of exercise. Additional strength training reduced pain sensitization compared to neuromuscular exercise and education alone, but also attenuated the reduction in pain intensity compared to neuromuscular exercise and education alone. The study provides the first dose- and type-specific insight into the effects of a sustained exercise period on pain sensitization in KOA. Future studies are needed to elucidate the role of different exercise modes. This study is an important step towards better understanding the effects of exercise in pain management of chronic musculoskeletal conditions. We found that strength training in addition to neuromuscular exercise and education compared with neuromuscular exercise and education only had a differential impact on pain sensitization and pain intensity, but also that regardless of the exercise mode, the positive effects on pain sensitization and pain intensity were comparable to the effects of other therapeutic interventions for individuals with knee osteoarthritis.

Frequency of Self-Reported Hip and Knee Pain in Elderly Population

Frequency of Self-Reported Hip and Knee Pain in Elderly Population

Analysis of Effectiveness of a Supplement Combining Harpagophytum procumbens, Zingiber officinale and Bixa orellana in Healthy Recreational Runners with Self-Reported Knee Pain: A Pilot, Randomized, Triple-Blind, Placebo-Controlled Trial.

Recreational running (RR) is becoming a popular way to increase physical activity for improving health, together with a higher incidence of knee injuries. The aim was to analyze the effect of a four-week supplementation with a mixture of Harpagophytum procumbens, Zingiber officinale and Bixa orellana on males, middle-aged, RR with an undiagnosed knee discomfort. A randomized triple-blind placebo-control trial was conducted among male RR aged 40–60 years suffering from self-declared knee discomfort after training. Participants were assigned to supplementation (2 g/day in 6 doses; n = 13; intervention group (IG)) or matched placebo (n = 15; control group (CG)) for 4 weeks. At pre- and post-intervention, assessment of routine blood biomarkers, body composition, running biomechanics and body temperature was performed using standardized procedures. Machine learning (ML) techniques were used to classify whether subjects belonged to IG or CG. ML model was able to correctly classify individuals as IG or CG with a median accuracy of 0.857. Leg fat mass decreased significantly (p = 0.037) and a deeper reduction in knee thermograms was observed in IG (p < 0.05). Safety evaluation revealed no significant differences in the rest of parameters studied. Subjects belonging to IG or CG are clearly differentiated, pointing into an effect of the supplement of ameliorating inflammation.

Physical activity thresholds for predicting longitudinal gait decline in adults with knee osteoarthritis

To investigate the longitudinal relationship between physical performance (via real-life accelerometry) and physical capacity (laboratory measurement of gait speed) in patients with knee osteoarthritis (KOA), and to derive accelerometry measured thresholds associated with gait speed decline in KOA that may provide targets for disease-specific physical activity guidelines. Longitudinal data from the Osteoarthritis Initiative (OAI) accelerometer sub-study was extracted from 1,229 participants assessed 2 years apart. Extracted data include functional capacity, demographic and anthropometric characteristics, patient-reported outcome measures, and accelerometry-based physical activity measures. A "poor capacity" group was defined based on the gait speed quintile decline between baseline and the 2-yr follow-up. A Random Forest classifier was trained to classify individuals' capacity status, and the impact of each extracted factor on the prediction outcome was analyzed using a novel machine learning interpretation algorithm. The most impactful predicting feature for gait decline is low minutes in the performance of moderate-vigorous activity (count per min 2,500+). Slower sit-to-stand performance, higher age and self-reported knee pain, and lower minutes in performance light activities (count per min 350-2499) also contributed to the model prediction. The overall classification accuracy is 76.3% (75.4% sensitivity, 76.5% specificity). We investigated the impact magnitude and direction of each predicting feature on the longitudinal capacity status among KOA patients. Using novel data interpretation method, we established feature thresholds that may increase the probability of gait decline. These identified thresholds may provide meaningful information for establishing specific physical activity guidelines for KOA.

Effect of Anterior Cruciate Ligament Rupture on Physical Activity, Sports Participation, Patient-Reported Health Outcomes, and Physical Function in Young Female Athletes

Background: Return to sports (RTS) is frequently considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). However, despite the well-recognized health benefits of physical activity (PA), little is known about objectively measured PA in the 1 to 2 years after ACLR. Given that young female athletes have a high prevalence of ACLR and lower RTS rates as compared with their male counterparts, an in-depth examination of PA in this subgroup is warranted. Hypothesis: We hypothesized that female youth and young adults who have had ACLR in the previous 1 to 2 years would have less moderate or vigorous PA (MVPA) compared with healthy matched controls. We also hypothesized that the ACLR group would report lower levels of sports participation, patient-reported health outcomes, and physical function. Study Design: Cohort study; Level of evidence, 3. Methods: Participants included 51 female athletes with primary unilateral ACLR for a sports-related injury in the previous 1 to 2 years and 51 age- and sports-matched controls. Outcomes included objectively measured PA (GT3X accelerometers), previous and current sports participation and RTS, body mass index, Knee injury and Osteoarthritis Outcome Score (KOOS), triple single-leg hop, and one-leg rise. Mean within-pair differences with 95% CIs were used to assess differences between groups across all outcomes. Multivariable linear regression (clustered by pair) was used to examine whether the ACLR group had less MVPA than did the age- and sports-matched control group, adjusting for total wear time, age, time since injury, and body mass index. Results: Median age was 17.8 years (range, 14.6-22.6 years). There was no significant difference between groups in MVPA. However, the injury group had fewer mean minutes per day of vigorous PA (–1.22; 95% CI, −2.40 to −0.04), poorer KOOS values on all subscales, and shorter triple single-leg hop distance. In the injury group, 28 (55%) returned to sports, including 14 (27.5%) who returned at preinjury performance level. Across both groups, over one-third changed their most important sport, shifting toward an individual-based sport. Conclusion: At 1 to 2 years after ACLR, female athletes demonstrated no differences in combined MVPA and only a very small reduction in vigorous PA, yet they had higher levels of self-reported knee pain and symptoms, reduced knee function in sports, lower quality of life, and poorer objective knee function compared with matched controls.

Endogenous anandamide and self-reported pain are significantly reduced after a 2-week multimodal treatment with and without radon therapy in patients with knee osteoarthritis: a pilot study

Multimodal therapies comprising spa applications are widely used as non-pharmaceutical treatment options for musculoskeletal diseases. The purpose of this randomized, controlled, open pilot study was to elucidate the involvement of the endocannabinoid system in a multimodal therapy approach. Twenty-five elderly patients with knee osteoarthritis (OA) received a 2-week spa therapy with or without combination of low-dose radon therapy in the Bad Gastein radon gallery. A 10-point numerical rating scale (pain in motion and at rest), WOMAC questionnaire, and the EuroQol-5D (EQ-5D) questionnaire were recorded at baseline, and during treatment period at weeks one and two, and at 3-month and 6-month follow-ups. Plasma levels of the endocannabinoid anandamide (AEA) were determined at baseline and at 2 weeks, and serum levels of several cartilage metabolism markers at all five time-points. A significant and sustained reduction of self-reported knee pain was observed in the study population, but no further significant effect of the additional radon therapy up and above base therapy. This pain reduction was accompanied by a significant reduction of AEA plasma levels during treatment in both groups. No significant differences were seen in serum marker concentrations between the groups treated with or without radon, but a small reduction of serum cartilage degradation markers was observed during treatment in both groups. This is the first study investigating AEA levels in the context of a non-pharmacological OA treatment. Since the endocannabinoid system represents a potential target for the development of new therapeutics, further studies will have to elucidate its involvement in OA pain.

Poor diet quality is associated with self-reported knee pain in community-dwelling women aged 50 years and older.

In the current study, we aimed to examine the association between knee pain and diet quality in women aged ≥ 50 years using data from the Korea National Health and Nutrition Examination Survey. This was a population-based, cross-sectional study. Diet quality was assessed using the Diet Quality Index-International (DQI-I), and knee pain and osteoarthritis were self-reported. A multivariate logistic regression model was used to adjust for age, body mass index, household income, marital status, education, occupation, smoking status, hazardous alcohol use, regular physical activity, menopause, and chronic diseases, including hypertension, diabetes, dyslipidemia, osteoarthritis, and depression. A total of 3,881 women were included in this study, and the prevalence of knee pain was 25.4%. The intakes of total energy, protein, and fat were lower in women with knee pain than in those without (all P < 0.01), while the carbohydrate intake was higher (P = 0.01). No significant differences were noted in the scores for variety, overall balance, and moderation components, except for the item of total fat intake, between the DQI-I scores for women with and without knee pain, after adjusting for age. Women without knee pain showed higher scores in several items of the adequacy component (P < 0.05) than did women with knee pain. The total DQI-I scores were lower in women with knee pain than in women without knee pain, after adjusting for covariates, including osteoarthritis (OR = 0.985, 95% CI = 0.973–0.997, P = 0.01). Knee pain independent of osteoarthritis was associated with poor diet quality in community-dwelling women aged ≥ 50 years.

Erratum to: Relationship between total fruit and vegetable intake and self-reported knee pain in older adults

In the published article, “Ho Sung Han, Chong Bum Chang, Duk-Chul Lee and Jee-Yon Lee, Relationship between total fruit and vegetable intake and self-reported knee pain in older adults. The journal of nutrition, health & aging. 21, 750–758 (2017), the affiliations were published incorrectly. The authors apologize for any inconvenience that it may have caused.

Effectiveness of a Program Combining Strengthening, Stretching, and Aerobic Training Exercises in a Standing versus a Sitting Position in Overweight Subjects with Knee Osteoarthritis: A Randomized Controlled Trial.

There is an increasing incidence, prevalence, and burden of knee osteoarthritis due to a global increase in obesity and an aging population. The aim of the present study was to compare the effectiveness of the addition of aerobic exercises performed in an unloaded or loaded position to a conventional exercise program in overweight subjects with knee osteoarthritis. Twenty-four subjects were randomly allocated to receive 36 sessions of 30-min duration of either sitting aerobic exercises (experimental group) or standing aerobic exercises (control group). Pain intensity, knee disability, and quality-of-life data were collected at baseline and at 12, 24, and 36 sessions. Generalized linear mixed models (GLMMs) were constructed for the analysis of the differences. Significant differences were found in the experimental group for self-reported pain and knee pain and disability at 24 and 36 sessions (p < 0.05). Significant between-group differences were observed in change in self-reported knee pain and disability and quality of life from baseline to 24th- and 36th-session measurements in favor of the experimental group. Adherence to treatment was higher in the experimental group. Adding aerobic exercises in an unloaded position to a conventional exercise program produced superior effects over time for self-reported knee pain, knee pain and disability and quality of life compared to loaded aerobic exercises in overweight subjects with knee osteoarthritis.

Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study

BackgroundKnee osteoarthritis (OA) is a common disease condition associated with aging and a frequent cause of primary care consultations. Few longitudinal studies have been conducted to investigate the incidence of symptomatic knee osteoarthritis (OA) and to identify its risk factors among the Chinese population.MethodsThe China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal survey of persons aged ≥45 years. Symptomatic knee OA was diagnosed when both self-reported knee pain and self-reported physician-diagnosis arthritis existed. Using the national survey data collected from the CHARLS, we estimated the incidence of symptomatic knee OA, taking into account the complex survey design and response rate. We applied weighted logistic regression analysis to identify its risk factors.ResultsIn the 4-year follow-up, the cumulative incidence of symptomatic knee OA among middle-aged and older Chinese adults was 8.5%; the incidence was higher among females (11.2%) than males (5.6%). Female (odds ratio (OR) 1.98 [95% confidence interval (CI) 1.65–2.37]), rural area (OR 1.32 [95% CI 1.08–1.60]), and West region (OR 2.33 [95% CI 1.89–2.87]) were associated with a higher risk of incident symptomatic knee OA. Physical activities (OR 0.47 [95% CI 0.29–0.76]) and high education level (OR 0.60 [95% CI 0.41–0.88]) was associated with a lower risk of incident symptomatic knee OA, while histories of heart disease (OR 1.40 [95% CI 1.07–1.82]), kidney disease (OR 1.80 [95% CI 1.35–2.39]), and digestive disease (OR 1.54 [95% CI 1.30–1.82]) were associated with a higher risk of incident symptomatic knee OA.ConclusionThe cumulative incidence of symptomatic knee OA over 4 years was relatively high, and varied by province and region. Lack of physical activities was confirmed to be risk factors of incident symptomatic knee OA. The presence of heart disease, kidney disease, and digestive disease may be associated with a higher risk of incident symptomatic knee OA, further research need to confirm these findings.

Investigating in vivo knee volumetric bone mineral density and walking gait mechanics in healthy people.

The aim of this study was to investigate if the distribution of subchondral volumetric bone mineral density (vBMD) from peripheral quantitative computed tomography (pQCT) is related to estimates of knee joint loads calculated during walking gait in healthy young people. We recruited 19 young (age 18-40years) healthy people with no self-reported knee pain or pathology. For all participants we collected two forms of data: (1) pQCT data at 2% of tibia length (from the proximal joint line) using a Stratec XCT3000 scanner at 0.2×0.2mm in plane resolution; and (2) indices of joint loading, specifically external joint moment, at the indexed knee during walking gait. Joint moments were calculated from motion capture and ground reaction force data. pQCT scans were performed immediately prior to gait analysis. A sub-group of 9 participants attended a second scanning session to establish the reproducibility of the pQCT workflow. vBMD was extracted for four sub-regions (anteromedial, anterolateral, posteromedial and posterolateral). Reproducibility of the pQCT workflow was good to excellent (ICCs 0.832-0.985) with minimal detectable differences ranging from 2.3-39.5mg HA/cm3. Significant independent correlations were identified between the external rotation moment and the medial-to-lateral (r=0.517), posteromedial-to-posterolateral (r=0.627) and posteromedial-to-anterolateral (r=0.518) vBMD ratios, and between the knee adduction moment and the medial-to-lateral (r=-0.476) and posteromedial-to-posterolateral (r=-0.497) vBMD ratios. There appear to be significant relationships between measures of vBMD from pQCT and indices of joint loading in healthy people. These data are the first to combine imaging at the resolution available with pQCT and indices of joint loading in the same cohort.

A Pilot Study of Hip Corrective Taping Using Kinesio Tape for Pain and Lower Extremity Joint Kinematics in Basketball Players with Patellofemoral Pain.

PurposeThis pilot study aimed to determine the feasibility of hip corrective taping to improve self-reported knee pain and lower extremity joint kinematics in basketball players with patellofemoral pain.Patients and MethodsA single group pre-test and post-test design. Collegiate basketball players with patellofemoral pain were recruited. Three-dimensional hip and knee joint kinematics were measured during two tasks, single-leg squat (SLS) and lay-up jump (LUJ), and each task was conducted under no-taping and taping conditions. Subjective report of pain was compared between no-taping and taping conditions only during SLS.ResultsTwelve collegiate basketball players with patellofemoral pain (median age, 22.7 [2.5] years; mean height, 173.8 ± 7.4 cm; mean weight, 72.5 ± 12.8 kg) participated in this study. Compared with no-taping, the use of hip corrective taping significantly increased the hip abduction angle at the instant of the maximal vertical ground reaction force during LUJ (no-taping vs taping: 0.6° ± 6.3° vs 3.3° ± 5.1°, p = 0.029), and also caused a trend of decreased maximal hip internal rotation angle during SLS (no-taping vs taping: 8.0° ± 6.6° vs 4.7° ± 6.9°, p = 0.050). Hip corrective taping also improved self-reported knee pain during SLS (no-taping vs taping: 3.4 ± 1.7 vs 2.6 ± 1.0, p = 0.046).ConclusionHip corrective taping may be used as an effective intervention for athletes with patellofemoral pain during basketball-related tasks.

The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial

BackgroundKnee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60–80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors.MethodsIn this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence ≥ II) of KOA were selected. Patients were divided into three groups namely, aquatic (n = 12), Total Resistance exercises (TRX) (n = 12) and control (n = 12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson’s questionnaire.ResultsThe results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p < 0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p < 0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p < 0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p = 0.05).ConclusionsAlthough TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.Trial registrationThis study was registered in the Iranian Clinical Trial Center with the number IRCT20181222042070N1, http://www.irct.ir/trial/36221, registered 02 February 2019.

Footwear for osteoarthritis of the lateral knee: protocol for the FOLK randomised controlled trial

BackgroundStructural features of lateral tibiofemoral (TF) joint osteoarthritis (OA) occur in up to half of all people with knee OA, and co-existing lateral TF OA is associated with worse knee pain in people with mixed compartmental knee OA. Clinical guidelines for management of knee OA advocate advice about appropriate footwear, yet there is no research evaluating which types of footwear are best for managing pain associated with lateral TF OA. Biomechanical evidence suggests that “motion-control” footwear, which possess midsoles that are stiffer medially compared to laterally, may shift load away from the lateral compartment of the knee and thus may reduce knee pain associated with lateral TF OA. The primary aim of this study is to compare the effects of motion-control shoes to neutral shoes on knee pain in people with predominantly lateral TF OA.MethodsThis will be an assessor- and participant-blinded, two-arm, comparative effectiveness randomized controlled trial (RCT) conducted in Melbourne, Australia. We will recruit a minimum of 92 people with painful lateral TF OA from the community. Participants will be randomly allocated to receive either motion-control shoes or neutral shoes and will be instructed to wear their allocated shoes for a minimum of 6 h per day for 6 months. The primary outcome is change in self-reported knee pain on walking, measured using a numerical rating scale, assessed at baseline and 6 months. Secondary outcomes include other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity levels.DiscussionThis study will compare the efficacy of motion-control shoes to neutral shoes for people with painful lateral TF OA. Findings will be the first to provide evidence of the effects of footwear on knee pain in this important subgroup of people with knee OA and allow clinicians to provide accurate advice about the most appropriate footwear for managing pain associated with lateral TF OA.Trial registrationThis trial has been prospectively registered by the Australian New Zealand Clinical Trials Registry on 15/11/2018 (reference: ACTRN12618001864213).

Objective performance tests assess aspects of function not captured by self-report in knee osteoarthritis

Purpose: Knee osteoarthritis (OA) may lead to substantial functional limitation, which can be assessed objectively with validated performance tests or using self-report data. The relationships between the findings of objective performance tests and self-report measures of functional status have received little investigation. We sought to determine whether the performance tests are independent of one another, whether they capture different information from self-report measures of function, and whether they are influenced by features of chronic pain including anxiety and depression, neuropathic pain, widespread pain, and pain catastrophizing. Methods: We used baseline data from participants enrolled in the ORBIT Registry (Osteoarthritis Registry of Biomarker and Imaging Trajectories). At study entry, participants were 40+ years old and had evidence of both symptomatic and radiographic knee OA (Kellgren-Lawrence grade 2-3) in at least one knee. Self-reported pain of the most bothersome knee (index knee) was ascertained using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain scale and functional status with the KOOS ADL scale (0-100, 100 best). Subjects completed the five-item Mental Health Index (MHI-5, a measure of anxiety and depressive symptoms), the Neuropathic Pain Scale (NPS), a widespread pain index (WPI; sum of 23 possible musculoskeletal pain locations), and the Pain Catastrophizing Scale (PCS). Performance testing included the 40-meter fast paced walk (40m Walk), Timed-Up-and-Go (TUG), timed single leg balance test (SLB), and 30-second sit-to-stand (30s STS) tests. We used Pearson correlation coefficients to examine linear associations among the four performance tests and the associations between each performance test and the self-report measures of pain, functional status and chronic pain features. We further investigated the associations between performance tests and self-reported knee pain and function with adjustment for MHI-5, WPI, PCS and NPS using partial correlations. Results: We assessed 78 subjects with mean age 63.1 (SD 10.0), mean body mass index (BMI) 30.2 (SD 5.4), 69% female. The mean (SD) values for the performance tests included: 40m Walk 27.9 (5.6) seconds, TUG 9.1 (2.2) seconds, SLB 21.8 (19.7) seconds, and 30s STS 11.7 (4.5) stands. The individual performance measures had modest correlations with one another (Pearson r ranging from 0.33 to 0.74). The highest correlation (r = 0.74) was between TUG and 40m Walk, indicating that just 50% of the variability in TUG was explained by variability in 40m Walk. ORBIT participants had an average KOOS ADL score of 66.1 (18.2) and KOOS Pain of 74.6 (19.8). The correlations between performance tests and KOOS Pain, KOOS ADL, PCS, NPS, WPI and MHI-5 are shown in the Table. None of the correlations exceeded 0.40. Correlations were weakest for the associations between widespread pain and MHI-5 scores and the performance tests (all ≤ 0.23). Partial correlations between KOOS ADL scores and the performance tests were 28-64% lower than the crude correlations, adjusting for PCS, NPS, widespread pain and MHI-5 (Table).Table 1Pearson correlation coefficients for associations between performance tests and self-report measures of pain, function and chronic pain features40 Meter WalkTimed Up and GoTimed Single Leg Balance30-Second Sit to StandKOOS Pain-0.25-0.260.290.40KOOS ADL-0.33-0.290.400.40Pain Catastrophizing0.340.26-0.19-0.24Neuropathic Pain Scale0.320.20-0.24-0.23Widespread Pain0.15-0.08-0.23-0.18Mental Health Index-0.10-0.050.170.03Partial correlations adjusting for pain catastrophizing, NPS, widespread pain, MHI-5KOOS Pain-0.15-0.240.280.30KOOS ADL-0.12-0.200.290.25 Open table in a new tab Conclusions: 40m Walk, TUG, SLB and 30s STS each assess different aspects of functional capacity in knee OA patients. Self-reported functional status in persons with knee OA has weak to modest correlations with objective measures of functional status, which are further attenuated with adjustment for pain catastrophizing, neuropathic symptoms, widespread pain and anxiety and depression. These data suggest that objective performance tests capture elements of physical functional status in persons with knee OA that are not assessed well by frequently used self-report measures of functional status. Objective performance tests are not influenced strongly by other features of chronic pain such as catastrophizing, neuropathic pain symptoms, widespread pain or depression and anxiety. These data point to the importance of adding objective measures to the assessment of functional status in OA trials.

Better Knee, Better Me\u2122: effectiveness of two scalable health care interventions supporting self-management for knee osteoarthritis \u2013 protocol for a randomized controlled trial

BackgroundAlthough education, exercise, and weight loss are recommended for management of knee osteoarthritis, the additional benefits of incorporating weight loss strategies into exercise interventions have not been well investigated. The aim of this study is to compare, in a private health insurance setting, the clinical- and cost-effectiveness of a remotely-delivered, evidence- and theory-informed, behaviour change intervention targeting exercise and self-management (Exercise intervention), with the same intervention plus active weight management (Exercise plus weight management intervention), and with an information-only control group for people with knee osteoarthritis who are overweight or obese.MethodsThree-arm, pragmatic parallel-design randomised controlled trial involving 415 people aged ≥45 and ≤ 80 years, with body mass index ≥28 kg/m2 and < 41 kg/m2 and painful knee osteoarthritis. Recruitment is Australia-wide amongst Medibank private health insurance members. All three groups receive access to a bespoke website containing information about osteoarthritis and self-management. Participants in the Exercise group also receive six consultations with a physiotherapist via videoconferencing over 6 months, including prescription of a strengthening exercise and physical activity program, advice about management, and additional educational resources. The Exercise plus weight management group receive six consultations with a dietitian via videoconferencing over 6 months, which include a very low calorie ketogenic diet with meal replacements and resources to support behaviour change, in addition to the interventions of the Exercise group. Outcomes are measured at baseline, 6 and 12 months. Primary outcomes are self-reported knee pain and physical function at 6 months. Secondary outcomes include weight, physical activity levels, quality of life, global rating of change, satisfaction with care, knee surgery and/or appointments with an orthopaedic surgeon, and willingness to undergo surgery. Additional measures include adherence, adverse events, self-efficacy, and perceived usefulness of intervention components. Cost-effectiveness of each intervention will also be assessed.DiscussionThis pragmatic study will determine whether a scalable remotely-delivered service combining weight management with exercise is more effective than a service with exercise alone, and with both compared to an information-only control group. Findings will inform development and implementation of future remotely-delivered services for people with knee osteoarthritis.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12618000930280 (01/06/2018).