ABSTRACT
BackgroundKnee osteoarthritis (KOA) is a common joint disorder in elderly individuals, causing pain, loss of physical functioning, disability, and reduction of life quality. Home exercise programs (HEP) serve as a crucial complement to outpatient rehabilitation therapy, as they save the cost of supervised physical therapy sessions, while also offering a high level of treatment. The aim of this study was to evaluate the effectiveness of the 6-month HEP on pain, quality of life, and self-efficacy in patients with primary KOA and to identify the adherence level to exercises and associations with patients' characteristics and clinical outcomes.ResultsAfter 6 months of HEP, there were statistically significant differences between groups for self-efficacy (p ≤ 0.001, from 58.29 to 71.5) (p = 0.23, from 55.98 to 57.72), quality of life (p ≤0.001, from 60.1 to 72.2) (p = 0.074, from 60.35 to 60.92), and pain severity (P ≤0.001, from 58.29 to 41.4) (P = 0.88, from 61.2 to 60.9) in favor of exercise group.ConclusionsHome-based exercise program improves pain score, self-efficacy, and quality of life in patients with knee osteoarthritis. Adherence level to the exercise program may have a positive impact on patient improvement.
ABSTRACT
Purpose: Osteoarthritis of the knee (knee OA) is the most prevalent form of OA, frequently leading to significant pain and an overall reduction in quality of life. The available options for managing pain, associated with knee OA, are well documented. They include various oral analgesic medications (for example, NASIDs and opioids), intraarticular agents, notably, hyaluronic acid and corticosteroids, and where pharmacological and lifestyle options have been exhausted, orthopedic surgery, including total knee replacement (TKR). The treatment option(s) a patient may receive, in which order and at what time point, post-diagnosis may vary significantly between healthcare centers. The current study focuses specifically on knee OA in Germany, aiming to determine the epidemiology, patient characteristics and treatment schemes for the management of pain associated with knee OA. Method(s): A non-interventional, retrospective health claims data analysis was performed with an anonymized, age- and sex-representative sample of the Institute for Applied Health Research Berlin GmbH (InGef) database. The database that was used for this study includes approximately 4.8 million persons from approx. 60 statutory health insurances (SHI). Patients >=18 years of age were analyzed cross-sectionally for each year 2015-2020. Using ICD-10 and ATC codes, newly diagnosed patients in 2015 were also analyzed longitudinally until end of 2020. Result(s): The average period prevalence of knee OA was 7.34%, with a slight increase during the years 2015-2020. Incidence ranged from 1.71% of patients in 2015 to 1.46% of patients in 2020. Females and patients aged >=66 years had both a higher prevalence and incidence proportion compared to males and younger persons. Approximately 62% of newly diagnosed patients in 2015 received medical treatment during follow-up, most of whom were prescribed non-opioid analgesics;WHO I category (96.84%), followed by WHO II (2.45%) and WHO III (0.71%), as first line treatment. This analysis could not account for the use of any over the counter medications, or medicines prescribed in hospital, prior to, or after diagnosis. As many as 16.58% of newly diagnosed patients had surgery within 5 years. Knee replacement was the most common type of surgery with rising prevalence. The number of patients in whom surgery was performed decreased slightly from 5,38% to 4,03% during the study years considered (Figure 1);the decrease in 2020 may, in-part, be a reflection of the COVID-19 pandemic and the knock-on impact on healthcare systems. Of the 8,318 surgical patients, 2,101 patients (25.26%) had no record of having received any prescription pharmacological treatment prior to first surgery. The median time from first diagnosis until surgery in newly diagnosed patients was 346 days for any surgery, and 564 days for knee replacement. [Formula presented] Conclusion(s): With a stable incidence and a growing population, the number of patients with knee OA in Germany is slowly rising. In parallel, there is an slight decrease in total knee surgeries occurring each year with an increasing proportion of TKRs. Time until first surgery, in general, and TKR in newly diagnosed patients is relatively short, compared to other countries, with some patients having no record of having received any prescription medication prior to first surgery. Other treatment options such as opioids and intraarticular agents, appear to play a relatively minor role, in newly diagnosed patients, in current practice in Germany.Copyright © 2023
ABSTRACT
Purpose: Knee distraction (KD) treatment for young (<65) patients with end-stage knee osteoarthritis (OA) has previously been shown to successfully postpone a knee arthroplasty for years by reducing pain, improving function, and inducing joint tissue repair. During KD treatment, the tibia and femur are separated ~5 mm for ~6 weeks using an external fixation device. The studies performed thus far have used proof-of-concept medical devices intended for other applications than KD. Recently, the first device specifically designed and intended for KD treatment has been developed. The purpose of the current study was to evaluate the clinical efficacy of this intended device. Method(s): In 5 hospitals, 65 patients with end-stage knee OA, in general practice considered for arthroplasty or high tibial osteotomy, were offered KD treatment by their orthopedic surgeon. Inclusion criteria were judged by the orthopedic surgeon and included age <=65 years, BMI <35 kg/m2 with weight <=110 kg, sufficient knee stability and physical condition, KL grade >=2, malalignment <=10 degrees, no history of inflammatory or septic arthritis. KD was performed according to a standardized protocol. Before and 1 and 2 years after treatment, standardized knee radiographs were performed and patients filled out WOMAC (for pain and function, 0-100, primary clinical outcome) and SF-36 (for quality of life, 0-100, secondary outcome) questionnaires. From the radiographs, minimum joint space width (JSW, mm, primary structural outcome) was measured by one experienced observer and KL grade at baseline was determined. Use of self-reported pain medication (paracetamol, opioids, NSAIDs) and intra-articular injections were registered as well, as were adverse events. Changes over 2 years were evaluated for statistical significance with paired t-tests for continuous variables and McNemar's tests for categorical variables. For the primary clinical outcome (WOMAC), clinical significance was evaluated as well, on group level defined as an increase of >=15 points and on individual level using OARSI-OMERACT response criteria. The influence of adverse effects on 2-year changes in primary outcomes was analyzed with independent t-tests. Result(s): Of the 65 treated patients (age: 53.3+/-6.7;BMI: 28.0+/-3.2;sex: 38 (55%) male;KL grade 0/1/2/3/4: 0 (0%) / 7 (11%) / 26 (40%) / 23 (36%) / 9 (14%)), 50 patients completed 2 years follow-up: 6 patients received partial or total arthroplasty (of which 3 in the 1st year) and 8 patients were lost to follow-up in the 2nd year (primarily due to COVID restrictions). The total WOMAC score (Figure 1A/B) showed a statistically and clinically significant improvement over 1 (+28.4 points;p<0.001) and 2 (+26.2 points;p<0.001) years, as did all the subscales (all p<0.001). After 1 year 72% of patients were OARSI-OMERACT responders, while after 2 years this was 51%. The minimum JSW (Figure 1C/D) significantly improved over 1 (+0.5 mm;p<0.001) and 2 (+0.4 mm;p=0.015) years as well. The physical component scale of the SF36 (Figure 2A/B) showed statistically significant improvement over 1 (+10.5 points;p<0.001) and 2 (+9.8;p<0.001) years, while the mental component scale (Figure 2C/D) did not (both p>0.26). The most common adverse event (Table 1) was pin tract skin infections, experienced by 46 (71%) of patients. In most cases (36;78% of cases) they could be treated with oral antibiotics, while in 3 of the cases (5% of treated patients) hospitalization and/or intravenous antibiotics were needed. Also, 8 (12%) of patients experienced device related complications. Experiencing pin tract infections or device complications did not significantly influence 2-year changes in primary outcomes in these patients (both p>0.05). Before treatment, 39 (60%) of patients used pain medication (Table 2), most often paracetamol (20;31%) or NSAIDs (16;25%). Around half used them daily. After treatment, significantly less patients used pain medication (p<0.001), with 35% at 1 year and 36% at 2 years. In total 12 (18%) patients had received an intra-arti ular injection before KD treatment, of whom 5 (8%) steroids and 3 (5%) hyaluronic acid. Both in the 1st and 2nd year after treatment, 1 patient (2%) received an injection. Conclusion(s): Patients treated with the first device intended for KD treatment showed significant clinical and structural improvement after 1 and 2 years. Importantly, the effect was clinically relevant, as a majority of patients were clinical responders and pain medication use decreased. Long-term evaluation will show whether arthroplasty can be postponed successfully as well. [Formula presented] [Formula presented] [Formula presented] [Formula presented]Copyright © 2023
ABSTRACT
PURPOSE: The purpose of this study was to evaluate pain, functional impairment, mental health, and daily activity in patients with end-stage hip and knee osteoarthritis (OA) during the COVID-19 lockdown. METHODS: The study included 63 patients, with hip or knee OA, who had been scheduled for arthroplasty that was postponed because of COVID-19. Patients were evaluated by telephone interviews during the first week after lockdown, in the fourth week, and again at the end of the lockdown. Patients rated their pain level on the basis of a visual analog scale (VAS) and completed WOMAC, SF-12 and Tegner activity scale (TAS) questionnaires. RESULTS: VAS and WOMAC scores increased significantly during lockdown, while physical activity significantly decreased. At the final evaluation, VAS and WOMAC showed a significant negative correlation with TAS. The SF-12 subscale scores showed a significant decrease of the physical component during the lockdown, while the mental component remained largely unchanged. Patients with knee OA showed a faster progress of pain compared to those with hip OA. 50 patients (79%) stated they wished to have arthroplasty as soon as possible. CONCLUSION: The COVID-19 lockdown had a significant impact on pain, joint function, physical function, and physical activity in patients with end-stage hip and knee OA. LEVEL OF EVIDENCE: II (Prospective cohort study).