Comparing the Effects of Corticosteroid Injections and Resistance Exercise on Knee Osteoarthritis Patients: A Systematic Review.

PURPOSE: To evaluate research on the effectiveness of intra-articular corticosteroids injections compared with resistance exercise on pain, stiffness, and function among patients diagnosed with knee osteoarthritis. METHODS: Using the PRISMA guidelines, the authors performed a systematic review of randomized controlled trials (RCTs) in PubMed and EBSCOhost published between January 2012 and October 2022. The authors used keywords to identify studies. After screening the abstracts, reviewers used two screening tools to evaluate for validity and strength of each RCT. Full text of selected articles was critically appraised and narrative analysis was performed. The outcome used to determine effectiveness of the interventions was the Western Ontario McMaster University Osteoarthritis Index (WOMAC). RESULTS: Of the 69,056 articles identified during the preliminary search, 8 met the inclusion criteria for use in the study. Three studies involved resistance exercise, and 5 studies involved corticosteroids. Of the 3 resistance studies, 2 had significant changes in WOMAC scores. Of the 5 studies on corticosteroid injections, 4 had significant changes in WOMAC scores. CONCLUSION: Evidence from this review suggests that there is a significant improvement in WOMAC scores for both intervention groups. Although an analysis of research evidence suggests that there is no superior treatment for knee osteoarthritis between corticosteroid injections and resistance exercise, it is important to consider contextual and environmental factors before recommending either treatment.

A descriptive study of losses associated with permanent long-term care placement.

OBJECTIVES: This qualitative study describes the process of and factors associated with losses connected to permanent long-term care (LTC) placement of the elderly. METHODS: Five subjects were recruited on a voluntary basis upon consultation with a staff member of a small rural long-term care facility in Northeast Arkansas. Researchers conducted 1 to 2, hour to hour-and-a-half interview sessions with each participant. In order for subjects to be included in the study, participants met the following criteria: placement within the past 12 months, absence of acute disease, and cognitive ability to respond to and communicate during interview sessions. The interviews were taped with the patients' consent, and then transcribed word for word. The transcriptions were analyzed for emergent themes using the grounded theory approach. RESULTS: Qualitative analysis revealed several themes related to losses associated with LTC placement. These include: cohort losses, defined as losses that participants identified with as a cohort through lived experiences; antecedent losses, defined as losses that have contributed greatly to long-term care placement; and consequent losses, defined as losses that have been experienced as a consequence of placement. CONCLUSION: The cumulative nature of losses that eventually results in LTC placement is an important consideration in geriatric physical therapy practice. The study highlights the physical therapist's role in prolonging function, preserving quality of life, and preventing for as long as possible LTC placement. Losses identified as leading to LTC were found to be in alignment with current research. Transitioning to LTC may interfere with the need to attend to end-of-life role expectations, resulting in the experience of additional loss. Gender-related differences appear to be significant as well, with males expressing a marked sense of loss of meaningful activity.