Efficacy of self-management program associated with a spa therapy for knee osteoarthritis patients (GETT 2): a research protocol for a randomized trial.

INTRODUCTION: Osteoarthritis is a chronic pathology that involves multidisciplinary management. Self-management for patients is an essential element, present in all international guidelines. During the time of the spa therapy, the patient is receptive to take the advantage of self-management workshops. The aim of this study is to assess the effects of 18 days spa therapy associated with a self-management intervention in patients with knee osteoarthritis in comparison with spa therapy alone on a priority objective, personalized and determined with the patient, chosen in the list of 5 objectives determined during the self-management initial assessment. METHODS AND ANALYSIS: Two hundred fifty participants with knee osteoarthritis will participate to this multicenter, prospective, randomized, controlled study. All patients will benefit 18 days of spa therapy and patients randomized in the intervention group will participate to 6 self-management workshops. Randomization will be centralized. The allocation ratio will be 1:1. Data analysts and assessor will be blinded. The primary outcome is the effectiveness of the educational workshops associated with spa therapy in comparison with spa therapy alone on a priority objective, measured by Goal Attainment Scaling (GAS). The secondary outcomes are disability, health-related quality of life, and pain intensity. ETHICS AND DISSEMINATION: Ethics were approved by the CPP Sud-Méditerranée II. The results will be disseminated in a peer-reviewed journal and disseminated at PRM, rheumatology, and orthopedics conferences. The results will also be disseminated to patients. TRIAL REGISTRATION: Trial registration number NCT03550547. Registered 8 June 2018. Date and version identifier of the protocol. Version N°6 of March 12, 2018.

Early rehabilitation management strategy for septic arthritis of the knee.

OBJECTIVES: Early rehabilitation management of septic arthritis in the native knee is not standardized. In this context, it is necessary to develop and validate an early rehabilitation strategy. MATERIEL AND METHODS: Based on the formalized HAS consensus method, a 4-phase rehabilitation strategy has been developed: recovery of joint amplitudes, muscle recovery without resistance, recovery with technical aid (crutches, canes), continuation of the rehabilitation (pursuit of muscle, articular, proprioceptive and endurance recovery). RESULTS: It was submitted to the opinion of multidisciplinary experts (PMR, general practitioner, rheumatologist, infectiologist, orthopedic surgeon, physiotherapist). Nearly 80% of the items were directly validated, with only five items scoring less than 5/10. Modifications were made in order to obtain a final version of the protocol. CONCLUSION: Use of a rigorous methodology enabled a consensual strategy for early rehabilitation management to be developed. Prospective validation of this strategy is needed to confirm its feasibility and effectiveness.

Perceived barriers to and facilitators of physical activity in people with knee osteoarthritis: Development of the Evaluation of the Perception of Physical Activity questionnaire.

BACKGROUND: The physical activity (PA) level of individuals with knee osteoarthritis is lower than in the general population. International recommendations recommend a non-pharmacological intervention including a self-management education program, weight loss and an adapted exercise program. However, we have no scale assessing the perceived barriers to and facilitators of PA in this population. OBJECTIVE: We constructed and validated a self-administered questionnaire assessing perceived barriers to and facilitators of regular practice of PA in people with knee osteoarthritis. METHODS: Semi-structured interviews identified 24 barriers and facilitators. We developed a 24-item questionnaire, Evaluation of the Perception of Physical Activity (EPPA) that was completed by 548 individuals with knee osteoarthritis, to assess acceptability, construct validity, internal consistency and convergent validity. Participants also completed the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and International Physical Activity Questionnaire (IPAQ). Reliability and sensitivity to change were evaluated in a second group of 168 people with knee osteoarthritis at a 3-week spa therapy resort. RESULTS: Factorial analysis identified 17 items grouped into 4 subscales (Barriers, Facilitators, Motivation and Beliefs). The internal consistency was good for Barriers, Facilitators and Motivation subscales (Cronbach α>0.70) and intermediate for the Beliefs subscale (Cronbach α=0.64). The EPPA subscale scores were significantly correlated with KOFBeQ and WOMAC scores but not associated with IPAQ physical activity level. Reliability was good for all subscales, with intraclass correlation coefficients>0.60. A sensitivity to change was found for only the Beliefs subscale, with a moderate effect size. CONCLUSIONS: The EPPA questionnaire has good psychometric properties and can help guide the management of knee osteoarthritis. It can be used in research for evaluating the perception of physical activity.

Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: Preliminary results in healthy subjects.

Many instruments exist for measuring grip strength. The Jamar hydraulic hand dynamometer is currently the gold standard. The Labin is a prototype electronic dynamometer that can also measure maximum grip strength. The main objective was to compare the Labin dynamometer with the gold standard instrument, the Jamar, in a healthy population, and secondarily to compare discomfort during use. A single-center exploratory study was conducted. The subjects enrolled had to be aged between 20 and 60, be volunteers and give consent. The required number of subjects was 30. The subjects were positioned according to American Society of Hand Therapists recommendations. Maximum grip force was measured in kilograms using the mean of three successive trials. The first dynamometer used was chosen randomly. The handle's discomfort during use was rated on a simple verbal scale from 0 to 10. Thirty-four subjects were included. The concordance coefficient for peak torque between the Labin and Jamar dynamometers was 0.90 for the dominant hand and 0.83 for the non-dominant hand. The intraclass correlation coefficient for peak torque with the Labin was 0.81 [0.69; 0.89] for the dominant hand and 0.86 [0.76; 0.92] for the non-dominant hand. In our study, we have shown that the Labin prototype has acceptable validity and reproducibility. The Labin will need to be tested in pathological conditions next.

An evidence-based information booklet helps reduce fear-avoidance beliefs after first-time discectomy for disc prolapse.

OBJECTIVE: We aimed to assess the impact of a booklet integrating the biopsychosocial model of chronic pain management on reducing disability among patients undergoing lumbar discetomy. METHODS: In a prospective, controlled, time-series study with an alternate-month design, we enrolled 129 patients from a tertiary care university hospital after they underwent uncomplicated lumbar discectomy for the first time. The intervention group received the biopsychosocial evidence-based booklet and the control group a biomedical-based booklet; the booklets differed only in information content. Patients were blinded to treatment group. The main outcome was disability at 2 months (measured by the Quebec back-pain disability scale [QBPDS]). Secondary outcomes were fear and avoidance beliefs measured by the Fear-Avoidance Beliefs Questionnaire (FABQ). All data were collected by self-reporting questionnaires. RESULTS: At 2 months, disability did not differ between the 2 groups (QBPDS score 32.4±22.8 vs 36.1±18.7, P=0.36). FABQ physical activity score was lower with the evidenced-based booklet as compared with controls (8.0±7.14 vs 11.2±6.3, P=0.008). CONCLUSIONS: Providing an evidence-based booklet had no effect at 2 months after surgery on disability but reduced fear-avoidance beliefs about physical activity. This booklet could be an effective tool for health care professionals in helping with patient education. CLINICALTRIALS. GOV IDENTIFIER: NCT00761111.

Evaluation of 'I-Preventive': a digital preventive tool for musculoskeletal disorders in computer workers-a pilot cluster randomised trial.

OBJECTIVES: I-Preventive is a digital preventive tool for musculoskeletal disorders (MSDs) in computer workers. We sought to determine its impact on pain in computer workers with upper limb MSDs and visual discomfort. METHODS: We conducted a pilot cluster randomised trial in 2 different sites of a tyre factory in France. We randomised 200 employees to either an intervention group (I-Preventive) or control group, each comprising symptomatic and asymptomatic employees. The workers were followed up for 5 months. The main outcome was overall recovery from symptoms following 1 month's intervention based on Nordic-style and eyestrain questionnaires. RESULTS: We included 185/200 workers: 96 in the intervention group (mean age 41.8±1.4 years; 88.5% males) and 79 in the control group (mean age 42.9±12.0 years; 94.5% males). The most painful areas (numerical scale ≥2) were the neck (40.0%), upper back (18.8%) and shoulders (15.7%). For the most painful anatomical area, the Nordic score significantly decreased after 1 month in the intervention group (p=0.038); no change was observed in the control group (p=0.59). After 1 month's use, the intervention group reported less pain in the painful area and less visual discomfort symptoms (p=0.02). Adherence to the I-Preventive program was 60%. CONCLUSIONS: I-Preventive is effective in the short term on musculoskeletal symptoms and visual discomfort by promoting active breaks and eyestrain treatment. This easy-to-use digital tool allows each worker to focus on areas of their choice via personalised, easy exercises that can be performed in the workplace. TRIAL REGISTRATION NUMBER: NCT02350244; Pre-results.

Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review.

OBJECTIVES: Highlight the role of patient education about physical activity and exercise in the treatment of hip and knee osteoarthritis (OA). METHODS: Systematic literature review from the Cochrane Library, PubMed and Wiley Online Library databases. A total of 125 items were identified, including 11 recommendations from learned societies interested in OA and 45 randomized controlled trials addressing treatment education and activity/exercise for the treatment of hip and knee osteoarthritis. RESULTS: In the end, 13 randomized controlled trials and 8 recommendations were reviewed (1b level of evidence). Based on the analysis, it was clear that education, exercise and weight loss are the pillars of non-pharmacological treatments. These treatments have proven to be effective but require changes in patient behaviour that are difficult to obtain. Exercise and weight loss improve function and reduce pain. Education potentiates compliance to exercise and weight loss programs, thereby improving their long-term benefits. Cost efficiency studies have found a reduction in medical visits and healthcare costs after 12 months because of self-management programs. CONCLUSION: Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346.

Isokinetic muscle strengthening for knee osteoarthritis: A systematic review of randomized controlled trials with meta-analysis.

OBJECTIVE: To assess the level of scientific evidence and the place in the rehabilitation framework of isokinetic muscle strengthening (IMS) for knee osteoarthritis (OA). METHODS: A systematic review of the English literature in MEDLINE via PubMed, the Cochrane Library, and PEDro databases for only randomized comparative trials. Data that were sufficiently homogeneous underwent comprehensive meta-analysis. Methodological assessment was done by using the CLEAR scale for non-pharmacologic trials. RESULTS: We identified articles for 9 trials (696 patients). All trials were of low to moderate quality. Tolerance of IMS was considered good. Improvement in muscle strength was better with an IMS program than no treatment or an isometric exercise but did not differ with an aerobic program. We found an important effect for pain (standardized mean difference 1.218 [95% CI 0.899-1.54], P<0.001) and functional Lequesne index (1.61 [0.40-2.81], P=0.009) and a moderate effect for the Western Ontario and McMaster Universities Osteoarthritis Index subscore C for disability (0.58 [0.04-1.11], P=0.03). CONCLUSIONS: IMS is an effective way to propose dynamic muscle strengthening for knee OA rehabilitation and has a significant effect on pain and disability. Because of the weak methodology and the great heterogeneity of studies, particularly in IMS protocol and outcome measures, insufficient data are available to provide guidelines about efficacy and strategy. Future clinical trials are needed, but more attention should be paid to the methods of such studies to clarify the role of IMS in the therapeutic armamentarium of knee OA.

The bigger, the stronger? Insights from muscle architecture and nervous characteristics in obese adolescent girls.

BACKGROUND: Young obese youth are generally stronger than lean youth. This has been linked to the loading effect of excess body mass, acting as a training stimulus comparable to strength training. Whether this triggers specific adaptations of the muscle architecture (MA) and voluntary activation (VA) that could account for the higher strength of obese subjects remains unknown. METHODS: MA characteristics (that is, pennation angle (PA), fascicle length (FL) and muscle thickness (MT)) and muscle size (that is, anatomical cross-sectional area (ACSA)) of the knee extensor (KE) and plantar flexor (PF) muscles were evaluated in 12 obese and 12 non-obese adolescent girls (12-15 years). Maximal isometric torque and VA of the KE and PF muscles were also assessed. RESULTS: Results revealed higher PA (P<0.05), greater MT (P<0.001), ACSA (P<0.01), segmental lean mass (P<0.001) and VA (P<0.001) for KE and PF muscles in obese girls. Moreover, obese individuals produced a higher absolute torque than their lean counterparts on the KE (224.6±39.5 vs 135.7±32.7 N m, respectively; P<0.001) and PF muscles (73.3±16.5 vs 44.5±6.2 N m; P<0.001). Maximal voluntary contraction (MVC) was correlated to PA for the KE (r=0.46-0.57, P<0.05-0.01) and PF muscles (r=0.45-0.55, P<0.05-0.01). MVC was also correlated with VA (KE: r=0.44, P<0.05; PF: r=0.65, P<0.001) and segmental lean mass (KE: r=0.48, P<0.05; PF: r=0.57, P<0.01). CONCLUSIONS: This study highlighted favorable muscular and nervous adaptations to obesity that account for the higher strength of obese youth. The excess of body mass supported during daily activities could act as a chronic training stimulus responsible for these adaptations.

French validation of the Foot Function Index (FFI).

OBJECTIVE: French validation of the Foot Function Index (FFI), self-questionnaire designed to evaluate rheumatoid foot according to 3 domains: pain, disability and activity restriction. METHODS: The first step consisted of translation/back translation and cultural adaptation according to the validated methodology. The second stage was a prospective validation on 53 patients with rheumatoid arthritis who filled out the FFI. The following data were collected: pain (Visual Analog Scale), disability (Health Assessment Questionnaire) and activity restrictions (McMaster Toronto Arthritis questionnaire). A test/retest procedure was performed 15 days later. The statistical analyses focused on acceptability, internal consistency (Cronbach's alpha and Principal Component Analysis), test-retest reproducibility (concordance coefficients), external validity (correlation coefficients) and responsiveness to change. RESULTS: The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis. The Cronbach's alpha ranged from 0.85 to 0.97. Reproducibility was correct (correlation coefficients>0.56). External validity and responsiveness to change were good. CONCLUSION: The use of a rigorous methodology allowed the validation of the FFI in the French language (FFI-F). This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot. The FFI-F could be used in other pathologies with foot-related functional impairments.

Breathing patterns during eccentric exercise.

Eccentric (ECC) work is interesting for rehabilitation purposes because it is more efficient than concentric (CON). This study assessed respiratory patterns and electromyographic activity (EMG) during ECC and CON cycling, both at similar power outputs and VO2 in eight healthy male subjects. Measurements include ventilation (VE), tidal volume (Vt), breathing frequency (Fb), arterial blood gases, and vastus lateralis (VL) and biceps brachii (BB) EMG. At the same mechanical power, VO2 and VE were fivefold lower in ECC as was VL EMG while BB EMG, Vd/Vt, PaO2 and PaCO2, were not different between modalities. At the same VO2, there was no difference in VE but Vt was lower and Fb higher in ECC. VL EMG was not different between modalities while BB EMG was higher in ECC. The latter observation suggests that ECC cycling may result in arm bracing and restricted chest expansion. Since hyperpnea is a known trigger of exaggerated dynamic hyperinflation, the prescription of ECC cycling for patient rehabilitation requires further assessment.

Transcultural validation of the Risk Assessment and Predictor Tool (RAPT) to predict discharge outcomes after total hip replacement.

OBJECTIVE: To assess the relevance of the RAPT (Risk Assessment and Prediction Tool), among a cohort of patients undergoing total hip arthroplasty (THA). METHOD: Prospective study of a cohort of patients evaluated before and after THA. The difference between the postoperative orientation predicted by the RAPT and the real one is assessed. Clinical, environmental and psychosocial criteria that could significantly change the orientation are discussed. RESULTS: One hundred and thirty-four patients (94 women and 40 men) were included. The average age was 71.6 (±10) years. Primary hip osteoarthritis was the indication for surgery in 78% of cases. The average length of stay in the surgery ward was 10 (±3) days. It was significantly higher for patients referred to a rehabilitation ward (P<0.0001). Sixty-six percent of patients were referred to a rehabilitation ward and 34% returned directly home. The average length of stay in rehabilitation ward was 27 (±13) days. The validity of the RAPT as a help decision tool has been confirmed. Thus, a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward, conversely, a high RAPT score is significantly related to more frequent direct return to home. CONCLUSION: This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty. The patient preference remains the main variable for orientation after THA. By the way, the patient preference must not be integrated into the RAPT, but need to be collected and be discussed with the patient.

Patient education after amputation: systematic review and experts' opinions.

OBJECTIVE: To perform a systematic review of the literature regarding amputee self-care, and analyze current experts' opinions. METHOD: The research in Medline and Cochrane Library databases was performed using the keywords "amputee self-care", "amputee health care", "amputee education", and "amputee health management". The methodological quality of the articles was assessed using four levels of evidence and three guideline grades (A: strong; B: moderate; C: poor). RESULT: One prospective randomized controlled study confirm the level of evidence of self-care amputee persons with grade B, which is similar others chronic diseases self-care. Self-care of amputee persons contributes to improve functional status, depressive syndrome, and also health-related quality of life. A review of the patients' needs and expectations in self-care amputee persons has been established thanks to the presence of qualitative focus group study. CONCLUSION: A multidisciplinary self-care of amputee persons can be recommended. Regarding literature date, the level of evidence of self-care amputee persons is moderate (grade B). Experts groups are currently working on a self-care amputee persons guideline book in order to standardize practicing and programs in the physical medicine and rehabilitation departments.

Job satisfaction evaluation in low back pain: a literature review and tools appraisal.

UNLABELLED: Among occupational risk factors of recurrence, chronicity and no return to work in low back pain, poor job satisfaction is the only high evidence-based factor. OBJECTIVE: To find out any validated questionnaire usable to assess job satisfaction in low back pain patients, both in clinical practice and research setting. METHOD: A systematic literature search on Pubmed and Cochrane library databases and un-indexed literature was made. "Job satisfaction" and "low back pain" keywords were used. Only English and French relevant articles were retained. A double assessment was made of listed questionnaires according to psychometric properties and daily practice use. RESULTS: Among the 40 articles retained only four used a validated questionnaire. Among the 12 different questionnaires, only two are validated in their English version (Job Descriptive Index [JDI] and the Work Environment Scale [WES]) and one in its French Version (JDI). Because they are time consuming, use these questionnaires in daily practice seems difficult. CONCLUSION: Based on literature review and questionnaire heterogeneity, at this time, there is no reference job satisfaction questionnaire. For daily practice, global job satisfaction visual analog scale could be useful. For research and intervention, JDI is more suitable despite its validity is still questionable.

Validation of an educational booklet targeted to patients candidate for total knee arthroplasty.

BACKGROUND: Knee osteoarthritis is a highly prevalent condition and the leading reason for total knee arthroplasty (TKA). No consensus exists about the optimal content of preoperative patient information and, to the best of our knowledge, no validated information document is available. Our objective here was to obtain validation by healthcare professionals and patients of an educational booklet for patients awaiting TKA. MATERIALS AND METHODS: The booklet was developed and validated in six phases: systematic literature review, drafting of the first version, critical revision by a panel of experts, modification of the booklet, validation by a multidisciplinary panel of experts, and validation by two groups of patients, one composed of patients awaiting TKA and the other of patients in the immediate post-TKA period. We assessed the impact of the booklet based on knowledge and belief scores before and 2 days after receiving the booklet. RESULTS: Critical revision of the first draft led to changes to meet the concerns voiced by the experts. Knowledge improved only in the patient group given the booklet preoperatively (from 6/10 to 9/10, P=0.005). The booklet did not modify beliefs in either patient group. DISCUSSION: We used a rigorous methodology to develop and validate the contents of an educational booklet. Receiving this document before TKA resulted in improved patient knowledge but had no impact on beliefs. LEVEL OF EVIDENCE: Level IV.

Evaluation of various ways to deliver information concerning non-steroidal anti-inflammatory drugs to osteoarthritis patients.

INTRODUCTION: It is essential to provide complete information to patients using non-steroidal anti-inflammatory drugs (NSAIDs) because of the risk of side effects. Today, most healthcare professionals recommend and privilege oral information regarding NSAIDs. OBJECTIVE: Evaluate the impact of three standardized NSAIDs information-delivery modalities on knowledge, anxiety and satisfaction of patients hospitalized in a Physical Medicine and Rehabilitation unit for debilitating and degenerative locomotor diseases. METHOD: Randomized prospective study with an alternate month design. Two control groups were provided with only one type of information modality: written (information sheet) or oral (presentation). The intervention group received both modalities of information. The information included: the definition of NSAIDs, advantages and side effects, and practical advice regarding proper use. The main evaluation criterion was knowledge progression assessed by a specific questionnaire. Secondary criteria were anxiety evolution (STAI-Y questionnaire) and satisfaction related to the information delivered. RESULTS: One hundred and forty patients were included. Knowledge was improved in the three groups, with a greater score improvement in the group that received both modalities (P=0.05). No intergroup difference was noted on anxiety or satisfaction. DISCUSSION AND CONCLUSION: Associating both information-delivery modalities (written+oral) contributes to improving knowledge but does not seem to have an impact on the anxiety of patients treated with NSAIDs for their degenerative locomotor disease. Using standardized information sheets with a validated content could help pharmacists in their role as healthcare education provider and effectively complement the information delivered orally.

Therapeutic education in cardiovascular diseases: state of the art and perspectives.

OBJECTIVE: To assess the impact of therapeutic education programmes for Coronary Artery Disease (CAD) and Chronic Heart Failure (CHF), as well as patients' expectations and education needs, tips to improve adherence to lifestyle modifications, and education materials. METHOD: We conducted a systematic review of the literature from 1966 to 2010 on Medline and the Cochrane Library databases using following key words: "counselling", "self-care", "self-management", "patient education" and "chronic heart failure", "CAD", "coronary heart disease", "myocardial infarction", "acute coronary syndrome". Clinical trials and randomized clinical trials, as well as literature reviews and practical guidelines, published in English and French were analysed. RESULTS: Therapeutic patient education (TPE) is part of the non-pharmacological management of cardiovascular diseases, allowing patients to move from an acute event to the effective self-management of a chronic disease. Large studies clearly showed the efficacy of TPE programmes in changing cardiac patients' lifestyle. Favourable effects have been proved concerning morbidity and cost-effectiveness even though there is less evidence for mortality reduction. Numerous types of intervention have been studied, but there are no recommendations about standardized rules and methods to deliver information and education, or to evaluate the results of TPE. The main limit of TPE is the lack of results for adherence to long-term lifestyle modifications. CONCLUSION: The efficacy of TE in cardiovascular diseases could be improved by optimal collaboration between acute cardiac units and cardiac rehabilitation units. The use of standardized rules and methods to deliver information and education and to assess their effects could reinforce this collaboration. Networks for medical and paramedical TPE follow-up in tertiary prevention could be organized to improve long-term results.