I exercise to postpone death - Interviews with persons with hip and/or knee osteoarthritis who are attending an osteoarthritis school.

BACKGROUND: Physical activity (PA) and exercise constitute the first line of treatment for osteoarthritis (OA) of the hip and/or knee. Even though the symptoms may vary, OA should be considered a chronic disease and therefore PA and exercise should be performed lifelong. That needs knowledge and motivation. PURPOSE: The purpose of this study was to explore and create a deeper understanding of the motivational processes for PA and exercise for persons with hip and/or knee OA who have participated in a self-management program OA school that included long-term exercise supervised by physical therapists. METHODS: Twenty-two in-depth interviews were conducted with 18 participants recruited from the OA school at a Physical Therapy Rehabilitation Clinic in Sweden. The interviews were analyzed with qualitative content analysis. RESULTS: The analysis resulted in one main theme, Developing health literacy to encourage motivational processes for PA and exercise in OA and four themes: 1) meeting an established self-management program; 2) carrying my life history; 3) understanding the intelligence of the body; and 4) growing in existential motivation. CONCLUSION: Motivation for being physically active and to exercise, the life history in relation to PA and what creates existential motivation are important areas to ask questions about when people come to OA schools. Knowledge about the signals of the body connected to OA should be implemented in OA schools in order to motivate people to live an active life despite OA. Health literacy and the awareness of how PA can postpone death are likely to be important for existential motivation.

Changes in received quality of care for knee osteoarthritis after a multicomponent intervention in a general practice in Denmark.

OBJECTIVE: First-line treatment for patients with knee osteoarthritis should ideally prescribe patient education, exercise, and if needed, weight loss. In practice, however, adjunctive treatments, including painkillers and referrals to specialists, are typically introduced before these measures. This study evaluated interventions to sustainably improve general practitioner delivered care for patients with knee osteoarthritis. DESIGN: Comparison of impacts of knee osteoarthritis care during four half-year periods: before, 6, 12, and 18 months after primary intervention based on electronic medical records (EMR) and patient questionnaires. SETTING: Danish general practitioners (GPs) treating 6240 patients. PARTICIPANTS: Four GPs, two GP trainees, and six staff members. INTERVENTIONS: Six pre-planned primary interventions: patient leaflet, GP and staff educational session, knee osteoarthritis consultation, two functional tests monitoring patient function, EMR phrase aiding consultation, and waiting room advertisement and three supportive follow-up interventions. MAIN OUTCOME MEASURES: Usage of first-line and adjunctive treatment elements, the functional tests, and the EMR phrase. RESULTS: Approximately 50 knee osteoarthritis cases participated in each of the four half-year periods. Primary interventions had only transient effects lasting <12 months on the knee osteoarthritis care. Functional tests and EMR phrases were used predominantly during the first 6 months, where a transient drop in the referral rate to orthopedics was observed. Use of educational elements was moderate and without significant change during follow-up. CONCLUSION: More routine use of the primary or inclusion of novel increased-adherence interventions is needed to sustainably improve care for knee osteoarthritis patients in Danish general practice.

Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark.

OBJECTIVE: While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient's satisfaction with the care for knee osteoarthritis in general practice. DESIGN: Cross-sectional study. SETTING: A Danish general practice. SUBJECTS: All consecutive patients ≥30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136). MAIN OUTCOME MEASURES: The questionnaire addressed patient's knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records. RESULTS: Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02-4.33), and the relationship between weight and osteoarthritis (1.38, 1.01-4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements. CONCLUSION: Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care.KEY POINTSGeneral practitioners worry about the doctor-patient relationship when addressing recommended lifestyle changes. However, this study revealed:•Patients in general practice with knee osteoarthritis are satisfied with care after having received information on lifestyle changes, such as exercise and the relationship between weight and osteoarthritis.•Patient satisfaction was not associated with the reception of adjunctive treatment elements for osteoarthritis.

Long-term effects of group exercise intervention on maximal step-up height in middle-aged female primary care patients with obesity and other cardio-metabolic risk factors.

BACKGROUND: Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Factors associated with changes in MSH was studied. METHODS: Female patients (n = 101), mean (SD) age of 52 (11) years, were recruited for a 3-month group exercise intervention including 2-3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO2-max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14-30 (mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO2-max, SF-36 and PA were studied with regression analyses. RESULTS: MSH, significantly, increased from T0 to T1, 27.2 (5.7) to 29.0 (5.5) cm and decreased to 25.2 (5.5) cm at T2. Time to follow-up (B = - 0.42, p < 0.001) and change in BMI (B = - 0.29, p = 0.012) correlated significantly to changes in MSH. Waist circumference, VO2-max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 session per week compared to one session. CONCLUSIONS: A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO2-max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients. TRIAL REGISTRATION: ISRCTN21220201 September 18, 2019, retrospectively registered.

Maximal step-up height as a simple and relevant health indicator: a study of leg muscle strength and the associations to age, anthropometric variables, aerobic fitness and physical function.

BACKGROUND: Low muscle strength is related to an increased risk for several chronic diseases. Increased muscle strength improves daily function and quality of life. OBJECTIVE: To measure maximal step-up height, an assessment of leg strength and function, and its association to age, anthropometric variables, maximal oxygen uptake (VO2-max) and self-reported physical function before and after a physical activity programme. METHODS: Female patients (n=178, 22-83 years) with musculoskeletal disorders, metabolic risk factors and other chronic diseases were recruited from primary care. Maximal step-up height (standardised step-up without a kick-off with the floor foot), anthropometric variables, VO2-max and self-reported physical function (Short Form 36 (SF-36)) were assessed before and after a 3-month group training intervention programme. Associations between maximal step-up height and other variables were examined using univariate and multivariate methods. RESULTS: At baseline and after intervention, maximal step-up height was negatively correlated to age, waist circumference and body weight and positively correlated to VO2-max, self-reported physical function and height. Furthermore, maximal step-up height correlated to training intensity at follow-up. Variations in changes in maximal step-up height were significantly explained by changes in waist circumference and physical function, regardless of age and changes in VO2-max. Maximal step-up height below 24 cm discriminated patients with self-reported severe limitation in physical function. CONCLUSIONS: Maximal step-up height, assessed simply with a standardised step-up test, may function as a relevant indicator of health since it correlated negatively to the metabolic risk factors, waist circumference, body weight and age, and positively to VO2-max and physical function.

Repeatability and validity of a standardised maximal step-up test for leg function--a diagnostic accuracy study.

BACKGROUND: Objectively assessed physical performance is a strong predictor for morbidity and premature death and there is an increasing interest in the role of sarcopenia in many chronic diseases. There is a need for robust and valid functional tests in clinical practice. Therefore, the repeatability and validity of a newly developed maximal step up test (MST) was assessed. METHODS: The MST, assessing maximal step-up height (MSH) in 3-cm increments, was evaluated in 60 healthy middle-aged subjects, 30 women and 30 men. The repeatability of MSH and the correlation between MSH and isokinetic knee extension peak torque (IKEPT), self-reported physical function (SF-36, PF), patient demographics and self-reported physical activity were investigated. RESULTS: The repeatability between occasions and between testers was 6 cm. MSH (range 12-45 cm) was significantly correlated to IKEPT, (r = 0.68, P < 0.001), SF-36 PF score, (r = 0.29, P = 0.03), sex, age, weight and BMI. The results also show that MSH above 32 cm discriminates subjects in our study with no limitation in self-reported physical function. CONCLUSIONS: The standardised MST is considered a reliable leg function test for clinical practice. The MSH was related to knee extension strength and self-reported physical function. The precision of the MST for identification of limitations in physical function needs further investigation.