Do we need another trial on exercise in patients with knee osteoarthritis?: No new trials on exercise in knee OA.

OBJECTIVE: We aim to investigate if we need additional trials on exercise in knee osteoarthritis (OA) to accept a certain effect size to be a 'true' effect size, and new studies are not needed anymore. DESIGN: We performed a secondary analyses of a meta-analysis of studies on patients with knee osteoarthritis, on pain immediately post treatment. We performed five different analysis: a) we evaluated publication bias, b) we performed subgroup analysis, c) a sensitivity analysis based on the overall risk of bias (RoB) score, d) a cumulative meta-analysis and e) we developed an extended funnel plot to explore the potential impact of a new study on the summary effect estimate. RESULTS: We included 42 studies with in total 6863 patients. The analyses showed that a) there is no clear publication bias, b) subgrouping did not affect the overall effect estimate, c) the effect estimate of exercise is more consistent (no heterogeneity) in the studies of low RoB, d) the benefit of exercise was clear since 2010 and e) the extended funnel plot suggests that an additional study has a none or very limited impact to change the current effect estimate. CONCLUSION: Exercise is effective and clinically worthwhile in reducing pain immediately post treatment compared to no or minimal interventions in patients with knee OA and adding new data will unlikely change this conclusion.

Physical functioning four years after total hip and knee arthroplasty.

Our previous study showed that 6 months after total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients reported having less difficulty with daily activities, showed better functional capacity, and performed activities in their natural environment faster compared to preoperatively. However, their actual daily activity level was not significantly improved. Six months is a rather short follow-up period and the discrepancy in recovery among different aspects of functioning might be explained by this limited duration of follow-up. The objective of the present study was to examine the recovery of different aspects of physical functioning at a follow-up nearly 4 years after THA/TKA. Special attention was given to the actual daily activity level, and whether it had increased 4 years after THA/TKA compared to 6 months postoperatively. Seventy-seven (35 hip, 42 knee) patients who were measured preoperatively and postoperatively (6 months after surgery) in a previous study were invited to participate; 44 patients (23 hip, 21 knee) agreed to participate. The 4-year follow-up data were compared with the preoperative and 6-month postoperative data. The daily activity level after 4 years was found to be actually lower than at 6 months post-surgery (128 min vs. 138 min activity per 24h; p-value 0.48). However, the patients continued to improve in other aspects of physical functioning. In conclusion, 4-year post-surgery patients continued to improve on perceived physical functioning, capacity, and performance of activities in daily life. However, even in this relatively healthy study population, patients did not adopt a more active lifestyle 4 years after surgery.

Choosing between hospitals: the influence of the experiences of other patients.

OBJECTIVE: Publicly available information on hospital performance is increasing, with the aim to support consumers when choosing a hospital. Besides general hospital information and information on outcomes of care, there is increasing availability of systematically collected information on experiences of other patients. The aim of this study was to assess the influence of previous patients' experiences relative to other information when choosing a hospital for surgical treatment. METHODS: Three hundred thirty-seven patient volunteers and 280 healthy volunteers (response rate of 52.4% and 93.3%, respectively) filled out an Internet-based questionnaire that included an adaptive choice-based conjoint analysis. They were asked to select hospital characteristics they would use for future hospital choice, compare hospitals, and choose the overall best hospital. Based on the respondents' choices, the relative importance (RI) of each hospital characteristic for each respondent was estimated using hierarchical Bayes estimation. RESULTS: Information based on previous patients' experience was considered at least as important as information provided by hospitals. "Report card regarding physician's expertise" had the highest RI (16.83 [15.37-18.30]) followed by "waiting time for outpatient clinic appointment" (14.88 [13.42-16.34]) and "waiting time for surgery" (7.95 [7.12-8.78]). Patient and healthy volunteers considered the same hospital attributes to be important, except that patient volunteers assigned greater importance to "positive judgment about physician communication" (7.65 v. 5.80, P < 0.05) and lower importance to "complications" (2.56 v. 4.22, P < 0.05). CONCLUSION: Consumers consider patient experience-based information at least as important as hospital-based information. They rely most on information regarding physicians' expertise, waiting time, and physicians' communication when choosing a hospital.

Walking and chair rising performed in the daily life situation before and after total hip arthroplasty.

OBJECTIVE: An earlier study showed that 6 months after total hip arthroplasty (THA) patients' overall daily activity level had not increased, despite significant improvement in their perceived physical functioning. This discrepancy might be because postoperative recovery is not expressed by a more overall active lifestyle, but by the fact that patients could perform the individual activities of daily living (ADL) faster and/or for a longer period of time. The aim of this study was to assess whether patients perform ADL faster and/or for a longer period of time 6 months post-THA compared to baseline. Also examined was whether patients perform activities on the level of healthy matched controls. METHOD: Thirty patients were measured at home with an accelerometry-based Activity Monitor, pre-operatively and 6 months post-THA. Patients were matched with healthy controls on gender and age (±2 years). RESULTS: Compared with baseline, 6 months post-THA the stride frequency and body motility during walking of patients had increased [56.1 (54.3, 57.8)strides/min vs 52.1 (50.3, 54.1)strides/min; P-value<0.0001, and 0.265 (0.245, 0.286)g vs 0.219 (0.197, 0.240)g; P-value<0.0001], and they rose faster from a chair [2.6 (2.5, 2.8)s vs 3.0 (2.8, 3.2)s; P-value<0.0001]. Compared with controls, preoperative all patients had lower values for these parameters. Six months post-THA the stride frequency and body motility during walking were similar to that of controls, but patients rose slower from a chair than controls. CONCLUSION: Six months post-THA patients walked faster and rose from a chair faster compared to baseline. Patients walked as fast as healthy controls but took longer rising from a chair.

Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls.

OBJECTIVE: Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. METHOD: The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. RESULTS: The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (beta=-0.29 and beta=-0.25, respectively), whereas mental functioning was positively related (beta=0.30). CONCLUSION: The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity.

Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score.

INTRODUCTION: The Hip disability and Osteoarthritis Outcome Score (HOOS) was constructed in Sweden; this questionnaire has proved to be valid for persons with hip disability with or without hip osteoarthritis (OA) and with high demands of physical function. OBJECTIVE: The objective of this study was to evaluate the internal consistency, reliability, construct validity, and floor and ceiling effects of the Dutch version of the HOOS questionnaire. PATIENTS AND METHODS: After translation with a forward/backward protocol, 74 hip arthroplasty patients and 88 hip OA patients filled in the Dutch HOOS, as well as a Short Form-36 (SF-36), an Oxford Hip Score (OHS) and a VAS-pain questionnaire. RESULTS: The Dutch version of the HOOS questionnaire achieved excellent scores in all of the clinimetric properties. CONCLUSION: The Dutch HOOS questionnaire has a good internal consistency and reliability. Moreover, the construct validity is good and no floor and ceiling effects were found. The HOOS is a good instrument for patients with different stadia of hip OA.