Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version-KOPS Brazilian version.

BACKGROUND: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. OBJECTIVE: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. METHODS: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. RESULTS: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. CONCLUSION: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

The effectiveness of a randomised clinical trial of PLE2 NO self-management and exercise programme for knee osteoarthritis to improve self-efficacy.

OBJECTIVE: This study aims to assess the effectiveness of a 12-weeks self-management and exercise intervention to improve self-efficacy in older individuals with knee osteoarthritis (KOA) DESIGN: Randomised Controlled Trial. SETTING: Four different community settings. SUBJECTS: Eighty individuals aged 60 years or over with clinical and radiographic knee osteoarthritis. INTERVENTION: The subjects were randomly assigned to (1) a combined self-management and exercise programme (treatment group) and (2) an educational programme (control group). MAIN MEASURES: The primary outcome was self-efficacy and secondary outcomes were physical activity, health-related quality of life and skill-related physical fitness measures. RESULTS: Sixty-seven participants, mean age 69.1 (5.8) years, completed the study: 32 in the control group and 35 in the treatment group. A significant group effect favourable to the treatment group was observed in the following variables: self-efficacy (F[2,64] = 9.2, p = 0.003), physical activity (F[2,64] = 43.6, p < 0.001) and balance for most painful knee (F(2,64) = 4.87, p = 0.031) and less painful knee (F[2,64] = 6.94, p = 0.010). No improvements regarding health-related quality of life, gait speed and agility were found. This study supports the importance of a combined self-management and exercise intervention to improve self-efficacy and physical activity in KOA individuals.

Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version—KOPS Brazilian version

Abstract Background: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. Objective: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. Methods: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. Results: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. Conclusion: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

Bedside clinical tests to assess sensitization in office workers with chronic neck pain.

OBJECTIVE: This study aimed to assess pain sensitization in individual office workers with chronic neck pain through simple bedside quantitative sensory tests (QST) and to associate the findings with pain intensity and pain catastrophizing. METHODS: One hundred-and-four office workers with chronic neck pain were assessed using pressure pain threshold (PPT) considering pain sensitive if PPTs were lower than 155 kPa in the upper trapezius and 245 kPa in the tibialis anterior. Pain sensitive to temporal summation of pain (TSP) was considered if there was a difference of two points in the visual analogue scale (VAS) comparing the first and last stimulus. Pain sensitive was considered to conditioned pain modulation (CPM) if the CPM-effect was less than -7.5%. Pain intensity and catastrophizing were measured using VAS and with the Pain Catastrophizing Scale. RESULTS: There was at least one pain sensitive QST finding in 66 office workers (63.5%). TSP findings were the most common (48.1%), followed by PPT's (31.7%) and CPM (20.2%). Based on the QST findings, office workers were divided based on the number of individual QST findings, and higher pain intensity and pain catastrophizing scores were found in office workers with one (N = 38, P < 0.05) or two (N = 28, P < 0.05) compared with office workers with no QST findings (N = 38). CONCLUSION: This study demonstrated that most office workers with chronic neck pain exhibit either widespread pressure hyperalgesia, facilitated TSP or impaired CPM, indicating pain sensitization within the central nervous system. This was associated with increased clinical pain and pain catastrophizing rumination scores.

Translation, cultural adaptation and validation of the self-efficacy to manage chronic disease 6-item scale for european Portuguese.

OBJECTIVES: Self-efficacy is an important factor in the acquisition of self-management skills in patients with chronic diseases. The present study provides a translation and cultural adaptation for the Portuguese population, as well as psychometric properties, of the Self-Efficacy for Managing Chronic Disease 6-Item Scale. MATERIALS AND METHODS: This is a cross-sectional study. As a first stage, a translation and cultural adaptation were conducted. After preparation, a final version was applied initially to a sample of 30 participants with chronic disease in two phases, with a one-week gap between phases, to assess teste retest reliability. Subsequently, a sample of 217 participants with chronic disease, mean age 42.8 (10.7) years, participated in the study. Participants were supposed to be over the age of 18 and with at least one clinically diagnosed chronic disease. The questionnaire was applied electronically. RESULTS: The results showed a good test retest reliability (ICC of 0.83, 95% CI: 0.65 - 0.92). Internal consistency met the criterion for a reliable measure (global Cronbach's alpha of 0.95). Item-total correlations of all items were above 0.30. A correlation matrix was considered favorable (KMO = 0.90; Bartlett's sphericity test = 1399.090, p < 0.01). The results confirmed the permanence of the 6 items, as in the original scale. CONCLUSIONS: A Self-Efficacy for Managing Chronic Disease 6-Item Scale is a reliable and valid instrument to assess the patients' self-efficacy for managing chronic diseases in Portuguese, enabling its use in clinical practice and in future studies.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities.

OBJECTIVES: Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. METHODS: One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as 'mild-pain' (Visual Analog Scale [VAS]≤3) and 'moderate-pain' (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. RESULTS: PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. CONCLUSIONS: Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

The Association of Grip Strength with Depressive Symptoms among Middle-Aged and Older Adults with Different Chronic Diseases.

Low grip strength has been associated with an increase in depressive symptoms, independent of age group or gender, although the literature has not investigated this association among different chronic diseases. The present study aims to investigate the association of grip strength and depressive symptoms among middle-aged and older adults with different chronic diseases. A cross-section of data from the Survey of Health, Ageing, and Retirement in Europe wave 6 (collected in 2015) was analysed. Grip strength was measured by a handgrip dynamometer, and the European Depression Symptoms 12-item scale (EURO-D) was used to assess depressive symptoms. Multivariable logistic regression analysis was conducted. Those in the high strength tertile had 42% (95% confidence interval: 0.50, 0.71; p < 0.005) and 41% (95% confidence interval: 0.50, 0.70; p < 0.001) lower odds of depressive symptoms in the 'no disease' and in the 'metabolic diseases' groups of participants, respectively, compared with those in the lower strength tertile. No statistically significant relationship between grip strength and depression was observed in the 'arthritis diseases' group of participants. The association of grip strength with depressive symptoms must consider, besides gender and age group, the chronic conditions that an individual could have.

A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program.

OBJECTIVE: To assess the effectiveness of a 12-week self-management and exercise intervention (the PLE2NO program) in elderly individuals with knee osteoarthritis. DESIGN: Randomized controlled trial. SETTING: Four different community settings. SUBJECTS: Eighty individuals aged 60 years or older with clinical and radiographic knee osteoarthritis enrolled in the study. INTERVENTION: A combined self-management and exercise intervention (treatment group) and an educational intervention (control group). MAIN MEASURES: The primary outcomes were pain and other knee osteoarthritis symptoms (swelling, crackling, limitation on movement, and stiffness), self-management behaviors (communication with physician and cognitive symptom management), and functional lower limb strength. Secondary outcomes were knee osteoarthritis-specific health-related quality of life, self-perceived health, aerobic capacity, lower and upper limb flexibility, and handgrip strength. RESULTS: In all, 67 participants, mean age 69.1 ± 5.8 years, completed the study: 32 in the Educational Group and 35 in the Self-Management and Exercise Group. A significant group effect favorable to the Self-Management and Exercise Group was observed in the following variables: communication with the physicians ( P = .048), aerobic capacity ( P = .035), and functional lower limb strength ( P = .015). Although no significant group effect was detected, clinical improvements in pain (31%) and knee osteoarthritis symptoms (29%) were observed in the experimental group. No improvements regarding cognitive symptom management, self-perceived health, lower limb flexibility, and handgrip strength were found. CONCLUSION: This study supports the importance of a combined self-management and exercise intervention to improve functional lower limb strength and aerobic capacity in a Portuguese sample. Additionally, pain and other symptoms have improved clinically.

Predictors of walking capacity in obese adults with knee osteoarthritis.

INTRODUCTION: Knee osteoarthritis(KOA) has a considerable prevalence in obese individuals and recommendations of weight loss for KOA management are gaining greater importance. Exercise is recommended to interrupt the cycle obesity-KOA-pain-inactivity, where walking is the most common exercise pattern recommended for obese individuals who initiate a weight loss exercise program. Thus this study aimed to analyse the factors which can affect the walking capacity in obese adults with symptomatic KOA. METHODS: 48 obese adults (age=55±7years; BMI=35±5 Kg/m2) with clinical and radiological KOA completed self-reported questionnaires (Knee Injury and Osteoarthritis Outcome Score, Brief Pain Inventory and Beck Depression Inventory), physical function tests (Six Minutes Walking Test-6MWT, chair sit and reach-CSRT, five repetition sit-to-stand test-FRSTST, handgrip strength-HST, isokinetic knee strength) and body composition was determined. RESULTS: The best model (F= 41.485; p<.001) explained 73% of the 6MWT's variance, where fat mass of the most painful limb, knee pain severity and lower limb strength were the strongest predictors of the 6MWT. CONCLUSION: Despite the importance of lower limb fat mass and strength, pain was the only variable that appeared as a predictor of 6MWT in the three tested models. The existence of knee pain affects the capacity to walk or to perform weight bearing exercises and consequently the exercise's adherence, compromising the objective of body composition improvement. Thus, authors suggest that, additionally to the lower limb strengthening, knee pain should be screened, controlled and acknowledged for exercise prescription. This study is inserted in the PICO Project (Clinical trial: NCT01832545).

The PLE(2)NO self-management and exercise program for knee osteoarthritis: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: International recommendations suggest exercise and self-management programs, including non-pharmacological treatments, for knee osteoarthritis (KOA) because they can benefit pain relief and improve function and exercise adherence. The implementation of a combined self-management and exercise program termed PLE(2)NO may be a good method for controlling KOA symptoms because it encourages the development of self-efficacy to manage the pathology. This study will assess the effects of a self-management and exercise program in comparison to an educational intervention (control program) on symptoms, physical fitness, health-related quality of life, self-management behaviors, self-efficacy, physical activity level and coping strategies. METHODS/DESIGN: This PLE(2)NO study is a single-blinded, randomized controlled trial of elderly (aged above 60 yrs old) patients with clinical and radiographic KOA. The patients will be allocated into either an educational group (control) or a self-management and exercise group (experimental). All participants will receive a supplement of chondroitin and glucosamine sulfates. This paper describes the protocol that will be used in the PLE(2)NO program. DISCUSSION: This program has several strengths. First, it involves a combination of self-management and exercise approaches, is available in close proximity to the patients and occurs over a short period of time. The latter two characteristics are crucial for maintaining participant adherence. Exercise components will be implemented using low-cost resources that permit their widespread application. Moreover, the program will provide guidance regarding the effectiveness of using a self-management and exercise program to control KOA symptoms and improve self-efficacy and health-related quality of life. TRIAL REGISTRATION: NCT02562833 (09/23/2015).

Determinant factors of pain intensity in overweight and obese adults with knee osteoarthritis.

Osteoarthritis is one of the most disabling diseases, the main symptom being pain, which is associated with a low level of physical activity. The incidence and progression of knee osteoarthritis are directly related with risk factors such as obesity, age and mechanical factors. OBJECTIVE: The aim of this study was to identify which variables (physical activity, anthropometry and body composition of the lower limb) best predict pain intensity in obese individuals with knee osteoarthritis. METHODS: The sample consisted of 44 individuals of both genders (mean age 56.6 ± 6.6 yrs). Anthropometric measures of body mass, stature, mid-thigh, patellar and calf circumferences, and foot breadth were obtained. The body composition of the most painful lower limb was obtained by dual-energy X-ray absorptiometry in different regions: mid-thigh; patella; calf and foot. For each of these regions, fat mass percentage, the amount of fat and fat-free mass, bone mass and bone mineral density were evaluated. Physical activity was assessed by the International Physical Activity Questionnaire (short version) and pain intensity with the numeric rating scale. Data analysis was done using the multifactorial logistic regression (backward conditional method). RESULTS: The multifactorial analysis showed that gender (Odds Ratio of 7.448 for a 95% Confidence Interval of [1.032 - 53.747]) and foot breadth (Odds Ratio of 3.730 for a 95% Confidence Interval of [1.006 - 13.827]) are important factors to explain the risk of pain. CONCLUSIONS: These results seem to indicate that the assessment of foot morphology must be considered in knee osteoarthritis studies, since foot breadth is a predictor of knee pain. Further research is required to investigate the influence of foot morphology as well as of the use of insoles, splints or adapting shoes, on obese individuals with knee osteoarthritis.

Development of the Knee OA Pre-Screening Questionnaire.

AIM: Self-report questionnaires are still considered to be a useful instrument for disease screening and for epidemiological studies. Few questionnaires have been developed for the purpose of screening for knee osteoarthritis (KOA). The aim of this study was to develop a KOA screening tool that is useful for health and exercise professionals who do not have access to advanced and costly diagnostic instruments. METHODS: This study comprised five steps: content validity, reliability, criterion validity, construct validity and responsiveness. Internal consistency was verified using Cronbach's alpha and the intraclass correlation coefficient (ICC). Reproducibility was analyzed using the ICC (1 week). Criterion validity was assessed by comparing the Knee OA Pre-Screening Questionnaire (KOPS) score with the Short Form (SF)-12, the Knee Injury and Osteoarthritis Outcome Scores questionnaire and the 6 min walk test. Construct validity was verified using the receiver operating characteristic (ROC) curve (American College of Rheumatology clinical criteria and X-ray). Responsiveness was analyzed over 3 months of an aquatic exercise program using the pooled effect size. RESULTS: The overall KOPS score yielded a Cronbach's alpha of 0.747 and an ICC of 0.646. KOPS was considered reproducible (ICC: 0.895-0.992; Cronbach's alpha: 0.894-0.979). The ROC curve revealed a sensitivity of 86.96 and a specificity of 75.82. The KOPS demonstrated medium responsiveness in terms of the total score and the pain and symptoms components. CONCLUSION: The KOPS questionnaire is valid for the purposes for which it was created, and its translation into English should be considered.

The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals.

BACKGROUND: Aquatic exercise is recommended by the Osteoarthritis Research Society (OARSI), by the American College of Rheumatology (ACR) and by the European League Against Rheumatism (EULAR) as a nonpharmacological method of controlling the knee osteoarthritis (KOA) symptoms. Moreover, given that weight loss results in a reduction of the load that is exerted upon the knee during daily activities, obesity is also considered to be a modifiable risk factor for the development and or exacerbation of KOA. The implementation of an exercise based weight loss program may, however, itself be limited by the symptoms of KOA. The aquatic program against osteoarthritis (termed "PICO" in Portuguese) prioritizes the control of symptoms and the recovery of functionality, with an attendant increase in the patient's physical activity level and, consequently, metabolic rate. Our laboratory is assessing the effectiveness of 3 months of PICO on the symptoms of KOA, on physical function, on quality of life and on gait. In addition, PICO shall examine the effects of said exercise intervention on inflammatory biomarkers, psychological health, life style and body composition. METHODS/DESIGN: The trial is a prospective, single-blinded, randomized controlled trial, and involves 50 overweight and obese adults (BMI = 28-43.5 kg/m²; age 40-65 yrs) with radiographic KOA. The participants are randomly allocated into either an educational attention (control) group or an aquatic (exercise program) group. This paper describes the experimental protocol that is used in the PICO project. DISCUSSION: The PICO program shall provide insight into the effectiveness of an aquatic exercise program in the control of KOA symptoms and in the improvement of the quality of life. As such, they are likely to prove a useful reference to health professionals who intend to implement any kind of therapeutic intervention based around aquatic exercise. TRIAL REGISTRATION: NCT01832545.

An Informational Algorithm as the Basis for Perception-Action Control of the Instantaneous Axes of the Knee.

Traditional locomotion studies emphasize an optimization of the desired movement trajectories while ignoring sensory feedback. We propose an information based theory that locomotion is neither triggered nor commanded but controlled. The basis for this control is the information derived from perceiving oneself in the world. Control therefore lies in the human-environment system. In order to test this hypothesis, we derived a mathematical foundation characterizing the energy that is required to perform a rotational twist, with small amplitude, of the instantaneous axes of the knee (IAK). We have found that the joint's perception of the ground reaction force may be replaced by the co-perception of muscle activation with appropriate intensities. This approach generated an accurate comparison with known joint forces and appears appropriate in so far as predicting the effect on the knee when it is free to twist about the IAK.