The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis.

OBJECTIVE: The purpose of this systematic review with meta-analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis. LITERATURE SURVEY: We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021. METHODOLOGY: Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self-efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random-effects model was used for the meta-analysis. SYNTHESIS: We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta-analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (-0.24, 0.24) in physical function, 0.33 (-0.51, 1.17) in exercise adherence, and 0.04 (-0.39, 0.47) in self-efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was -0.33 (-0.53, -0.13) and 0.21 (-0.05, 0.47) with moderate and low certainty of evidence, respectively. CONCLUSION: The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design. PROTOCOL REGISTRATION: PROSPERO (CRD42020212904).

Gender Differences in Life-space Mobility-associated Factors and Structures in Community-dwelling Older People.

Objectives: This cross-sectional study sought to examine gender dissimilarities in factors and structures associated with life-space mobility (LSM) in community-dwelling older people. Methods: This study included a total of 294 older people living in Okawa, Fukuoka Prefecture, Japan. The subjects' body mass index (BMI) and skeletal muscle mass index (SMI) were evaluated. Furthermore, the age, gender, and LSM of the participants were assessed. LSM was assessed using a framework based on social isolation, fall self-efficacy, mobility, cognitive function, and lower limb muscle strength. Path analysis was performed to assess LSM-associated factors and their respective effect sizes (ESs), and male and female LSM models were established. Results: Path analysis identified SMI and social isolation as direct factors and cognitive function as an indirect factor associated with LSM in both men and women. In the male LSM model, the direct factors in descending order of ES were BMI, social isolation, SMI, and lower limb muscle strength. In the female model, the direct factors in descending order of ES were age, fall self-efficacy, mobility, social isolation, and SMI; age was noted as having an indirect effect on the remaining associated factors. Conclusions: This study clarified the gender differences in factors influencing LSM and the underlying structure of LSM mediation by these factors. Therefore, gender differences should be considered when planning interventions aimed at improving the LSM and general well-being of older people, particularly for community-dwelling individuals.

Physical Therapists' Perception and Educational Opportunities to Improve Exercise Adherence in Older Patients and Clients: A Qualitative Study.

OBJECTIVES: : The aim of the study was to understand the physical therapist's experience and perception of the support they give to their older patients or clients to continue exercising. METHODS: : Using purposive sampling, we recruited fifteen physical therapists with more than 5 years of clinical experience and conducted semi-structured interviews. We analyzed the transcribed data using thematic analysis. RESULTS: : Three main themes emerged: (1) the expected results as healthcare professionals, (2) clinical experience and continuing professional development, and (3) limited educational opportunities. Physical therapists struggled to achieve a certain level of exercise adherence in their patients, and the low success rate decreased their confidence. We found that physical therapists needed not only to rely on clinical experience but also to integrate scientific evidence to implement better behavioral change techniques; they would also appreciate receiving appropriate educational opportunities. CONCLUSIONS: : This study revealed a possibility of educational insufficiency for physical therapist to support of behavior change to improve exercise adherence in the older population.

Effects of gender and grade on differences in physiotherapy students' interest and reasons for participating in overseas volunteer programs.

[Purpose] The purpose of the present study was to evaluate the gender and grade differences in interest and reasons associated with overseas volunteer participation among physiotherapy students using a cross-sectional survey. [Participants and Methods] The participants were 1,093 physiotherapy students who were enrolled at the International University of Health and Welfare's Ohtawara, Narita, Odawara, and Fukuoka campuses in 2017. A cross-sectional design was used to study the differences between gender and among undergraduate grade levels. The degree of interest and reasons associated with overseas volunteer participation were evaluated by a questionnaire survey using a four-point scale. [Results] Female students were significantly more interested and active in overseas volunteer participation than male students. As for participation by students' grades, significant differences were found in three items only among female students. [Conclusion] Female students were significantly more active at volunteering than male students. It was suggested that we need to encourage students to engage in overseas volunteer participation from the time of admission, especially female students.

A path analysis of the interdependent relationships between life space assessment scores and relevant factors in an elderly Japanese community.

[Purpose] This study aimed to examine the direct and indirect effects of factors influencing the risk of life space assessment using path analysis. [Participants and Methods] A sample of 212 elderly residents (at least 65 years old) with no clear indications of cognitive dysfunction, visual impairment, and physical dysfunction were recruited for the study. Data on these factors were collected from the participants at a community gathering using measures of life space assessment, skeletal muscle mass, lower extremity muscle strength, mobility, cognitive function, and fear of falling. Correlational and path analyses were used to investigate the relationships between these variables. [Results] The final path model satisfied the requisite statistical criteria, and subsequently, the relationships between the physiological and psychological factors associated with life space assessment were structured and represented visually. Age, skeletal muscle mass, fear of falling, and mobility had a direct effect on life space assessment, whereas lower extremity muscle strength and cognitive function affected it indirectly. [Conclusion] In this study, direct and indirect effects of physiological and psychological factors related to risk of life space assessment of the elderly were clarified using path analysis.

Relationship between falls and physical performance measures among community-dwelling elderly women in Japan.

BACKGROUND AND AIMS: The relationship between falls and physical performance has focused on the frail elderly who have several health problems, particularly those in nursing homes or care facilities. It is important to clarify the relationship between falls and physical performance among the community-dwelling elderly. METHODS: We examined the relationship between falls and physical performance measures (grip strength, chair stand time, functional reach, usual walking speed) among 402 community-dwelling Japanese elderly women aged 60 years and over. RESULTS: Overall prevalence of falls was 21.1%, and increased with age. In univariate analysis, grip strength and functional reach were not significantly different between women who did and did not fall. Chair stand time of women who fell was longer than that of women who did not (p = 0.05), and the usual walking speed of women who fell was significantly slower than that of women who did not fall (p < 0.0001). Physical functioning significantly decreased with age; grip strength, functional reach and usual walking speed decreased, and chair stand time increased. Logistic regression analysis, adjusting for age and other covariates, showed that slower usual walking speed was significantly associated with falls, but grip strength and functional reach were not. Increased chair stand time had a borderline association (p = 0.1). CONCLUSIONS: Our findings indicate that poor lower extremity function, especially walking ability, is an important risk factor for falls in elderly Japanese community-dwelling women.