Hands-On Test Predicts Worsening Knee OA

Physical exam findings of patellofemoral grind may help predict which patients with knee osteoarthritis (OA) are likely to experience significant worsening of their disease, analysis of data from the Osteoarthritis Initiative showed.

Individuals with persistent patellofemoral grind had a greater annual loss of cartilage volume compared with those without this clinical finding (1.30% vs 0.90%, P<0.001), according to Yuanyuan Wang, MD, PhD, of Monash University in Melbourne, Australia, and colleagues.

They also had twice the risk of having a total knee replacement by 6 years (OR 2.10, 95% CI 1.30-3.38, P=0.002), the researchers reported online in Arthritis Care & Research.

The natural history of knee OA can vary notably among patients, and because of the increasing numbers of affected patients worldwide it has become critical to identify those who are most likely to progress, so as to better target healthcare resources.

Full story at MedPage Today

 

From PTJ: Getting at the Risk Factors for Falls Post-TKA

Up to a third of patients with total knee arthroplasty (TKA) experience a fall within 6 months to a year after surgery, but a new study suggests that physical therapists (PTs) can reduce this risk by targeting specific deficits for intervention.

Researchers followed 134 individuals at a Hong Kong hospital for 6 months after TKA to determine falls frequency, circumstances, and risk factors. All patients had been referred for outpatient rehabilitation. The individuals were all between the ages of 50 and 85 with a primary diagnosis of knee osteoarthritis (OA). Results were published in the September issue of PTJ(Physical Therapy).

Participants attended physical therapy 1-2 times per week for 8-10 weeks, beginning 2 weeks after surgery. Sessions included electrotherapy, mobilizing and strengthening exercises, and gait and balance training. At 4 weeks postsurgery, PTs evaluated knee proprioception, balance, knee pain, knee extension and flexion muscle strength, range of motion, and balance confidence. Patients also were given a log book to record any falls. After the evaluation, authors followed up monthly to ask participants about any falls they may have experienced.

Full story at APTA

A manual physical therapy intervention for symptoms of knee osteoarthritis and associated fall risk

Patients with knee osteoarthritis (OA) are at an increased risk of falling. Further, the symptoms associated with knee OA are correlated with fall risk. A manual physical therapy (MPT) approach consisting of mobilizing techniques and reinforcing exercise improves the symptoms and functional limitations associated with knee OA. The purpose of this case series is to evaluate an MPT intervention of mobilization techniques and exercise for knee OA on improving symptoms and quantify the secondary benefit of improving stumble recovery.

Four patients with symptomatic knee OA and four matched controls completed a fall risk assessment. Following 4 weeks of intervention, patients were reevaluated. Initial Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores indicated notable symptoms and functional limitations in all patients. In addition, all patients displayed elevated fall risk and/or impaired stumble responses. Following 4 weeks of intervention, all patients reported meaningful reductions in all three WOMAC subscales and demonstrated improvements in at least two of the three fall risk measures.

Full story at Physiospot

Study: For Individuals With Knee OA, 3 Tests Can Predict Ability to Walk 6k Steps a Day

Getting individuals with knee osteoarthritis (OA) to walk regularly is a crucial component in reducing knee pain, improving physical function, and staving off comorbidities such as cardiovascular disease. But how can a clinician know if a patient is capable of meeting minimum walking recommendations? Authors of a recent study believe it may come down to performance on 3 simple tests.

In a study of 1,925 participants with or at risk for knee OA, researchers sought to link performance on the 5 times sit-to-stand test, the 20-meter walk test, and the 400-meter walk test to walking patterns outside the clinic. Participants ranged in age from 56 to 74 years, with an average age of 65. The study was e-published ahead of print in Arthritis Care and Research.

Full story at APTA

Sleep therapy may help ease knee pain troubles for some

Patients with knee osteoarthritis and insomnia may be less troubled by joint pain after they get treatment to help them sleep better, a recent study suggests.

Knee osteoarthritis, a leading cause of pain and disability in older adults, occurs when flexible tissue at the ends of bones wears down. While it can’t be cured, physical therapy or anti-inflammatory medications are often prescribed to relieve pain and improve mobility.

More than 70 percent of people with knee osteoarthritis also suffer from sleep disturbances, researchers note in the journal Pain.

Full story at Reuters

Study: Prevalence of Knee OA Today Twice What It Was 75 Years Ago

Knee osteoarthritis (OA) has more than doubled among Americans since 1940, say researchers, and the increase can’t be explained by longer lifespans or a higher prevalence of obesity and overweight in recent decades. Instead, the real culprit could be physical inactivity, which authors describe as “epidemic in the postindustrial era.”

The study, appearing in the Proceedings of the National Academy of Sciences, compared knee joints of 2,756 skeletons from 3 groups of individuals: those who lived in the 1800s and early 1900s (“early industrial,” N=1,581), those who lived during the late 1900s through the early 2000s (“postindustrial,” N=819), and prehistoric hunter-gatherers who lived between 6,000 and 300 BCE (“prehistoric,” N=176). Researchers were looking for knee joint eburnation—the ivory-like result of bone-on-bone contact that occurs after cartilage erodes—as the indicator for moderate to severe OA.

Full story at APTA

Study: Knee OA Treatment That Doesn’t Follow Guidelines Comes at a Price

In brief:

  • Current orthopedic surgeon guidelines recommend use of physical therapy, tramadol, and NSAIDs for nonsurgical treatment of knee OA, and against use of injections and opioids other than tramadol.
  • Analysis of claims utilization data found that the top 3 interventions were corticosteroid injections (46.0%), hyaluronic acid injections (18.0%), and opioids other than tramadol (15.5%), none of which are recommended in the guidelines.
  • Physical therapy was prescribed for only 13.6% patients.
  • Adhering to AAOS treatment guidelines for knee OA could decrease cost of care by 45%.

If health care providers treated patients with knee osteoarthritis (OA) according to established guidelines that include physical therapy, researchers say costs of treatment could drop by as much as 45%. Yet too many physicians are prescribing interventions that are not supported by evidence and may even carry extra risk.

Full story of knee OA treatment not following guidelines at APTA

Flex CEUs: New CEU Courses

SHOE MODIFICATIONS FOR ADULTS WITH KNEE OSTEOARTHRITIS

Knee osteoarthritis (OA) is the most common form of OA and is the leading cause of pain and disability in older adults.  The goal of this CEU course is to determine the difference between different shoes and lateral wedge insoles on external knee adduction moment (EKAM), knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA.

PARKINSON’S DISEASE EXERCISE MODE COMPARISON

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease.  Physical rehabilitation is commonly used in patients with PD to improve their health and alleviate the symptoms.  The goal of this CEU course is to determine the overall effect of resistance training (RT) on measures of muscular strength in people with PD and identify effective RT interventions to increase strength in people with PD in order to provide evidence-based guidelines.  Further, this course compares resistance training with balance training for the improvement of postural control in people with PD.  Lastly, this course explores a technology-assisted exercise protocol that is specifically aimed at reducing bradykinesia.

For more on these new ceu courses and many more, visit Flex CEUs

From PTJ: Group-Based Physical Therapy No More Effective Than 1-on-1 Care for Knee OA

In a recent clinical trial published in the May issue of Physical Therapy (PTJ), APTA’s science journal, group physical therapy for individuals with knee osteoarthritis (OA) was found to be no more effective in reducing pain and improving functional outcomes than 1-on-1 sessions—contrary to researchers’ expectations.

Researchers randomly assigned 320 patients with pain, aching, stiffness, or swelling associated with knee OA at a Veterans Administration (VA) medical center to either group or individual physical therapy. Most (88%) were male. Authors hypothesized that group-based physical therapy would lead to superior outcomes, citing several advantages of this setting, including the potential for more visits per patient, better ways to deliver education and support for chronic conditions, and stronger peer support that could lead to greater adherence to exercise-based interventions.

Most aspects of care were the same for both groups. All patients were instructed in a home exercise program, educated on joint protection and activity pacing, and screened to determine if they required braces, assistive devices, or shoe lifts. To start, they all were instructed to perform the same 4 stretching exercises daily and 6 strengthening exercises 3 times a week. As they progressed, they were given opportunities to increase the difficulty of their exercises.

Full story of group PT versus 1-on-1 care for knee OA at APTA

Aquatic Exercise Good for Knee/Hip OA, Could Help With Transition to Land-Based Exercise

Aquatic exercise can provide small, short-term benefits for people with mixed hip and knee osteoarthritis (OA), according to an updated Cochrane systematic review (partial review available; also accessible through PTNow ArticleSearch). But its real promise may be as a catalyst to move people with knee or hip OA toward effective land-based exercise.

The update analyzed 13 randomized clinical trials (up from 6 in the previous version) to discern the effects of any aquatic exercise program on disability, pain, quality of life, and radiographic evaluation. Of the 1,190 participants, 75% were women, and the average age was 68. Most of the studies included individuals with hip, knee, or mixed knee and hip OA, though a handful examined knee or hip OA alone.

Overall, the authors found moderate-quality evidence that active aquatic exercise caused a small, immediate improvement in disability, pain, and quality of life for mixed knee and hip OA. The jury is still out on whether it can be effective for people with arthritis in only the hip or knee—the trials focused on aquatic exercise for either knee or hip OA showed no statistically significant effect at any point after completing the program.

Full story of aquatic exercise and knee/hip osteoarthritis at APTA