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

FLEX CEUs: New CEU Courses

LOW BACK PAIN: THE ROLE OF FEAR

Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, and evidence suggests that psychosocial factors, especially fear-avoidance beliefs are important in predicting patients who will progress from an acute to a chronic stage, as well as failure of interventions.  The goals of this CEU course are to evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP, determine whether balance response of LBP patients is different from healthy controls under various conditions, and find out whether body sway is related to the fear of fall in LBP individuals.  Fear and psychological distress in regards to pain and disability is also discussed.

LOW LEVEL LASER THERAPY EFFECTS ON INFLAMMATION

Inflammation of the synovial membrane plays an important role in the pathophysiology of osteoarthritis (OA).  The goal of this CEU course is to evaluate the effects of low-level laser therapy (LLLT) on joint inflammation.

Free Continuing Education for Life!

Did you know that we have a program available that gives you free continuing education for life? If this sounds like something you’re interested in, just visit https://www.flextherapistceus.com/account-refer.php to get all the details.

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

Do We Really Understand Osteoarthritis of the Knee?

Osteoarthritis (OA) is a major cause of disability worldwide and according to “The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study“, OA of the knee is the 11th highest contributor to global disability. Put simply, millions of lives are affected by the disease every single day. It is predicted that it will advance to become the 4th leading cause of disability by 2020.

The cause of knee osteoarthritis is complex and certainly multi-factorial in nature.  There is a great summary over on Physiopedia, but in brief, it is a complex interaction between systemic and local factors. These factors include: advancing age, genetics, trauma, knee malalignment, increased biomechanical loading of joints through obesity, augmented bone density and an imbalance in physiological processes. It has been frequently reported, and it is a common thought, that obesity and advancing age are the two critical, and biggest, contributors to increasing prevalence of OA. This belief is being challenged by new evidence which may suggest that perhaps we have been approaching our understanding from the wrong perspective.

Full story at PhysioSpot

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

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

Can Care Meet the Need? Studies Show Arthritis Prevalence Is Growing, but Care System has ‘Substantial Room for Improvement’

By 2040, 1 in 4 Americans will have arthritis, 1 in 10 will experience a disability because of the condition, and—if things don’t improve—many will receive treatment from community-based programs that, more often than not, fail to recommend exercise and education as a first-line approach. That’s the picture created by 2 separate studies—one on predicted prevalence of arthritis, and another on the state of community-based osteoarthritis (OA) care.

The prevalence study, which was e-published ahead of print in Arthritis & Rheumatology, uses National Health Interview Survey responses gathered over 3 years (2010-2012) to update earlier prevalence statistics based on 2003 data. Researchers then combined results with data from the US Census Bureau to make prevalence predictions, given demographic variables including the aging of the baby boomer population.

Among their findings:

Full story of the state of community-based osteoarthritis care at APTA

More Evidence Questions Benefits of Arthroscopic Knee Surgery

The case continues to mount around the lack of evidence to support arthroscopic surgery for degenerative knees—this time, by way of research that calls for a “reversal of a common medical practice,” even among patients with knee osteoarthritis. Authors of the article write that the procedure produces “small inconsequential” benefits in pain and that surgery produced no benefit in function.

In an article published in BMJ, researchers share the results of a systematic review and meta-analysis of 9 trials, involving 1,270 individuals, that looked at the benefits of knee arthroscopic surgery in middle-aged and older patients with knee pain and degenerative knee disease. Patient data were analyzed in several different ways, including in terms of those with no knee osteoarthritis (OA) found by radiography, those with knee OA confirmed through radiography, and a mixed OA and no-OA group.

Full story of benefits of arthroscopic knee surgery at APTA