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Orthopaedic Journal of Sports Medicine May 2023Exercise is an effective nonpharmaceutical therapy for knee osteoarthritis (KOA). (Review)
Review
BACKGROUND
Exercise is an effective nonpharmaceutical therapy for knee osteoarthritis (KOA).
PURPOSE
To identify the most effective type of exercise therapy for KOA with regard to pain, stiffness, joint function, and quality of life.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
The PubMed, Web of Science, Embase, and Cochrane Library databases were searched, from inception to April 4, 2022. Included were randomized controlled trials that assessed the efficacy on KOA among 5 different exercise therapy groups (aquatic exercise [AE], stationary cycling [CY], resistance training [RT], traditional exercise [TC], and yoga [YG]) and compared with the control group. Outcomes among the groups were assessed with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk test (6-MWT), visual analog scale (VAS) for pain, and Knee injury and Osteoarthritis Outcome Score (KOOS); weighted mean differences (WMDs) and 95% confidence intervals were calculated. Network meta-analyses comparing outcomes between all groups and with controls were performed, and group rankings were calculated using the surface under the cumulative ranking curve (SUCRA).
RESULTS
A total of 39 studies (N = 2646 participants) were included. Most of the studies failed to blind participants and researchers, resulting in a high risk of performance bias. Significantly worse WOMAC-Pain scores were seen in controls compared with all exercise interventions except AE (WMD [95% CI]: CY, -4.45 [-5.69 to -3.20]; RT, -4.28 [-5.48 to -3.07]; TC, -4.20 [-5.37 to -3.04]; and YG, -0.57 [-1.04 to -1.04]), and worse scores were seen in controls compared with YG regarding WOMAC-Stiffness (WMD, -1.40 [95% CI, -2.45 to -0.34]) and WOMAC-Function (WMD, -0.49 [95% CI, -0.95 to -0.02]). According to the SUCRA, CY was the most effective for improving WOMAC-Pain (80.8%) and 6-MWT (76.1%); YG was most effective for improving WOMAC-Stiffness (90.6%), WOMAC-Function (77.4%), KOOS-Activities of Daily Living (72.0%), and KOOS-Quality of Life (79.1%); AE was the most effective regarding VAS pain (77.2%) and KOOS-Pain (64.0%); and RT was the most effective regarding KOOS-Symptoms (84.5%).
CONCLUSION
All 5 types of exercise were able to ameliorate KOA. AE (for pain relief) and YG (for joint stiffness, limited knee function, and quality of life) were the most effective approaches, followed by RT, CY, and TC.
PubMed: 37346776
DOI: 10.1177/23259671231172773 -
Clinical Biomechanics (Bristol, Avon) May 2022This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL)... (Review)
Review
BACKGROUND
This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions. Studies were excluded if performed on both skeletally immature and mature or non-human grafts, or if the grafts were tested after fixation in a cadaveric knee. For each graft, failure load, stiffness, Young's modulus, maximum stress, and maximum strain were recorded.
FINDINGS
Twenty-six articles were included. Most studies reported equal or increased biomechanical failure load and stiffness of their tested bone-patellar tendon-bone, hamstring, quadriceps, peroneus longus, tibialis anterior and posterior, Achilles, tensor fascia lata, and iliotibial band grafts compared to the native ACL. All recorded biomechanical properties had similar values between graft types.
INTERPRETATION
Most grafts used for ACL reconstruction are biomechanically superior to the native ACL. Utilizing a proper graft, combined with a standard surgical technique and a rigorous rehabilitation before and after surgery, will improve outcomes of ACL reconstruction.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Biomechanical Phenomena; Hamstring Muscles; Humans; Patellar Ligament
PubMed: 35428007
DOI: 10.1016/j.clinbiomech.2022.105636 -
BMC Complementary Medicine and Therapies Jul 2020Osteoarthritis (OA) is the commonest form of inflammatory joint disease. Unfortunately, to date, there is no appropriate treatment for OA. Boswellia serrata was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Osteoarthritis (OA) is the commonest form of inflammatory joint disease. Unfortunately, to date, there is no appropriate treatment for OA. Boswellia serrata was considered as a potent anti-inflammatory, anti-arthritic and analgesic agent that may be a drug for OA.
METHODS
In this meta-analysis, data from randomized controlled trials were obtained to assess the effects of Boswellia or its extract versus placebo or western medicine in patients with OA. The primary outcomes included visual analogue score (VAS), WOMAC pain, WOMAC stiffness, WOMAC function and lequesne index.
RESULT
Seven trials involving 545 patients were included. Compared with the control group, Boswellia and its extract may relieve the pain [VAS: (WMD -8.33; 95% CI -11.19, - 5.46; P<0.00001); WOMAC pain: (WMD -14.22; 95% CI -22.34, - 6.09; P = 0. 0006)] and stiffness [WOMAC stiffness: (WMD -10.04; 95% CI -15.86, - 4.22; P = 0. 0007)], and improve the joint's function [WOMAC function: (WMD -10.75; 95% CI -15.06, - 6.43; P<0. 00001); lequesne index: (WMD -2.27; 95% CI -3.08, - 1.45; P<0. 00001)].
CONCLUSION
Based on current evidence, Boswellia and its extract may be an effective and safe treatment option for patient with OA, and the recommended duration of treatment with Boswellia and its extract is at least 4 weeks.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Boswellia; Humans; Osteoarthritis, Knee; Pain Measurement; Plant Extracts; Randomized Controlled Trials as Topic; Surveys and Questionnaires; Triterpenes
PubMed: 32680575
DOI: 10.1186/s12906-020-02985-6 -
Journal of Sports Science & Medicine Sep 2023Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in... (Meta-Analysis)
Meta-Analysis Review
Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.
Topics: Female; Male; Humans; Muscle Stretching Exercises; Tendons; Muscles; Hamstring Muscles
PubMed: 37711702
DOI: 10.52082/jssm.2023.465 -
Sensors (Basel, Switzerland) Feb 2020Rigidity is one of the cardinal symptoms of Parkinson´s disease (PD). Present in up 89% of cases, it is typically assessed with clinical scales. However, these...
Rigidity is one of the cardinal symptoms of Parkinson´s disease (PD). Present in up 89% of cases, it is typically assessed with clinical scales. However, these instruments show limitations due to their subjectivity and poor intra- and inter-rater reliability. To compile all of the objective quantitative methods used to assess rigidity in PD and to study their validity and reliability, a systematic review was conducted using the Web of Science, PubMed, and Scopus databases. Studies from January 1975 to June 2019 were included, all of which were written in English. The Strengthening the Reporting of observational studies in Epidemiology Statement (STROBE) checklist for observational studies was used to assess the methodological rigor of the included studies. Thirty-six studies were included. Rigidity was quantitatively assessed in three ways, using servomotors, inertial sensors, and biomechanical and neurophysiological study of muscles. All methods showed good validity and reliability, good correlation with clinical scales, and were useful for detecting rigidity and studying its evolution. People with PD exhibit higher values in terms of objective muscle stiffness than healthy controls. Rigidity depends on the angular velocity and articular amplitude of the mobilization applied. There are objective, valid, and reliable methods that can be used to quantitatively assess rigidity in people with PD.
Topics: Electromyography; Humans; Joints; Movement; Muscle Rigidity; Muscles; Observational Studies as Topic; Parkinson Disease
PubMed: 32041374
DOI: 10.3390/s20030880 -
Annals of Palliative Medicine Oct 2021A number of researches indicated preoperative functional exercise may improve the rehabilitation progress. This study aimed to investigate the effect of preoperative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A number of researches indicated preoperative functional exercise may improve the rehabilitation progress. This study aimed to investigate the effect of preoperative exercise intervention on rehabilitation before total knee arthroplasty (TKA) by literature retrieval and meta-analysis.
METHODS
Embase, Cochrane library, PubMed, Ovid, and ClinicalTrials.gov were selected as the search database platforms. All published English articles related to preoperative exercise of TKA from January 2000 to January 2021 were searched with the following keyword strategy: ("preoperative functional exercise" or "prehabilitation exercise") AND ("TKA" or "total knee arthroplasty"). After literature screened according to the inclusion and exclusion criteria, the risk of bias and quality of the included articles were evaluated. RevMan 5.3.5 software was used for analysis to obtain the forest plot and funnel plot.
RESULTS
A total of 911 articles were preliminarily searched in this study, and 12 were finally included for the quantitative analysis, comprising 889 patients; the result showed after intervention, the experimental group patients had wider ROM flexion than the control group patients [mean difference (MD) =4.28; 95% CI: 2.28 to 6.28; Z=4.19; P<0.0001]; the experimental group patients were with higher quadriceps strength value than the control group (MD =1.86, 95% CI: 0.58-3.15; Z=2.84, P=0.005); the WOMAC score (The Western Ontario and McMaster Universities Osteoarthritis Index), were higher for the experimental group patients (MD =-10.59; 95% CI: -11.88 to -9.29; Z=16.03; P<0.00001); and the standing and walking test index are higher (MD =-1.29, 95% CI: -1.90 to -0.67; Z=4.08; P<0.001); the quality of life score were higher too for the experimental group patients (MD =1.66; 95% CI: 1.13-2.20; Z=6.08; P<0.00001).
DISCUSSION
Preoperative exercise intervention before TKA can improve knee flexion and flexibility, reduce inflammatory pain and stiffness, improve muscle strength, improve joint function, and thus improve the quality of life of patients.
Topics: Arthroplasty, Replacement, Knee; Humans; Osteoarthritis, Knee; Preoperative Exercise; Quality of Life; Range of Motion, Articular
PubMed: 34763461
DOI: 10.21037/apm-21-2670 -
Frontiers in Medicine 2023In recent years, platelet-rich plasma (PRP) injections for osteoarthritis (OA) have been widely promoted in clinical practice, but their effectiveness is controversial....
BACKGROUND
In recent years, platelet-rich plasma (PRP) injections for osteoarthritis (OA) have been widely promoted in clinical practice, but their effectiveness is controversial. Therefore, we conducted a meta-analysis of relevant randomized controlled trials (RCTs) to determine the efficacy and safety of PRP injections for the treatment of OA.
METHODS
We searched databases including Embase, Web of Science, Medline, PubMed, and the Cochrane Library for relevant studies. Two researchers (YQX and CG) performed literature screening, baseline data extraction, literature quality assessment, and heterogeneity analysis of RCTs from the retrieved studies. Based on the magnitude of heterogeneity , random-effects or fixed-effects models were selected for the meta-analysis.
RESULTS
We included 24 RCTs comprising 1344 patients with OA who met the inclusion criteria, with the main types of morbidity being knee osteoarthritis (KOA), hip osteoarthritis (HOA), ankle osteoarthritis (AOA), and temporomandibular joint osteoarthritis (TMJOA). Our results indicate that PRP injections were effective in improving Visual Analog Scale (VAS) pain scores in patients with KOA, HOA, and AOA compared to controls (AOA, MD = -1.15, CI = 95% [-1.74, -0.56], = 40%, < 0.05; KOA, MD = -1.03, CI = 95% [-1.16, -0.9], = 87%, < 0.05; TMJOA, MD = -1.35, CI = 95% [-1.74, -0.97], = 92%, < 0.05) but showed no significant efficacy in patients with HOA (MD = -0.27, CI = 95% [-0.8, 0.26], = 56%, >0.05). Compared to controls, PRP injections were effective in improving Knee Injury and Osteoarthritis Outcome Score (KOOS), including the patient's pain symptoms, activities of daily living (ADL), and adhesion symptomatology, but not for that of sports function (KOOS-pain, MD = 2.77, CI = 95% [0, 5.53], = 0%, < 0.05; KOOS-symptoms, MD = 3.73, CI = 95% [0.76, 6.71], = 0%, < 0.05; KOOS-ADL, MD = 3.61, CI = 95% [0.79, 6.43], = 0%, < 0.05; KOOS-QOL, MD = 4.66, CI = 95% [0.98, 8.35], = 29%, < 0.05, KOOS-sport, MD = 0.48, CI = 95% [-3.02, 3.98], = 0%, > 0.05). PRP injections were effective in improving Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, including pain, stiffness, and functional joint motion, in patients with OA compared with the control group (WOMAC-pain, MD = -1.08, CI = 95% [-1.62, -0.53], = 87%, < 0.05; WOMAC-stiffness, MD = -1.17, CI = 88% [-1.72, -0.63], = 87%, < 0.05; WOMAC-function, MD = -1.12, CI = 95% [-1.65, -0.58], = 87%, < 0.05). In addition, subgroup analysis showed that leukocyte-poor (LP) PRP injections were more effective than leukocyte-rich (LR) PRP injections in improving pain symptoms in patients with OA (VAS, LR-PRP, MD = -0.81, CI = 95% [-1.65, -0.03], = 83%, = 0.06 > 0.05; LP-PRP, MD = -1.62, CI = 95% [-2.36, -0.88], = 92%, < 0.05). A subgroup analysis based on injection sites showed that no statistical difference in efficacy between intra-articular (IA) combined with intra-osseous (IO) simultaneous PRP injections. IA PRP injections only improved VAS pain scores in patients with OA (IA+IO PRP injections, MD = -0.74, CI =95% [-1.29, -0.18], = 61%, < 0.05; IA PRP injections, MD = -1.43, CI = 95% [-2.18, -0.68], = 87%, < 0.05, test for subgroup differences, > 0.05, = 52.7%).
CONCLUSION
PRP injection therapy can safely and effectively improve functional activity in patients with OA and produce positive analgesic effects in patients with KOA, TMJOA, and AOA. However, PRP injection therapy did not significantly reduce pain symptoms in patients with HOA. In addition, the analgesic effect of LP-PRP was greater than that of LR-PRP.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022362066.
PubMed: 37441691
DOI: 10.3389/fmed.2023.1204144 -
BMC Musculoskeletal Disorders Jun 2021Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA... (Meta-Analysis)
Meta-Analysis
Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis.
BACKGROUND
Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA.
METHODS
All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies.
RESULTS
Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (- 0.78 (- 1.34 to - 0.23) standard mean deviations (SMD) and - 1.63 (- 2.14 to - 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (- 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01).
CONCLUSIONS
IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection.
PROSPERO TRIAL REGISTRATION NUMBER
CRD42020181928 .
Topics: Adrenal Cortex Hormones; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Male; Middle Aged; Osteoarthritis, Knee; Platelet-Rich Plasma; Treatment Outcome
PubMed: 34134679
DOI: 10.1186/s12891-021-04308-3 -
Nutrients Oct 2021Rheumatoid Arthritis (RA) is a chronic autoimmune condition characterized by symptoms of inflammation and pain in the joints. RA is estimated to have a worldwide...
Rheumatoid Arthritis (RA) is a chronic autoimmune condition characterized by symptoms of inflammation and pain in the joints. RA is estimated to have a worldwide prevalence of 0.5-1%, with a predominance in females. Diet may play an important role in the symptoms of RA; however, little is known about the effects of various diets. The aim of this systematic review is to explore the effect of dietary interventions, with or without omega-3 supplementation for the management of RA. The electronic databases MEDLINE, EMBASE, CINAHL, and the Cochrane Library were systematically searched for clinical trials investigating dietary interventions, with or without omega-3 supplementation to retrieve papers from inception to April 2021. Randomized and non-randomized controlled trials of dietary interventions in adults with RA were eligible for inclusion. Twenty studies with a total of 1063 participants were included. The most frequently reported outcomes were pain, duration of morning stiffness, joint tenderness, grip strength and inflammatory markers. Dietary interventions with an anti-inflammatory basis may be an effective way for adults with RA seeking complementary treatments, potentially leading to improvements in certain parameters. However, there is a need for longer duration studies that are well-designed and sufficiently powered to investigate the influence of diet on RA.
Topics: Adult; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Diet; Dietary Supplements; Fatty Acids, Omega-3; Female; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 34684507
DOI: 10.3390/nu13103506 -
Recent Advances in Food, Nutrition &... 2024Osteoarthritis (OA) is a progressive degenerative joint disease. It basically impairs the structural integrity of articulate cartilage and imbalances the catabolic and... (Review)
Review
Osteoarthritis (OA) is a progressive degenerative joint disease. It basically impairs the structural integrity of articulate cartilage and imbalances the catabolic and anabolic signals in the joint. A degenerative disease is characterized by swelling, pain, and joint stiffness. The treatment and management of osteoarthritis are based on analgesic and anti-inflammatory agents, whereas the exact cause of OA is not known yet. The negative effects of synthetic medications have led to a daily rise in the usage of nutraceuticals and dietary supplements. Clinicians are aware of these treatments, and they also recommend nutraceuticals in addition to the currently preferred therapy. Many and experiments have been performed in past years to evaluate the function of these on osteoarthritis. The collection of articles was published on search engines like PubMed, Scopus, Google Scholar, ResearchGate, and ScienceDirect. The evaluation covers every potential nutraceutical utilized in osteoarthritis, together with its supporting data and mode of action. The present review discusses nutraceuticals, including devil's claw, vitamin D, boswellic acid, capsaicin, ginger, curcumin, krill oil, ginger, and avocado/soybean unsaponifiable.
Topics: Dietary Supplements; Osteoarthritis; Humans; Capsaicin; Animals; Curcumin; Zingiber officinale; Vitamin D; Persea; Triterpenes
PubMed: 38258782
DOI: 10.2174/012772574X270405231102054920