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JMIR MHealth and UHealth May 2024The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field... (Review)
Review
BACKGROUND
The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA.
OBJECTIVE
This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications.
METHODS
A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data.
RESULTS
A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study.
CONCLUSIONS
The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.
Topics: Humans; Osteoarthritis, Knee; Behavior Therapy; Mobile Applications
PubMed: 38696250
DOI: 10.2196/53798 -
Sports Medicine - Open Apr 2024Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament...
Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis.
BACKGROUND
Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament reconstruction (ACLR). To improve our understanding of the extent of deficits in psychological readiness, a systematic review is necessary.
OBJECTIVE
To investigate psychological readiness (measured via the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI)) over time after ACL tear and understand if time between injury and surgery, age, and sex are associated with ACL-RSI scores.
METHODS
Seven databases were searched from the earliest date available to March 22, 2022. Articles reporting ACL-RSI scores after ACL tear were included. Risk of bias was assessed using the ROBINS-I, RoB-2, and RoBANS tools based on the study design. Evidence certainty was assessed for each analysis. Random-effects meta-analyses pooled ACL-RSI scores, stratified by time post-injury and based on treatment approach (i.e., early ACLR, delayed ACLR, and unclear approach).
RESULTS
A total of 83 studies were included in this review (78% high risk of bias). Evidence certainty was 'weak' or 'limited' for all analyses. Overall, ACL-RSI scores were higher at 3 to 6 months post-ACLR (mean = 61.5 [95% confidence interval (CI) 58.6, 64.4], I = 94%) compared to pre-ACLR (mean = 44.4 [95% CI 38.2, 50.7], I = 98%), remained relatively stable, until they reached the highest point 2 to 5 years after ACLR (mean = 70.7 [95% CI 63.0, 78.5], I = 98%). Meta-regression suggests shorter time from injury to surgery, male sex, and older age were associated with higher ACL-RSI scores only 3 to 6 months post-ACLR (heterogeneity explained R = 47.6%), and this reduced 1-2 years after ACLR (heterogeneity explained R = 27.0%).
CONCLUSION
Psychological readiness to return to sport appears to improve early after ACL injury, with little subsequent improvement until ≥ 2-years after ACLR. Longer time from injury to surgery, female sex and older age might be negatively related to ACL-RSI scores 12-24 months after ACLR. Due to the weak evidence quality rating and the considerable importance of psychological readiness for long-term outcomes after ACL injury, there is an urgent need for well-designed studies that maximize internal validity and identify additional prognostic factors for psychological readiness at times critical for return to sport decisions.
REGISTRATION
Open Science Framework (OSF), https://osf.io/2tezs/ .
PubMed: 38689130
DOI: 10.1186/s40798-024-00712-w -
Osteoarthritis and Cartilage Jul 2024To examine the pain relief effects of comparators (placebos and untreated control groups) in hand osteoarthritis trials and the impact of contextual factors. (Meta-Analysis)
Meta-Analysis
Comparative effectiveness of different placebos and comparator groups for hand osteoarthritis exploring the impact of contextual factors: A systematic review and meta-analysis of randomised trials.
OBJECTIVE
To examine the pain relief effects of comparators (placebos and untreated control groups) in hand osteoarthritis trials and the impact of contextual factors.
METHODS
We systematically searched PubMed, EMBASE and CENTRAL from inception to December 26, 2021. We included randomised controlled trials of people with hand osteoarthritis with a placebo or an untreated control group. We assessed the Risk of Bias with Cochrane Risk-of-Bias tool version 2. Each comparator was contrasted with a null-arm, imputed as having a zero change from baseline with the same standard deviation as the comparator. We combined the standardised mean differences with a random effects meta-analysis. The contextual factors' effect was explored in meta-regression and stratified models with pain as the dependent variable.
RESULTS
84 trials (7262 participants) were eligible for quantitative synthesis, of which 76 (6462 participants) were eligible for the stratified analyses. Placebos were superior to their matched null-arms in relieving pain with an effect size of -0.51 (95% confidence interval -0.61 to -0.42), while untreated control groups were not. When analysing all comparators, blinded trial designs and low risk of bias were associated with higher pain relief compared to an open-label trial design and some concern or high risk of bias.
CONCLUSION
The placebo response on pain for people with hand osteoarthritis was increased by appropriate blinding and a lower risk of bias assessment. Placebos were superior to a null-arm, while untreated control groups were not. Results emphasise the importance of using appropriate comparators in clinical trials.
PROSPERO REGISTRATION ID
CRD42022298984.
Topics: Humans; Control Groups; Hand Joints; Osteoarthritis; Placebos; Randomized Controlled Trials as Topic
PubMed: 38679284
DOI: 10.1016/j.joca.2024.02.947 -
Medicina (Kaunas, Lithuania) Mar 2024This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial...
This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.
Topics: Humans; Meniscectomy; Menisci, Tibial; Osteoarthritis, Knee; Quality of Life; Tibial Meniscus Injuries
PubMed: 38674215
DOI: 10.3390/medicina60040569 -
BMC Musculoskeletal Disorders Apr 2024An optimized fit of the tibial component to the resection platform and correct rotational alignment are critical for successful total knee arthroplasty (TKA). However,... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
An optimized fit of the tibial component to the resection platform and correct rotational alignment are critical for successful total knee arthroplasty (TKA). However, there remains controversy regarding the superiority of symmetric tibial component versus asymmetric tibial component. The objective of this systematic review and meta-analysis was to evaluate the current evidence for comparing the coverage and rotation of asymmetrical and symmetrical tibial component.
METHODS
We searched potentially relevant studies form PubMed, Web of science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and China National Knowledge Infrastructure (CNKI), up to 1 March 2023. Data extraction and quality assessment were performed by two independent reviewers. Meta-analysis was conducted using Review Manager 5.4.
RESULTS
Sixteen articles were identified. Compared to symmetric tibial component, asymmetric tibial component increased the coverage of the proximal tibial cut surface (MD, -2.87; 95%CI, -3.45 to -2.28; P < 0.00001), improved the prevalence of tibial baseplate underhang (OR, 0.16; 95%CI, 0.07 to 0.33; P < 0.00001) and malrotation (OR, 0.13; 95%CI, 0.02 to 0.90; P = 0.04), and reduced the degree of tibial component rotation (MD, -3.11; 95%CI, -5.76 to -0.47; P = 0.02). But there was no statistical significance for improving tibial baseplate overhang (OR, 0.58; 95%CI, 0.08 to 3.97; P = 0.58). Additionally, no revision had occurred for the two tibial components in the included studies.
CONCLUSION
The current evidence shows asymmetric tibial component offer advantages in terms of coverage and rotation compared with symmetric tibial component in TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Tibia; Knee Prosthesis; Knee Joint; Rotation; Prosthesis Design; Treatment Outcome; Osteoarthritis, Knee; Range of Motion, Articular
PubMed: 38671454
DOI: 10.1186/s12891-024-07466-2 -
Journal of Fungi (Basel, Switzerland) Apr 2024Zoonotic sporotrichosis, a subcutaneous mycosis caused by , has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the... (Review)
Review
Zoonotic sporotrichosis, a subcutaneous mycosis caused by , has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998-2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas.
PubMed: 38667958
DOI: 10.3390/jof10040287 -
Healthcare (Basel, Switzerland) Apr 2024Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or... (Review)
Review
Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.
PubMed: 38667585
DOI: 10.3390/healthcare12080823 -
Rheumatology Advances in Practice 2024To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over... (Review)
Review
OBJECTIVES
To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA.
METHODS
A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions.
RESULTS
Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue.
CONCLUSIONS
Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation.
PubMed: 38660024
DOI: 10.1093/rap/rkae050 -
Cureus Mar 2024Globally, knee osteoarthritis (KOA) is the leading cause of disability. The most prevalent complaints associated with KOA are knee pain, joint stiffness, and weakness in... (Review)
Review
Globally, knee osteoarthritis (KOA) is the leading cause of disability. The most prevalent complaints associated with KOA are knee pain, joint stiffness, and weakness in the muscles of the lower limbs. These symptoms impede movement and result in functional limitations. As a result, people with KOA have a lower quality of life. For all patient groups with knee OA, an effective rehabilitation program focuses on improving knee range of motion, isometric quadriceps strength, and productivity level while reducing discomfort. The American College of Rheumatology (ACR) categorization criteria for KOA, research on KOA physiotherapy, and reviews covering various physical therapy interventions, including exercise, physical modalities, and patient education, were used to narrow down the pool of 180 systematic reviews to 15 articles. Google Scholar, PubMed, the Cochrane Library, and EMBASE were the databases that were used. The following keyword combinations were included in our search: KOA and physiotherapy or interventions or exercises, strengthening and stretching, concentric and eccentric training. Through our analysis, we identified a few methods that, in addition to standard therapy, could be used in clinical settings for people with osteoarthritis in the knee. It has been shown that Mulligan, Pilates, Kinesiotaping, Aquatic Therapy, and other current therapies are effective. The study employed a broad range of results. This review concludes that rather than relying solely on conventional therapy, it is preferable to combine a number of the most current physiotherapy techniques with it.
PubMed: 38654798
DOI: 10.7759/cureus.56817 -
Health Science Reports Apr 2024Osteoarthritis (OA) is one of the most common debilitating diseases among the aging population. is one potential treatment for OA. Here, we sought to evaluate the...
BACKGROUND AND AIMS
Osteoarthritis (OA) is one of the most common debilitating diseases among the aging population. is one potential treatment for OA. Here, we sought to evaluate the efficacy and safety of for treating patients with OA.
METHODS
PubMed, Scopus, Embase, and Web of Science were searched up to October 20, 2022. The primary outcome was changes in the pain score after receiving or control agents based on the results of randomized controlled trials (RCTs). The secondary outcome was set as the frequency of adverse events reported during the follow-up period.
RESULTS
Six RCTs involving a total of 370 patients with knee OA were included in the present systematic review. Among the four screened studies, the topical administration of oil was found to be more effective than the placebo in relieving pain in three trials. Additionally, the oral use of oil was assessed in two trials, and an improvement in pain score relative to placebo was documented in only one of the studies. Also, the trial that evaluated the effectiveness of oral capsules did not demonstrate any difference in pain reduction between the intervention and placebo groups. Overall, either topical or oral administration of was well tolerated, and no serious adverse events were reported.
CONCLUSION
is generally safe, but conflicting findings from low-quality studies hinder the ability to make clinical recommendations for or against treating OA. Robust trials are needed for informed decisions.
PubMed: 38650731
DOI: 10.1002/hsr2.1989